Aetiological study of the presumed ocular histoplasmosis syndrome in the Netherlands

Aim. To investigate whether presumed ocular histoplasmosis syndrome in the Netherlands is caused by Histoplasma capsulatum and whether other risk factors might play a role in the pathogenesis of this syndrome. Methods. 23 patients were clinically diagnosed as having presumed ocular histoplasmosis syndrome based on the following criteria: peripapillary atrophy, punched out lesions, a macular disciform lesion or scar in one eye without vitritis. As controls, 66 sex and age matched healthy volunteers were used. Serum samples from both patients and controls were tested for the presence of antibodies against H capsulatum, Toxoplasma gondii, Toxocara canis et cati, Ascaris sp, and for the presence of antigens of Cryptococcus neoformans. Serum samples were also tested for the presence of autoantibodies against retinal or choroidal proteins. To investigate other risk factors, patients and controls were asked to fill in a health and travel related questionnaire. Ten patients with ocular toxoplasmosis were used as a disease control group. Results. None of the patients with presumed ocular histoplasmosis syndrome or controls had circulating antibodies directed against H capsulatum. No risk factors could be identified and no indications for autoimmunity and no evidence for the role of the other infectious agents could be demonstrated. Conclusions. In a Dutch group of patients fulfilling the criteria of a disease currently named presumed ocular histoplasmosis syndrome, no risk factors or relation with the fungus H capsulatum could be detected

Neurocysticercose: een importziekte om aan te denken.

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Congenital toxoplasmosis and DALYs in the Netherlands.

The calculation of disability-adjusted life years (DALYs) enables public health policy makers to compare the burden of disease of a specific disease with that of other (infectious) diseases. The incidence of a disease is important for the calculation of DALYs. To estimate the incidence of congenital toxoplasmosis (CT), a random sample of 10,008 dried blood spot filter paper cards from babies born in 2006 in the Netherlands were tested for Toxoplasma gondii-specific IgM antibodies. Eighteen samples were confirmed as positive for IgM, resulting in an observed birth incidence of CT of 1.8 cases per 1,000 live-born children in 2006 and an adjusted incidence of 2.0 cases per 1,000. This means that 388 infected children were born in 2006. The most likely burden of disease is estimated to be 2,300 DALYs (range 820-6,710 DALYs). In the previous calculations, using data from a regional study from 1987, this estimate was 620 DALYs (range 220-1,900 DALYs). The incidence of CT in the Netherlands is much higher than previously reported; it is 10 times higher than in Denmark and 20 times higher than in Ireland, based on estimates obtained using the same methods. There is no screening program in the Netherlands; most children will be born asymptomatic and therefore will not be detected or treated

Congenital toxoplasmosis and DALYs in the Netherlands.

The calculation of disability-adjusted life years (DALYs) enables public health policy makers to compare the burden of disease of a specific disease with that of other (infectious) diseases. The incidence of a disease is important for the calculation of DALYs. To estimate the incidence of congenital toxoplasmosis (CT), a random sample of 10,008 dried blood spot filter paper cards from babies born in 2006 in the Netherlands were tested for Toxoplasma gondii-specific IgM antibodies. Eighteen samples were confirmed as positive for IgM, resulting in an observed birth incidence of CT of 1.8 cases per 1,000 live-born children in 2006 and an adjusted incidence of 2.0 cases per 1,000. This means that 388 infected children were born in 2006. The most likely burden of disease is estimated to be 2,300 DALYs (range 820-6,710 DALYs). In the previous calculations, using data from a regional study from 1987, this estimate was 620 DALYs (range 220-1,900 DALYs). The incidence of CT in the Netherlands is much higher than previously reported; it is 10 times higher than in Denmark and 20 times higher than in Ireland, based on estimates obtained using the same methods. There is no screening program in the Netherlands; most children will be born asymptomatic and therefore will not be detected or treated

Antigen recognition by IgG4 antibodies in human trichinellosis

The antibody isotype response to Trichinella spiralis excretory/secretory (ES) products of muscle larva was examined using sera from patients with confirmed trichinellosis. Using Western blots we identify components of the ES antigen that are recognized by IgM and IgG antibodies. A 45 kDa component was strongly recognized by different antibody classes and subclasses. We observed a 45 kDa-specific lgG4 response that was detected exclusively using sera of patients with trichinellosis and not of patients with echinococcosis, filariasis, cysticercosis, ascariasis, strongyloidiasis or toxocariasis. These results are relevant for the diagnosis of human trichinellosis

Antigen recognition by IgG4 antibodies in human trichinellosis

The antibody isotype response to Trichinella spiralis excretory/secretory (ES) products of muscle larva was examined using sera from patients with confirmed trichinellosis. Using Western blots we identify components of the ES antigen that are recognized by IgM and IgG antibodies. A 45 kDa component was strongly recognized by different antibody classes and subclasses. We observed a 45 kDa-specific lgG4 response that was detected exclusively using sera of patients with trichinellosis and not of patients with echinococcosis, filariasis, cysticercosis, ascariasis, strongyloidiasis or toxocariasis. These results are relevant for the diagnosis of human trichinellosis

Gastro-enteritis in huisartsenpeilstations.

De incidentie van huisartsconsulten voor gastro-enteritis van 77 per 10.000 persoonjaren lijkt een lichte daling te vertonen t.o.v. de incidentie van 90 per 10.000 persoonjaren in een vergelijkbaar onderzoek in 1992-1993. De belangrijkste verwekkers van gastro-enteritis waarvoor de huisarts wordt geconsulteerd waren Campylobacter spp, Salmonella spp, rotavirus, SRSV en Giardia lamblia en Dientamoeba fragilis. Deze laatste twee werden echter ook veel bij controles aangetroffen. De incidentie en het percentage positief voor Salmonella spp, Salmonella Enteritidis en Campylobacter leken enigszins gedaald ten opzichte van een vergelijkbaar onderzoek in 1992-1993. De risicofactoren die uiteindelijk geïndentificeerd werden voor de verschillende groepen pathogenen kunnen dienen als handvaten bij het bepalen van preventieve maatregelen voor het oplopen van een infectie met deze pathogenen

A comparison of gastroenteritis in a general practice-based study and a community-based study.

We compared gastroenteritis cases that consulted a general practitioner (GP) with those who did not in a community-based study and also with those in a GP-based study. We aimed to identify factors associated with consultation, and with inclusion of cases by GPs, and secondly to study the effects on the frequency of detection of pathogens. Furthermore, we estimated the under-ascertainment by GPs. Both studies were performed in The Netherlands in the same population in an overlapping time-period. Overall, 5% of community cases consulted a GP. Cases who consulted suffered from more severe episodes than non-consulting cases. Inclusion of cases by GPs, instead of a study team, caused a selection of more severe cases with more chronic symptoms. When extrapolating data from GP-based studies, it should be taken into account that, in general practice, gastroenteritis due to bacteria and Giardia lamblia is a relatively large proportion of that in the community and gastroenteritis due to Norwalk-like viruses is a relatively small proportion. The incidence of gastroenteritis in general practices was estimated between 14 and 35 per 1000 person years

Zoonotic parasites in fecal samples and fur from dogs and cats in The Netherlands.

Pets may carry zoonotic pathogens for which owners are at risk. The aim of the study is to investigate whether healthy pets harbour zoonotic parasitic infections and to make an inventory of the interactions between pet-owners and their companion animals in The Netherlands. Fecal and hair samples were collected from healthy household dogs and cats in Dutch veterinary practices. Owners were interviewed about interaction with their pets. The samples were investigated by microscopy, ELISA, and PCR. From 159 households, 152 dogs (D) and 60 cats (C), information and samples were collected and examination for several zoonotic parasites was performed. Toxocara eggs were found in 4.4% (D) and 4.6% (C) of the fecal samples and in 12.2% (D) and 3.4% (C) of the fur samples. The median epg in the fur was 17 (D) and 28 (C) and none of these eggs were viable. From 15.2% of the dog and 13.6% of the cat feces Giardia was isolated. One canine and one feline Giardia isolate was a zoonotic assemblage A (12%). Cryptosporidium sp. were present in 8.7% (D) and 4.6% (C) of the feces. Fifty percent of the owners allow the pet to lick their faces. Sixty percent of the pets visit the bedroom; 45-60% (D-C) are allowed on the bed, and 18-30% (D-C) sleep with the owner in bed. Six percent of the pets always sleep in the bedroom. Of the cats, 45% are allowed to jump onto the kitchen sink. Nearly 39% of the dog owners never clean up the feces of their dog. Fifteen percent of the dog owners and 8% of the cat owners always wash their hands after contact with the animals. Close physical contact between owners and their pets is common and poses an increased risk of transmission of zoonotic pathogens. Education of owners by the vet, specifically about hygiene and potential risks, is required

Brachyspira Species and Gastroenteritis in Humans

Brachyspira species have been implicated as a potential cause of gastroenteritis in humans; this is, however, controversial. In 733 gastroenteritis cases and 464 controls, we found 29 samples positive for Brachyspira species (2.3% of cases and 2.6% of controls; P = 0.77). Brachyspira species were not associated with gastroenteritis in humans