Imported Loa Loa Filariasis: Three Cases and a Review of Cases Reported in Non-Endemic Countries in the Past 25 Years

Summary Objectives The aim of this study was to highlight the increasing chance of Western physicians encountering patients (both immigrants and expatriates/travelers) seeking help for loiasis. Methods We describe three cases of imported loiasis observed at two hospitals in Italy and France, and present a review of all previously published cases in the medical literature in the last 25 years (1986–2011). The search was performed using PubMed and Scopus databases using the terms " Loa loa " AND "loiasis". Results We reviewed 101 cases of imported loiasis of which 61 (60.4%) were reported from Europe and 31 (30.7%) from the USA. Seventy-five percent of infestations were acquired in three countries: Cameroon, Nigeria, and Gabon. Overall, peripheral blood microfilariae were detected in 61.4% of patients, eosinophilia in 82.1%, eye worm migration in 53.5%, and Calabar swellings in 41.6%. However, Calabar swellings and eosinophilia were more common among expatriates/travelers, whereas African immigrants were more likely to have microfilaremia. Eye worm migration was observed in a similar proportion in the two groups. Only 35 patients (including the three described here) underwent clinical follow-up for a median period of 10.5 months (range 1–84 months); clinical relapse occurred in three of these patients and persistence or reappearance of blood microfilaria in another two. Conclusions Due to increasing travel and the migration of people from the endemic countries of West Africa to Europe and the USA, we speculate on the possible emergence of loiasis. Western physicians should be aware of the typical (eye worm migration and Calabar swellings) as well as unusual clinical presentations

General and specific replication profiles are detected in normal human cells by genome-wide and single-locus molecular combing

Mammalian genomes are replicated under a flexible program, with random use of origins and variable fork rates, and many details of the process must be still unraveled. Molecular combing provides a set of direct data regarding the replication profile of eukaryotic cells: fork rates; organization of the replication clusters; proportion of unidirectional forks; and fork dynamics. In this study the replication profiles of different primary and immortalized non-cancer human cells (lymphocytes, lymphoblastoid cells, fibroblasts) were evaluated at the whole-genome level or within reference genomic regions harboring coding genes. It emerged that these different cell types are characterized by specific replication profiles. In primary fibroblasts, a remarkable fraction of the mammalian genome was found to be replicated by unidirectional forks, and interestingly, the proportion of unidirectional forks further increased in the replicating genome along the population divisions. A second difference concerned in the proportion of paused replication forks, again more frequent in primary fibroblasts than in PBL/lymphoblastoid cells. We concluded that these patterns, whose relevance could escape when genomic methods are applied, represent normal replication features. In single-locus analyses, unidirectional and paused replication forks were highly represented in all genomic regions considered with respect to the average estimates referring to the whole-genome. In addition, fork rates were significantly lower than whole-genome estimates. Instead, when considering the specificities of each genomic region investigated (early to late replication, normal or fragile site) no further differentiating features of replication profiles were detected. These data, representing the integration of genome-wide and single-locus analyses, highlight a large heterogeneity of replication profiles among cell types and within the genome, which should be considered for the correct use of replication datasets

Replication dynamics at common fragile site FRA6E

The replication dynamics at common fragile site FRA6E has been evaluated by molecular combing and interphase fluorescent in situ hybridisation (FISH) in primary human lymphocytes cultured under normal or aphidicolin-induced stress conditions. FRA6E is one of the most frequently expressed common fragile sites of the human genome. It harbours several genes, PARK2 being regarded as the most relevant one. According to the results obtained from interphase FISH analysis, FRA6E can be considered a mid-late-replicating sequence characterised by heterogeneous replication timing. Molecular combing did not reveal specific replication parameters at the fragile site: fork rates were highly comparable to those detected at an early replicating locus (LMNB2) used as control and in very good agreement with the whole-genome data obtained in parallel. The same indication applied to the density of initiation zones, the inter-origin distances from adjacent ongoing forks, the frequencies of unidirectional forks, fork arrest events and asynchronous forks. Interestingly, PARK2 appeared embedded in an early/late replication transition zone, corresponding to intron 8 (162 kb) and to the fragility core of FRA6E. In cells exposed to aphidicolin, few forks progressing at a rather slow rate were observed, the majority of them being unidirectional, but again a specific response of the fragile site was not observed. In summary, at FRA6E the replication process is not impaired per se, but chromosome breakages occur preferentially at an early/late replication transition zone. Aphidicolin might increase the occurrence of breakage events at FRA6E by prolonging the time interval separating the replication of early and late replication domains. These results may be of general significance to address the problem of fragile site instability

Older age limits the use of adjuvant chemotherapy according to all negative risk factors in early breast cancer patients.

Background: Adjuvant chemotherapy of elderly women is currently perceived as one of the priorities in breast cancer (BC) research and prospective trials are still lacking. We performed a retrospective analysis of the actual use of adjuvant cytotoxic treatment according to each negative prognostic factor at our Institution. Methods: Charts of 384 women 65 70 yrs with BC referred from 2000 to July 2003 were reviewed for tumor stage and treatment, and compared with an equal cohort of younger, randomly selected post-menopausal patients (pts) (control group). Results: 232 elderly pts with histologic diagnosis of early BC were eligible, mean age 75 yrs, range 70\u201397 (vs 61 yrs, range 50\u201369). Fifty-four percent of pts underwent conservative surgery (vs 68.7%); nodal dissection was performed in 85% (vs 92.2%), sentinel node biopsy in 4.7% (vs 5.9%). Tumor size was pT2-T3 in 43% of pts, grading was G3 in 26.7%, hormonal status was positive in 79%, lymphnodes were positive in 35%. Of 161 elderly pts presenting one or more risk factors (pT2-T3, N+, G3 or ER-), 50.3% (vs 6.7%) were not proposed adjuvant chemotherapy. Were considered unfit for adjuvant chemotherapy 50% of women with pT2-pT3 (vs 11.7%), 39.5% with nodal involvement (vs 4.3%), 38.7% with G3 (vs 1.4%) and 22.5% of ER- (vs 0%). Thirteen pts (16%) of those proposed for chemotherapy refused (vs 7.3%), while 19 women starting treatment (27.9%) were not able to complete the planned number of cycles (vs 13.2%). Toxicity in pts receiving CMF (and not anthracyclines) is outlined in table. Conclusions: Age or age-associated conditions strongly limited the choice for adjuvant chemotherapy in elderly BC pts according to all prognostic factors, with ER- status probably being the most impelling factor for its use. Toxicity of CMF regimen frequently imposed treatment interruption, therefore alternative regimens should be assessed in this age class

Tungiasis in Italy: An imported case of Tunga penetrans and review of the literature

Tungiasis is an animal and human parasitic disease caused by fleas of the genus Tunga (Siphonaptera, Tungidae), endemic in equatorial and subtropical regions and rarely described in European countries, where clinicians and general pathologists could be not aware of this parasitic disease. To our knowledge, only 75 cases of human tungiasis (not all described in detail) were previously reported in Italy. We described a new case in a 34-year-old Italian flight attendant who developed a granuloma-like, ulcerated nodule in the subungual region of his left 5th toe, partially detaching the nail, about 20-30 days after his return from Brazil. We performed a detailed review of the literature of the Italian cases, suggesting the use of histochemical stains (especially Trichrome stain) in order to underline parasitic details. Tourism in endemic regions and globalization may result in new cases in developed countries and previously unaffected regions, therefore pathologists should consider this parasitic disease