The trends of human dirofilariasis in Croatia: Yesterday – Today – Tomorrow

Abstract

Introduction Human dirofilariasis is a disease historically linked to the Mediterranean area. For the last few decades, however, Dirofilaria nematodes have been spreading, both in terms of prevalence and the geographical expansion in non-endemic areas. Currently, cases of human dirofilariasis are recorded in more than 40 countries worldwide. Croatia is considered an endemic area of the Adriatic basin. Methods In a nationwide investigation, new and previously published cases of human dirofilariasis in Croatia were analyzed. Results Since 1996, 30 cases of human dirofilariosis were reported in Croatia. A total of 14 (46,67%) cases were from the coastal and 16 (53,33%) from continental regions of the country. Based on anatomical location, 13 (43,33%) cases were subcutaneous, 12 (40%) were ocular and five (16,67%) occurred in the reproductive organs. In all 30 cases, Dirofilaria repens was identified as the causative agent. Conclusions An increase in air temperature as climate change, changes in mosquito fauna, high prevalence of D. repens in dogs and limited use of chemoprophylaxis are possible risk factors for Dirofilaria infection in the Croatian population. Since reporting to epidemiological services is not mandatory in this country, the real number of human dirofilariasis cases is probably significantly higher than published. This emphasizes the need for mandatory reporting of human cases and surveillance of Dirofilaria infection in dogs and mosquitoes in Croatia, following the “One Health” concept.

Epidemiological Survey of Dirofilaria Spp. and Acanthocheilonema Spp. in Dogs from the Republic of Moldova

“…Other localisations (e.g. pulmonary, oral cavity, eyelid) have also been reported in the literature (9). In Europe, it is recognised as an emergent pathogen.…”

“…D. immitis causes a severe cardiopulmonary condition in dogs and other domestic and wild carnivores (5). Although humans are considered as accidental hosts, infections occur occasionally and can cause pulmonary life-threatening conditions and, in some instances, even ocular or subcutaneous diseases (7)(8)(9). D. repens is the agent of subcutaneous diro lariasis in animals and usually has a mild or unrecognised clinical form.…”

An epidemiological survey of Dirofilaria spp. and Acanthocheilonema spp. in dogs from the Republic of Moldova

“…D. immitis may cause a severe cardiopulmonary condition in dogs and other domestic, and wild, carnivores [ 5 ]. Although humans are considered to be accidental hosts, infections occasionally occur and can cause pulmonary conditions and, in some instances, ocular or subcutaneous diseases [ 7 – 9 ]. D. repens is the agent of subcutaneous dirofilariasis in animals, which usually has a mild clinical manifestation or is unrecognised.…”

“…Other localisations (e.g. pulmonary, oral cavity, eyelid) of the disease have also been reported [ 9 ]. In Europe, D. repens is recognised as an emergent pathogen.…”

Emergence of zoonotic filariasis, Dirofilaria repens, in eastern Thailand 2019-2020: The impact of climate change

“…D. repens is one of neglected canine lariasis but also found in cats and human (Yilmaz et al, 2016). The epidemiology of D. repens was rstly studied Southern Europe and expanded to Northern Europe (Deksne et al, 2020;Otranto et al, 2013;Pupic-Bakrac et al, 2020). Recently, some study suggested that D. repens in Asia had higher diversity than in European country which purposed name Candidatus D. hongkongensis from Hong Kong and D. repens "Thailand II" found in Narathiwat province, Thailand (To et al, 2012;Yilmaz et al, 2016;Yilmaz et al, 2019).…”