An integrated model, based on a One Health approach, was implemented to estimate the epidemiological and economic outcomes of cystic echinococcosis (CE) in Veneto region, an hypo-endemic area of ...Northern Italy, and the costs for its prevention. Data and information needed to populate the model were retrieved from published literature, official statistics, expert opinions, or actively searched through data mining (i.e., Hospital and slaughterhouse data), when fundamental data were not available. Human-health and animal-health costs, both public and private, were considered. The overall impact of CE in the study area was estimated in an yearly cost of about 0.5 million €, due to an average of 19.5 human hospitalized cases and about 200 infected animals among cattle and sheep, per year. The human:animal costs ratio was about 8:1. Most of the infected animals were autochthonous, while the identification of an autochthonous source of the infection for the human cases was extremely difficult, and unlikely in most cases. No specific action resulted to be in place for human surveillance, while veterinary surveillance accounted for a yearly cost of about 22,000 €. Sheepherders were found to pay privately an overall amount of around 2000 € for the preventive treatment of their dogs every year, but the applied protocol proved to be sub-optimal. The source of most of the human cases was likely external to the study area, and their economic impact accounts for a cost that is far exceeding that of surveillance and preventive actions in place in the veterinary sector. Although autochthonous human cases appeared to be very rare, the strengthening of preventive actions and surveillance systems can reduce the risk of their increment.
•The study integrated epidemiology and economic aspects in a One Health perspective.•The research estimates in detail the overall impact of CE in a hypo-endemic region in Italy.•The study provided data for evidence-based actions to control CE in the study area.•The investigated case study represents a reproducible model for zoonotic diseases evaluation.
Cystic echinococcosis (CE) and alveolar echinococcosis (AE) are chronic, complex and neglected diseases. Their treatment depends on a number of factors related to the lesion, setting and patient. We ...performed a literature review of curative or palliative non-surgical, non-chemical interventions in CE and AE. In CE, some of these techniques, like radiofrequency thermal ablation (RFA), were shelved after initial attempts, while others, such as High-Intensity Focused Ultrasound, appear promising but are still in a pre-clinical phase. In AE, RFA has never been tested, however, radiotherapy or heavy-ion therapies have been attempted in experimental models. Still, application to humans is questionable. In CE, although prospective clinical studies are still lacking, therapeutic, non-surgical drainage techniques, such as PAIR (puncture, aspiration, injection, re-aspiration) and its derivatives, are now considered a useful option in selected cases. Finally, palliative, non-surgical drainage techniques such as US- or CT-guided percutaneous biliary drainage, centro-parasitic abscesses drainage, or vascular stenting were performed successfully. Recently, endoscopic retrograde cholangiopancreatography (ERCP)-associated techniques have become increasingly used to manage biliary fistulas in CE and biliary obstructions in AE. Development of pre-clinical animal models would allow testing for AE techniques developed for other indications, e.g. cancer. Prospective trials are required to determine the best use of PAIR, and associated procedures, and the indications and techniques of palliative drainage.
L’échinococcose kystique (EK) et l’échinococcose alvéolaire (EA) sont des maladies chroniques, complexes, et négligées. Leur traitement dépend de facteurs associés à la nature des lésions, du patient et du lieu de prise en charge. Nous avons réalisé une revue de la littérature concernant les modalités curatives ou palliatives d’interventions non-chirurgicales et non-chimiothérapiques dans l’EK et l’EA. Dans l’EK, certaines de ces techniques, comme l’ablation par radiofréquence (ARF), ont été mises à l’écart après des premières tentatives ; d’autres comme les ultrasons focalisés de haute intensité semblent prometteuses, mais encore au stade préclinique. Dans l’EA, l’ARF n’a jamais été essayée ; toutefois, la radiothérapie et l’hadronthérapie ont été testées dans les modèles expérimentaux, mais on peut douter de leur application en clinique humaine. Dans l’EK, bien qu’on manque encore d’études cliniques prospectives, les techniques de drainage non-chirurgical à visée thérapeutique, comme la perforation, aspiration, injection, ré-aspiration (PAIR) et ses variantes, sont maintenant considérées comme des options valables dans des cas sélectionnés. Enfin, des interventions palliatives percutanées de drainage biliaire guidées par écho- ou scannographie, de drainage d’une cavité centrale surinfectée, ou de pose de stent vasculaire, ont été couronnées de succès. Les techniques de drainage associées à la cholangio-pancréatographie per-endoscopique sont maintenant plus souvent utilisées pour le traitement des fistules biliaires dans l’EK et des obstructions biliaires dans l’EA. Le développement de modèles animaux précliniques permettrait de tester différentes techniques développées pour d’autres indications, comme le cancer, en particulier pour l’AE. Des études prospectives sont nécessaires pour déterminer la meilleure utilisation de la PAIR et des procédures associées, et les meilleures indications et techniques de drainage palliatifs.
Italy is presently facing an increase in immigration from sub-Saharan Africa through the Mediterranean Sea. Case reports of human cystic echinococcosis (CE) have been reported from most sub-Saharan ...countries. Therefore, an increase in the number of patients with CE coming from these areas in the Italian and European centers for infectious diseases is expected. Unfortunately, the epidemiology of CE in sub-Saharan countries is poorly known, which makes clinical suspicion and diagnosis of such infection difficult in patients coming from these areas.
Here we report a case of hepatic CE in a patient from Niger who arrived in Italy through Libya and visited in a Tropical Medicine referral center in Northern Italy. The parasite was identified molecularly as the G6 "camel" strain of Echinococcus granulosus (E. canadensis). The diagnosis and management of a chronic and clinically complex infection like CE in such situation is difficult. Only 40 cases of CE from Niger have been reported; of these, 75% had extra-hepatic localization. To our knowledge, no strain characterization of human isolates from Niger has been reported so far. The CE cyst of the patient was in CE3a stage, indicating active transmission from the area in which the patient came. However, prevalence data from Niger, and from any other country in West Africa, are almost inexistent.
We argue that population epidemiology surveys with ultrasound are warranted in Sahelian countries, including Niger. These studies could improve the knowledge of CE epidemiology, provide health authorities with important information for public health interventions targeting this zoonosis, and shed light on any difference between tissue tropism and clinical manifestations caused by the different E. granulosus strains.
Mass drug administration (MDA) programmes against Onchocerca volvulus use ivermectin (IVM) which targets microfilariae (MF), the worm's offspring. Most infected individuals are hyporesponsive and ...present regulated immune responses despite high parasite burden. Recently, with MDA programmes, the existence of amicrofilaridermic (a-MF) individuals has become apparent but little is known about their immune responses. Within this immunoepidemiological study, we compared parasitology, pathology and immune profiles in infection-free volunteers and infected individuals that were MF(+) or a-MF. The latter stemmed from villages in either Central or Ashanti regions of Ghana which, at the time of the study, had received up to eight or only one round of MDA respectively. Interestingly, a-MF patients had fewer nodules and decreased IL-10 responses to all tested stimuli. On the other hand, this patient group displayed contrary IL-5 profiles following in vitro stimulation or in plasma and the dampened response in the latter correlated to reduced eosinophils and associated factors but elevated neutrophils. Furthermore, multivariable regression analysis with covariates MF, IVM or the region (Central vs. Ashanti) revealed that immune responses were associated with different covariates: whereas O. volvulus-specific IL-5 responses were primarily associated with MF, IL-10 secretion had a negative correlation with times of individual IVM therapy (IIT). All plasma parameters (eosinophil cationic protein, IL-5, eosinophils and neutrophils) were highly associated with MF. With regards to IL-17 secretion, although no differences were observed between the groups to filarial-specific or bystander stimuli, these responses were highly associated with the region. These data indicate that immune responses are affected by both, IIT and the rounds of IVM MDA within the community. Consequently, it appears that a lowered infection pressure due to IVM MDA may affect the immune profile of community members even if they have not regularly participated in the programmes.
Neurocysticercosis (NCC) is an important cause of adult-onset seizures in endemic areas, whereas it is emerging in some nonendemic areas as well because of extensive immigration.
We describe three ...cases of imported NCC recently admitted to San Bortolo Hospital in Vicenza, located in Northern Italy.
All patients were immigrants. One patient was human immunodeficiency virus positive with severe immunosuppression. The diagnosis of NCC was made on the basis of magnetic resonance results; failure of anti-Toxoplasma, antitubercular, and antifungal therapy; and regression of the cystic lesions after empiric therapy with albendazole. Serology was positive in only one case. In one patient, NCC was diagnosed by biopsy of the brain lesion.
In nonendemic countries, NCC should be included in the differential diagnosis of all patients coming from endemic areas with seizures, hydrocephalus, and compatible lesions on brain imaging. Long-term follow-up is required but may be difficult to implement because these patients tend to move in search of employment. Screening of patient's household contacts for Taenia solium infection should always be carried out.
The World Health Organization has started a process to issue guidelines for the control of strongyloidiasis. The guidelines might recommend to implement preventive chemotherapy (PC) at community ...level (i.e. to all individuals above 5 years of age), over a defined prevalence threshold. We previously estimated the number of school-age children (SAC) who would need PC. Here we estimate the number of people above 15 years of age who might be included in PC for strongyloidiasis. Based on previous
prevalence estimates and on countries' age distribution, we retrieved the number of adults in need of PC. We then subtracted the number of people already involved in ivermectin mass distribution for the elimination of onchocerciasis and lymphatic filariasis and people living in countries where
is endemic. The number of adults to be involved in PC was estimated at 905.4 (95% confidence interval (CI): 520.6-1177.2), 660.2 (95% CI: 512.7-1214.9), and 512.1 (95% CI: 276-719.4) million people, when the strongyloidiasis prevalence threshold for implementing PC was set to 10%, 15% and 20%, respectively. Estimates at country level are also provided.These estimates might help endemic countries wishing to implement PC for strongyloidiasis to allocate resources to include adults in addition to SAC in control programmes. This article is part of the Theo Murphy meeting issue '
: omics to worm-free populations'.
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