Fatal human eosinophilic meningo-encephalitis caused by CNS co-infection with Halicephalobus gingivalis and West Nile virus

Anwar, M.A.; Gokozan, Hamza; Ball, Matthew K.; Otero, José; McGwire, Bradford S.

doi:10.1016/j.parint.2015.06.001

Cited by 10 publications

(11 citation statements)

References 22 publications

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“…However, considering the severity of the lesions, it can be anticipated that the damage caused by the infection could be irreversible, in spite of the efficacy of anthelmintic drugs. As with horses, the cases described in humans were invariably fatal (Papadi et al 2013;Anwar et al 2015;Lim et al 2015;Monoranu et al 2015). Gross lesions included diffuse changes such as oedema or hyperaemia of brain parenchyma and dullness of meninges.…”

Section: Discussionmentioning

confidence: 99%

“…This opportunistic parasite is commonly found in soil, manure, foul water or decaying humus (Johnson et al 2001;Nadler et al 2003). There are so far, <100 cases of halicephalobosis described in literature, mostly in horses (Rames et al 1995;Anderson et al 1998;Br€ ojer et al 2000;Johnson et al 2001;Nadler et al 2003;Bryant et al 2006;Vasconcelos et al 2007) -including ponies (Akagami et al 2007) -, but also in zebras (Isaza et al 2000), cattle (Enemark et al 2016) and humans (Papadi et al 2013;Anwar et al 2015;Lim et al 2015;Monoranu et al 2015). H. gingivalis infection in horses has been reported in five continents, usually involving a wide range of ages (from colts to aging adults) and breeds, leading almost invariably, to a fatal outcome (Anderson et al 1998;Lim et al 2015;Monoranu et al 2015).…”

Section: Introductionmentioning

confidence: 99%

“…In the rare cases in which the disease has been correctly diagnosed in vivo, progression of the disease was quick (hours to a few weeks) and fatal, in spite of treatment (Rames et al 1995;Isaza et al 2000;Kinde et al 2000). Human cases have been reported in various countries, including in North America, Canada (Hoogstraten & Young 1975) and USA (Shadduck et al 1979;Ondrejka et al 2010;Papadi et al 2013;Anwar et al 2015), Australia (Lim et al 2015) and Europe, namely Germany (Monoranu et al 2015), likewise affecting a wide range of patient ages (from 5 to 74 years) and usually involving clinical presentations of fever (which is rarely seen in affected horses (Br€ ojer et al 2000;Bryant et al 2006)), blindness, mental changes and lethargy. The reported outcome has always involved death of the patient.…”

Section: Introductionmentioning

confidence: 99%

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First description of a fatal equine infection with Halicephalobus gingivalis in Portugal. Relevance for public health

Noiva

Ruivo

Carvalho

et al. 2019

Veterinary Medicine & Sci

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Halicephalobus gingivalis is a small saprophytic rhabditid nematode, represented only by females with a typical rhabditoid oesophagus and one egg in the uterus, capable of infecting vertebrates. This opportunistic parasite present in the soil, manure and decaying humus, is thought to penetrate through previous injuries to the mouth, eyes and skin of horses and migrate to various organs. The brain is one such organ, where the females lay their eggs, leading to malacia and causing a sudden onset of neurological signs, such as anorexia, ataxia, urinary incontinence, blindness, decreased menace and tonal reflexes, tremors and aggressiveness. The disease is invariably fatal whenever brain lesions are present, and the diagnosis usually achieved only post‐mortem. The present work aims to describe the first case of infection by H. gingivalis ever reported in Portugal. An 8‐year old warmblood horse presented with an 8‐day history of progressive blindness involving the left eye, initially with normal pupillary reflexes, advancing to bilateral blindness and increasing deterioration in clinical condition. After euthanasia, the animal was submitted for necropsy. Organ samples were collected and fixed in 10% neutral buffered formalin for routine histopathology. A large mass was found in the left kidney corresponding to fibrous tissue heavily infiltrated with inflammatory cells and numerous nematodes. In the brain, multiple, bilateral and asymmetrical foci of malacia containing several rhabditoid nematodes, larvae and zygotes, and high numbers of inflammatory cells were found. The nematodes were identified as H. gingivalis . The clinical history, necropsy and histological findings presented constitute a typical case of H. gingivalis infection in a horse, never previously described in Portugal to the authors’ best knowledge. Humans can be infected by contact with contaminated manure, which makes this nematode a public health concern, especially for people living and/or working in close proximity to horses.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

First description of a fatal equine infection with Halicephalobus gingivalis in Portugal. Relevance for public health

Noiva

Ruivo

Carvalho

et al. 2019

Veterinary Medicine & Sci

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“…On the other hand, only eight fatal cases of H. gingivalis infection have been reported in humans in Canada [34], Australia [35], and Germany [36] and five in the United States [5]. All known human cases presented CNS involvement and neurological symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Occasionally this parasite affects horses, humans, zebras, cattle and big horn sheep [1–5] generally with a fatal outcome. It is characterized by a rhabditiform esophagus, dorsiflexed ovary and ventroflexed vulva.…”

Section: Introductionmentioning

confidence: 99%

Isolation and molecular characterisation of Halicephalobus gingivalis in the brain of a horse in Piedmont, Italy

et al. 2017

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BackgroundA fatal case of meningoencephalitis was reported in a 13-year-old Koninklijk Warmbloed Paard Nederland stallion, suspected of West Nile virus (WNV) infection, in the Piedmont region of Italy. Clinical signs included right head tilt and circling, depression alternated with excitability, fever and lateral strabismus. Combined treatment consisting of dimethylsulfoxide, dexamethasone, sulphonamides and sedative was administered, but because of the poor conditions the horse was euthanatized and submitted for necropsy.ResultsAt post-mortem examination no skin lesions were observed, all organs appeared normal on gross evaluation and only head and blood samples were further investigated. Neuropathological findings consisted of granulomatous meningoencephalitis and larvae and adult females of Halicephalobus gingivalis were isolated and identified from the digested brain. Frozen brain was submitted to PCR amplification and 220 bp multiple sequence alignment was analysed by Bayesian phylogenetic analysis.ConclusionsPhylogenetic inference revealed that the isolate belongs to H. gingivalis Lineage 3. WN surveillance can help to deepen our knowledge of horse neurological disorders investigating their causes and incidence. Moreover, it can help to understand the geographic distribution of the H. gingivalis, to unravel epidemiological information, and to estimate risk for humans.

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First report of fatal systemic Halicephalobus gingivalis infection in two Lipizzaner horses from Romania: clinical, pathological, and molecular characterization

et al. 2015

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Halicephalobus gingivalis (H. gingivalis) causes a rare and fatal infection in horses and humans. Despite the zoonotic potential and severity of the disease, the epidemiology and pathogenesis of halicephalobiasis are still poorly understood. Several European cases of equine halicephalobiasis have been documented; however, in South-Eastern European countries, including Romania, equine neurohelminthiasis caused by H. gingivalis has not been previously described. Two Lipizzaner horses with a clinical history of progressive neurological signs were referred to the Pathology Department of the Cluj-Napoca (Romania) for necropsy. Both horses died with severe neurological signs. Gross examination and cytological, histological, and molecular analyses were performed. The stallions came from two different breeding farms. No history of traveling outside Romania was recorded. At necropsy, granulomatous and necrotizing lesions were observed in the kidneys, lymph nodes, brain, retroperitoneal adipose tissue, and lungs, indicating a systemic infection. Parasitological and histopathological analyses evidenced larval and adult forms of rhabditiform nematodes consistent with Halicephalobus species. Parasites were observed in both lymph and blood vessels of different organs and were also identified in urine samples. A subunit of the large-subunit ribosomal RNA gene (LSU rDNA) of H. gingivalis (673 bp) was amplified from lesions in both horses.To the authors' knowledge, this is the first report of equine systemic H. gingivalis infection in Romania and in South-Eastern Europe. Our findings provide new insights into the geographic distribution of specific genetic lineages of H. gingivalis, while also raising public health awareness, as the parasite is zoonotic.

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Fatal human eosinophilic meningo-encephalitis caused by CNS co-infection with Halicephalobus gingivalis and West Nile virus

Cited by 10 publications

References 22 publications

First description of a fatal equine infection with Halicephalobus gingivalis in Portugal. Relevance for public health

First description of a fatal equine infection with Halicephalobus gingivalis in Portugal. Relevance for public health

Isolation and molecular characterisation of Halicephalobus gingivalis in the brain of a horse in Piedmont, Italy

First report of fatal systemic Halicephalobus gingivalis infection in two Lipizzaner horses from Romania: clinical, pathological, and molecular characterization

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