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Human Dirofilariasis in the European Union

https://doi.org/10.1016/S0169-4758(99)01496-9Get rights and content

Abstract

The dog parasites Dirofilaria immitis and D. (Nochtiella) repens, well known as zoonotic agents, are widely distributed in southern Europe. Although both species are canine parasites, infection with immature worms has been found in humans, who develop nodules, mainly in subcutaneous tissue or in lung parenchyma arising from branches of the pulmonary artery. In humans, the parasites do not usually reach the adult stage and microfilaremia is absent, as has been shown by diagnosis using invasive methods for removing the nodules. In this article, Antonio Muro, Claudio Genchi, Miguel Cordero and Fernando Simón review the current situation concerning the clinical and epidemiological aspects, immune response and diagnosis of human dirofilariases.

Section snippets

Antigenic characteristics and immunology

The surface antigens of L3, L4 and adult worms of D. immitis differ. In L3 there are dominant polypeptides of 6 and 35 kDa, while in L4, up to eight dominant polypeptides appear in the range of 8 to 57 kDa16. During in vitro culture, the 6 and 35 kDa molecules of L3 were shed into the medium and were not subsequently replaced17. In addition, two other 20.5 and 22 kDa polypeptides were shed by L3 during the moult process to L4 (Ref. 18). In a recent study on the purification of these two

The main problem

The detection and diagnosis of both D. immitis and D. (Nochtiella) repens in humans present different aspects (Fig. 2). In the case of subcutaneous nodules, it is usually the patient who seeks medical attention, while most pulmonary nodules are detected accidentally, by thoracic radiography. Given that both subcutaneous and pulmonary nodules can cause suspicion of a malignant tumour and other pathological conditions (tuberculosis, fungal infections and hamartomas)27, surgery is usually

Conclusions and future perspectives

In the European Union, the geographical distributions of human dirofilariases coincide with those observed in dogs. Most reported cases have been in the southern countries. Nevertheless, a number of cases have been diagnosed in individuals living in northern countries who had travelled to the south. This shows that the risk exists not only for human populations living in areas where canine infections are endemic, but also for people who visit these areas.

Immunological studies have shown that an

Acknowledgements

This work was supported by Acción Integrada 26A España-Italia (Ministerio de Educación y Ciencia, Subdirección General de Cooperación Internacional). We are grateful to Ramón Admetlla for assistance with the figures and to G.H. Jenkins for translating the manuscript.

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