In the present study, 67 patients suspected to be cases of visceral leishmaniasis (VL) were each checked for leishmanial infection by the microscopical evaluation of various biological specimens, in-vitro culture, serology and an assay based on nested PCR. Most (35) of the subjects were immunocompetent (IC) but 32 were immunodeficient (ID) as the result of HIV infection (18 cases), treatment to prevent transplanted organs being rejected (six) or haematological malignancies (eight). Forty-one (61.2%) of the subjects (19 IC subjects, 12 HIV-positive patients, four transplant patients and six patients with malignancies) were considered true cases of VL.For the IC subjects, only the production and microscopical examination of leucocytoconcentrates and cultures of Buffy coats gave sensitivities of < 80%, the results of the other methods showing higher sensitivities and almost perfect agreement with the 'gold-standard' diagnoses. For the ID subjects, however, only the serological tests and the PCR gave reasonable sensitivities (of >80%). For the initial diagnosis of leishmaniasis in ID patients, IFAT and western blots may be useful, as, among the present ID patients, they gave sensitivities (of 80.9% and 88.2 respectively) that were almost as high as that for the PCR, and specificities of 100%.In the diagnosis of VL in either IC or ID patients, the assay based on a nested PCR appeared to be particularly reliable, with sensitivities of 88.9% and 95.2%, respectively, and a specificity of 100% in both groups of patients. The testing of bone-marrow aspirates by PCR revealed very few VL cases who were not found positive when samples of their peripheral blood were checked in the same assay. For both IC and ID subjects therefore, the use of the PCR-based method to test samples of peripheral blood (which can be collected much more easily than bone-marrow aspirates and with much less pain for the subject) is recommended.

Scopo: Rilevare la presenza di infestazione di Strongyloides stercoralis in soggetti ospedalizzati asintomatici a rischio per tale nematodosi, individuare un metodo diagnostico efficace per lo screening dei pazienti residenti in zone a rischio.

Background: Very few sporadic cases of autochthonous diphyllobothriasis have been reported in Italy during the past 20 years, probably due to the drastic decrease or disappearance of some fish species, mainly Perca fluviatilis L, known as the intermediate host of the infective larval stage of this tapeworm. However, increasing consumption of raw or undercooked fish during the last years as influenced by Oriental cuisine, played an improtant role in a number of new single cases of the infection or microepidemics. Patients: We describe six cases which were diagnosed within a period of 4 months, which all originated from the area of Lake Como (Lombardy region). All subjects had previously eaten raw perch fillets. Four individuals complained of gastrointestinal signs and symptoms, whereas two were asymptomatic. Discussion: Parasitological diagnosis was achieved in four cases by recovery of typical operculated eggs in stool specimens; in two others by morphological features of proglottids recovered from feces. Treatment with niclosamide, as a single oral dose, cured the infection in all subjects. This is the first report of this infection in Italy in the last 10 years.

The review summarizes the results in the main parasitological topics of our Lab: amoebic infections due to Entamoeba histolytica/Entamoeba dispar complex and to Acanthamoeba spp. respectively, and human infections caused by microsporidia. Different rapid and advanced techniques have been included in the standardized diagnostic protocols for each topic, and a critical comparison among them was made, in order to define the gold standard diagnostic method: a) E. histolytica/E. dispar: in vitro culture, zymodeme typization, biomolecular identification (PCR), immunoenzymatic assay (ELISA) for direct detection in stools of specific surface antigenic lectins; b) Acanthamoeba spp.: in vitro culture, light and ultrastructural characterization, species identification by immunofluorescence method with monoclonal antibodies, in vitro pharmacological studies; c) Microsporidia: ultrastructural (TEM), biomolecular (PCR), biochemical and immunological (SDS-PAGE, Immunoblotting) studies for species identification, use of advanced ultrastructural techniques ("freeze-etching", "deep-etching") in order to deepen the spore wall structure, to study the cytoskeletal function of actin and to define the mode of infection, in vitro pharmacological assays on some inhibitors of chitin-synthases.

Of 550 mentally retarded patients in an Italian institution, 125 (23%) were found to be infected with intestinal parasites. The infections were most frequent in young men, those with severe mental retardation, the chronically institutionalized and those living in older wards. Ninety-four (75.2%) of the parasitised subjects were infected only with protozoa, 25 (20%) only with helminths, and six (4.8%) with protozoa and helminths. Entamoeba histolytica and E. dispar infections were detected, but at low prevalences; in-vitro culture in Robinson's medium and isoenzyme electrophoresis of the cloned amoebic isolates indicated one infection with E. histolytica (zymodeme XII) and two infections with E. dispar (zymodemes I and III). All three Entamoeba-positive subjects were asymptomatic cyst-passers. Antibodies to E. histolytica were detected in seven (1%) of the sera from the 550 patients examined; only one of these was a carrier of an E. dispar strain at the time of investigation. The low prevalences of all the parasitic infections and of the amoebic infections in particular (compared with those observed previously in institutions for the mentally retarded) reflect relatively good facilities and sanitary conditions, an adequate number of well trained staff and good control of the more susceptible subjects.

ABSTRACT Since 1985 microsporidia have been recognized as a cause of emerging infections in humans, mainly in immunocompromised human immunodeficiency virus-positive subjects. As chitin is a basic component of the microsporidian infective stage, the spore, we evaluated in vitro the susceptibility of a human-derived strain ofEncephalitozoon hellem to nikkomycin Z, a peptide-nucleoside antibiotic known as a competitive inhibitor of chitin synthase enzymes. Transmission electron microscopy showed that this drug, at 25 μg/ml, reduced the number of parasitic foci by about 35% ± standard deviation after 7 days of culture (P< 0.0001) and induced cell damage of both mature and immature spores and also other sporogonic and merogonic stages. In particular, an irregular outline of the cell shape and an abnormally condensed cytoplasm in meronts and sporonts were documented. Also, the polar tubule and the polaroplast membranes appeared disarrayed in the sporoblast stage. The spore wall showed an enlarged endospore and delaminated exospore. Mature spores had a complete cytoplasmic disorganization and a swollen and delaminated cell wall. No ultrastructural cell damage was observed in uninfected control cultures treated with the drug.

Imported tropical infections have become a serious health problem in industrialized countries, and have greatly contributed to the birth of a new branch of medicine called travel medicine. Several specific factors play an important role in this pathology, including the progressive and constant increase of subjects who travel to tropical and subtropical countries for various reasons (tourism, job, missionary institutions, etc.), the extracommunitary, often underground, flow of immigration, and the adoption of children from the same areas. A high percentage of imported tropical pathology is constituted by intestinal helminthic and protozoan infections, in particular those due to the Entamoeba histolytica / Entamoeba dispar complex. The aim of our study was to evaluate E. histolytica / E. dispar incidence in a casuistry composed of international travelers (IT), adult immigrants (AI), and adopted children (AC) collected from 1994–1999.

Using transmission electron microscopy, fluorescence microscopy, immuno‐electron microscopy, and biochemical techniques such as 2‐D electrophoresis and immunoblotting, actin was found in all biological stages of the microsporidia Encephalitozoon hellem and Encephalitozoon cuniculi.

Four cases of amoebiasis are described: two symptomatic with intestinal and hepatic involvement and two asymptomatic, diagnosed in two, heterosexual, Italian couples. Infection was probably acquired first by the men, via an indirect faccal-oral route, and then transmitted to their partners in the same way. The two amoebic strains isolated, from the woman of one couple and the man of the other, were characterized by electrophoresis as zymodemes II alpha- and XIX of Entamoeba histolytica. These four cases emphasise once more the role of cyst-passers in the spread of infection and the importance of biochemical identification of the amoebic isolates, enabling more specific treatment.

The microsporidian Encephalitozoon hellem is being reported with increasing frequency in HIV-positive subjects, as an agent of disseminated microsporidiosis without involving the gastrointestinal tract. We describe a case of pulmonary microsporidiosis in a 27-year-old Italian man with AIDS who developed fever, cough, and dyspnea. A chest X-ray showed multiple bilateral pulmonary opacities and mediastinal lymph-node enlargement. Stained smears of bronchoalveolar lavage sediment showed oval structures consistent with microsporidian spores. Viral, bacterial and fungal cultures were repeatedly negative, whereas microsporidia were successfully cultured in human and bovine fibroblast cell lines. Analysis of electron micrographs indicated that the isolate belonged to the genus Encephalitozoon. Based on further immunological, biochemical and molecular studies it was characterized as E. hellem. Even though a temporary improvement with albendazole therapy was noticed the patient deteriorated clinically and died of severe respiratory distress.

Objective: To estimate the prevalence of bacterial vaginosis, Candida albicans, and Trichomonas vaginalis infections in a population of postmenopausal women with symptoms of vaginitis seen at a vaginitis clinic either as self-referred or clinician referred patients. Methods: A cross-sectional study of 148 postmenopausal women (cases) and 1564 controls of reproductive age attending a vaginitis clinic. C. albicans and T. vaginalis infections were diagnosed by culture techniques. Bacterial vaginosis was diagnosed on the basis of clinical findings. Results: Fifty-six (37.8%) postmenopausal women and 834 (53.3%) controls were diagnosed with T. vaginalis or C. albicans infection, or bacterial vaginosis, or mixed infection (odds ratio (OR) 0.53, 95% confidence interval (CI) 0.37-0.75). C. albicans and T. vaginalis infection were diagnosed in 34.1% (534/1564) and 1.92% (30/1564) of women of childbearing age and in 13.5% (20/148) and 10.8% of postmenopausal women, respectively. (P < 0.05 for both comparisons). The prevalence of bacterial vaginosis was similar between the two groups (14/148 in postmenopausal patients and 210/1564 in controls of reproductive age; P = 0.22). Conclusions: Among postmenopausal women attending a vaginitis clinic, a defined diagnosis of bacterial vaginosis, C. albicans or T. vaginalis infection can be made in about one third of such patients. Concerning the two thirds of symptomatic women lacking such a microbiologic diagnosis, alternative causes (e.g., estrogen deficiency, nonanaerobic bacterial infections, local irritants or allergenes, and dermatologic conditions) need to be considered. (C) 1997 Elsevier Science Ireland Ltd.

Journal of Eukaryotic MicrobiologyVolume 44, Issue s6 p. 79s-79s Extrainstestinal Microsporidiosis in AIDS Patients: Clinical Features and Advanced Protocols for Diagnosis and Characterization of the Isolates SIMONETTA GATTI, SIMONETTA GATTI Lab. parasitology, Virology Serv., IRCCS S.Matteo, Pavia, ItalySearch for more papers by this authorLUCIANO SACCHI, LUCIANO SACCHI Dept. Animal Biology, University, Pavia, ItalySearch for more papers by this authorSTEFANO NOVATI, STEFANO NOVATI Inst. Infectious Diseases, University-IRCCS S.Matteo, Pavia, ItalySearch for more papers by this authorSILVIA CORNONA, SILVIA CORNONA Dept. Animal Biology, University, Pavia, ItalySearch for more papers by this authorANNA MARIA BERNUZZP, ANNA MARIA BERNUZZP Dept. Animal Biology, University, Pavia, ItalySearch for more papers by this authorHERCULES MOURA, HERCULES MOURA Biology and Diagnostics Branch, Div.Parasitic Diseases, CDC, Atlanta, USASearch for more papers by this authorNORMAN J. PIENIAZEK, NORMAN J. PIENIAZEK Biology and Diagnostics Branch, Div.Parasitic Diseases, CDC, Atlanta, USASearch for more papers by this authorGOVINDA S. VISVERVARA, GOVINDA S. VISVERVARA Biology and Diagnostics Branch, Div.Parasitic Diseases, CDC, Atlanta, USASearch for more papers by this authorMASSIMO SCAGLIA, MASSIMO SCAGLIA Infectious Diseases Research Labs, (Lab.Parasitiology), University-IRCCS S.Matteo, Pavia Italy.Search for more papers by this author SIMONETTA GATTI, SIMONETTA GATTI Lab. parasitology, Virology Serv., IRCCS S.Matteo, Pavia, ItalySearch for more papers by this authorLUCIANO SACCHI, LUCIANO SACCHI Dept. Animal Biology, University, Pavia, ItalySearch for more papers by this authorSTEFANO NOVATI, STEFANO NOVATI Inst. Infectious Diseases, University-IRCCS S.Matteo, Pavia, ItalySearch for more papers by this authorSILVIA CORNONA, SILVIA CORNONA Dept. Animal Biology, University, Pavia, ItalySearch for more papers by this authorANNA MARIA BERNUZZP, ANNA MARIA BERNUZZP Dept. Animal Biology, University, Pavia, ItalySearch for more papers by this authorHERCULES MOURA, HERCULES MOURA Biology and Diagnostics Branch, Div.Parasitic Diseases, CDC, Atlanta, USASearch for more papers by this authorNORMAN J. PIENIAZEK, NORMAN J. PIENIAZEK Biology and Diagnostics Branch, Div.Parasitic Diseases, CDC, Atlanta, USASearch for more papers by this authorGOVINDA S. VISVERVARA, GOVINDA S. VISVERVARA Biology and Diagnostics Branch, Div.Parasitic Diseases, CDC, Atlanta, USASearch for more papers by this authorMASSIMO SCAGLIA, MASSIMO SCAGLIA Infectious Diseases Research Labs, (Lab.Parasitiology), University-IRCCS S.Matteo, Pavia Italy.Search for more papers by this author First published: 02 May 2007 https://doi.org/10.1111/j.1550-7408.1997.tb05793.xCitations: 8AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Canning EU. In: Kreier JP, Baker, JR, Parastic Protozoa (1993) 2d ed. Academic Press, New York , 6: 299. 2 Rabenek L., Genta RM, Gyorkey F., Foote LW, Risser JMH. Ann. Intern.Med. (1993) 119: 895. 3 Rabenek L., Genta RM, Gyorkey F., Clarridge JE, Gyrokey P., Foots LW. Clin. Intect. Dis. (1995) 20: 1229. 4 Scaglia M., Sacchi L., Gatti S., Bernuzzi AM, Piacentini I., Concia E., Croppo GP, da Silva, AJ, Pieniazek NJ, Slemenda SB, Wallace S., Leitch GJ, Visvesvara GS. APMIS (1994) 102: 817. 5 Scaglia M., Sacchi L., Croppo GP, da Silva, A., Gatti S., Corona S., Orani A., Bernuzzi AM, Pieniazek NJ, Slemenda SB, Wallace S., Visvesvara GS. J. Infect. (1997) 34: 119. 6 Visvesvara GS, Leitch GJ, Moura H., Wallace S., Weber R., Bryan RT. J. Protozool. (1991) 38: 105S. 7 Weber R., Kuster H., Visvervara GS, Bryan RT, Sehwartz DA, Lüthy R. Clin. Infect. Dis. (1993) 17: 415. Citing Literature Volume44, Issues6November 1997Pages 79s-79s ReferencesRelatedInformation

Microsporidia are primitive mitochondria-lacking spore-forming eukaryotic protozoa that infect a wide variety of animals and also humans. Of the five genera (Encephalitozoon, Enterocytozoon, Septata, Nosema and Pleistophora) that cause infections in humans, Enterocytozoon bieneusi, Septata intestinalis, and Encephalitozoon hellem are being increasingly identified in patients with acquired immunodeficiency syndrome (AIDS). E. bieneusi causes gastrointestinal disease, S. intestinalis causes gastrointestinal and disseminated disease, and E. hellem causes ocular as well as disseminated disease. We have established in continuous culture a strain of microsporidia isolated from the urine and throat washings of an Italian AIDS patient and identified it as Encephalitozoon hellem, based on its ultrastructural morphology, antigenic pattern, and polymerase chain reaction-amplified small subunit ribosomal RNA. We believe that this is the first time that a strain of microsporidia has been isolated from the throat washings of a patient with microsporidiosis.

Journal Article Cryptosporidiosis in Tourists Returning from Egypt and the Island of Mauritius Get access S. Gatti, S. Gatti Laboratory of Clinical Parasitology, Department of Infectious Diseases, University-IRCCS San Matteo, Pavia, Italy Correspondence: Dr. Simonetta Gatti, Laboratory of Clinical Parasitology, Department of Infectious Diseases, University-IRCCS San Matteo, 27100 Pavia, Italy. Search for other works by this author on: Oxford Academic PubMed Google Scholar C. Cevini, C. Cevini Laboratory of Clinical Parasitology, Department of Infectious Diseases, University-IRCCS San Matteo, Pavia, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar A. Bruno, A. Bruno Laboratory of Clinical Parasitology, Department of Infectious Diseases, University-IRCCS San Matteo, Pavia, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar A. M. Bernuzzi, A. M. Bernuzzi Laboratory of Clinical Parasitology, Department of Infectious Diseases, University-IRCCS San Matteo, Pavia, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar M. Scaglia M. Scaglia Laboratory of Clinical Parasitology, Department of Infectious Diseases, University-IRCCS San Matteo, Pavia, Italy Search for other works by this author on: Oxford Academic PubMed Google Scholar Clinical Infectious Diseases, Volume 16, Issue 2, February 1993, Pages 344–345, https://doi.org/10.1093/clind/16.2.344 Published: 01 February 1993