Wiadomoœci Parazytologiczne 2011, 57(4), 205–218 Copyright© 2011 Polish Parasitological Society

Review articles

Parasitic diseases and fungal infections – their increasing importance in medicine 1

Joanna Błaszkowska, Anna Wójcik

Chair of Biology and Medical Parasitology, Medical University of Lodz, 1 Hallera Square, 90-647 Lodz, Poland

Corresponding author: Joanna Błaszkowska; E-mail: [email protected]

ABSTRACT. Basing on 43 lectures and reports from the scope of current parasitological and mycological issues presented during the 50th Jubilee Clinical Day of Medical Parasitology (Lodz, 19–20 May 2011), the increasing importance of parasitic diseases and mycoses in medicine was presented. Difficulties in diagnosis and treatment of both imported parasitoses (malaria, intestinal amoebiosis, mansonelliasis) and native parasitoses (toxoplasmosis, , CNS ), as well as parasitic invasions coexisting with HIV infection (microsporidiosis) have been emphasized. The possibility of human parasites transmission by vertical route and transfusion has been discussed. The important issue of diagnostic problems in intestinal parasitoses has been addressed, noting the increasing use of immunoenzymatic methods which frequently give false positive results. It was highlighted that coproscopic study is still the reference method for detecting parasitic intestinal infections. The mechanism of the immune reaction induced by intestinal resulting in, among others, inhibition of the host innate and acquired response was presented. Mycological topics included characteristics of various clinical forms of mycoses (central nervous system, oral cavity and pharynx, paranasal sinuses, nails and skin), still existing problem of antimicrobial susceptibility of fungal strains, diagnostic and therapeutic difficulties of zoonotic mycoses and the importance of environmental factors in pathogenesis of .

Key words: medical parasitology, mycology, parasitoses, mycoses

Basing on lectures and reports delivered during detection of calcified 50. Clinical Day of Medical Parasitology (Lodz, eggs in the kidneys of Egyptian mummies of the 19–20 May 2011) the review of actual problems of twentieth dynasty (1250–1000 BC) [1]. Intensive medical parasitology and mycology is presented. study of coprolites and mummified corpses in Archeoparasitology appeared as a new branch of search of developmental forms of human parasites parasitology in the beginning of the 20th century, were carried out in the years 1960–1980. In 1979 when a new technique to rehydrate desiccated Ferreira et al. [2] introduced a new name for a tissues allowed the finding of helminth eggs in subfield of archaeology-paleoparasitology. Appli- mummies (A.C. Majewska, Medical University of cation of the new research techniques (electron Poznan). Archeoparasitology studies provided microscopy, immunoassays) since 1980, and important information on human and animal molecular biology methods (PCR) since 1997 parasitic infections, as well as on social and dietary significantly facilitated the identification of the behaviors in the past. Various species of parasites detected parasitological material. In many cases, it have been found in mummies as well as in animal is difficult to identify parasites from archaeological and human fecal material from historic and material with the routine procedure, and then it is prehistoric times in different part of the world. The necessary to use immunological and molecular earliest documented archeoparasitological methods. Molecular characterization of ancient discovery made by Ruffer in 1910 concerned the parasite DNA is very useful in making definitive

1 The review was supported by Medical University of Lodz, No. 503/1-013-01-503-01 206 J. B³aszkowska, A. Wójcik diagnosis of ancient parasites and identifying developmental forms above parasites have different genetic strains of single species. Immunological time vitality in the soil ( T. gondii oocysts – about 2 tests helped to identify cysts and/or coproantigens years; Toxocara eggs – a few years). Children more of intestinal protozoa Giardia spp. (Peru, 4300 frequently have clinical symptoms of these years ago), Entamoeba histolytica (Switzerland, parasitoses because of the closer contact with 5300 years ago), Cryptosporidium spp. (the Andes, contaminated soil in yards and sandpits, the lack of 3000 years ago) in coprolites [3]. The DNA of hygiene, and because of eating dirt. Similar location Trypanosoma cruzi was detected in 39% of samples of parasites in the human organs is detected in the from 18 Chinchorro people mummies dating from course of toxoplasmosis and toxocarosis (central before 9000 years found in the Atacama desert nervous system, skeletal muscles, heart muscle, (southern Peru, northern Chile) [4]. The oldest eggs eyeball, lungs, liver, and kidneys). Toxocara larval of intestinal parasites in coprolites were detected migration in the body can cause various clinical from before tens of thousands of years ago syndromes; (VLM), ocular (8450–30000 years – ) [5]. Eggs larva migrans (OLM), neurotoxocarosis and of originating from the „Great asymptomatic toxocarosis are described. The first Cave” in France dating 30000 years allowed to evidence for the existence of different strains of establish that the primary species of the genus T. gondii came from isoenzyme analysis of isolates Ascaris was a human, not swine worm, because mainly of French origin [9]. Parasite strains can be domestication of wild pigs took place only about divided into three clonal lineages: types I, II, and III, 9000 years ago [6]. Recently, study of human according to their pathogenicity in mice. Type I coprolites was performed in Poland; the aim of this strains are uniformly lethal and have a greater a study was recovery of helminth eggs and Giardia capacity to cross tissue barriers in vitro and in vivo , cysts from archeological excavations of latrines, whereas types II (intermediate virulence) and III dating from the 14th to the 17th centuries, in Poznan (low virulence) show much lower levels of [7]. In examined samples , Trichuris and Ascaris pathogenicity. Congenital toxoplasmosis is eggs were most frequently identified, less often associated mainly with type I and II strains. Most Opisthorchis sp., sp., Taenia sp. strains from patients with acquired and Syphacia sp. The presence of few Giardia cysts syndrome are type II, and animal were observed in examined latrine samples from the strains are predominantly type III. A number of 17th century [7]. issues concerning the epidemiology of invasion Toxoplasmosis and toxocarosis are the most with T. gondii and Toxocara spp. remain inade- common antropozoonoses acquired per os , and still quately explained. Current research focuses, among pose a valid and serious epidemiological problem others, on attempts: to determine the prevalence of (H. Mizgajska-Wiktor, W. Jarosz, R. Fogt-Wyrwas T. gondii in different soil types (clonal lines I, II and – Physical Education Academy in Poznan). III), to detect the main source of Toxoplasma Toxoplasma gondii is a common, global protozoan invasion in children (contaminated soil, or food?), parasite, which requires both a definitive host and to compare the degree and dynamics of soil an intermediate host to complete its life cycle. contamination with T. gondii oocysts in urban and Although felines are the only definitive host of rural environments, to determine the role of T. gondii , any warm-blooded animal, including synanthropic foxes in contamination of the humans, can be infected. and T. cati environment with Toxocara eggs. The following are common ascarid parasites of dogs and cats, and difficult questions pose a challenge to the are considered to be the principal etiological agents researchers: whether genetic types or subtypes are of visceral larva migrans syndrome (VLM). organ-specific? whether different genotypes of the T. gondii oocysts after 1–5 days presence in the parasite have different opportunities of the host external environment reach the stage of colonization? whether there is genetic variation in invasiveness; the intake of 10 oocysts is sufficient to Toxocara and T. gondii depending on geographical infect intermediate hosts, and 100 of the protozoan location? how proteins and gene expression of these oocysts for definitive host. By contrast, eggs of parasites modify in response to changes in the Toxocara spp. acquire invasiveness after 10–20 environment? days of staying in the soil, but only one invasive egg Parasitic infection in pregnant women may affect can cause invasion in the host [8]. The pregnancy (J. Błaszkowska, Medical University of Parasitic diseases 207

Lodz). Many premature births are recorded in the ga nism ( T. tri chiu ra , E. ver mi cu la ris , He lig mo so - course of parasitoses (malaria, , mo ides po ly gy rus ) or after mi gra tion ( A. lum bri co- ascariosis, amoebiasis), retarded fetal growth, and ides , N. ame ri ca nus , A. du ode na le , N. bra si lien sis ). even abortion (malaria, toxoplasmosis, Chagas Ho we ver, re gar dless of this fact, the com mon fe atu- disease). Vertical infection is the consequence of res in the im mu ne re spon se in du ced by in te sti nal ne - transmission of the parasite from mother to ma to des are high ac ti vi ty of Th2 lym pho cy tes and offspring: through placenta ( Toxoplasma gondii ), in hi bi tion of the im mu ne re spon se. The clas si cal re - during childbirth ( Trichomonas vaginalis ), via ac tion of the host to hel minth in fec tions is the lactation ( ). Congenital induction of Th2 immune responses with a toxoplasmosis is frequently recorded in the regulatory component. Dendritic cells (DC), as offspring of mothers who become infected with central players in the induction and maintenance of T. gondii during pregnancy [10]. However, immune responses, play a prominent role in both reactivation of invasion during pregnancy was these processes [15]. Helminth-derived molecules noted, most often in mothers whose CD4+ can directly interact with DC to condition them to lymphocyte count falls below 200/ml. In addition, drive Th2 or Treg responses. Additionally, innate there were reported cases of superinvasion with cells (e.g. mast cells, macrophages, granulocytes), another T. gondii strain, more virulent than the tissue cells (e.g. epithelial cells) and adaptive primary, in seropositive immunocompetent pre- immune cells (e.g. B cells) secrete several cytokines gnant women. The possibility of reinvasion and and other factors in response to helminth infections super invasion of T. gondii in pregnant women that can act on DC to shape their immune polarizing under mines the current belief that the immunity properties. The presence of intestinal helminths in produced in the course of toxoplasmosis protects the the host leads to inhibition of host innate and host for life from reinfection [11,12]. Congenital acquired responses, expansion of CD4+CD25+ visceral leishmaniosis may also be a consequence of regulatory lymphocytes, immunosuppressive acti- both, the primary invasion of Leishmania during vity independent of cytokines with the participation pregnancy, and reactivation of latent leishmaniosis of CD8+ lymphocytes. An important mechanism of [13]. Congenital malaria occurs mostly as a immunoregulation induced by intestinal nematodes consequence of trophoblast damage, placental is the impact on apoptosis of host cells that cause immaturity and leakage, premature rupture of elimination of some of the immunologically membranes [14]. The re we re de scri bed in trau te ri ne competent cells subpopulations (CD4+ auxiliary fe tal in fec tion with mi cro fi la ria ( Wu che re ria ban- lymphocytes) [16]. Epidemiological studies show cro fti , On cho cer ca vo lvu lus , Man so nel la per stans ) that poor hygiene and ineffective and la rvae ( Tri chi nel la sp., Asca ris lum bri co ides , prophylaxis among poor societies facilitate long- An cy lo sto ma du ode na le , Ne ca tor ame ri ca nus , To - term persistence of intestinal infections. xo ca ra ca nis , Stron gy lo ides sp.). It is po ssi ble bre- Simultaneously, there are cases of nonspecific ast- fe eding trans mis sion of pro to zoa ( Try pa no so ma , inflammatory bowel disease and asthma, Le ish ma nia ) and ne ma to de la rvae ( A. du ode na le , N. increasingly reported in industrialized countries. ame ri ca nus , Stron gy lo ides sp.) to the neo na te. Da ta The inverse correlation between the incidence of from li te ra tu re show that con ge ni tal pa ra si to ses are allergies and intestinal parasitoses was the basis for most fre qu en tly re cor ded as a con se qu en ce of in fec- launching a „hygiene hypothesis”, whereby the rarer ting wo men du ring first pre gnan cy with blo od and helminth infections of children in the period of tis su es pa ra si tes ( Pla smo dium , To xo pla sma , Le ish - immune system maturation may condition increased ma nia ). Dif fi cul ties with pro per dia gno sis and the incidence of lifestyle diseases later in life. lack of in va si ve fac tors iden ti fi ca tion in abor ted fe- Currently, the results of both epidemiological and tu ses and stil l bir ths ( To xo pla sma , Le ish ma nia , Tri - experimental studies suggest that in the course of chi nel la ) lo wer the va lue of con ge ni tal pa ra si to ses certain diseases the helminth invasion may inhibit pre va len ce. gastrointestinal inflammation. There were noted Gastrointestinal parasite infections provide a beneficial effects of Trichuris suis invasion in unique challenge to the host immune system (M. people with colitis, Crohn’s disease, or of T. spiralis Doligalska, University of Warsaw). Parasitic in type I diabetes. There were also demonstrated nematodes in the host alimentary tract can colonize inhibition of gastrointestinal inflammation in model the intestine wi tho ut prior mi gra tion in the host or - invasions in laboratory animals experimentally 208 J. B³aszkowska, A. Wójcik infected with T. spiralis or Heligmosomoides poly - increasingly replaced by stem cell transplantation. gyrus [17], and alleviating allergy symptoms in The most characteristic feature of stem cells is their experimental infections with Nippostrongylus ability to multiply and increasingly differentiate into brasiliensis or H. polygyrus [18]. organ-specific daughter cells that exhibit increased The success of an epidemiological program resistance to radiation and cytostatics. In recent against infectious diseases depends on an effective years the concepts have appeared to use primitive prophylactic vaccine (H. Długońska, M. Grzy - pluripotent stem cells (PSC) which have the ability bowski – Lodz University). The effect of vaccina- to differentiate into all cells of the body. PSC can be tion depends on many factors such as sex, age, potentially extracted from embryos and from tissues present hormonal status, as well as the composition (bone marrow). This type of stem cells isolated from of microbiota [19]. Studies in humans and adult tissues is called VSELs – very small experimental animals indicate that the number and embryonic-like stem cells. These cells are deposited activity of immune cells (e.g. antigen-presenting in tissues during embryonic development as the cells, APC) and the severity of inflammatory population of PSC, which shows the expression of reactions are higher in females. There were found several markers of pluripotent cells (SSEA-4, Oct-4, stronger stimulation of the immune system and Rex-1 and Rif-1). VSELs are mobilized into more frequent side effects in the majority of peripheral blood in case of acute damage to organs vaccinated women in comparison with the men. and tissues. At present, studies are being conducted Pregnancy can also substantially alter immune on the use of VSEL stem cells and other in the responses to vaccines. Concentrations of 17 β- treatment of non-specific enteritis (W. Marlicz, estradiol and progesterone are substantially higher Medical University of Szczecin). It was found that during pregnancy than during other times in the the human and murine mesenchymal stem cells female reproductive cycle. The polymorphism of (MSC) administered parenterally reduce infla - genes encoding immunologically important proteins mmation of the intestinal mucosa in models of and also the level of steroid hormones in the colitis in mice. A particular challenge for clinical vaccinated individuals (immune cells have receptors medicine is the prospect of regeneration of nerve for hormones) may be responsible, among others, tissue in degenerative diseases of central nervous for the diverse response to the vaccine. Some system. Cell therapy aims is providing cellular researchers believe that a group of microorganisms, structures that are the substitute for structures especially from the gastrointestinal tract and damaged by the disease process, and also mucous membranes, should also be taken into stimulating immunoregulation which facilitates the account in the development of vaccines. Influence action of corrective systems (multiple sclerosis). of microorganisms on the human immunity is This therapy in Parkinson’s disease will rely on the significant, because they induce maturation of delivery of dopaminergic neurons from the T lymphocytes function and affect the metabolism „outside”. Clinical trials conducted to date bring of drugs, toxins, and vaccines. It was shown that about a moderate success. However, special hopes bacteria SFB (segmented filamentous bacteria) for future therapeutic use of stem cells are coordinate the response of Th1 helper and Th17 associated with such diseases as myocardial regulatory lymphocytes [20]. There was found an infarction, stroke, Parkinson’s disease, diabetes, increased response to oral vaccines (rotaviruses, muscular dystrophies, toxic liver and kidney polio, Salmonella , V. cholerae ) in individuals damage. treated for 1–5 weeks with probiotics. Moreover, in are obligate intracellular, neonates, 6-month administration of probiotics led primitive , lacking mitochondria and to increased response to parenteral vaccines (anti- characterised by the typical structure of their . diphtheria, anti-tetanus HBV, against HBV). To Intestinal microsporidiosis ranks among the most date observations confirm the need for detailed and common causes of in immunodeficient comprehensive study of microbiota composition patients. Species identified as causing and effectiveness of vaccines. microsporidiosis in humans include the following: The aim of regenerative medicine is to use stem , E. intestinalis , E. cuniculi , cells to treat damaged organs and tissues (P. Rieske, E. hellem . There were examined 92 children with Medical University of Lodz). It is believed that congenital , and after liver whole organ transplantation in the future will be transplantation, and 86 adults taking immuno - Parasitic diseases 209 suppressive drugs, and with chronic diarrhoea is still not fully appreciated, and the impact of this (M. Bed nar ska, A. Ba jer, R. Welc- Fa lę ciak, B. Sa- disease on transfusion medicine is undoubtedly mo liń ski, B. Wol ska- Ku śnierz, I. Jan kow ska, T. underestimated. Transfusion-transmitted babesiosis Gra czyk, E. Siń ski – War saw Uni ver si ty, Me di cal might play a role in the emergence of this disease, Uni ver si ty of War saw, Child Health Centre). In this especially in the northeast of Poland where there are study, faeces of patients were evaluated – smears well recognized endemic areas for Babesia. stained with Chromotrp 2R technique, as well as by Amoebiosis continues to be a significant world- PCR method using primers specific for the SSU wide health problem. It has been estimated that 500 rRNA gene. There were found microsporidia million individuals are infected with Entamoeba E. bieneusi and E. intestinalis in 13 tested subjects histolytica and of these, 50 million would develop (7.3%). Intestinal microsporidiosis has been invasive disease. By contrast, E. dispar is regarded implicated as a major cause of chronic diarrhea in as a non-pathogenic commensal of man. Although AIDS humans. The first time in Poland cases of biochemical, immunological, and genetic data microsporidiosis in HIV-infected pa tients we re pre- account for a clear separation between E. histolytica sen ted (M. We so łow ska, B. Knysz, M. Kváč, and E. dispar , macroscopically both strains are B. Sak, J. Ja no cha, D. Kve to no va, A. Gła dysz – Me - undistinguishable. The diagnosis of E. histolytica di cal Aca de my of Wroc law, Aca de my of Scien ces infection has relied upon detection of the specific of the Czech Re pu blic). The coproscopic studies E. histolytica coproantigen (galactose-specific (chromotrope staining and fluorescence with adhesin) in stool specimens, detection of antibodies Calcofluor White 2MR technique) and PCR method to E. histolytica in patient sera or application PCR were performed and microsporidia were detected in methods. In Poland, the great problem for diagnosis 5 out of 50 tested patients; in 4 – E. cuniculi , and in and treatment makes „imported” amoebiosis. 1 – E. intesti nalis. Atypical clinical course of intestinal amoebiosis Babesiosis in humans is a potentially emerging complicated by multiple liver abscesses in a patient tick-borne zoonotic disease caused by infection of after travelling to Cape Verde Islands was presented red blood cells (RBCs) with various species of (M. Paul, J. Stefaniak – Medical University of protozoan of the genus Babesia (Apicomplexa, Poznan). The authors discussed the diagnosis and Piroplasmida) (E. Siński, R. Welc-Falęciak, treatment of 53-year-old patient. Before leaving, he R. Pogłód – Warsaw University and Institute of had been consulted neither by tropical medicine Hematology and Blood Transfusion, Warsaw). specialist nor by travel medicine specialist, he did Babesiosis is transmitted primarily through the bite not undergo immunization recommended for of an infected tick, typically Ixodes spp., although international travellers, and did not respect the rules occasionally transmission occurs via transfusion of of tropical hygiene while staying abroad; during the blood products collected from asymptomatic trip there were no complaints. After returning to the infected donors. Less common routes of country he developed fever up to 39 °C preceded by transmission are transplacentally or perinatally chills, drenching sweats, muscle aches, general (congenital babesiosis). In the literature, only three malaise, substantial weight loss, severe abdominal cases of congenital babesiosis are reported. For the pain, loose bowel movement (3x/day with mucus). period of 1979–2009, 159 B. microti transfusion- E. histolytica IgG was found by serological ELISA associated cases were documented in the United test, and computed tomography (CT) showed signs States. 46 patients in Poland with chronic Lyme of a liver abscess. Additionally, indirect immuno- disease, who had a history of confirmed contact fluorescence assay (IFA) gave positive result. with ticks, were examined [21]. In 14 of them Diagnostic and therapeutic difficulties of severe (30.4%) Babesia spp. antibodies were found (IFA- P. falciparum malaria based on own clinical indirect fluorescent-antibody technique) and in 1 experiences were presented (K. Mrówka, Medical person infection with B. venatorum was confirmed University of Poznan). Severe human malaria is (molecular methods). In Poland, only seven human attributable to an excessive sequestration of cases of babesiosis have been reported, including P. falciparum – infected and uninfected one imported from Brazil [22]. Babesiosis in erythrocytes in vital organs. This leads to humans particularly is the asymptomatic infection obstruction of the microcirculation and results in (when low parasitaemia lasts more than a year). The dysfunction of multiple organs, typically the brain problem of human babesiosis in Poland and Europe in cerebral malaria. The main clinical-pathological 210 J. B³aszkowska, A. Wójcik features of severe malaria include central nervous reference centres after returning from countries of system (CNS) involvement, severe anemia, renal different climate and sanitary zones. The most of failure, pulmonary dysfunction, shock, dissemin a- illnesses contracted in the tropical and subtropical ted in tra va scu lar co agu la tion, hy po gly cemia, zones may be asymptomatic, or minimally metabolic acidosis and liver dysfunction. A case of symptomatic, or manifest clinically after a few severe malaria in 22-years-old man was presented. months and even years after returning from the The patient stayed six weeks in Ghana where tropics. worked as missionary was presented. After return to Neurocysticercosis, which is caused by infection Poland, he had following symptoms: up to 39 °C of the human with the cysticercus larva of Taenia fever, shivers, drenching sweat, general weakness, solium , is the most common of the splenomegaly. Imported malaria is a major problem, human nervous system. The recognition of which affects not only tourists but also missionaries, neurocysticercosis is difficult, it require a multi- humanitarian volunteers, travellers to the tropics for disciplinary approach of a parasitologist, a professional purposes (businessmen, diplomats), neurologist and a radiologist, while introduction of immigrants (students, people visiting relatives in treatment in the early stages of invasion facilitates home countries) and soldiers of stabilization full patient recovery. The clinical manifestations missions. In Poland mortality in malaria 7–16 times depend on the number, and location of cysticercus higher than in Western European countries [23]. cellulosae disrupting neural tissues. There are wide Improper anti-malaria chemoprophylaxis and lack variations of clinical manifestations of neuro - of pre-departure medical consultation with a cysticercosis (epilepsy, diplopia, vertigo). Three tropical medicine specialist are important risk cases of central nervous system cysticercosis were factors favouring the occurrence of infection with presented among patients diagnosed in the Plasmodium spp. in the travellers. Due to the Department and Clinic of Tropical and Parasitic indefinite symptoms of the disease, patients with Diseases in Poznan (Ł. Pielok, B. Skoryna – malaria require professional and frequently Medical University, Poznan). 32-years-old woman multidisciplinary differential diagnostics. has been referred to the clinic with brain tumour Report on a severe case of symptomatic suspicion. She had the following sings: right-sides mansonellosis in an 11-year-old girl who took paresis, aphasia and troubles with writing. Second multiple trips to Egypt and the Dominican Republic patient – 63-years-old woman with neurological was discussed (J. Stefaniak, M. Paul, K. Mrówka – symptoms was hospitalised. She was previously Medical University of Poznan). Her last stay in diagnosed with multiple sclerosis. This woman had Egypt was 2 months before, and in the Dominican signs such as dizziness, equilibrium disturbances, Republic 22 months earlier. She stayed in high diplopia and conjunctivitis. The third patient (32- standard hotels but she was repeatedly bitten by years-old woman) showed epileptic seizures during insects. Before departure she had been consulted night sleep. neither by tropical medicine specialist nor by travel Coproscopic study is still the reference method medicine specialist, and had not been vaccinated in for detecting invasion of intestinal parasites. The accordance with recommendations for international most common causes of errors in the parasitological tourist traffic. She did not use anti-malaria assessment of stool are non proper collection and chemoprophylaxis and did not follow tropical storage of the material, lack of experience of the hygiene rules. There were the following symptoms evaluator and inappropriate selection of the research in the patient: growing swelling of eyelids, method . Plant pollens are often misinterpreted as inflammatory infiltration of soft tissue of eye parasite eggs. Morphometric analysis of parasitic socket, conjunctivitis, enlargement of lymph nodes. eggs from the human alimentary tract and plant Immunochromatographic test for circulating filarial pollens were demonstrated (K. Szwabe, antigen (AD12) gave positive result and was P. Kurnatowski – Medical University of Lodz). The confirmed by peripheral blood examination using aim of the study was to demonstrate the differences Knott concentration method, showing single and similarities between the morphological microfilaria in the afternoon characteristics of selected intestinal helminth eggs hours (parasitaemia size: 0.5 microfilaria/ml). The and pollens of garden plants, commonly found in authors emphasized the need for carrying out check- Lodz. Photographs of the compared objects, up to detect exotic diseases in tropical medicine subjected to computerized image analysis using the Parasitic diseases 211

SCAN MULTI BASE programme, revealed in most rural areas in the Lodz district with geohelminth cases a large morphological similarity of evaluated eggs was demonstrated (P. Damięcka, P. morphological parameters: length, width and Kurnatowski, J. Błaszkowska – Medical University length/width ratio of eggs with pollens similar to of Lodz). In this study, the authors have found high them. Small differences in the size of the evaluated percentage (60 to 100%) positive samples of soil eggs and pollens are not detected in routine from agricultural fields fertilized with livestock microscopic evaluation. This may be the cause of manure. Out of the 285 isolated helminths as many diagnostic errors during testing for the presence of as 250 eggs belonged to the genus Ascaris , 22 to faecal eggs of intestinal parasites, and also in the Toxocara , and 10 eggs to Trichuris . 164 eggs were helminthological evaluation of environmental detected in samples from Kolumna, where the samples. average density was 82 eggs/100g. The presence of The stool concentration procedures provide parasitic eggs (mainly Toxocara spp. – 73.9%) was detection of developmental forms of intestine found while assessing soil samples from rural parasites. The literature data show that backyards, and the mean density of eggs ranged sedimentation methods are more sensitive than from 3 to 48 per 100 g of soil. The obtained results flotation. Using MINI PARASEP set in the show a significant degree of soil contamination with diagnostics of intestinal parasitoses was presented geohelminth eggs in rural areas in the Lodz region. (K. Szwabe, G. Lipowczan, P. Kurnatowski, Special attention was drawn to the poor sanitary J. Błaszkowska – Medical University of Lodz). The condition of backyards confirmed by a large density efficacy of detection of intestinal parasites in 49 of Toxocara spp. eggs in the soil of the rural samples of faeces by traditional methods (direct homestead areas. formulation, the method of Kato-Miura, flotation by Human dirofilariosis is a zoonotic filariosis Faust) was compared with assessment by MINI caused by infection with several species of worms PARASEP. Identical recognition – 19% of positive belonging to the genus Dirofilaria. The reservoir of tests – was obtained evaluating the direct these parasites are mainly dogs or cats, while the preparations, smears of Kato-Miura method and microfilaria vector are mosquitoes of the genus, i.a., centrifuged sludges from the MINI PARASEP set. Culex, Anopheles, Aedes . Although a man is an Parasites by flotation method were detected only in accidental host for Dirofilaria , these nematodes 8% of tested samples. Available on the market reach sexual maturity in a human body. There are MINI PARASET concentrator based on two clinical forms of dirofilariosis in humans: sedimentation method can be successfully used for pulmonary (mainly Dirofilaria immitis ) and detection of developmental forms of intestinal subcutaneous ( D. tenuis and D. repens ). In Europe, protozoa and helminths in humans and animals. The the endemic area of D. repens occurrence contain advantages of above device are as follows: high primarily Mediterranean countries as well as density of the material, the possibility of semi- Hungary, Ukraine, Slovakia and the Czech Re- quantitative assessment of parasitic eggs in the public. The diagnostic methods used for diffe - sample, the minimum amount of reagents rentiation of nematodes of Dirofilaria spp. isolated consumed, fast reading and ease of use. In addition, from humans were presented (A. Masny, MINI PARASEP is a single use test, which H. Żarnowska-Prymek, D. Cielecka, R. Salamatin, eliminates the contamination of samples with E. Dove – National Institute of Public Health- environmental factors. National Institute of Hygiene, Warsaw). Antropozooses, which are difficult to diagnose Determination of parasite species is based on and treat, pose still important epidemiological evaluation of stained histological preparations from problem. There are human infections reported with subcutaneous tissue nodules which contain sections parasites of domestic animals and livestock of the nematode. The most important morphological (Toxocara canis and T. cati , Ascaris suum , characteristics of the adult form of the parasite are Trichuris suis , T. vulpis and Capillaria spp.). The taken into consideration (the maximum body growing number of newly registered cases of diameter, thickness and striation of multilayer geohelminthosis, mainly toxocarosis, both in Poland cuticle, the presence of a double uterus, arrangement and the world, calls for continuous monitoring of of fibres and muscle cells, hypoderma appearance the sanitary status of the soil [24]. Preliminary and its lateral ridges). The assessment of assessment of the degree of soil contamination in morphological microfilaria detected in the blood of 212 J. B³aszkowska, A. Wójcik the host is often insufficient for the determination of Published results of numerous researchers suggest the species. In such cases, membership of a species that the state of hyperprolactinaemia may inhibit the should be confirmed by molecular methods. In the development of invasions caused by T. gondii [26]. PCR techniques species-specific markers are used But there is still unanswered questions: whether the (mitochondrial and ribosomal) and ITS universal protective effect of PRL is due to the direct markers (spacer region of rDNA). influence of the hormone on extracellular forms of Most infants with congenital Toxoplasma gondii T. gondii , or is the result of the immunoregulatory infection have no symptoms at birth, but many will role of PRL which, while activating the host cells, have retinal disease or neurologic abnormalities leads to inhibition of parasite replication and, later in life. Early detection and treatment of consequently, to its gradual eradication. The congenital toxoplasmosis may reduce these literature data show that PRL activates intracellular sequelae. Congenital toxoplasmosis is treated with killing of protozoa and releasing of IL-1 β, IL-3 and pyrimethamine and sulfadiazine in combination IL-6, what results in the decrease in the number of therapy for a period of 2–6 months. The next step in cysts formed in the brain of experimental animals. the therapy is administration of Fansidar until the The report on the influence of recombinant and end of the first year of age. Pyrimethamine is an serum prolactin on T. gondii growth in human anti-protozoal agent irreversibly blocking the peripheral blood mononuclear cells (K. Dzitko, synthesis of nucleic acids by inhibiting dihydrofolic H. Ławnicka J. Gatkowska, B. Dziadek, J. Komo- acid reductase. Therapeutic range of this drug is row ski, H. Długońska – Lodz University, Medical 0.08–0.6 µg/ml of serum. The report on monitoring, University of Lodz) was presented. The authors of in clinical practice, of plasma pyrimethamine this study evaluated the effect of this hormone on concentration in infants with congenital Toxo - the rate of proliferation of T. gondii in peripheral plasma gondii infection was presented (B. Lipka, blood mononuclear cells (PBMCs). There was B. Milewska-Bobula, M. Filipek – Child Health observed a significant decrease in intracellular Center, Warsaw). In this study, pyrimethamine multiplication of parasites in the presence of high levels were monitored in the plasma of 24 infants concentrations (91.00–175.00 ng/ml) in both the aged 1–5 months with congenital toxoplasmosis. serum prolactin (SPRL: 60.04 ± 16.09%), and the The high performance liquid chromatography re com bi nant (rhPRL: 78.69 ± 14.40%), what con- (HPLC) was used to identify pyrimethamine firms that the sta te of hy per pro lac ti ne mia may in hi- concentration. It ranged between 0.01–1.2 µg/ml. In bit the growth of T. gon dii in host cells. 14 infants the drug concentration was within the Mycological topics of this congress included therapeutic range, in 7 patients it was significantly characteristics of different clinical forms of fungal too low, and in 3 the concentration above the infections (central nervous system, oral cavity and therapeutic range was reported. The obtained data pharynx, paranasal sinuses, skin and nails), still suggest that monitoring of pyrimethamine in plasma current problem of antimicrobial susceptibility of can improve the safety and efficiency of treatment fungal strains, diagnostic and therapeutic difficulties and enable selection of appropriate, individual dose. in zoonotic mycoses. The most common side effect of pyrimethamine The risk fac tors, cli ni cal symp toms, mi cro sco pic occurring even when using the recommended dose ima ge of CNS my co sis (asper gil lo sis, mu cor my co- is neutropenia. That’s why it is necessary to check sis, can di dio sis, coc ci dio ido my co sis and cryp to coc- the blood count regularly during treatment. co sis) we re di scus sed (B. Si kor ska, Me di cal Uni ver- During the development and effector phases of si ty of Lodz). Mo re over, ra re cli ni cal ca ses of cen- the anti- Toxoplasma response, the immunological tral ne rvous system mycoses leading to coma and system of a host is involved in several complex death of patients were presented. The CNS mycoses interactions with the endocrine system, and most commonly occur in people with compromised prolactin (PRL) is one of the most important immune systems (AIDS, immuno suppressive hormones involved in immunoregulation. The therapy), or chronically ill (diabetes, cancer), and protective effect of prolactin (PRL) in T. gondii are manifested by symptoms of meningitis, abscess infection was demonstrated in experimental models formation or granulomous changes, infarctions and of toxoplasmosis in mice [25]. Moreover, the micro-infarcts in the brain. Cryptococcus neofor- prevalence of T. gondii invasion in humans was mans , , immitis are determined depending on the level of PRL. common causes of . Fungi of the Parasitic diseases 213 genus and Mucor are known to cause topical or systemic antifungal drugs may be used. mass lesions in brain. The morphology and size of Despite extensive research dedicated to the the organism determine the pathology of CNS development of new therapeutic strategies, there are lesions. Small forms ( Coccidioides , only a limited number of available drugs to fight Cryptococcus , Candida ) reach the small arterioles against invasive fungal infections. The new and capillaries producing meningitis and ischemic possibilities for treatment of mycoses of oral cavity lesions. Intermediate-sized pseudo hype ( Candida ) and pharynx were delivered (P. Kurnatowski, occludes small vessels in the microcirculation to Medical University of Lodz). The increasing produce local areas of tissue necrosis that evolve to incidence of invasive fungal infections is the result abscess formation. The large hyphal forms of many factors, including an increasing number of (Aspergillus spp., Mucor spp.) of variable size patients with severe immunosuppression. The high obstruct large and intermediate-size arteries and risk group for the incidence of mycoses, among occasionally veins, giving rise to large infarcts. others, include: the persons with neutropenia below The results of long-standing mycological 0.5x10 9/l persisting over 5 weeks, subject to analyses of biological materials from selected organ corticosteroid therapy (2 mg/kg > 2 we eks), sho- ontocenoses were reported (M. Dynowska, wing si gns of trans plant re jec tion, and co lo ni za tion K. Góralska, P. Troska, G. Barańska, A. Biedunkie- by C. tro pi ca lis . De spi te im pro ve ment of an ti fun gal wicz, E. Ejdys, E. Sucharzewska – University of the ra pies over the last 30 years, the phe no me non of Warmia and Mazury, Hospital of the Ministry of an ti fun gal re si stan ce is still of ma jor con cern in cli- Internal Affairs and Administration, Oncology ni cal prac ti ce. Cur ren tly, it is no ted a de cre ase in in- Centre in Olsztyn, District Hospital, Biskupiec). fec tions cau sed by C. al bi cans from 90 to 30% and Changes in the number of taxa of fungi isolated an in cre ase in pre va len ce of stra ins re si stant to an ti- from the respiratory and digestive tract of patients fun gal drugs: C. kru sei , C. tro pi ca lis (from 2 to from the Hospital of the Ministry of Internal Affairs 24%), C. gla bra ta (from 2 to 26%), C. pa rap si lo sis and Administration, Oncology Centre in Olsztyn (from 10 to 20%). In ad di tion, the re has be en an in- and the District Hospital in Biskupiec in the years cre ase in the fre qu en cy of in fec tions with drug- re si- 1990–2010 were noted. Recording up to 9 taxa more stant stra ins of Fu sa rium so la ni , Mu cor sp., Rhi zo - in the respiratory tract than in the alimentary tract pus sp., Cryp to coc cus neo for mans , Asper gil lus sp. confirms earlier assumptions that fungi in the It is worth no ting that fun ge mia in ap pro xi ma te ly respiratory system find better conditions for 30% of ca ses re sults in de ath of the pa tient. One of survival and development (greater stability, oxygen the an ti fun gal drugs with a bro ad spec trum of ac tion supply) than in gastrointe sti nal tract, what do es not is No xa fil (po sa co na zo le) which can be used to tre- un der mi ne the fact that the ga stro in te sti nal tract is at my co ses cau sed by Can di da al bi cans , C. tro pi ca- the most com mon way of in tra- sys te mic fun gal lis , C. fa ma ta , C. pa rap si lo sis , C. kru sei , C. gla bra - trans mis sion. During above period, Pa ra coc ci dio- ta , C. neo for mans , Hi sto pla sma cap su la tum , Bla sto - ides bra si lien sis , Can di da lac tis- con den si , Oospo ri- my ces der ma ti ti dis , Coc ci dio des im mi tis , Pa ra coc - dium mar ga ri ti fe rum , Rho do spo ri dium dio bo va tum ci dio des bra si lien sis , Asper gil lus fu mi ga tus , A. fla- and Rho do spo ri dium kra to chvi lo vae we re iso la ted vus , A. ni ger , Fu sa rium so la ni , Sce do spo rium apio- in Po land for the first ti me. At ten tion was drawn to sper mum , Rhi zo pus sp., Mu cor sp., Rhi zo mu cor sp. the gra du al expan sion of the ta xo no mic and eco lo- In di ca tions for the drug use include of gi cal spec trum of fun gi in hu man or gan ontocenoses the oral cavity and pharynx (first-line therapy), and increasingly noted multifocal settlements of , , , fungi, which greatly raises the risk of the spread of . Noxafil is effective on fungal fungal invasion via blood to different organs. The strains resistant to azoles or amphotericin B. It is number of persons with compromised immune recommended in patients with severe mycosis or systems and increased sensitivity to fungi is reduced resistance, in whom poor response to growing, and also more iatrogenic factors appear topical therapy is expected. It is also indicated for enabling the growth of expansiveness of fungal the prevention of invasive mycoses in patients saprotrophs that reveal accelerating pathogenic receiving chemotherapy (acute myeloid leukaemia, potential in man, treating ontosphere as one of the myelodysplastic syndrome), and bone marrow natural reservoirs. transplant. Depending on the nature of the fungal infection, Pathogenic fungi play a significant role in 214 J. B³aszkowska, A. Wójcik chronic rhinosinusitis. In about half of the patients soil phytopathogens, easily invading weakened not only Candida species are detected, but also organisms. The fungi, forming hyaline hyphae, may Aspergillus , Penicillium , and Alternaria . be the cause of mycoses named hyalohypho - In the last decade increased prevalence of fungal mycosis. Literature describes rare cases of isolation invasions within the nasal cavity and paranasal of Fusarium oxysporum and/or F. solani from sinuses has been recorded. Several factors favour necrotic changes in skin and subcutaneous tissue, expansion of fungal sinusitis, including, i.a., cornea, surgical wounds, and the inter-digital skin frequent use of antibiotics that disturb the lesions and nails in surgical, dialysed and physiological bacterial flora, or increasing number immunocompromised patients. The rare detection of of immunocompromised patients. A particularly Fusarium fungi may be the result of errors in the important factor facilitating the current develop- standard diagnostics – caused by the action of ment and spread of fungi is contaminated actidion added to the standard Sabouraud media as environment. Also advances in diagnostic testing an inhibitor of mould growth. Analysis of several (mycological, serological, histopathological and cases of hialohyphomycosis caused by F. solani and radiological) allow for identification of fungal F. oxysporum recorded in Olsztyn and Lidzbark etiological factors. In patients undergoing surgery Warminski showed that the PDA medium (potato- for chronic rhinosinusitis in the Department of dextrose agar) should be introduced into routine Otolaryngology and Laryngological Oncology, diagnostics of fungi isolated from skin lesion and most frequently isolated from the mucous surgical wounds (K. Góralska, M. Dynowska, G. membrane fragments of the ethmoidal bulla region Barańska, P. Troska, M. Tenderenda – University of were fungal strains of the ge ne ra Pe ni cil lium , Warmia and Mazury, Hospital of the Ministry of Asper gil lus , Fu sa rium , Cla do spo rium , Rhi zo pus , Internal Affairs and Administration, Oncology Odium and Rho do to ru la (M. Twa ru żek, J. Gra jew- Centre in Olsztyn, District Hospital, Biskupiec, ski, P. Wi niar ski, E. Sosz czyń ska – Ka zi mierz Independent Public Centre of Tuberculosis and Wiel ki Uni ver si ty, Byd goszcz). Lung Diseases, Olsztyn). Identification of fungi from the genus Madura foot (lat. mycetoma ) is a chronic Penicillium originating from clinical specimens in infectious disease of the skin and subcutaneous the majority of laboratories is based on culturing tissue characterized by progressive course which over Sabouraud medium with chloramphenicol in may affect muscles, bones and neighbouring organs. 37 °C, then micro- and macroscopic evaluation. The The name derives from the region of Madura in growth of strains of Penicillium nalgoviense (from Madras (India), where it was first described in the BAL), P. ochrochloron (from bio-aerosol of nineteenth century and it is now observed laboratory area) and P. simplicissimum (from nasal endemically in Africa, Latin America, India, Pakis- cavity) on different substrates and at different tan and Au stra lia. The etio lo gi cal fac tor may be dif- temperatures was compared (E. Ejdys, M. Dy - fe rent mi cro or ga ni sms – ac ti no my ce tes ( No car dia nowska, M. Rosłan, K. Góralska, A. Biedun kie- aste ro ides , No car dia ma du rae , Ac ti no ma du ra ma - wicz, E. Sucharzewska – University of Warmia and du rae , Ac ti no ma du ra pel le tie ri , Strep to my ces so ma- Mazury, Independent Public Centre of Tuberculosis lien sis , No car dia bra si lien sis, No car dia ca viae ) or and Lung Diseases, Olsztyn). According to the nu me ro us pa tho ge nic fun gi ( Ma du rel la my ce to ma- authors, the clinical material from the respiratory tis , Ma du rel la gri sea , Py re no cha eta spp., Sce do spo- tract should be incubated in parallel at least at two rium apio sper mum , Fu sa rium spp., Acre mo nium temperatures: 37 °C (testing the potential pathoge- spp., Asper gil lus ni du lans , Neo te stu di na ro sa ti , nicity of Penicillium isolate) and 25 °C (quicker Pseu do al le sche ria boy dii , Exo phi lia spp., Lep to - development of morphological features needed to spha eria se ne ga lien sis ). An excep tio nal ca se of bi- identify the ). Although the fungi of Penici- la te ral ma du ro my co sis in 51-year- old wo man after a llium genus generally grow better on Sabouraud 3-we ek stay in Ethio pia was pre sen ted (M. Paul, agar without antibiotics, it is advisable to conduct Ł. Pie lok, J. Ste fa niak – Me di cal Uni ver si ty, Po- observation also on the Czapek-Dox medium. znan). The pa tient was ad mit ted to the De part ment Differences in morphology of colony observed on of Tropical and Parasitic Diseases, Medical both the media are helpful in efficient identification University in Poznan with suspicion of malaria. The of the Penicillium genus . clinical picture was manifested by 39 °C fever, Fungi strains of Fusarium species are common chills, substantial general weakness, muscle aches, Parasitic diseases 215 headaches, feeling cold. Moreover, bilaterally on occasionally by human to human transmission. both feet numerous painful inflammatory lesions in Mycosis is often observed in children and young the form of deep skin ulcers with purulent content adults; changes are visible on head, beard or other were observed, accompanied by swelling of not protected body parts. In cattle infected inflamed subcutaneous tissue. Staphylococcus under Wood’s lamp show fluorescence, which is not aureus and Streptococcus pyogenes were grown in observed in humans. Zoonotic may bacteriological cultures from swabs of the patient’s show course not only with deep skin changes, but feet ulcers, and also, the direct preparation from also with intensive pain (Z. Adamski, A. Grajewska, purulent content revealed Actinomyces sp. A. Kubisiak-Michalska, H. Kubisiak-Rzepczyk – Combined chemotherapy (Co-trimoxazole, amoxi- Medical University, Poznan). are cillin and clavulanate, ketoconazole, clindamycin, invasive fungi and/or allergizing agents – in skin, ciprofloxacin) for a total period of 2 months was subcutaneous tissue and in vascular system mycides introduced, which brought significant alleviation of (dermatophytids) may develop, as response to maduromycosis symptoms. fungus antigens within 4–6 weeks of invasion (e.g. The predominant form of chronic derma- erythema nodosum picture with reactive arthritis). tophytoses are athlete’s foot ( tinea pedum ) and feet Systemic treatment with antifungals and a non- onychomycoses ( tinea unguium ) caused mainly by steroidal anti-inflammatory drug are reducing rubrum . The two types of mycoses are symptoms of the organism reaction. considered the civilization-related diseases. A zoophilic species Trichophyton equinum can European evaluation Achilles revealed the spread from the environment of infected animals prevalence of athlete`s foot of 22% and feet (horses, dogs) to healthy ones, with the incidence of onychomycoses – 23%. Between sportsmen it raised invasion reaching up to about 20%, while in humans to 31% (runners) or 63,6% (swimmers). Also work is rare. In the analysis of 1195 mycoses in Poland environment may favor the fungi invasion. There (1984–1995), the presence of T. equinum was not are different types of : Distal Lateral detected in any of the cases (A. Grajewska, Z. Subungual Onychomycosis DLSO, Proximal Adamski, H. Kubisiak-Rzepczyk, A. Banaszak – Subungual Onychomycosis PSO, White Superficial Medical University, Poznan). The fungus species Onychomycosis WSO, Total Dystrophic Onycho - case of in 4-year-old boy was probably my cosis TDO and Endonyx Onychomycosis EO. caused by a horse, on which the boy rode in The genotype typing of the fungus strains isolated kindergarten. Griseofulvin therapy was introduced from patients may be useful in epidemiological for a period of 13 weeks yielding satisfactory studies. The differentiation of T. rubrum genotype clinical outcome without observed side effects. This based on the analysis of polymorphism in regions of drug is effective and safe in the treatment of TRS-1 and TRS-2 showed seven patterns, and in T. equinum infection, possible for use in children. RAPD reactions (Baeza primers 1 and 6) only two Fungi of the genus causing pityriasis pairs of strains presented the same genotype, the versicolor ( ) belong to dimorphic others pre sen ted uni que ge no ty pic pat terns fungi, which use lipids as a carbon source. Fats (A. Hryn ce wicz- Gwóźdź, T. Ja giel ski, A. Sa de kier- present in sufficiently secure their ska- Chu dy, K. Ka li now ska, K. Paw lik – Me di cal demand for fatty acids. 12 lipodependent species Aca de my, Wro cław). This in di ca tes si gni fi cant ge- (M. furfur , M. sympodialis , M. globosa , M. obtusa , ne tic variety of tested T. rubrum population. M. restricta , M. slooffiae , M. dermatis , M. japonica , However, analysis of fluconazole and itraconazole M. nana , M. yamatoensis , M. equina , M. caprae ) sensitivity of strains qualified for different and 1 non-lipodependent ( M. pachydermatis ) – genotypes did not show a strict correlation between causing skin lesions in animals have been detected genetic types and their susceptibility. so far. The natural substance that is produced by The other Trichophyton verruco- Malassezia – saturated dicarboxylic azelaic acid – sum is a zoophilic species, most often causing competitive inhibits tyrosinase, a key enzyme in dermatomycoses in cattle. The incidence of the human melanogenesis. This substance contributes fungus infections in humans is small (<1% of all to the formation of hypopigmented skin spots [27]. skin fungal infections), it causes deep lesions of Analysis the patients’ data showed the greatest Celsi type. Humans are mainly infected incidence of tinea versicolor in young people in through direct contact (farmers, cattle breeders), relation to other age groups (J. Kwaśniewska, E. 216 J. B³aszkowska, A. Wójcik

Morus-Urbańska, A. Jaskółowska – Medical children. In one of them co-infection with Univer sity of Lodz). The most frequent location of parainfluenza virus type 3 was detected. The authors clinical changes concerned the skin on the back indicated that the primary fungus infection may (significantly more frequent in women than in men) manifest as acute airways inflammations suggestive or both back and chest. The only favourable factor of viral infections. In the differential diagnosis of of infection was seborrhea, predominantly found in Pneumocystis infections in children molecular patients from the youngest age group. methods are useful for their high sensitivity of Water ecosystems and animals closely connected samples testing of material collected noninvasively. with them are rich reservoirs of factors potentially Deposits of cells, forming complex surface- pathogenic for humans. Special role belong to associated communities enclosed in a matrix water and mud birds – cormorants and produced by them are named biofilms. Biofilm- Charadriiformes. Evaluation of alimentary tract associated microorganisms have been shown to be (beak, intestine and cloaca) and respiratory system the cause of several human diseases, such as native of these birds revealed 14 spe cies of 8 ge ne ra of valve endocarditis and cystic fibrosis, and to yeast- li ke fun gi and one spe cies of mo uld fun gus colonize a wide variety of medical devices. The (A. Bie dun kie wicz, J. Dzie koń ska- Ryn ko, M. Dy - study of biofilm formation in YNB and serum by now ska, E. Su cha rzew ska, E. Ej dys, K. Gó ral ska Candida albicans strains isolated from fungal – Uni ver si ty of War mia and Ma zu ry, Olsz tyn). Can- infections of the mucous membranes of the oral di da kru sei was dominating species (28% of cavity, vagina and gastrointestinal tract was positive isolates). In all tested birds the presence of conducted in flat bottom titration plates larvae and adult nematodes Contracaecum (P. Krzyściak, Jagiellonian University Medical rudolphii was found. Man can be a paratenic host College, Cracow). To quantitative assessment of for this cosmopolitan parasite. Also, all the birds biofilm formation the light microscopy and were infected with Paradilepis scolecina tapeworm evaluation with crystal violet staining were used. which does not invade humans. It is worth pointed There were no differences in the ability of biofilm out, that the human body may be a new habitat for formation among examined 41 strains of C. albicans fungi and parasites, for which the reservoir are wild from different ontocenoses in both substrates. birds. These vertebrates are still in contact with Serum, however, increases several times the ability water reservoirs and easily translocate in man’ to form biofilms by these strains. surrounding environment. Mo le cu lar ana ly sis of fun gi stra ins al lows un der- is the causative agent of stan ding the ge ne tic di ver si ty and struc tu re of fun- (PCP), one of the severe gus po pu la tions. Stra ins of the ge ne ra Tri cho phy ton , infections in premature infants, dystrophic children Epi der mo phy ton , and Mi cro spo rum de ri ved from and children with immunological disfunctions or hu mans and ani mals from Lodz and Lu blin we re highly hypoalimented. Serologic studies have exa mi ned with ap pli ca tion of the RAPD me thod ba - shown that children are exposed to P. jirovecii early sed on (GA CA) 4 and (ACA) 5 pri mers (J. Dęb ska, in life. It may be transplacental or airborne A. Cie siel ska, A. Ja wor ski – Uni ver si ty of Lodz). acquisition of the disease from human sources. The stu dy re ve aled dif fe ren tia tion of stu died stra ins Evaluation of group of children (age 7 days to 24 wi thin spe cies T. men ta gro phy tes and T. ajel loi months) hospitalized with acute respiratory (both in not nu me ro us num ber of stra ins) and lack infections revealed P. jirovecii prevalence of 16% of dif fe ren tia tion of 59 stra ins of M. ca nis . The au- [28]. From the group of 70 children, aged from 11 thors em pha si zed that in or der to con firm the ob ta- days to 5 years, treated in Warsaw hospitals with ined pre li mi na ry re sults fur ther re se arch is ne eded acute respiratory infections, the aetiology of which on a lar ger col lec tion of stra ins and ba sed on other was defined as viral basing on clinical symptoms, mo le cu lar me thods (PCR- MP). nasopharynx swabs were collected (E. Gołąb, Sco pu la riop sis bre vi cau lis cau sing ma in ly su- W. Rożej-Bielicka, K. Pancer – NIPH-NIH, per fi cial in fec tions (na il fun gal in fec tions, less often Warsaw). In 86% of patients the infection with at skin) may al so be the cau se of in va si ve my co ses least one of RNA viruses was detected: RSV, (i.a., ke ra ti tis, en do ph thal mi tis , en do car di tis , si nu si - hMPV, PIV 1-3, enteroviruses. The use of nested tis , pul mo na ry asper gil lo sis, cerebral mycosis). PCR method allowed for P. jirovecii infection Literature data indicate that this species is resistant identification in two (2.9%) of the examined to Amphotericin B, 5-Fluorocytosine, Terbinafine, Parasitic diseases 217 and azole drugs. Assessment of antimicrobial airways (nose and throat); Cladosporium susceptibility carry out in vitro using agar diffusion macroparvum: diameter 5–10 μm – upper and lower method revealed sensitivity of 31 clinical and 4 airways; Aspergillus fumigatus: diameter 2–5 μm – references S. bre vi cau lis stra ins to 12 an ti fun gal lower airways) and cause allergies or dysfunctions drugs (M. Skó ra, A.B. Ma cu ra – Ja giel lo nian Uni- of the tract. The analysis of seasonal biodiversity of ver si ty Me di cal Col le ge, Cra cow). An ti fun gal ac ti- pathogenic fungi present in the air of poultry house vi ty aga inst all tested strains was demonstrated for and around farm by the collision method (aeroscope terbinafine, ciclopirox and clotrimazole, but in the MAS 100 Merck) revealed, out of 90 air samples, 26 case of the latter drug 87% of strains were weakly fun gi spe cies of the ge ne ra: Asper gil lus , Pe ni ci lium , sensitive. Multiple drug resistance of S. brevicaulis Al ter na ria , Cla do spo rium , Exo phia la , Fu sa rium , may require combination therapy, and/or surgical Cha eto mium , Sco pu la riop sis , Acre mo nium , Can di- procedures. The authors pointed out that promising da and Rho do to ru la (K. Ple wa, E. Lonc – Wroc law result have been obtained by a team of Cuenca- Uni ver si ty). The gre atest bio di ver si ty of fungi was Estrella , who have demonstrated that certain in the spring/summer, and the highest concentration combinations of antifungal drugs (Posokonazole of fungi in the autumn. Outdoor air was plus Terbinafine, Voriconazole plus Terbinafine, characterized by greater biodiversity and lesser Itrakonazole plus Terbinafine, Amphotericin B plus concentration in comparison with the interior of the Caspofungin, Posokonazole plus Caspofungin, poultry houses, where the cfu/m 3 values exceeded Vorikonazole plus Caspofungin) exhibit synergistic the recommended level. activity in vitro against S. brevicaulis [29]. Fungi and fungus-like organisms, together with The health implications of the fungal some bacteria species, play significant role in the contamination of indoor air are still an issue of aquatic ecosystems – take part in decomposition of increasing concern in recent years. It is recognized organic matter commonly found in inland waters. that fungi can cause spectrum of illnesses in But also, fungi potentially pathogenic and humans, ranging from rhinitis to invasive diseases. allergogenic for humans may be present in water Especially important is the role of environmental reservoirs. For evaluation of the organisms fungi in causing in occurring in the Horodnianka river water, near immunocompromised patients in hospitals. waste landfills in the vicinity of Bialystok, the Contamination of air and walls in one of Cracow method of plant and animal baiting was used (B. Ki- hospitals, in five operating rooms equipped with air zie wicz, E. Zdroj kow ska, B. Ga jo, A. Go dlew ska, conditioning with absolute filters was evaluated for E. Mu szyń ska, B. Ma zal ska – Me di cal Uni ver si ty of 5 days (twice a day, 7.00 am and 7.00 pm) (A. Bia ly stok). 26 spe cies of fun gi and fun gus- li ke or - Gniadek, A. B. Macura – Jagiellonian University ga ni sms we re cul ti va ted, in c lu ding po ten tial ly pa- Medical College, Cracow). Air samples were taken tho ge nic, of the ge ne ra: Al ter na ria , Asper gil lus , Fu - using a MAS 100 (Merck) device, and imprints sa rium , La ge ni dium and Pe ni cil lium . The pre sen ce from the walls were collected by Count-Tact of se wa ge fun gus Lep to mi tus lac teus was al so de - method. Of the 50 air samples in 48 cases the fungal tec ted which, in ad di tion to bac te ria Spha ero ti lus growth was observed (mean numbers 5–100 no tans , Be agia toa al ba and Zo oglea ra mi ge ra may cfu/m 3). Only three samples exceeded the be a good biological indicator of α-mesosaprobic permissible concentration of microorganisms for zone. highly aseptic operating rooms according to the Polish and Swiss requirements. The dominant fungi References isolated from the operating theatres environment were microorganisms from species Aspergillus [1] Ruffer M.A. 1910. Note on presence of Bilharzia (35%), Penicillium (24%) and Cladosporium haematobia in Egyptian mummies of Twentieh dynasty (1250–1000 B.C.). British Medical Journal (19%). 1: 16. Bioaerosol consisting of viruses, bacteria, [2] Ferreira L.F., Araújo A., Confalonieri U. 1979. moulds and yeast fungi, Acaridae – stored product Subsídios para a paleoparasitologia do Brasil: mites and plants pollen may constitute threat to parasitos encontrados em coprólitos no município de human health. Fungal spores depend on diameter, Unaí, MG. Congresso da Sociedade de Parasiliera de can be deposed in some parts of respiratory tract Parasitologia 4, Campinas, Resumos: 66. (Alternaria alternata : diameter > 10 μm – upper [3] Ortega Y.R., Bonavia D. 2003. Cryptosporidium, 218 J. B³aszkowska, A. Wójcik

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He ad- to- he ad com pa ri son of the ac ti vi ties of receptors, Th2 and Treg Responses. European cur ren tly ava ila ble an ti fun gal agents aga inst 3,378 Journal of Immunology 40: 1525–1537. Spa nish cli ni cal iso la tes of and fi la men to us [16] Doligalska M., Donskow-Schmelter K., Rzepecka fun gi. An ti mi cro bial Agents and Che mo the ra py 50: J., Drela N. 2007. Reduced apoptosis in BALB/c mice 917-921 . infected with Heligmosomoides polygyrus . Parasite Immunology 29: 283-291. Received 16 October 2011 [17] Elliott D.E., Urban, J.F., Curtis K., Argo C.K., Joel Accepted 24 November 2011