QJM: An International Journal of Medicine, May 24, 2018
Learning points for clinicians Clinical manifestations of ophthalmomyiasis are similar to the tri... more Learning points for clinicians Clinical manifestations of ophthalmomyiasis are similar to the trivial viral or allergic conjunctivitis, presented with hyperemia, irritation or a foreign body sensation. In most cases, patients describe a collision of a flying insect with their eye. Regarding the nazal myiasis, a serous nasal discharge and a sense of a local irritation are the dominant presentations. It is advisable for all clinicians to take into account the peculiarities of the external myiasis, especially in terms of examining patients who live in areas with developed livestock farming.
Background: In Bulgaria, more than 20 autochthonous human parasitic infections have been describe... more Background: In Bulgaria, more than 20 autochthonous human parasitic infections have been described and some of them are widespread. Over 50 imported protozoan and helminthic infections represent diagnostic and therapeutic challenges and pose epidemiological risks due to the possibility of local transmission. Aims: To establish the distribution of autochthonous and imported parasitic diseases among the population of the country over a 2-year period (2013-2014) and to evaluate their significance in the public health system. Study Design: Cross sectional study. Methods: We used the annual reports by regional health inspectorates and data from the National Reference Laboratory at the National Centre of Infectious and Parasitic Diseases on all individuals infected with parasitic diseases in the country. Prevalence was calculated for parasitic diseases with few or absent clinical manifestations (oligosymptomatic or asymptomatic infections). Incidence per 100.000 was calculated for diseases with an overt clinical picture or those that required hospitalisation and specialised medical interventions (e.g. surgery). Results: During the research period, parasitological studies were conducted on 1441.244 persons, and parasitic infections were diagnosed in 22.039 individuals. Distribution of various parasitic pathogens among the population displayed statistically significant differences in prevalence for some intestinal parasites (enterobiasis 0.81%, giardiasis 0.34% and blastocystosis 0.22%). For certain zoonotic diseases such as cystic echinococcosis (average incidence of 3.99 per 100.000) and trichinellosis (average incidence of 0.8 per 100.000), the incidence exceeds several times the annual incidence recorded in the European Union. Conclusion: Parasitic diseases still pose a substantial problem with social and medical impacts on the residents of our country. Improved efficiency regarding autochthonous and imported parasitic diseases is essential in providing the public health system the tools it needs to combat these diseases. Attention should be focused on the various imported vector-borne parasitic diseases (e.g. malaria and cutaneous leishmaniasis) for which the country is potentially endemic.
PROBLEMS of Infectious and Parasitic Diseases, Feb 19, 2023
The aim of this report is to review and assess the dynamics of parasitic diseases in Bulgaria dur... more The aim of this report is to review and assess the dynamics of parasitic diseases in Bulgaria during 2020-2021. Materials and methods. The analysis is based on the annual reports of the Regional Health Inspectorates (RHIs) about the cases of registered parasitic diseases among humans in the country and on data from the National Reference Laboratory "Diagnosis of Parasitic Diseases" at the National Centre for Infectious and Parasitic Diseases (NCIPD), Sofia, for all examined cases. Results. For the study period a total of 1,225,485 individuals were examined in the country's parasitological laboratories at the Regional Health Inspectorates, stand-alone medical diagnostic laboratories and at the National Center for Infectious and Parasitic diseases (NCIPD), of whom 19,509 (1.59%) were diagnosed with a positive result for parasitic pathogens. Among the zoonotic helminth infections with local transmission, a special attention deserve cystic echinococcosis and trichinellosis as the incidence of these parasitoses in Bulgaria is the highest among the European member states. The prevalence of ascariasis and trichuriasis in the country have been reduced to such an extent that they do not represent a public health danger any more. Data regarding community acquired giardiasis and hymenolepiasis can be interpreted in a similar way, while for enterobiasis, an increasing prevalence among both children and adults has been observed in recent years. Although imported parasitic pathology is relatively limited in volume, Bulgarian climate and fauna are quite favorable for local transmission of a number of imported parasitic diseases. Control measures regarding this pathology consist in the timely detection and removal of infection sources. Conclusion. In Bulgaria, there is a well-established system for surveillance and control of human parasitic diseases, which allows the acquisition of comprehensive information including patients demographic data and characteristics of the causative agents. This enables the monitoring of parasitic pathology among the population and an accurate assessment of the the endemic-related risks.
The pathogen transmittingAedes albopictusmosquito is spreading rapidly in Europe, putting million... more The pathogen transmittingAedes albopictusmosquito is spreading rapidly in Europe, putting millions of humans and animals at risk. This species is well-established in Albania since its first detection in 1979. The sterile insect technique (SIT) is increasingly gaining momentum worldwide as a component of area-wide-integrated pest management. However, estimating how the sterile males will perform in the field and the size of target populations is crucial for better decision-making, designing and elaborating appropriate SIT pilot trials, and subsequent large-scale release strategies. A mark-release-recapture (MRR) experiment was carried out in Albania within a highly urbanized area in the city of Tirana. The radio-sterilized adults ofAe. albopictusAlbania strain males were transported by plane from Centro Agricoltura Ambiente (CAA) mass-production facility (Bologna, Italy), where they were reared. In Albania, sterile males were sugar-fed, marked with fluorescent powder, and released. T...
Background Colonization of large part of Europe by the Asian tiger mosquito Aedes albopictus is c... more Background Colonization of large part of Europe by the Asian tiger mosquito Aedes albopictus is causing autochthonous transmission of chikungunya and dengue exotic arboviruses. While pyrethroids are recommended only to reduce/limit transmission, they are widely implemented to reduce biting nuisance and to control agricultural pests, increasing the risk of insurgence of resistance mechanisms. Worryingly, pyrethroid resistance (with mortality < 70%) was recently reported in Ae. albopictus populations from Italy and Spain and associated with the V1016G point mutation in the voltage-sensitive sodium channel gene conferring knockdown resistance (kdr). Genotyping pyrethroid resistance-associated kdr mutations in field mosquito samples represents a powerful approach to detect early signs of resistance without the need for carrying out phenotypic bioassays which require availability of live mosquitoes, dedicated facilities and appropriate expertise. Methods Here we report results on the ...
Antarctica peninsula periphery islands undergo one of the most dramatic ecological changes due to... more Antarctica peninsula periphery islands undergo one of the most dramatic ecological changes due to ongoing global warming. The front fields of the Antarctic glaciers are extreme environments and pioneering sites for ecological succession. Rising temperatures lead to deglaciation in the Antarctic habitats, and the new terrain is subjected to the process of soil formation and microbial colonization. In the present study, we investigated the formation of pathogenic fungal soil microbiomes as an effect of forefield deglaciation. Soil samples were taken from two different forefields, one formed several years ago and the other freshly uncovered. Both habitats were in the vicinity of the Perunika Glacier situated in the northeastern direction of Hurd Peninsula, Livingston Island, the second largest island from the South Shetland Archipelago, about 100 km north of the Antarctic Peninsula. Total DNA was extracted and targeted ITS amplicon sequencing was applied. The ITS marker sequences were ...
Visceral leishmaniasis is a sporadic illness in Bulgaria. However, cases in humans are registered... more Visceral leishmaniasis is a sporadic illness in Bulgaria. However, cases in humans are registered nearly every year. This study describes the geographical distribution of the disease in Bulgaria from 1988 to 2012, over a period of 25 years. Cases were analysed according to age, sex, and place of residence. A total of 122 cases were registered in 25 years, 118 of which were autochthonous and four of which were imported from endemic countries in southern Europe. The average annual incidence for the study period was 0.06 per 100,000 population, or an average of five cases per year (maximum 15 in 1989; no cases notified in 1991, 1995, 1996 and 2008). Cases of visceral leishmaniasis were recorded in 13 out of 28 regions in Bulgaria, mainly in the southern part of the country. The highest number of cases were registered in the regions of Blagoevgrad (n=36) and Stara Zagora (n=34). Data presented in this study show that there is ongoing transmission of visceral leishmaniasis in Bulgaria with a high mortality rate (1:7), affecting mostly children.
Mosquitoes are a group of blood-sucking insects that plays a major role in disease transmission i... more Mosquitoes are a group of blood-sucking insects that plays a major role in disease transmission in both humans and animals. They can pose a heavy nuisance, or serve as vectors of numerous viruses and parasites on most continents, including Europe. The strategy for successful control of the mosquito populations relies on the use of insecticides of five different categories: organochlorines, organophosphates, carbamates, pyrethroids, and biopesticides. The extensive use of the first four classes has resulted in the development of resistance originating in various mechanisms. The main ones are metabolic resistance and genetic resistance, manifested by point mutations in the insecticide targets, resulting in limited binding of neurotoxic substances. Much data is available on mosquito insecticide resistance in Bulgaria between 1948 and 1990, but only regarding organochlorines, organophosphates and carbamates. There is no data on pyrethroid resistance, which should raise an alarm for both...
Objective: Cystic echinococcosis (CE) is one of the most severe parasitoses, which leads to prolo... more Objective: Cystic echinococcosis (CE) is one of the most severe parasitoses, which leads to prolonged disability, frequent recurrences, and even to death. In Bulgaria it is one of the most frequently registered and severe helminthic infection.. The aim of this study is to determine the epidemiological indicators as morbidity, mortality and lethality from CE in Bulgaria for the period 2011-2020, as well as a comparative analysis of morbidity in the country with that of other EU member states. Materials and Methods: The study is a retrospective analysis of confirmed cases of CE, as well as of the deceased from this parasitic disease. Data from several sources were used - the annual analyzes of parasitic morbidity in the country, prepared by the NCIPD, as well as information from the National Center for Public Health and Analysis and the National Statistical Institute. Statistical methods were used to calculate morbidity and mortality rates Results: From 2011 to 2020, a total of 2626 c...
Cystic echinococcosis (CE) is one of the most severe parasitoses, which leads to prolonged disabi... more Cystic echinococcosis (CE) is one of the most severe parasitoses, which leads to prolonged disability, frequent recurrences, and even to death. In Bulgaria it is one of the most frequently registered and severe helminthic infection. The aim of this study is to determine the epidemiological indicators as morbidity, mortality and lethality from CE in Bulgaria for the period 2011-2020, as well as a comparative analysis of morbidity in the country with that of other EU member states. Materials and Methods: The study is a retrospective analysis of confirmed cases of CE, as well as of the deceased from this parasitic disease. Data from several sources were used-the annual analyzes of parasitic morbidity in the country, prepared by the NCIPD, as well as information from the National Center for Public Health and Analysis and the National Statistical Institute. Statistical methods were used to calculate morbidity and mortality rates. Results: From 2011 to 2020, a total of 2626 cases of CE are registered in Bulgaria (95% Confidence Interval: 263 ± 3.16), with an average incidence for the period of 3.7%₀₀₀ (95% CI: 3.65 ± 0.357). The registered primary cases are 2336 (95% CI: 233.6 ± 3.03) in total and 290 (95% CI: 29 ± 1.04) are recurrences. Cystic echinococcosis is comparatively more prevalent in women than in men, respectively 1397 (95% CI: 139.7 ± 2.39) and 1229 (95% CI: 122.9 ± 2.14) registered cases for the period and for morbidity values are 3,7%₀₀₀ (95% CI: 3.71 ± 0.36) to 3,5%₀₀₀ (95% CI: 3.53 ± 0.343). The most affected is the age group 20-59 years, i.e. people of active working age. The number of affected children aged 1 to 19 (509 cases) is relatively high, which indicates an active transmission of the parasite. During the studied period deceased patients due to echinococcosis are 65 of whom 38 men and 27 women. The average mortality and the lethality are respectively 0.09%₀₀₀ (95% CI: 0.09 ± 0.103) and 2.49% (95% CI: 2.49 ± 0.405). Conclusion: The results show a reduction in examined indicators regarding cystic echinococcosis compared to data for the 1990s and the studied from us period, but these values are still higher than the established EU averages.
Additional file 1 of Sand flies (Diptera: Psychodidae) in eight Balkan countries: historical review and region-wide entomological survey
Additional file 1: Table S1. Historical data review on the sand fly fauna of the study area. Tabl... more Additional file 1: Table S1. Historical data review on the sand fly fauna of the study area. Table summarizing essential published literature between 1910 and 2019.
Background Sand flies (Diptera: Psychodidae) are medically important vectors of human and veterin... more Background Sand flies (Diptera: Psychodidae) are medically important vectors of human and veterinary disease-causing agents. Among these, the genus Leishmania (Kinetoplastida: Trypanosomatidae), and phleboviruses are of utmost importance. Despite such significance, updated information about sand fly fauna is missing for Balkan countries where both sand flies and autochtonous leishmaniases are historically present and recently re-emerging. Therefore, a review of historical data on sand fly species composition and distribution in the region was followed by a large-scale entomological survey in eight Balkan countries to provide a recent update on local sand fly fauna. Methods The literature search involved the period 1910–2019. The entomological survey was conducted at 1189 sampling stations in eight countries (Bulgaria, Bosnia and Herzegovina, Croatia, Kosovo, Montenegro, North Macedonia, Serbia and Slovenia), covering 49 settlements and 358 sampling sites between June and October in ...
West Nile virus was first isolated in Uganda during 1937. The virus that causes West Nile fever i... more West Nile virus was first isolated in Uganda during 1937. The virus that causes West Nile fever is responsible for thousands of cases of morbidity and mortality among birds, horses and humans. Through the history, epidemics have been described in Europe, Africa, the Middle East and a part of Asia. The virus mainly causes mild febrile illness in humans. However, in the end of the century, the virus became more virulent and expanded its geographic range all the way to North America. Clinical manifestations in humans range from asymptomatic (in approximately 80% of the infected) to encephalitis, paralysis and death (in less than 1% of the infected). There is currently no licensed vaccine, and only supportive treatment is recommended. Persons who survive infection often have a long-term recovery period. This article reviews the current literature on the molecular virology, epidemiology, clinical manifestations, pathogenesis, diagnosis, treatment, immunology and protective measures again...
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