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Biomedical subjects

T Romig

Publications and source records attributed to T Romig.

At least 19 recordsLinked to original sources

Echinococcus multilocularis--a zoonosis of anthropogenic environments?

Transmission of the fox tapeworm Echinococcus multilocularis, the causative agent of human alveolar echinococcosis, is known to depend on various environmental factors which are subject to human influence. Epidemiological data suggest that in most endemic regions anthropogenic landscape changes (e.g. deforestation and agricultural practices) have led to more favourable conditions for the parasite's animal hosts, especially arvicolid rodents, thereby increasing the risk for parasite transmission and human disease. Examples are the conversion of forests or crop fields into meadows and pastures in Europe, China and North America, and overgrazing of natural grassland in central Asia. Other anthropogenic factors include interference with host population densities by wildlife disease control, changing hunting pressure and provision of new habitats, e.g. in urban areas. Domestic dogs may, under certain conditions, get involved in the otherwise largely wildlife-based transmission, and thereby greatly increase the infection pressure to humans. The introduction of neozootic host species may increase transmission, or even initiate the parasite's life-cycle in previously non-endemic regions. Lastly, the parasite itself may be accidentally introduced into non-endemic areas, if suitable host populations are present (e.g. in northern Japan).

Animals↗

Echinococcus multilocularis in red foxes (Vulpes vulpes) of the Italian Alpine region: is there a focus of autochthonous transmission?

Alveolar echinococcosis, caused by the metacestode of Echinococcus multilocularis, is a zoonosis with a wider distribution area than described in the past. Fox populations living in the Alpine regions of Italy had been considered free from this parasite until 2002, when two infected foxes (Vulpes vulpes) were detected in the Bolzano province (Trentino Alto Adige region) near the Austrian border. The aim of this work was to evaluate the prevalence of infection in red fox populations from five Italian regions. A modified nested PCR analysis was used to detect E. multilocularis DNA in faecal samples. Amplicons were confirmed by sequencing. Of 500 faecal samples from foxes shot in Valle d'Aosta (n=57), Liguria (n=44), Lombardy (n=102), Veneto (n=56), and Trentino Alto Adige (n=241) regions, 24 animals, all from the Trentino Alto Adige region, were found positive. Twenty-two positive animals originated from the Bolzano province and two positive animals from the Trento province. Several localities of the Bolzano province, in which positive foxes were detected, are the same as those where alveolar echinococcosis had been described in humans in the second half of the 19th century, suggesting an old endemicity for the investigated area, which is adjacent to endemic areas of Austria. Therefore, the question arises if we are observing an increase and expansion of foci, or if the new records are due to the more sensitive and specific methods used to detect the worm DNA.

Animal Diseases↗

Emergence/re-emergence of Echinococcus spp.--a global update.

This review provides an update of the biological aspects of the genus Echinococcus and focuses on newly recognized endemic areas. Infection with the intermediate cystic stage of all species of Echinococcus causes disease and incapacity in animals and humans, and in the most serious cases, death of the host. Transmission of Echinococcus to new continents has occurred during European colonisation and the parasite has often taken advantage of Echinococcus-naive wildlife populations in these new environments, incorporating them into its transmission pattern. Echinococcus granulosus consists of a complex of 10 strains. Host specificities of these strains have important implications for transmission and control. As a result of human behaviour and/or political instability in a number of countries Echinococcus is re-emerging as an important public health issue. The importance of wildlife reservoirs in perpetuating transmission and as a source of infection for domestic animals and humans is addressed. The review also refers to the transmission pattern of a recently described new species, Echinococcus shiquicus, from China.

Animals↗

Cystic echinococcosis of livestock and humans in central Sudan.

New information was collected on cystic echinococcosis in livestock (camels, cattle and sheep) and humans in the central region of Sudan. The livestock data were collected in abattoir-based surveys in the towns of Omdurman, Tamboul and Wad Madani, between 1998 and 2001, and covered a total of 8205 animals. The highest prevalence of infection was found in the camels (44.6% of 242 infected), followed by the sheep (6.9% of 5595) and cattle (3.0% of 2368). Records were made of the sizes of the 1320 hydatid cysts detected in the livestock (907 in sheep, 71 in cattle, and 342 in camels), whether or not each cyst was fertile, and where it occurred in the body of the host. Cysts collected from cattle and camels where much more likely to be fertile (22% and 24%, respectively) than those from sheep (1%). Camels and cattle therefore appear to be the principal intermediate hosts for Echinococcus granulosus in central Sudan, whereas sheep apparently play a marginal role in transmission. In 2002, as a preliminary assessment of the public-health impact of the disease, 300 residents of a rural village 60 km west of Wad Madani were surveyed using a portable ultrasound scanner. Only one (0.33%) of the villagers investigated was found infected. The implications of these finding are discussed in terms of the various strains of E. granulosus and the role of each in human disease.

Adolescent↗

Prevalence of zoonotic important parasites in the red fox (Vulpes vulpes) in Great Britain.

A national necropsy survey of red foxes was carried out across Great Britain to record Echinococcus, Trichinella and Toxoplasma. The survey did not record directly, or indirectly using coproantigen/PCR tests, evidence for the presence of Echinococcus multilocularis in 588 animals, although E. granulosus was suspected in six animals. Parasitological evidence for Trichinella spp. could not be found in 587 fox muscle digests, and a specific PCR test also failed to detect Toxoplasma in a sub-set of 61 random fox tongue biopsies. The upper 95% confidence interval for the above parasites was 0.60% (E. multilocularis), 0.60% (Trichinella spp.) and 5.6% (Toxoplasma). The commonest gut parasites were the hookworm Uncinaria stenocephala (41.3%) and the ascarid Toxocara canis (61.6%). This study also reports the second occurrence of Trichuris vulpis in Great Britain.

Animals↗

Milbemycin oxime in a new formulation, combined with praziquantel, does not reduce the efficacy of praziquantel against Echinococcus multilocularis in cats.

Twenty European domestic cats were each infected with 15,000 protoscoleces of Echinococcus multilocularis extracted from metacestodes grown in experimentally infected common voles (Microtus arvalis). Sixteen days after infection, ten cats were treated with a broad-spectrum anthelmintic and acaricide comprising praziquantel and milbemycin oxime. Five days later treated and untreated cats were euthanized and the intestine examined for E. multilocularis. Five of ten untreated cats were infected with E. multilocularis with worm burdens ranging from 235 to 1920 worms per cat. No E. multilocularis were recovered from any of the treated cats. This study has demonstrated that this new combination broad spectrum anthelmintic and acaricide for cats is highly efficacious against E. multilocularis and the relevance of this is discussed.

Animals↗

Perspective on control options for Echinococcus multilocularis with particular reference to Japan.

Following a brief introduction of recent advances in molecular and immunological technology for detection of persons and animals infected with Echinococcus multilocularis and an overview of the current situation of alveolar echinococcosis (AE) in Japan, perspectives on control options are discussed with reference to different epidemiological situations. AE is considered the most serious parasitic zoonosis in temperate and arctic regions of the northern hemisphere. The number of human cases differs drastically among regions. While high numbers of patients are apparently associated with high E. multilocularis prevalence in domestic dogs, e.g. in parts of Alaska and western China, the number of cases is moderate or low in areas where the parasite is mainly transmitted by wild canid species (e.g. in central Europe or temperate North America). However, the severity of the disease, the absence of curative treatment for most cases, the high cost of long-term chemotherapy and the anxiety caused for the population in highly endemic areas call for the development of preventive strategies even in regions where human AE is rare. Furthermore, in view of (1) drastically increasing numbers and infection rates of foxes involved in transmission of E. multilocularis, and (2) increasingly close contact between humans and foxes e.g. in Europe and Japan, there is considerable concern that AE incidences may in future increase in these regions. Control options depend on a variety of factors including the species of canid principally responsible for transmission and the socio-economic situation in the region. Where domestic dogs (stray or owned) are the principal hosts for E. multilocularis, control options can include those applicable to E. granulosus, i.e. reduction of the number of stray dogs, registration and regular preventive chemotherapy of owned dogs, and information campaigns for the population promoting low-risk behaviour for man and dogs. Where E. multilocularis is mainly transmitted by wild canids, the situation is far more difficult with preventive strategies still being in trial stage. Integrated control measures could include prevention information campaigns, restricting access of pet animals (dogs and cats) to rodents, chemotherapy of foxes on local or regional scales, and strategies to minimize contacts between people and foxes.

Animals↗

Efficacy of Droncit Spot-on (praziquantel) 4% w/v against immature and mature Echinococcus multilocularis in cats.

The causative agent of alveolar hydatidosis in humans, the fox tapeworm Echinococcus multilocularis, is extending its geographical range in Europe and has been found in domestic cats in some areas. A dermally applied cestocidal treatment for domestic cats has been developed and the efficacy of this treatment is reported. Thirty purpose-bred cats were experimentally infected each with 10000 protoscoleces of Echinococcus multilocularis. Ten days later one group of ten cats was treated with Droncit(R) Spot-on (Praziquantel) 4% w/v dermally in one place on the dorsal aspect of the neck at a dose of 8 mg/kg. Eleven days later (21 days p.i.) a second group of ten cats was also treated with Droncit(R) Spot-on the same way. One group of ten cats was left untreated as controls. Twenty three days after infection the cats were examined for the presence of E. multilocularis tapeworms. No E. multilocularis were recovered from any of the cats in either of the treated groups. Echinococcus multilocularis were recovered from eight of the ten cats left untreated as controls. The worm burdens in the untreated cats were 0, 0, 5, 15, 75, 110, 220, 815, 2635, and 3045 worms per cat. The worms ranged in development from the three to four segment stage. Many of the E. multilocularis with four segments contained unshelled eggs in the terminal segment. This study indicates that Droncit(R) Spot-on (Praziquantel) 4% w/v applied dermally at 8 mg/kg is highly effective in removing E. multilocularis from the small intestine of cats infected with immature and mature (prepatent) infections of E. multilocularis. In the cats with the mature infections all tapeworms were absent from the small intestine within 2 days of treatment.

Animals↗

Experimental investigations on the B and T cell immune response in primary alveolar echinococcosis.

Susceptibility/resistance of the intermediate host to alveolar echinococcosis (AE) seems to be based on hitherto unknown immunological mechanisms, possibly involving the activation of different CD4+ T cell immune responses (Th1/Th2). Mice of two strains previously characterized as 'susceptible' (C57BL/6 J) and 'resistant' (C57BL/10 J) to secondary AE were orally infected with eggs of Echinococcus multilocularis and the course of infection was analysed by macroscopical, pathohistological and immunohistochemical examinations of the lymphocytes and cytokines participating in the periparasitic granulomas and by serological examinations of cytokines and E. multilocularis-specific antibodies. Although differences in the extent of parasitic growth were seen between the two groups, the composition of the granulomas was quite similar with CD4+ cells being the dominant lymphocyte subpopulation, succeeded by B cells and CD8+ cells. Interferon (IFN)-gamma-, interleukin (IL)-2- and IL-4-expressing cells could not be detected in the lesions of the early phase of the infection, possibly indicating the host's immunosuppression, but were present at the end. IL-10 was the most prominent cytokine throughout the course of the disease. Serological analyses of the cytokine concentrations revealed small amounts at the beginning and high levels at the end of the infection. The pattern of cytokine response was similar for IL-4 in both strains, but different for IL-2 and IL-10 in the late phase, when the C57BL/10 J strain developed higher levels than the C57BL/6 J strain. Correspondingly only small amounts of immunoglobulin (Ig)M, IgG1, IgG2a and IgG3 could be detected at the beginning of disease, followed by higher levels at the end. The courses of antibody titres were similar in both groups except IgG3, which was more pronounced in the C57BL/10 J strain. Parasite-specific IgG2b could neither be detected in the C57BL/6 J nor in the C57BL/10 J strain by the test system used. The results of the study suggest both subsets of CD4+ T cells (Th1 and Th2) being involved in murine primary alveolar echinococcosis. A strict differentiation of mice in susceptible and resistant animals based on the activation of different CD4+ T cell immune responses (Th1 'resistant' and Th2 'susceptible') should be avoided.

Animals↗

An epidemiologic survey of human alveolar echinococcosis in southwestern Germany. Römerstein Study Group.

The inhabitants of a rural community in southwestern Germany were examined for alveolar echinococcosis (AE). The study was prompted by the recent increase of the prevalence of the parasite in foxes and the increase of fox populations: in the study area, 75% of the foxes carried Echinococcus multilocularis. The human population was screened using hepatic ultrasound and serology. All participants were interviewed for demographic and potential risk factors. Of 2,560 participants, one was identified with active AE, while 3 others had suspicious liver lesions. Another 9 participants were seropositive for specific antibodies without detectable lesions. Demographic and behavioral factors were not correlated with active or suspected cases nor with seropositivity. If the prevalence of 40/100,000 (95% confidence interval = 15-295/100,000) for active cases would be representative for the rural population in high endemicity areas, the current number of AE cases in southwestern Germany is considerably higher than previously suspected.

Adolescent↗

[Current spread and epidemiology of Echinococcus multilocularis].

Recently, a wealth of new data was collected on the distribution and ecology of E. multilocularis. The parasite is now known to occur at surpisingly high prevalence rates in e.g. Belgium and northwestern Germany, new records exist for the Netherlands, and the parasite was found to be widespread in Poland and the Czech Republic. In addition, foxes in continental Europe have adapted their behaviour and are now common in many towns and cities where they are also known to carry the parasite. New data exist on endemicity regions in western Asia. In addition to new informations on the parasite's range, a summary is given of the current knowledge on prevalence of alveolar echinococcosis in man.

Animals↗

Detection of Echinococcus multilocularis in the definitive host: coprodiagnosis by PCR as an alternative to necropsy.

Recently, extensions of the range of Echinococcus multilocularis in Europe and North America and drastic increases in fox populations in Europe put an increasing proportion of the human population at risk of alveolar echinococcosis. To obtain data on the local infection pressure, studies of the prevalence of the parasite in the animals that transmit the parasite, foxes, dogs, and cats, are urgently required. Such investigations, however, have been hampered by the need for necropsy of the host animal to specifically diagnose infection with the parasite. In this study, a nested PCR and an improved method for DNA extraction were developed to allow the sensitive and specific diagnosis of E. multilocularis infections directly from diluted fecal samples from foxes. The target sequence for amplification is part of the E. multilocularis mitochondrial 12S rRNA gene. The specificity of the method was 100% when it was tested against 18 isolates (metacestodes and adult worms) of 11 cestode species, including E. granulosus. The sensitivity of the method was evaluated by adding egg suspensions and individual eggs to samples of diluted feces from uninfected foxes. The presence of one egg was sufficient to give a specific signal. To confirm the PCR results, an internal probe which hybridized only with E. multilocularis amplification products but not with the DNA of other cestodes was constructed. In order to investigate the applicability of this method for epidemiological studies, 250 wild foxes from a area in southern Germany where echinococcosis is highly endemic were examined by both necropsy and PCR of rectal contents. The sensitivity correlated with the parasites' number and stage of maturity. It ranged from 100% (>1,000 gravid worms) to 70% (<10 nongravid worms). On the basis of positive PCR results for 165 foxes, the sensitivity of the traditional and widely used necropsy method was found to be not higher than 76%. We therefore present this PCR system as an alternative method for the routine diagnosis of E. multilocularis in carnivores.

Animals↗

Chemotherapy with praziquantel has the potential to reduce the prevalence of Echinococcus multilocularis in wild foxes (Vulpes vulpes).

In order to evaluate the applicability of anthelminthic treatment of wild foxes (Vulpes vulpes) to limit their infection with Echinococcus multilocularis, bait pellets, each containing 50 mg praziquantel, were repeatedly distributed in an area of 566 km2 where many foxes are infected, in southern Germany. After six baiting campaigns (15-20 baits/km2) over a period of 14 months, the prevalence of the cestode in foxes, initially 32%, had fallen to 4%. The effect was most pronounced in the central part of the treated area, where no positive fox was found in the 2 months before the end of the trial. The study was controlled for other factors that could influence the parasite's prevalence, such as the availability of intermediate hosts. While the potential of this baiting method to remove E. multilocularis from wild hosts has been demonstrated, the question of its long-term efficacy and other unresolved problems have to be addressed by consecutive studies before routine application can be recommended.

Animals↗

Antibody responses against natural Taenia hydatigena infection in dogs in Kenya.

Antibody responses (IgG) against Taenia hydatigena infection in dogs in Kenya were analysed in ELISA using excretory/secretory products of T. hydatigena scoleces derived from goat cysticercus cysts. Helminth infections of individual dogs were confirmed at autopsy. T. hydatigena worms were found in 89.5% of 143 dogs, and positive anti-T. hydatigena antibody levels were detected in 58.7% of infected dogs. Positive antiscolex antibody levels were detected in 40.0% of Turkana dogs uninfected with T. hydatigena, suggesting previous infection. Antibody was not detected in 34.4% of infected dogs. There was no relationship between individual T. hydatigena worm burdens and absorbance values for sera in ELISA. It was not possible to distinguish between sera from T. hydatigena-infected and uninfected dogs.

Animals↗

Observations on human echinococcosis (hydatidosis) and evaluation of transmission factors in the Maasai of northern Tanzania.

An attempt was made to estimate the prevalence of hydatid disease amongst the Maasai people of northern Tanzania and to examine the factors which would contribute to the transmission of the disease in this region. Retrospective review of hospital records revealed an annual surgical rate of hydatid disease for 1977 through 1986 of 11 per 100,000 people. Ten (1%) of 959 people screened by ultrasound scanning had hydatid cyst-like echoes, giving a prevalence estimation of 1.4%. Thirty per cent of positive ultrasound cases were also positive in an ELISA antibody test. Three of four dogs necropsied and two of six dogs purged were found to harbour patent Echinococcus infections. Quantitative man:dog contact studies, examination of soil and water samples for Echinococcus eggs and comparison of the anti-Echinococcus antibody responders revealed that there are few marked differences in exposure to infection between the Maasai and the Turkana, who have a much higher prevalence of hydatidosis and perhaps the highest prevalence in the world. Hypotheses to explain the differences in the infection rate between these two groups of pastoralists who share a similar traditional lifestyle are presented. The Maasai, like the Turkana, had no knowledge of hydatid disease, and it is suggested that the best way to control the disease in Maasailand would be by proven dog control measures, supported by a suitable, more durable, educational programme.

Adolescent↗