Profile of Trypanosoma cruzi Infection in a Tropical Medicine Reference Center, Northern Italy

Chagas disease (CD) is endemic in Central and South America, Mexico and even in some areas of the United States. However, cases have been increasingly recorded also in non-endemic countries. The estimated number of infected people in Europe is in a wide range of 14000 to 181000 subjects, mostly resident in Spain, Italy and the United Kingdom

Epidemiology of Strongyloides stercoralis in northern Italy: Results of a multicentre case-control study, February 2013 to July 2014

Strongyloides stercoralis is a soil-transmitted helminth widely diffused in tropical and subtropical regions of the world. Autochthonous cases have been also diagnosed sporadically in areas of temperate climate. We aimed at defining the epidemiology of strongyloidiasis in immigrants and Italians living in three northern Italian Regions. Screening for S. stercoralis infection was done with serology, confirmation tests were a second serological method or stool agar culture. A case-control approach was adopted and patients with a peripheral eosinophil count 65 500/mcL were classified as cases. Of 2,701 individuals enrolled here 1,351 were cases and 1,350 controls; 86% were Italians, 48% women. Italians testing positive were in 8% (97/1,137) cases and 1% (13/1,178) controls (adjusted odds ratio (aOR) 8.2; 95% confidence interval (CI): 4.5-14.8), while positive immigrants were in 17% (36/214) cases and in 2% (3/172) controls (aOR 9.6; 95% CI: 2.9-32.4). Factors associated with a higher risk of infection for all study participants were eosinophilia (p < 0.001) and immigration (p = 0.001). Overall, strongyloidiasis was nine-times more frequent in individuals with eosinophilia than in those with normal eosinophil count

Autochthonous human and canine strongyloides stercoralis infection in europe: Report of a human case in an italian teen and systematic review of the literature

Autochthonous human and canine strongyloidiasis is reported in Europe but is unclear whether the transmission of infection still occurs. We report a previously unpublished human case in an Italian teen and perform a systematic review of literature on autochthonous human and canine strongyloidiasis in Europe to investigate the current dynamic of transmission. Overall, 109 papers published after 1987 were included and one previously unpublished Italian case was added. Eighty case reports were retrieved and 42 of them (52.5%) had severe strongyloidiasis. Most cases were diagnosed in Spain, Italy and France. The median age was 58, the most represented age group was 61–70 years, 11 patients were under 30, and 7 of them were diagnosed after 2000. Epidemiological studies on human strongyloidiasis showed prevalence ranging from 0.56% to 28%. Overall, agriculture work, mine work and walking barefoot were the most commonly reported risk factors for infection. Canine strongyloidiasis was reported mainly in Italy (68 cases), but a few cases occurred also in Iceland, Finland, England, Germany, France, Switzerland, Russia, Slovakia, Romania and Greece. Autochthonous strongyloidiasis is still reported in Europe and sporadic transmission still occurs. Health care professionals should be aware of this issue to identify infected subjects and avoid adverse outcomes, especially in immunosuppressed patients. Further investigations are needed to clarify the zoonotic transmission of this nematode

Early hyperreactive malarial splenomegaly and risk factors for evolution into the full-blown syndrome: a single-centre, retrospective, longitudinal study

Background: The hyperreactive malarial splenomegaly (HMS) represents a chronic, potentially fatal complication of malaria. Case definition includes: gross splenomegaly, high level of anti-malarial antibody and IgM, response to long-term anti-malarial prophylaxis. In this study, a large series of patients not fully meeting the case definition was tentatively classified as early hyperreactive malarial splenomegaly (e-HMS). The main research questions was: does "e-HMS" tend to evolve to the full-blown syndrome? And if so, what are the main factors influencing this evolution? Methods: Retrospective, longitudinal study. The patient database was searched to retrieve all potentially eligible patients. e-HMS was defined by splenomegaly of any size (with or without raised IgM), high anti-malarial antibody titre and exclusion of other causes of splenomegaly. The clinical outcome at following visits was analysed in relation to re-exposure to malaria, and to treatment (only part of the patients with e-HMS were treated with a single anti-malarial treatment and advised to follow an effective anti-malarial prophylaxis, if re-exposed). The association of the outcome with the main independent variables was first assessed with univariate analysis. A stepwise logistic regression model was then performed to study the association of the outcome with the main independent variables. Results: One hundred and twenty-six subjects with e-HMS were retrieved. Eighty-one had at least one follow-up visit. Of 46 re-exposed to malaria for a variable period, 21 (46 %) had progressed, including 10/46 (22 %) evolving to full-blown HMS, while of 29 patients not re-exposed, 24 (93 %) had improved or cured and five (7 %) progressed (p < 0.001). At logistic regression re-exposure was confirmed as a major risk factor of progression (OR 9.458, CI 1.767-50.616) while treatment at initial visit was protective (OR 0.187, CI 0.054-0.650). Conclusion: e-HMS should be regarded as a clinical condition predisposing to HMS. Although the case definition may include false positives, e-HMS should be treated just as the full-blown syndrome. A single anti-malarial treatment is probably adequate, followed by effective prophylaxis for patients exposed again to malaria transmission

Improving molecular epidemiological surveillance of strongyloidiasis upon differentiation of Strongyloides fuelleborni fuelleborni from Strongyloides stercoralis

Molecular epidemiological surveillance for zoonotic strongyloidiasis is confounded by a genus-specific TaqMan probe assay that conflates Strongyloides fuelleborni fuelleborni with Strongyloides stercoralis. To improve surveillance, we developed and validated a novel duplex species-specific TaqMan probe assay, screening a representative collection of available clinical samples. Our assay was highly discriminatory, evidencing no cross-reactivity, and had a lowest DNA detection limit of 1 pg/µL. However, as the genus-specific DNA assay has greater detection ability, we propose a 2-step protocol where samples are first screened with this assay then, if positive, screened with our species-specific assay, discriminating (co)infections between each threadworm species

Evaluation of microscopy, serology, circulating anodic antigen (CAA), and eosinophil counts for the follow-up of migrants with chronic schistosomiasis: a prospective cohort study

Background: An accurate test for the diagnosis and post-treatment follow-up of patients with schistosomiasis is needed. We assessed the performance of different laboratory parameters, including the up-converting reporter particle technology lateral flow assay to detect circulating anodic antigen (UCP-LF CAA), for the post-treatment follow-up of schistosomiasis in migrants attending a dedicated outpatient clinic in a non-endemic country.Methods: Routine anti-Schistosoma serology results and eosinophil counts were obtained of patients with positive urine/stool microscopy and/or PCR (confirmed cases) or only positive serology (possible cases), and at least one follow-up visit at 6 (T6) or 12 (T12) months after praziquantel treatment. All sera samples were tested with the UCP-LF CAA assay.Results: Forty-eight patients were included, 23 confirmed and 25 possible cases. The percentage seropositivity and median antibody titers did not change significantly during follow-up. UCP-LF CAA was positive in 86.9% of confirmed and 20% of possible cases. The percentage positivity and median CAA levels decreased significantly post-treatment, with only two patients having positive CAA levels at T12.Conclusions: The UCP-LF CAA assay proved useful for the diagnosis of active infection with Schistosoma spp. and highly valuable for post-treatment monitoring in migrants, encouraging the development of a commercial test.Cancer Signaling networks and Molecular Therapeutic

Unravelling data for rapid evidence-based response to COVID-19: a summary of the unCoVer protocol

Introduction unCoVer—Unravelling data for rapid evidence-based response to COVID-19—is a Horizon 2020-funded network of 29 partners from 18 countries capable of collecting and using real-world data (RWD) derived from the response and provision of care to patients with COVID-19 by health systems across Europe and elsewhere. unCoVer aims to exploit the full potential of this information to rapidly address clinical and epidemiological research questions arising from the evolving pandemic. Methods and analysis From the onset of the COVID-19 pandemic, partners are gathering RWD from electronic health records currently including information from over 22 000 hospitalised patients with COVID-19, and national surveillance and screening data, and registries with over 1 900 000 COVID-19 cases across Europe, with continuous updates. These heterogeneous datasets will be described, harmonised and integrated into a multi-user data repository operated through Opal-DataSHIELD, an interoperable open-source server application. Federated data analyses, without sharing or disclosing any individual-level data, will be performed with the objective to reveal patients’ baseline characteristics, biomarkers, determinants of COVID-19 prognosis, safety and effectiveness of treatments, and potential strategies against COVID-19, as well as epidemiological patterns. These analyses will complement evidence from efficacy/safety clinical trials, where vulnerable, more complex/heterogeneous populations and those most at risk of severe COVID-19 are often excluded. Ethics and dissemination After strict ethical considerations, databases will be available through a federated data analysis platform that allows processing of available COVID-19 RWD without disclosing identification information to analysts and limiting output to data aggregates. Dissemination of unCoVer’s activities will be related to the access and use of dissimilar RWD, as well as the results generated by the pooled analyses. Dissemination will include training and educational activities, scientific publications and conference communications

Landscape of guidance documents used at TropNet and GeoSentinel centres for the clinical management of schistosomiasis outside endemic areas: A systematic appraisal.

Background: The diagnostic and treatment approaches for schistosomiasis in individual patients, outside endemic areas, are not standardised. This study aimed to appraise the reference documents that the experts from the TropNet and GeoSentinel networks use in practice as guidance for the clinical management of their patients with (suspect) schistosomiasis. Methods: We systematically appraised the following data from the referenced guidance documents: i) document type, ii) case definitions, iii) diagnostic techniques envisaged; iv) treatment recommendations; v) follow-up recommendations; vi) screening recommendations, and vii) symptom-based diagnostic suspicion. Results: Twenty-two of the 30 responders (73.3 %) indicated 19 reference documents, three of which were WHO material not intended for individual clinical management. Only 4/19 (21.1 %) documents were national recommendations; no international guideline was indicated. Case definitions were explicitly presented in only one document (1/19; 5.3 %). Diagnostic tools were detailed in 11/16 (68.8 %) and follow-up guidance in 8/16 (50 %) documents. Treatment guidance was provided in 14/16 (87.5 %) documents. Conclusions: Heterogeneity in clinical guidance was evident, although with noticeable overlap at least for chronic schistosomiasis. This confirms the need to formalise case definitions, which should be used to design trials to rigorously assess diagnostic tools and treatment schemes, and eventually come to harmonization of clinical management guidance

Landscape of guidance documents used at TropNet and GeoSentinel centres for the clinical management of schistosomiasis outside endemic areas: a systematic appraisal

Background The diagnostic and treatment approaches for schistosomiasis in individual patients, outside endemic areas, are not standardised. This study aimed to appraise the reference documents that the experts from the TropNet and GeoSentinel networks use in practice as guidance for the clinical management of their patients with (suspect) schistosomiasis. Methods We systematically appraised the following data from the referenced guidance documents: i) document type, ii) case definitions, iii) diagnostic techniques envisaged; iv) treatment recommendations; v) follow-up recommendations; vi) screening recommendations, and vii) symptom-based diagnostic suspicion. Results Twenty-two of the 30 responders (73.3%) indicated 19 reference documents, three of which were WHO material not intended for individual clinical management. Only 4/19 (21.1%) documents were national recommendations; no international guideline was indicated. Case definitions were explicitly presented in only one document (1/19; 5.3%). Diagnostic tools were detailed in 11/16 (68.8%) and follow-up guidance in 8/16 (50%) documents. Treatment guidance was provided in 14/16 (87.5%) documents. Conclusions Heterogeneity in clinical guidance was evident, although with noticeable overlap at least for chronic schistosomiasis. This confirms the need to formalise case definitions, which should be used to design trials to rigorously assess diagnostic tools and treatment schemes, and eventually come to harmonisation of clinical management guidance