Trichinellosis is a zoonosis caused by ingestion of undercooked raw meat from animals that harbour infectious larvae. In most of the Slovak regions there is ongoing life cycle of circulating trichinellosis in wild carnivores and wild boar population. The outbreak of trichinellosis occured in Rožňava district east Slovakia during spring in 2008. Ten members of farmer’s family and their relatives got ill while processing meat from home-made pig-slaughter for meals and meat products intended for wedding dinner. During the meat processing all of them tasted raw meat. Moreover, another 45 persons were exposed to this infection by eating heat-treated meat products. The most common predominant clinical signs were: myalgias, fever, fatigue, exanthema and periorbital oedema. On the 40th day after infection there were intermediate to high titres of trichinella IgG antibodies detected (10 patients), high levels of eosinophilia (10 patients) with maximum of 6.76 × 109/l (55 %) and profound changes in selected laboratory parameters: decreased levels of total proteins, increased levels of alpha 1-globulin and C reactive protein. Presence of IgG antibodies as well as aforementioned laboratory parameters was important markers of trichinellosis in our study, whereas other laboratory changes (leukocytosis, high levels of activity lactate dehydrogenase and creatine kinase) were detected only in few hospitalized patients.
We report the case of a 4-year-old boy suffering from a cerebral form of toxocariasis. High serum titres of anti-Toxocara antibodies indicated that the primary infection was induced by a high number of Toxocara eggs and that the larvae did not penetrate to cerebrospinal fluid due to the hematoencephalic barrier. MRI of the patient’s brain showed multiple focal lesions spread diffusely in almost all parts of the brain, predominantly paraventricularly. These might be eosinophil-rich granulomatous infiltrates enclosing larvae. Extensive morphological changes were the cause of serious neurological symptoms, most of them being reversible after follow-up therapy. Radiology proved to be useful diagnostic method, but the specific serological assessment had a key role for the final diagnosis. In conclusion, diagnosis of this patient was intracranial primary Toxocara infection with central quadruparesis and parainfective myocarditis.
We report the case of a 14-year-old girl who suffered from headache, fatigue, caught and a fever with body temperature up to 40 °C for a week. The patient had abdominal enlargement and clinical examination showed the hepatomegaly +5 cm. In ELISA assays employing Em2+ antigen, high titres of specific IgG antibodies to Echinococcus multilocularis somatic antigens were found in the serum. Western blot analysis also indicated on presence of alveolar echinococcosis (AE). CT examination showed expansive foci in the right liver lobe and histological examinations of the biopsy after PAS staining confirmed the presence of alveolar echinococcosis. After 320 days of chemotherapy with albendazole, CT revealed progression of parasitic foci and new abscess lesions inside parasitic cysts were detected, with some parts being necrotic. The surgical removing of foci was performed as following — the laparotomic revision, the removal of the right liver lobe with dilatation, reconstruction of v. cavae cum prothesis PTFE in length 12 cm. Three months after the operation, the rest of the patient’s left liver lobe had grownup and compensated at least a part of the removed liver.
A study involved 1800 hospitalised children (age: 9 months to 16 years) examined by ovoscopic analyses and confirmed the occurrence of Ascaris lumbricoides and Trichuris trichiura in 46 patients (2.55 %). Of these, 30 patients had Ascaris infection, 13 were positive for both nematodes and 3 patients had Trichuris infection. The mean count of A. lumbricoides eggs in positive cases was 1050 eggs per gramme (EPG) in range 150–4450 EPG. The mean count of T. trichiura eggs was 150 EPG (50–250 EPG). The highest intensities of A. lumbricoides and T. trichiura infections occurred in children 3–5 years of age living in poor hygienic conditions. Most common clinical conditions in all the patients included anaemia combined with complicated bronchopneumonia, colitis and gastritis. The strongest correlation between the parasite burden and selected laboratory test data (eosinophil count, haemoglobin, total serum iron) was found in children of 2 years of age (P < 0.05) and decreased with age.
Alveolar echinococcosis (AE), caused by proliferating metacestodes of the parasitic fox tapeworm Echinococcus multilocularis, is a life-threatening disease in humans. In this study we report four human cases of AE in Slovak Republic with regard to various clinical manifestations and susceptibility to chemotherapy with albendazole or mebendazole. Patients were monitored serologically by ELISA test and Western Blots within 2–5 years after initiation of chemotherapy/surgery. Using computerized tomography (CT) we compared morphological changes of the parasitic lesions in the liver during the course of treatment.
The parasitic lesions in the CT were manifested as nodular hyperplasia with hyper or hypodense zones and calcified foci within the lesion. In other cases the lesion was visualised as a hypodense poorly-delineated septated focus without calcifications. In the last case, the diagnosis of AE was confirmed only at surgery. Calcified foci found inside the main parasitic lesions were the only abnormality that was detected in two cases and were absent in other two cases. The levels of specific anti-parasitic antibodies followed the pathomorphological changes in the livers. Total IgG levels to Em2+ and EmP antigen declined gradually during the follow-up (1–5 years) and disappeared only in the patient receiving radical surgery (cured). In comparison with total IgG, concentration of the IgG4 antibody subclass seemed to correlate more adequately with the outcome of therapy as their levels decreased in improved/stabilised patients, but were elevated in “aggravated” patients. We showed that, in patients with AE in Slovakia, radical surgery of parasitic foci proved to be the most successful treatment and, in inoperable cases, albendazole and mebendazole were differently effective. Moreover. IgG4 levels rather than total IgG to protoscoleces antigens proved to be more sensitive serological marker of the progress of therapy.
Infections of various aetiology during pregnancy present a serious risk factor that can lead to abortion, premature birth, stillbirth, birth of newborn with genetic developmental defects, or seemingly healthy infant that may develop symptoms later in life. A total of 530 sera of patients from gynaecology departments were examined for antibodies against Toxoplasma gondii, Toxocara spp. and Listeria monocytogenes using ELISA (IgG, IgM). In women with habitual abortions we determined up to 42.1 % seroprevalence of IgG antibodies against T. gondii. The prevalence of antibodies was statistically significant (p < 0.0004) when compared to control group (25.1 %). In the patients diagnosed with sterility the prevalence of antibodies (26.3 %) was similar to that of control group. The prevalence of antibodies against Toxocara spp. (5.5 %) and Listeria monocytogenes (2.3 %) in patients with habitual abortions were similar to those of women in the general population.
A modified McMaster method has been used for the diagnosis and estimating helminth egg load in human faecal samples obtained from random consecutive patients in the areas non-endemic for helminth infections (Slovak Republic, North West Russia). Both positive and negative findings were in a 100 % concordance to those obtained with a reference method accepted in clinical diagnostic laboratories (microscopy of the native stool smear). The McMaster method was efficient in detecting nematode eggs in patients’ stool samples with egg load varying from very low (15–60 epg for T. trichiura) to moderate (1650–4500 epg for A. lumbricoides). Therefore, this method may be successfully (and with a better technical feasibility) used for the diagnosis of intestinal helminth infections in non-endemic areas, with further quantitative analysis of the sample when required.
We present a case of 53 years old patient with transplanted kidney, chronic hepatitis C and alveolar echinococcosis who was treated with pegylated interferon α which resulted in regression and calcification of Echinococcus multilocularis loculi. Patient had been diagnosed with chronic hepatitis C two years after kidney transplantation. Hepatitis was left untreated because of immunosuppressive treatment and satisfactory graft function. Nine years after transplantation the patient was diagnosed with alveolar echinococcosis and treated with mebendazole 2 × 200 mg daily for 6 months. Cessation of temporary treatment resulted in echinococcosis progression with appearance of secondary loculi and a small ascites after which mebendazole was restarted. Ten years after transplantation, kidney graft failure occurred and the patient was started on hemodialysis in conjunction with pegylated-interferon alpha 2a for treatment of chronic viral hepatitis C. Complete early viral response was observed 3 months after therapy initiation while a follow-up CT scan after 4 months did not document any changes in the number or size of E. multilocularis loculi. A completed course of antiviral therapy resulted in sustained viral response while a subsequent second follow-up CT scan 6 months after cessation of antiviral therapy documented regression and calcification of main E. multilocularis loculi along with resolution of secondary loculi and ascites.
52-years old man years following the kidney transplantation from deceased donor was admitted to the hospital with fever and progressive abdominal pain. The patient was diagnosed with chronic hepatitis C seven years before admission. Graft function in posttransplant period was stable and optimal, the patient was treated with standard maintenance immunosupresive protocol (cyclosporine A, mycophenolate mofetil and low-dose prednison), metylprednisolon bolus therapy (1 g/m2 body surface area), was administered two months prior to admission due to creeping creatinine (suspection of acute rejection was not confirmed by biopsy). Empiric antibiotic treatment due to febrile status was ineffective. Abdominal ultrasound and computer tomography (CT) scan revealed three tumorous lesions in the liver, radical surgical intervention was not executable. Histological examination of the tissue from the lesions demostrated alveolar echinococcosis, serology for Echinoccocus multilocularis was positive. Long-term treatment by mebendazol 200 mg twice daily led to disappearance of the clinical symptoms, but after the therapy cessasion patient was again hospitalized with fever and progression of cystic lesions in CT scan. Following the mebendazol therapy reinstalation the clinical course of echinococcosis was improved and remained stable, transplant kidney failure occurred due to progression of interstitial fibrosis/tubular atrophy and chronic haemodialysis was initiated one year later.
Dirofilariosis is a vector-borne disease that is spreading in Europe from the southern endemic regions to the northern countries, including Slovakia. The dog parasites Dirofilaria immitis and D. repens are zoonotic agents, responsible for the development of human pulmonary and subcutaneous dirofilariosis, respectively. The present paper reports the third case of human dirofilariosis in Slovakia caused by D. repens. The pacient, a 41-year-old woman, was referred with tumour process in the subcutaneous area of the right forearm. Within 14 days the USG confirmed the rapid increase of the nodule from 20 × 10 mm to 30 × 25 mm. The surgical extirpation of the tumour was indicated. Histological examination revealed the formation with eosinofilic rime and the presence of a worm in the centre, detected as D. repens.