Update: Malaria, U.S. Armed Forces, 2020

Malaria infection remains an important health threat to U.S. service members who are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. In 2020, a total of 28 service members were diagnosed with or reported to have malaria. This was the lowest number of cases in any given year during the 10-year surveillance period and represents a 15.2% decrease from the 33 cases identified in 2019. The relatively low numbers of cases during 2012-2020 mainly reflect decreases in cases acquired in Afghanistan, a reduction largely due to the progressive withdrawal of U.S. forces from that country. The number of malaria cases caused by Plasmodium falciparum in 2020 (n=8) was the second lowest observed during the surveillance period. The percentage of 2020 cases of malaria caused by Plasmodium vivax (53.6%; n=15) was the highest during any given year of the surveillance period. The remaining 5 malaria cases were labeled as associated with other/unspecified types of malaria (17.9%). Malaria was diagnosed at or reported from 13 different medical facilities in the U.S., Germany, Africa, and Korea. Providers of medical care to military members should be knowledgeable of and vigilant for clinical manifestations of malaria outside of endemic areas.

Avian mite bites acquired from pigeons: Report of three cases and review of the literature

BACKGROUND

Skin lesions caused by avian mite bites are uncommon and often misdiagnosed. They are usually caused by bites from avian mites that have infested domestic poultry or birds nesting in or near human habitation. We report three cases of human skin lesions from avian mites infesting pigeons.

OBSERVATIONS

Three persons working in the same place developed similar skin pruritic papules simultaneously. The diagnosis remained unknown until Dermanyssus gallinae (chicken mite) was found on the computer's table of the three individuals workplace, situated near a window where pigeons used to live. Antihistaminic treatment was carried out with a skin disinfestation. In two cases, symptoms resolved after one week of treatment. In the third case, corticosteroids were needed.

CONCLUSIONS

Avian mite bites skin lesions can remain unrecognized or misdiagnosed. Inquiry about contact with pigeons or poultry may be helpful in patients with nonspecific skin lesions.

Prevalence of glucose-6-phosphate dehydrogenase deficiency, U.S. Armed Forces, May 2004-September 2018

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited genetic disorder most commonly associated with hemolytic anemia. Among those with G6PD deficiency, hemolytic anemia may be triggered by bacterial or viral infections and by certain foods and drugs, including the 8-aminoquinoline (8-AQ) class of antimalarials. Because 8-AQ drugs remain the only drugs approved by the U.S. Food and Drug Administration for malaria relapse prevention, the Department of Defense (DoD) requires testing of all service members' G6PD status. To estimate prevalence of G6PD deficiency among DoD service members, Composite Health Care System-generated, Health Level 7-formatted laboratory records for all service members (n=2,311,223) dated between May 2004 and September 2018 were queried for G6PD testing. Corresponding demographic data were obtained from the Defense Enrollment Eligibility Reporting System. Overall prevalence of G6PD deficiency among this cohort was low, at 2.2%. Demographic trends mirrored U.S. statistics; the cohort prevalence among males (2.3%) was higher than among females (1.5%), and the prevalence among non-Hispanic blacks (9.5%) was higher than among those in any other race/ethnicity group.

Rubber plantations and drug resistant malaria: a cross-sectional survey in Cambodia

BACKGROUND

The ongoing spread of artemisinin resistant Plasmodium falciparum malaria is a major threat to global health. In response, countries in the Greater Mekong Sub-region, including Cambodia, have declared ambitious goals to eliminate malaria. Major challenges include the lack of information on the at-risk population-individuals who live or work in or near the forest where the malaria vectors are found, including plantation workers. This study aimed to address this knowledge gap through a cross-sectional survey conducted in rubber plantations in Cambodia in 2014.

METHODS

The survey was conducted in two rounds in four provinces and included a malaria prevalence survey, analysis for the K13 genetic mutation, and a comprehensive behavioural questionnaire. Forty plantations were included in each round, and 4201 interviews were conducted. An additional 701 blood samples were collected from family members of plantation workers.

RESULTS

Overall malaria prevalence was relatively low with adjusted PCR prevalence rate of 0.6% for P. falciparum and 0.3% for Plasmodium vivax, and was very heterogenous between plantations. There was little difference in risk between permanent residents and temporary workers, and between the two rounds. The main risk factors for P. falciparum infection were smaller plantations, age under 30 years, lack of self-reported use of a treated net and recent travel, especially to the Northeastern provinces. Proximity of plantations to the forest was also a risk factor for malaria in round one, while male gender was also a risk factor for malaria by either species.

CONCLUSIONS

With Cambodia's P. falciparum elimination target on the horizon, identifying every single malaria case will become increasingly important. Plantations workers are relatively accessible compared to some other at-risk groups and will likely remain a high priority. Ongoing surveillance and adaptive strategies will be critical if malaria elimination is to be achieved in this setting.

Porcine cysticercosis in slaughtered pigs and factors related to Taenia solium transmission amongst abattoir workers in Ibadan, Nigeria

INTRODUCTION

porcine cysticercosis is under-reported particularly in Nigeria, despite the reportedly high prevalence of epilepsy and associated life-threatening health implications. This study was aimed at determining the prevalence of porcine cysticercosis and factors related to Taenia solium transmission to humans.

METHODS

slaughtered pigs at a major abattoir, south-western Nigeria were randomly inspected and questionnaire was administered to pig workers/consumers while the data were analysed using Stata 12.0.

RESULTS

a 4.4% (11/250) prevalence of porcine cysticercosis was obtained; the age, breed, sex and body conditions of pigs were not significant for infection (p < 0.05). Further, none (0.0%) of the respondents knew that T. solium could cause epilepsy in man and 39.5% often defaecated on neighbouring open fields and farmlands. Respondents purchasing pork from home slaughter were about four and ten times less likely to demonstrate good knowledge (OR = 0.24; 95% CI: 0.08-0.74) and practice (OR = 0.10; 95% CI: 0.05-0.22) than those purchasing from abattoir. Moreover, those lacking toilet facility were about four and five times less likely to demonstrate good knowledge (OR = 0.24; 95% CI: 0.07-0.86) and practice (OR = 0.19; 95% CI: 0.08-0.45) than those who had it. Other factors associated with practices related to T. solium transmission included age (p = 0.000), sex (p = 0.000) and duration (p = 0.003).

CONCLUSION

the increased odds of poor knowledge and practices related to Taenia solium transmission especially among respondents purchasing home slaughter pork and lacking toilet facility provides insights into the parasite epidemiology. Above findings are important in lowering the infection prevalence in pigs and humans in this endemic area.

Update: Malaria, U.S. Armed Forces, 2018

Malaria infection remains an important health threat to U.S. service members who are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. In 2018, a total of 58 service members were diagnosed with or reported to have malaria. This represents a 65.7% increase from the 35 cases identified in 2017. The relatively low numbers of cases during 2012-2018 mainly reflect decreases in cases acquired in Afghanistan, a reduction due largely to the progressive withdrawal of U.S. forces from that country. The percentage of cases of malaria caused by unspecified agents (63.8%; n=37) in 2018 was the highest during any given year of the surveillance period. The percentage of cases identified as having been caused by Plasmodium vivax (10.3%; n=6) in 2018 was the lowest observed during the 10-year surveillance period. The percentage of malaria cases attributed to P. falciparum (25.9%) in 2018 was similar to that observed in 2017 (25.7%), although the number of cases increased. Malaria was diagnosed at or reported from 31 different medical facilities in the U.S., Afghanistan, Italy, Germany, Djibouti, and Korea. Providers of medical care to military members should be knowledgeable of and vigilant for clinical manifestations of malaria outside of endemic areas.

Re-evaluation of the MSMR Case Definition for Incident Cases of Malaria

The MSMR has been publishing the results of surveillance studies of malaria since 1995. The standard MSMR case definition uses Medical Event Reports and records of hospitalizations in counting cases of malaria. This report summarizes the performance of the standard MSMR case definition in estimating incident cases of malaria from 2015 through 2017. Also explored was the potential surveillance value of including outpatient encounters with diagnoses of malaria or positive laboratory tests for malaria in the case definition. The study corroborated the relative accuracy of the MSMR case definition in estimating malaria incidence and provided the basis for updating the case definition in 2019 to include positive laboratory tests for malaria antigen within 30 days of an outpatient diagnosis.

A fine scale eco-epidemiological study on endemic visceral leishmaniasis in north ethiopian villages

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We conducted fine-scale eco-epidemiological analyses of factors associated with visceral leishmaniasis transmission.

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The population densities of Phlebotomus orientalis, the vector, were negatively correlated with distance from vertisols.

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Sero-positivity to Ph. orientalis saliva, was found in people living close to vertisol areas.

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Apparent clustering of infections indicates that transmission occurs around houses located close to vertisols.

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Our data suggest that asymptomatic individuals serve as reservoir hosts for anthroponotic transmission inside villages.

Visceral Leishmaniasis (VL) is a disseminated protozoan infection caused by Leishmania donovani that affects almost half a million people annually. In Northern Ethiopia, VL is common in migrant agricultural laborers returning from the lowland sesame fields of Metema and Humera. Recent VL foci have emerged in resident rural populations near the town. In the current study, we evaluate multilevel entomological, epidemiological and ecological factors associated with infection and disease through fine-scale eco-epidemiological analyses in three villages. Satellite images showed that villages constructed in or close to vertisols, were likely to become endemic for VL. Vertisols or black-cotton soil, are characterized by high contents of smectitic clay minerals, which swell when hydrated and shrink upon desiccation, causing extensive deep cracking during the dry season. The population densities of Phlebotomus orientalis, the vector, were negatively correlated with distance from vertisols and persons living close to vertisols were more likely to be bitten by sand flies, as evidenced by sero-positivity to Ph. orientalis saliva. Apparent (albeit non-significant) clustering of VL cases and abundant asymptomatic infections close to vertisols, suggest anthroponotic transmission around houses located close to vertisols. Comparable rates of male and female volunteers, mostly under 15 years of age, were infected with L. donovani but a significantly higher proportion of males succumbed to VL indicating a physiological gender-linked male susceptibility. Our data suggest that the abundant infected persons with high parasitemias who remain asymptomatic, may serve as reservoir hosts for anthroponotic transmission inside villages. Only limited insights on the transmission dynamics of L. donovani were gained by the study of environmental factors such as presence of animals, house structure and vegetation cover.

Armed Forces Health Surveillance Branch. Update: Malaria, U.S. Armed Forces, 2017

Malaria infection remains an important health threat to U.S. service members who are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. In 2017, a total of 32 service members were diagnosed with or reported to have malaria, which is the lowest number of cases in any given year during the 10-year surveillance period. The relatively low numbers of cases during 2012-2017 mainly reflect decreases in cases acquired in Afghanistan, a reduction due largely to the progressive withdrawal of U.S. forces from that country. The percentage of cases of malaria caused by unspecified malaria species (53.1%; n=17) in 2017 was the highest during any given year of the surveillance period. The percentages of cases caused by Plasmodium vivax (15.6%; n=5), P. falciparum (25.0%; n=8), and by P. malariae (6.3%, n=2) remained similar to those of the preceding 4 years, although the numbers of cases decreased. Malaria was diagnosed at or reported from 19 different medical facilities in the U.S., Afghanistan, Qatar, Germany, Djibouti, Japan, and Korea. Providers of medical care to military members should be knowledgeable of, and vigilant for, clinical manifestations of malaria outside of endemic areas.

Surveillance for vector-borne diseases among active and reserve component service members, U.S. Armed Forces, 2010-2016

This report summarizes available health record information about the occurrence of vector-borne infectious diseases among members of the U.S. Armed Forces during a recent 7-year surveillance period. Information about confirmed, possible, and suspected cases was obtained from electronic reports of reportable medical events (RMEs) and records of diagnoses documented during hospitalizations and outpatient healthcare encounters. Lyme disease and malaria were the most common diagnoses among confirmed and possible cases. Diagnoses of chikungunya and Zika were elevated in the years following their respective entries into the Western Hemisphere. Large numbers of diagnoses of arboviral diseases were recorded in the category of suspected cases, but the overwhelming majority were associated with coding errors and tentative diagnoses not subsequently confirmed. For many confirmed cases, documentation could not be found in healthcare databases for positive laboratory tests that would be the basis for confirmation. Discussion covers the limitations of the available data and the importance to surveillance of RMEs, confirmatory laboratory tests, and accurate recording of diagnoses and their codes.

Diagnostic evaluation of military blood donors screening positive for Trypanosoma cruzi infection

Routine blood donor screening for Trypanosoma cruzi, the causative parasitic agent of Chagas disease, began in the U.S. in 2007. Results of follow-up testing and evaluation after a positive screen have not been studied in the armed forces. Among first-time donors at the Joint Base San Antonio- Lackland Blood Donor Center between January 2014 and December 2016 (N=43,402), a total of 23 (0.05%) screened positive for T. cruzi. This descriptive study highlights demographic and follow-up information for all 22 active duty service members who screened positive; a non-active duty member was excluded due to unavailability of clinical records. Members who screened positive received 13 different combinations of confirmatory testing (mean: 2.7 tests per person). In select cases, clinical evaluation included electrocardiogram (n=15) and 30-second rhythm strip (n=5). Two patients met criteria for Chagas disease; 11 patients were considered negative; and nine patients were indeterminate. Among a small cohort of active duty service members who screened positive for T. cruzi infection on blood donation, diagnostic evaluation varied considerably. Opportunities exist to decrease heterogeneity of clinical workup and improve evaluation of persons who screen positive.

OCCUPATIONAL, NOSOCOMIAL OR HOSPITAL ACQUIRED TOXOPLASMOSIS

Toxoplasma gondii is protozoan parasite infects wild and domestic animals including birds, cats, sheep, goats, cattle, pigs and poultry. Cats are the definitive host of Toxoplasma and transmitted to other animals or people. There are three forms of T gondii: the tachyzoite (the rapidly reproducing form), the bradyzoite (a slower reproducing form contained in tissue cysts), and the sporozoite (contained in oocysts). The tachyzoite invade cells in the body where it thep multiplies rapidly and can destroy cells. When the cells die, the tachyzoites are released and infect other cells. For this reason, tachyzoites are seen in many tissues and organs throughout the body that are infected during this acute phase of the disease. This is also called the extraintestinal phase of the infection since it can affect all cells outside the intestines in all infected animals. However, only cats have the. intestinal phase of the infection. Two or three weeks after the first infection, the Toxoplasma divides more slowly and a protective membrane forms around the parasite cells. The cyst containing the parasites is called a zoitocyst and the cells inside the cyst are called bradyzoites. The tissue cysts are formed primarily in brain, eye, heart muscle, and skeletal muscle. Bradyzoites persist in tissues for many years, possibly for the life of the host. In cats, Toxoplasma infects the small intestine lining where they reproduce asexually. After a few days of rapid reproduction the cells transform into a sexual form, combine, and become enclosed in a cyst called an oocyst. Oocysts contain the sporozoite form of the Toxoplasma parasite. Gocysts are found in both wild and domestic cats but not in any other animals or birds.

Armed Forces Health Surveillance Branch. Update: Malaria, U.S. Armed Forces, 2015

U.S. service members are at risk of acquiring malaria infection when they are located in endemic areas because of long-term duty assignments, participation in shorter-term contingency operations, or personal travel. The number of malaria cases among U.S. military service members in 2015 (n=30) was the lowest annual count in at least 20 years and follows 3 previous years of greatly reduced incidence. The relatively low numbers of cases during 2012-2015 mainly reflect decreases in cases acquired in Afghanistan as the number of troops who served in Afghanistan sharply diminished in those years. About 43% of the 2015 cases were caused by Plasmodium falciparum (n=13) and 13% by Plasmodium vivax (n=4); about one-third of cases (37%) were reported as "unspecified" malaria. Malaria was diagnosed at or reported from 21 different medical facilities in the U.S., Afghanistan, Germany, and Korea. Providers of health care to military members should be knowledgeable regarding, and vigilant for, clinical presentations of malaria outside of endemic areas.

First report of two asymptomatic cases of human infection with Babesia microti (Franca, 1910) in Poland

Human infection by Babesia microti has been recognized as an emerging zoonosis with important public health implications worldwide. In Europe the reported cases of human babesiosis have been attributed mostly to B. divergens infection, with only sporadic cases of the disease caused by B. microti or B. venatorum. This study, based on molecular methods (PCR, R-T PCR, DNA sequencing and phylogenetic analysis), reveals for the first time in Poland, asymptomatic infection with . microti in immunocompetent healthy individuals working in forest ecosystems. Of the 58 professional foresters examined, two (3.4%) were identified as B. microti-positive by specific PCR. The results of this study also provide strong evidence that in eastern Poland, where tick-borne diseases (TBDs) are endemic, there is a potential risk of acquiring human babesiosis due to zoonotic B. microti parasites commonly found in rodents and I. ricinus ticks. The potential public health importance of this finding is discussed.

Effectiveness of permethrin-treated clothing to prevent tick exposure in foresters in the central Appalachian region of the USA

Outdoor workers are at risk from mosquito and tick bites and the extent to which exposures are linked to vector-borne disease is not understood. This pilot study characterizes for ester exposure to mosquitoes and ticks, and assesses effectiveness of permethrin-treated clothing for prevention of tick bites. Foresters (N = 34) from Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia were placed into treatment (permethrin-treated clothing) or control (untreated clothing) groups. Foresters completed questionnaires about work-related tick/mosquito exposure and 454 ticks were collected/identified from May to June 2013. A time-weighted analysis based on information submitted by foresters about time working outdoors showed that control participants received a lower rate of tick exposure (0.15 tick bites/hour; 13 bites/person) compared to treatment participants (0.27 bites/hour; 21 bites/person). However, more control participants (85 %) received at least one tick bite compared to treatment participants (52 %). Outdoor workers should be aware of available protective measures, such as permethrin-treated clothing, that may mitigate occupational risks.

Prevalence of antibodies against selected zoonotic agents in forestry workers from eastern and southern Poland

INTRODUCTION AND OBJECTIVE

Due to the nature of their work, foresters are exposed to many infectious pathogens from the wildlife reservoir. The primary aim of this study was to assess their contact with these pathogens.

MATERIAL AND METHODS

Sera and antibodies, mainly of IgG class against selected infectious factors, collected from a group of 216 employees of National Forests from eastern and southern Poland, were investigated.

RESULTS

Antibodies to Anaplasma phagocytophilum were detected in 64 sera (29.6%), to Bartonella spp. in 133 sera (61.6%), to Babesia microti in 50 sera (23.1%), and to Coxiella burnetii in 14 sera (6.4%); 7 sera (3.2%) were positive to Francisella tularensis. In studies of diseases not carried by ticks positive results were found in 28 sera (12.9%) to Toxocara canis, 13 sera (6.0 %) to Trichinella spiralis, and in 7 sera (3.2%) to Echinococcus granulosus. Antibodies to Hanta viruses were detected with antigens from Puumala and Dobrava/Hantaan strains in both IgM and IgG class. In 9 foresters, positive results were found, including one positive result to 2 antigens, 5 to Dobrava/Hantaan antigen and 3 to Puumala antigen.

CONCLUSION

Frequently higher percentages of positive results were found in people working utdoors, and in men when compared with women.

Protective efficacy of permethrin-treated trousers against tick infestation in forestry workers

INTRODUCTION AND OBJECTIVE

Prevention of tick borne diseases in forestry workers is essentially based on the use of appropriate clothing. The objective of this pragmatic, randomized, controlled trial was to assess the potential benefit of permethrin-treated working trousers for the prevention of tick infestation during forestry work.

MATERIALS AND METHODS

N=164 male forestry workers were equipped for a period of 16 weeks with permethrin-treated (intervention group-I) or untreated work trousers (control group-II). Subgroups, according to the use of trousers with (I-1, II-1) or without cut protection lining (I-2, II-2) were constituted. Tick infestation (quantity of ticks on the body surface) was assessed by questionnaire after 16 workdays. Control and intervention groups were compared by calculating the infestation rate (percentage of subjects with ticks) and the average number of ticks per workday.

RESULTS

The infestation rate in the intervention group was significantly lower than in the control group (36.6 vs. 63.4%, p=0.001; Fisher-test). Further analysis revealed a significant reduction of tick infestation by permethrin treatment only for subjects wearing trousers without the cut protection lining (I-2: 34.2 vs. II-2: 80.0%, p<0.001), while users of cut protection trousers did not benefit from such treated trousers (I-1: 38.6 vs. II-1: 47.6%, n.s.). Similar results were found for comparisons based on the average number of ticks per workday.

CONCLUSIONS

The use of permethrin-treated trousers does not completely prevent tick infestations. Improvement of tick protection has been shown only for some applications, but not in general. Additional prevention measures are therefore still indispensable.

Strongyloidiasis in a nonagenarian who previously worked in conservancy services

We report a case of strongyloidiasis in a patient born in Hong Kong and was possibly infected via her prior occupation in conservancy services. She presented with chronic diarrhoea, anorexia, and extensive scratch marks over the lower extremities. Further assessment yielded eosinophilia, intermittent dyspepsia, and an episode of unexplained Clostridium perfringens bacteraemia. She was treated with a course of albendazole. Subsequently, the eosinophilia and diarrhoea subsided.

Ticks of Poland. Review of contemporary issues and latest research

The paper presents current knowledge of ticks occurring in Poland, their medical importance, and a review of recent studies implemented in the Polish research centres on ticks and their significance in the epidemiology of transmissible diseases. In the Polish fauna there are 19 species of ticks (Ixodida) recognized as existing permanently in our country: Argas reflexus, Argas polonicus, Carios vespertilionis, Ixodes trianguliceps, Ixodes arboricola, Ixodes crenulatus, Ixodes hexagonus, Ixodes lividus, Ixodes rugicollis, Ixodes caledonicus, Ixodes frontalis, Ixodes simplex, Ixodes vespertilionis, Ixodes apronophorus, Ixodes persulcatus, Ixodes ricinus, Haemaphysalis punctata, Haemaphysalis concinna, Dermacentor reticulatus. Occasionally, alien species of ticks transferred to the territory of Poland are recorded: Amblyomma sphenodonti, Amblyomma exornatum, Amblyomma flavomaculatum, Amblyomma latum, Amblyomma nuttalli, Amblyomma quadricavum, Amblyomma transversale, Amblyomma varanensis, Amblyomma spp., Dermacentor marginatus, Hyalomma aegyptium, Hyalomma marginatum, Ixodes eldaricus, Ixodes festai, Rhipicephalus rossicus, Rhipicephalus sanguineus. The most common species of the highest medical and veterinary importance in Poland is invariably Ixodes ricinus. The review also sets out information on the risks of tickborne diseases in recreational areas of large cities in Poland, ticks as the cause of occupational diseases and dangerous species of ticks attacking people outside the Polish borders. Selected problems of the biology of ticks, the spread of alien species transferred on hosts and prevention of tick attacks have also been presented. The Polish studies on ticks are a valuable contribution to global research on the Ixodida.

Immunological correlates of cure in the first American cutaneous leishmaniasis patient treated by immunotherapy in Argentina. A case report

A patient with localized cutaneous leishmaniasis due to Leishmania (Leishmania) amazonensis infection was treated with an antigen containing heat-killed L. (L.) amazonensis promastigotes plus BCG. Expression of T-cell differentiation, memory and senescence receptors markers were analyzed on T cell subpopulations, in order to establish the correlation between the percentages of expression of these receptors and his clinical status, at different stages of his follow up. The following case reports on the achievement of a successful clinical outcome with complete resolution after receiving immunotherapy. A thorough clinical and immunological follow up supporting the healing process of this patient's lesion is presented in detail.

[Malaria and life at sea: prophylactic regimens on merchant ships]

The purpose of this article is to describe requirements for protection/treatment of malaria on merchant ships. The first part of the article reviews recent data on the incidence of malaria in seagoing personnel. The second part provides advice on mosquito-bite prevention on merchant ships. The third part presents the most important information on prophylaxis for seafarers working in malarial risk areas. Several regimens are proposed. The last part of the article discusses curative treatment for malaria on merchant ships.

Examinations regarding the prevalence of intestinal parasitic diseases in Polish soldiers contingents assigned to missions abroad

The aim of this paper is to present the program of diagnostic examinations regarding the detection and following treatment of intestinal parasitic diseases in the population of Polish soldiers serving in different climatic and sanitary conditions. Intestinal parasitoses remain one of the health problems of soldiers participating in contemporary military operations. This fact mainly results from unsatisfactory sanitary and hygienic standards in the regions where troops are deployed, contamination of water and soil, inappropriate processes of purifying drinking water, and the terrible condition of sewage systems, water purification plants, or sewage treatment facilities. The occurrence of such diseases is further facilitated by disregard of some basic principles of food and feeding hygiene. Mass examinations of Polish troops to find the prevalence of intestinal parasitoses will cause a decrease in the morbidity rate of parasitic diseases among Polish soldiers deployed in military operations. They can also lead to a decrease in expenditure on medical treatment of disease-related complications and on damages awarded to soldiers who have developed a serious disease while being engaged in a mission abroad.

Demodex infections in general Polish population, in patients suffering from blepharitis, and among people who work with microscopes

In this study we examined 264 people to estimate the prevalence of Demodex infection. The subjects were divided into 4 groups. First two groups consisted of young people (mean age 22 years) and seniors (mean age 66 years) respectively. The third group included people who work with microscopes (mean age 44 years). Forth group consisted of patients with diagnosed blepharitis (mean age 65 years). From every individual 3-4 lashes were epilated from the eyelids of both eyes and examined under the microscope for Demodex mites. The statistical analysis based on logistic regression was used to estimate the probability of infection. Age was independent variable significant for this model (p < 0.001). Significant relation between age and probability of Demodex infection was showed. The lowest number of infected individuals was observed in the group of young subjects (only 5%), the highest in the blepharitis patients (74% infected). Among microscope users 30% were infected, in the group of seniors 34% were infected.

Production of experimental hydatid cyst in the eye, peritoneum and liver of BALB/c mice

As the main treatment for this infection is surgery, the surgery team personnel are at the risk of the protoscoleces released from the hydatid cysts (HC) of patients. The first goal of this study was to determine the probability of the production of ocular HC in mice due to the fluid of the aspirated protoscoleces from the sheep liver with HC. The second goal of this study was to produce HC in the peritoneum and liver, in order to gather more information for future studies on hepatic and peritoneal HC treatment procedures. For the first goal of this study, different concentrations of protoscoleces were prepared and injected into the eyes of 60 mice. After 20 weeks, 10 of the 60 mice of this group died. The remaining 50 mice were examined by a surgeon under the anesthesia. There weren't any symptoms of HC in the eyes and around it. For the second goal, 39 new mice were separated into three sub groups and 0.5 ml of protoscolex solution was injected intraperitoneally. After 20 weeks, they were anesthetized and their peritoneum, intestines and liver were examined. HC was seen in the peritoneum and liver of 6 mice.

Emerging cutaneous leishmaniasis in Sirte-Libya: epidemiology, recognition and management

The present work aimed to determine the risk factors, lesion pattern and effective therapy of emerging ZCL in Sirte-Libya. The study was carried out on 163 patients referred to health centers of Al-Gadaheya and Al-Hisha villages in the years 2006 & 2007. Methods consisted of a predesigned questionnaire (personal and demographic data), clinical examination of lesions, and parasitological examination by slit smear, treatment and follow up. Results showed an annual incidence of 0.95%, with onset peak during autumn months. Important local risk factors included: increased occupational exposure of farmers and construction worker to infection from fat sand rat burrows, facilitated by lack of prevention knowledge and prophylactic measures; close association of bad-ventilated animal shelters to houses, and increased soil moisture by warm spring ponds. The majority of lesions were multiple (73%) located on legs, arms, and face 66.8%, 52.1% and 41.1%. Most lesions were active 1-2 month duration and 1-3 cm size, ulcerative type (77.3%), and papulo-nodular (21.5%). Giemsa slit smear proved quite reliable for active lesions, confirmed 79.5% of lesions. The majority of lesions (60.1%) were treated by intra-lesional Pentostam. Systemic route was restricted to facial, over-joint, multiple or large lesions producing, good response in 31.9%. Cryotherapy and oral Fluconazole gave satisfactory response in 5.5% & 2.5% of cases.

A case of naso-ophthalmic myiasis

Myiasis is defined as an occupational disease and it is mainly seen in people who are in contact with animals, in particular sheep. We detected nasal and external ophthalmomyiasis caused by Oestrus ovis in a 33-year-old male who worked as a research assistant in the faculty of agriculture. The presenting complaints were severe foreign body sensation and discharge in the nose, cough, and foreign body sensation in the right eye. Ophthalmologic examination revealed many moving larvae in the right eye of the patient. Larvae were removed and nasolacrimal duct irrigation was performed through the inferior canaliculus. Endoscopic nasal examination also showed larvae colonies. The larvae were removed under local anesthesia and were taken to the parasitology laboratory, wherein Oestrus ovis was identified. Minimal endoscopic sinus surgery showed nonspecific chronic inflammation.

[Occurrence of Toxoplasma gondii specific antibodies in group of forestry workers from pomorskie and warmińsko-mazurskie provinces]

Toxoplasma gondii infection is one of the most common human zoonosis. Humans acquire toxoplasmosis by consuming raw or undercooked meat, from environments and from via vertical transmission to the foetus through the placenta during pregnancy. In the present study, a total of 784 persons (forestry workers), from north-eastern region of Poland (pomorskie and warmińsko-mazurskie provinces), were tested by using commercially available ELISA test (DiaSorin) to determine the frequency of Toxoplasma gondii infection. The study was based on detection of IgG and IgM specific antibodies in collected serum samples. The T. gondii-specific IgG were found in 490 samples (62.5%), while the IgM antibodies were noted only in 18 persons (3.7%). High prevalence of seropositive results in forestry workers may suggest an occupational exposure of this group to T. gondii.

[Investigation of Cryptosporidium sp. in workers of the Van municipality slaughterhouse and in slaughtered animals]

This study was carried out in order to investigate the prevalence of Cryptosporidium sp. in slaughtered animals and workers of the Van municipality slaughterhouse in Van. Animals slaughtered at different times and workers who had been working in different departments of the slaughter house were included in the study for three months. A total of 309 fecal specimens from animals including 167 sheep, 56 goats and 86 cattle and 87 fecal specimens from workers were examined for Cryptosporidium sp. oocysts. In slaughtered animals, the modified acid-fast staining method was used to determine the oocysts of Cryptosporidium sp. The fecal samples of slaughter workers were examined by using RIDA (R) Quick Cryptosporidium Strip Test (R-Biopharm, Germany) and the modified acid-fast staining method. Fecal samples found to be positive by stripe test were also confirmed with the ELISA method (R-Biopharm, Germany). Oocysts of Cryptosporidium sp. were found in fecal specimens of 22 sheep (13.17%), 6 goats (10.71%) and 7 cattle (8.13%). Intestinal parasites were observed in 34 fecal specimens of workers (39.08%). Cryptosporidium sp., Hymenolepis nana, Chilomastix mesnili, Endolimax nana, Iodamoeba bütschlii were found in the specimen of one worker (1.14%), Entamoeba coli in 4 workers (4.59%), Blastocystis hominis (9.19%) in 8 workers, and Giardia intestinalis (19.54%) in 17 workers.

Human babesiosis, an emerging zoonosis

Data of human babesiosis are shortly reviewed with particular emphasis to Europe. In Europe, most cases of human babesiosis are caused by Babesia divergens. Although both phenotypic and genotypic features suggest that zoonotic B. microti may occur in Europe, convincing medical evidence is lacking. Recently a non-Babesia divergens organism causing zoonotic infection has been found in Italy and Austria. Overall, the seroprevalence against both B. microti and B. divergens microrganisms in human ranges 1.5%-11.5% in Europe.

[Human auricular myiasis caused by Wohlfahrtia magnifica (Diptera: Sarcophagidae): about three observations in Morocco]

We report three cases of human otomyiasis observed in rural Moroccan children. Myiasis of external orifices usually occurs from neglected chronic lesions of the patients with poor personal hygiene. The parasitologic identification revealed Wohlfahrtia magnifica. Wohlfahrtiosis is common myiasis of sheep and goats in Mediterranean basin. Through this paper we underline the epidemiological, pathogenic, clinical and therapeutic aspects of this parasitosis.

[Prevalence of intestinal parasites among workers in food sector in Van region]

Stool and cellophane tape specimens were taken for parasitological examination from 739 people who work in food sector and applied to the public health lab of the Van Health Administration for porter examination. Parasites were determined at 131 people (17.71%) of 739 worker whom samples were investigated. Ninety-five people had one, 30 people had two, 5 people had three and one person had four parasite species. Parasites determined in the study were 19.08% helminthes and 80.91% protozoon. In this study, 1.21% Ascaris lumbricoides, 0.81% Enterobius vermicularis, 0.67% Hymenolepis nana, 0.40% Trichuris trichiura, 0.27% Taenia saginata, 4.87% Blastocystis hominis, 3.24% Entamoeba coli, 2.84% Giardia intestinalis, 2.02% Iodamoeba bütschlii, 0.67% Endolimax nana, 0.27% Entamoeba histolytica/Entamoeba dispar, 0.27% Chilomastix mesnili, 0.13% Entamoeba hartmanni were found.

[The investigation of the seroprevalence of cystic echinococcosis in veterinary surgeons]

In Turkey where agriculture is a major industry, cystic echinococcosis is a serious public health problem which also has a significant impact on the country's economy. In this case, echinococcosis seroprevalence among veterinary surgeons was tested using the enzyme linked immunosorbent assay (ELISA) and indirect hemagglutination (IHA) methods and the samples tested positive were subjected to a further verification test using the western blot (WB) method. While sera from 2 out of 93 veterinary surgeons (2.15%) were found to be positive for Echinococcus-IgG antibody using the ELISA method, the optic density values of the two sera were found to be very close to the limits. All of the sera were found to be seronegative for Echinococcus-IgG antibody using the IHA method. Further verification using the WB method was used for confirmation of the 2 (2.15%) sera positive with ELISA, one of the sera tested positive for IgG and the other was at the limit.

Giardia, Cryptosporidium and the spectre of zoonosis: the Italian experience from land to sea

In the last decade, a major concern for the scientific community has been whether infected animals can serve as reservoirs of Giardia and Cryptosporidium infection for humans. Worldwide, prevalence studies and molecular tools have provided insights into the taxonomy and epidemiology of these protozoa in order to better understand such a relation. This paper presents data on the prevalence and molecular genotyping studies from several sample types from land to sea (humans, companion animals, sheep, cattle, goats, wastewaters, surface water, and shellfish) available in Italy. The contribution of Italian researchers to the international debate on the veterinary significance of these infections and their impact on public health is highlighted and the main objectives to be pursued in the future depicted.

Toxocara-infestations in Austria: a study on the risk of infection of farmers, slaughterhouse staff, hunters and veterinarians

A total of 585 persons from several occupational groups (farmers, slaughterhouse staff, hunters, veterinarians) exposed to Toxocara infestations and 50 persons of a control group were tested for the presence of specific antibodies to the Toxocara canis antigen using an enzyme-linked immunosorbent assay and a western blot. Farmers showed the highest seroprevalence (44%), followed by veterinarians (27%), slaughterhouse staff (25%) and hunters (17%), whereas only 2% of the individuals of the control group were seropositive. Thus, the risk to Toxocara infestation is 39, 18, 16 and 9 times higher for farmers, veterinarians, slaughterhouse staff (some workers were part-time farmers) and for hunters, respectively, when compared to the control group. The main source of infection in rural areas seems to be (roaming) farm cats and dogs that have not been dewormed. The results are discussed with a view to potential risk factors and preventive measures, in terms of veterinary and human medicine.

Cryptosporidium and cryptosporidiosis in Denmark--current status

The genus Cryptosporidium comprises a group of protozoan parasites that infect a broad variety of vertebrates causing severe diarrhoeal illness in immunocompromised as well as immunocompetent hosts. Although molecular heterogeneity of the genus is being increasingly recognised, traditional diagnostic methods do not discriminate all species/subtypes, and population genetic studies of these parasites, using discriminatory molecular markers, have only been published recently. In Denmark, Cryptosporidium research has focussed mainly on detection methods, pathogenicity and veterinary aspects. The present paper gives an overview of recent and ongoing Cryptosporidium research in Denmark with an emphasis on molecular approaches to study epidemiology and transmission.

Prevalence of Demodex in Health Personnel Working in the Autopsy Room

The health personnel working in the autopsy rooms and laboratories are considered among the professional groups carrying a high risk of contamination with infection. In this study, we have investigated the prevalence of Demodex, which provides a convenient environment for bacteria and acts as a vector for certain microorganisms, in the health personnel working in autopsy rooms. The study, which was cross-sectional, was conducted on 58 health personnel working in autopsy rooms. A questionnaire was administered to the individuals. Specimens were obtained from 4 different regions of the face using the standard skin-surface biopsy technique. The data obtained were then evaluated statistically. This study group consisted of 76% males and 24% females. The prevalence of Demodex was 26%. Demodex was found to occur more frequently in women. The most frequent occurrence of Demodex was seen among people with darker complexion and in cheek localizations. We believe that Demodex, which has a role in the pathogenesis of dermatologic diseases, provides a convenient environment for bacteria, and acts as a vector for some pathogenic microorganisms, poses a risk as far as individuals working in the autopsy room are concerned.

[Coxiella burnetii: what is the reality?]

After the Second World War, in Italy Q Fever or Coxiellosis has been shown a significant relevance, a recrudescence with an epidemic state for over ten years. Later, the infectious disease occurred as endemic since the 80s, the outbreaks were just isolated. Workflows analysis of some authors has demonstrated the spread out of the infection throughout Italian herds with a prevalence ranging from 1.2 per cent to 10 per cent. Our survey carried out throughout Campania area in cattle has shown a real positivity over 14 per cent performing the IFAT for the detection of IgG antibodies for Coxiella burnetii. Therefore, it has been so important to stress the influence of cattle farming management in stables as a real risk of Coxiellosis. For example, the Relative Risk (RR) has been registrated about 6.84 (2.18<RR<21.4) in comparison with some herds permanently housed than those kept unhoused and about 8.4 (1.8<RR<38.6) in housed herds and those permanently kept at pasture. Therefore, we have detected a seroprevalence of Q Fever about 11.8 per cent within sheep and about 6.3 per cent within goats. The investigations have focused buffaloes too, tested by several authors, especially from India, but in Italy, only Galiero has recorded significant results: the overall seroprevalence (1.2 per cent) was observed within 1012 buffaloes. Other studies have demonstrated that dogs may transmit Q Fever to humans by infected birth fluids and membranes and by urine. Because of this observation, addressed some of our search projects to assess possible relation among other pathogens, such as Leishmania infantum, Rickettsia conori and Ehrlichia canis. The results have confirmed the presence of C. burnetii (seroprevalence about 7 per cent) within tested dogs in southern Italy. There was no direct estimated relationship between C. burnetii and E. canis and R. conori, instead of significant relation has been shown for L. infantum. The investigation focused on the direct interaction between seropositivity and the age of ruminants. For example, the highest prevalence has been observed in cows and sheep ranging from 3-5 years in which the infection risk was higher than in younger herds. In accordance with the workflows serological analysis, C. burnetii is widespread in Italy among housed ruminants. PCR assay was, therefore performed to test cows with clinical signs of abortion and neonatal mortality. All the survey involved 305 animals (267 foeti and 38 stillborn) with 77 positive herds showing DNA of C. burnetii. To detect C. burnetii pathogen in milk samples, two methods have been combined: the immunomagnetic separation (IMS) and PCR assay, obtaining an increasing of sensitivity (10(-17)) more than only PCR technique (10(-8)). The overall analysis of serological and biomolecular results has demonstrated that C. burnetii is really widespread and may have detrimental effects on farm management system.

[Human cystic hydatidosis in Italy: a public health emergency? Past to present]

Starting from 1991 the Central Office of Statistics ISTAT, according to changed regulations on notification of infective diseases, stopped reporting official national data on human hydatidosis. On the other hand until then notified data, concerning only about a hundred cases per year in mean during the last decades and just 36 in 1991, appeared unreliable, suggesting a diffusion far from the actual. Owing to specific studies on different research groups it is possible to try to describe a not exhaustive but indicative pattern of trend of human hydatidosis in Italy. More recent publications regarding different regions report an annual mean incidence rate of surgical cases of 9.77/100,000 inhabitants in Sardinia, of 1.57 in Emilia Romagna, of 2.30 in Sicily and of 2.33 in Apulia, the latter encompassing only hepatic cysts treated in the region, irrespective of residence of subjects. A comparison with previous studies regarding the period between 1948-1952 and 1980-84 respectively, indicates an increase in the more recent surveys. However, as even underlined by Authors, former surveys were not all-embracing (for example not including patients from private Clinics etc). On the other hand during time, improvements in surgical as well in anaesthesiological skills have made surgery possible in patients previously inoperable, and particularly in old subjects. Conversely, at present, availability of alternative therapies such as chemotherapy, PAIR or modified PAIR-based techniques may allow cases to avoide surgical surveys. However, actual parasite burden in humans may be estimated by assessing the trend of likely young cysts, as due to recent infections. Rate of pulmonary cysts, that are sure to be young, was of 48.6%/100,000 inhab. in 1952 in Italy, then falling to 18.2 in 1980-84 in the 9 considered regions, to 12.7 in Sicily (1989-91), 6.5 in Emilia-Romagna (1989-93) and 15.7 in Sardinia (1990-95). Another "class" of surely young cysts regards all cysts in young age group that necessarily have been recently infected. Ratio of infection rates in the old/young people was around 1 in 1941-52 but was exceeding 3 in 1980-84. In addition available data from more recent surveys indicate that ratio is at present still relatively low in Sardinia (3.9), where sheep-breeding is widespread, and dog-livestock-man interaction is most likely to exist, and conversely is very high in Emilia-Romagna (5.75) where pastoral economy is not prevalent (just 92,000 sheep). Actual trend both parasitological and in terms of public health would ameliorate if studies were provided with long temporary series. In Sardinia all hydatid cases surgically treated from 1969 to 1995 have been registered and analysed with a standardized methodology. During the considered period incidence appears nearly unvaried (16.9 in 1969 vs 15.8 in 1985), with a fall only for the last 5 years (9.1 in 1995), and with an increase regarding 1984-88 period. Analysis according to cyst localization strongly suggests that fall in the last period is only weakly related to hepatic cysts, that conversely are near completely responsible of rise in 1984-88. On the contrary for pulmonary cysts, i.e. young cysts, a slow but continuous and significant decrease (from 6.5 in 1969 to 1.4 in 1995) is evident. In the same way the above- mentioned old/young ratio rises from 1.7 (1969-79) to 3.9 (1990-95). On the whole analysed data suggest that although parasitic burden, strong in central-south Italy for decades, is now slow lowering due to structural changes and improvements in general conditions of life rather to specific preventive actions, human hydatidosis still represents a public health problem that will continue in the future as, because of latency, incidence rates will stay long relevant.

[Epidemiology of parasitic diseases in military personnel treated in the United Nations Interim Force hospital in Lebanon, from 1993 to 2000]

The study examined the incidence and prevalence of parasitic diseases among military personnel of the United Nations Interim Force in Lebanon (UNIFIL) and local civilian population. Additionally, the authors investigated the potential risk factors, including environmental conditions, influencing the incidence of infectious diseases. Epidemiological analysis was conducted based on the medial records of patients treated in the Internal and Surgical Ward of the UNIFIL Hospital from 1993 to 2000. The patients with parasitic diseases accounted for 3.78% of all patients hospitalized during the analyzed period. The most frequent infectious diseases treated during that time were trichuriasis, ancylostomiasis, giardiasis and ascariasis.

Seroprevalence of Toxoplasma gondii infection among veterinary staff in Ontario, Canada (2002): implications for teratogenic risk

BACKGROUND

Toxoplasma gondii infection is embryotoxic in humans. It is mainly transmitted through raw/undercooked meat and ingestion of oocysts in cat feces. There remains controversy about the actual risk of cats transmitting the disease to humans. Our primary objective was to determine the seroprevalence of T. gondii antibody among veterinary staff, to ascertain whether they have an increased risk through occupational exposure. Our secondary objective was to examine their practices regarding cats, toxoplasma infection, and pregnancy.

METHODS

Veterinary staff attending the 2002 Annual Ontario Veterinary Medical Association Conference were invited to discuss their toxoplasma seroprevalence. Interested attendees completed a questionnaire and a physician drew blood samples to determine T. gondii titres using the ELISA IgG test.

RESULTS

We collected 161 completed questionnaires, and 141 blood samples. There were 20 (14.2%, CI 95%:8.4-19.9%) reactive titres among the veterinarian staff (80% females aged 30-45). All were regularly exposed to cats, washed their hands when in contact and few wore gloves routinely.

CONCLUSIONS

These findings of low positive rates may be used to reassure veterinary staff that their exposure to cats does not appear to increase their risk of contracting toxoplasma infection and that pregnant women are not at an increased risk by owning a cat.

Hematological effects of Blastocystis hominis infection in male foreign workers in Taiwan

Blastocystis hominis found in stool specimens has been the most frequently identified parasite among foreign workers from Southeast Asia in Taiwan since 1992. The prevalence of B. hominis was 14.1% in this study. In their quarantine physical examinations, 121 male Thai workers were examined hematologically and screened for stool parasites using the merthiolate-iodine-formaldehyde concentration method. Hematological values were compared in workers with and without a B. hominis infection. Multiple regressions were used to adjust for age. Those infected with any parasite other than B. hominis were excluded from further analysis. The workers infected with B. hominis had a lower leukocyte count (6.5+/-0.4 X 10(3)/microl) than those who were not (7.4+/-0.2 X 10(3)/microl). This was mainly caused by a reduced neutrophil count (3.2+/-0.4 vs 4.2+/-0.2 X 10(3)/microl). Hemoglobin (13.9+/-0.3 vs 14.5+/-0.1 g/dl) and hematocrit (41.4+/-0.6 vs 42.9+/-0.2%) were also reduced in B. hominis-positive workers.

Molecular characterisation of airport malaria: four cases in France during summer 1999

Four airport malaria cases have been observed in the vicinity of the Roissy-Charles-de-Gaulle International Airport, Paris, France. These cases were geographically very close to each other and clustered in a short period of time during the summer of 1999. The phenotype and genotype of the Plasmodium falciparum isolates obtained from these patients were determined in order to know whether a single mosquito could have infected more than one subject. The genomic characterisation of isolates was performed using the polymorphic markers merozoite surface protein 1 (Msp 1) and merozoite surface protein 2 (Msp 2) genes, the kappa and omega repeats domains of cg2 and the dihydrofolate reductase (DHFR) genotypes. Results showed identical genotypes for isolates 1, 2 and 4 whereas the genotype of isolate 3 differed at one locus. The molecular analysis was consistent with the hypothesis that all patients could have been bitten by the same mosquito and that patient 3, may have received a different clone and an additional species. In vitro susceptibility data did not confirm or rule out this hypothesis because isolates had the same profile of susceptibility to the tested drugs.