{"id":2219,"date":"2020-09-08T12:34:48","date_gmt":"2020-09-08T10:34:48","guid":{"rendered":"https:\/\/www.newslab.sk\/ojedinely-pripad-autochtonnej-humannej-dirofilariozy-s-prejavom-pseudotumoru-nadsemennika-sposobenej-helmintom-dirofilaria-repens\/"},"modified":"2020-09-08T12:37:25","modified_gmt":"2020-09-08T10:37:25","slug":"a-rare-case-of-autochthonous-human-dirofilariasis-with-the-manifestation-of-pseudotumor-of-the-epididymis-caused-by-helminth-dirofilaria-repens","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/a-rare-case-of-autochthonous-human-dirofilariasis-with-the-manifestation-of-pseudotumor-of-the-epididymis-caused-by-helminth-dirofilaria-repens\/","title":{"rendered":"A rare case of autochthonous human dirofilariasis with the manifestation of pseudotumor of the epididymis caused by helminth Dirofilaria repens"},"content":{"rendered":"

*A rare case of autochthonous human dirofilariasis with the manifestation of pseudotumor of the epididymis caused
\nby helminth Dirofilaria repens<\/strong><\/span><\/p>\n

 <\/p>\n

\u00davod<\/strong><\/p>\n

Za ochorenie zn\u00e1me ako hum\u00e1nna dirofilari\u00f3za je zodpovedn\u00fd nitkovit\u00fd obl\u00fd helmint s ve\u013ekos\u0165ou 5 a\u017e 17 cm. Ide o zoon\u00f3zu, kde pren\u00e1\u0161a\u010dmi larv\u00e1lnych \u0161t\u00e1di\u00ed s\u00fa kom\u00e1re. \u010clovek je len ak\u00fdmsi ne\u0161pecifick\u00fdm pr\u00edle\u017eitostn\u00fdm hostite\u013eom, av\u0161ak psy, ma\u010dky a r\u00f4zne m\u00e4so\u017eravce s\u00fa definit\u00edvnymi hostite\u013emi. V\u0161etky diagnostikovan\u00e9 hum\u00e1nne pr\u00edpady (20), (graf 1) na Slovensku boli sp\u00f4soben\u00e9 druhom D. repens(1,2). Infekcia u pacientov sa prejavuje najm\u00e4 tvorbou subkut\u00e1nnych uzl\u00edkov, subkut\u00e1nnou migr\u00e1ciou, eryt\u00e9mom alebo prienikom helminta do oka. Lokaliz\u00e1cia dirofilari\u00f3zy v oblasti genit\u00e1li\u00ed je ve\u013emi zriedkav\u00e1, \u010do potvrdzuje aj literat\u00fara, kde bolo op\u00edsan\u00fdch iba nieko\u013eko pr\u00edpadov. Chirurgick\u00e9 odstr\u00e1nenie parazita sa pova\u017euje za \u00fa\u010dinn\u00fa formu terapie(3).<\/p>\n

 <\/p>\n

Vlastn\u00fd pr\u00edpad<\/strong><\/p>\n

\u0160tyridsa\u0165\u0161es\u0165ro\u010dn\u00fd mu\u017e poch\u00e1dzaj\u00faci z obce Topo\u013en\u00edky (okres Dunajsk\u00e1 Streda) a pracuj\u00faci ako vodi\u010d kami\u00f3nu si objavil podko\u017en\u00fa hr\u010dku v oblasti skr\u00f3ta. Obvodn\u00fd lek\u00e1r predpokladal cystu, ktor\u00e1 by sa po nieko\u013ek\u00fdch mesiacoch mala vstreba\u0165. V krvnom obraze boli detegovan\u00e9 anom\u00e1lie v podobe zv\u00fd\u0161en\u00e9ho po\u010dtu eozinofilov (16,6 %) a zn\u00ed\u017een\u00e9ho po\u010dtu neutrofilov (38,9 %). Hr\u010dka sa v\u0161ak ani po 9 mesiacoch nevstrebala a pacient bol n\u00faten\u00fd nav\u0161t\u00edvi\u0165 urologick\u00e9 oddelenie v Nemocnici v Galante, kde mu bolo indikovan\u00e9 sonografick\u00e9 vy\u0161etrenie. Z\u00e1verom bol lok\u00e1lny n\u00e1lez, pravdepodobne pseudotumor s kalcifik\u00e1ciou, bez prekrvenia s ve\u013ekos\u0165ou 13 x 18 mm, na pravom nadsemenn\u00edku aj s vo\u013enou tekutinou. Po exc\u00edzii bola vzorka odoslan\u00e1 na histologick\u00e9 vy\u0161etrenie, ktor\u00e9ho v\u00fdsledkom bolo podozrenie na fibr\u00f3m. Av\u0161ak a\u017e po parazitologickom vy\u0161etren\u00ed na z\u00e1klade morfologick\u00fdch znakov (mnohovrstvov\u00e1 kutikula a pozd\u013a\u017ene kutikul\u00e1rne hrebene, dvojit\u00fd uterus a \u010drevo) sme identifikovali sami\u010dku parazita Dirofilaria repens (obr\u00e1zok 1). Fin\u00e1lne potvrdenie priniesol d\u00f4kaz DNA D. repens (209 bp fragment g\u00e9nu cytochr\u00f3m oxid\u00e1zy podjednotky CO1) s pou\u017eit\u00edm PCR(4).<\/p>\n

 <\/p>\n

Diskusia<\/strong><\/p>\n

Dokumentujeme prv\u00fd pr\u00edpad dirofil\u00e1riovej infekcie skr\u00f3ta u pacienta zo Slovenska. Autocht\u00f3nny p\u00f4vod dirofilari\u00f3zy predpoklad\u00e1me aj napriek tomu, \u017ee pacient je vodi\u010dom kami\u00f3nu a cestuje do zahrani\u010dia (Nemecko, D\u00e1nsko). V oboch t\u00fdchto krajin\u00e1ch bol doteraz dokumentovan\u00fd iba po jednom pr\u00edpade hum\u00e1nnej dirofilari\u00f3zy(5). Na Slovensku bolo potvrden\u00fdch 13 subkut\u00e1nnych, 4 o\u010dn\u00e9, 1 p\u013e\u00facna hum\u00e1nna dirofilari\u00f3za, 1 prie\u010dne pruhovan\u00e9ho svalu prsn\u00edka a 1 v nadsemenn\u00edku. Preva\u017en\u00e1 v\u00e4\u010d\u0161ina diagnostikovan\u00fdch pr\u00edpadov (13\/20) dirofilari\u00f3zy bola zaznamenan\u00e1 v juhoz\u00e1padn\u00fdch \u00fazemiach Slovenska. V okolit\u00fdch krajin\u00e1ch (Ma\u010farsko, Rak\u00fasko, Po\u013esko) bolo taktie\u017e diagnostikovan\u00fdch nieko\u013eko pr\u00edpadov (30) autocht\u00f3nnej hum\u00e1nnej dirofilari\u00f3zy. Av\u0161ak na Ukrajine bolo dokumentovan\u00fdch a\u017e vy\u0161e 1 400 os\u00f4b infikovan\u00fdch D. repens(6). Pribli\u017ene 25 % v\u0161etk\u00fdch n\u00e1dorov nadsemenn\u00edkov je zhubn\u00fdch vr\u00e1tane fibrosark\u00f3mov, adenokarcin\u00f3mov, lymf\u00f3mov a \u010fal\u0161\u00edch. Dirofilari\u00f3za mu\u017esk\u00fdch pohlavn\u00fdch org\u00e1nov je ve\u013emi zriedkav\u00e1, \u010do dokumentuje iba 22 op\u00edsan\u00fdch pr\u00edpadov v odbornej literat\u00fare(3). Tieto n\u00e1lezy na pohlavn\u00fdch org\u00e1noch je mo\u017en\u00e9 si zameni\u0165 za zhubn\u00e9 n\u00e1dory. Pre stanovenie spr\u00e1vnej diagn\u00f3zy neexistuj\u00fa spo\u013eahliv\u00e9 pr\u00edznaky ochorenia a ani laborat\u00f3rne parametre v krvnom obraze, najm\u00e4 zv\u00fd\u0161en\u00e9 hladiny eozinofilov \u010di IgE protil\u00e1tok. Aj
\nke\u010f v na\u0161om pr\u00edpade sme u pacienta detegovali zv\u00fd\u0161en\u00e9 hladiny eozinofilov na za\u010diatku infekcie. Objekt\u00edvna diagn\u00f3za je prim\u00e1rne zalo\u017een\u00e1 na morfologick\u00fdch znakoch helminta pomocou mikroskopick\u00e9ho d\u00f4kazu spolu s konfirm\u00e1ciou za vyu\u017eitia PCR pre d\u00f4kaz \u0161pecifickej DNA dirofil\u00e1ri\u00ed(3,4).<\/p>\n

 <\/p>\n

Z\u00e1ver<\/strong><\/p>\n

Do bud\u00facna mo\u017eno o\u010dak\u00e1va\u0165 st\u00fapaj\u00faci po\u010det infikovan\u00fdch pacientov na na\u0161om \u00fazem\u00ed, \u010do potvrdzuje a\u017e 8 diagnostikovan\u00fdch pr\u00edpadov hum\u00e1nne dirofilari\u00f3zy za posledn\u00e9 2 roky (graf 1). Tento predpoklad s\u00favis\u00ed s glob\u00e1lnym otep\u013eovan\u00edm, so z\u00e1plavami, a t\u00fdm zv\u00fd\u0161en\u00fdm kalamitn\u00fdm v\u00fdskytom kom\u00e1rov.<\/p>\n

Pr\u00e1ca bola podporen\u00e1 projektom KEGA 013TTU-4\/2019.<\/p>\n

 <\/p>\n

LITERAT\u00daRA<\/strong>
\n1. Boldi\u0161 V, Ondriska F, Bo\u0161\u00e1k V, et al. Pseudo-tumor of the epididymis, a rare clinical presentation of human Dirofilaria repens infection: a report of autochthonous case of dirofilariasis in south western Slovakia. Acta Parasit 2020; DOI 10.2478\/s11686-020-00170-w
\n2. Ondriska F, Boldi\u0161 V, Stanislavov\u00e1 M, et al. Ocular dirofilariasis after clinically manifested subcutaneous migration of the parasite: a case report. Iran J Parasitol 2020; 15: 147-152.
\n3. Leccia N, Patouraux S, Carpentier X, et al. Pseudo-tumor of the scrotum, a rare clinical presentation of dirofilariasis: a report of two autochtonous cases due to Dirofilaria repens. Pathog Glob Health 2012; 106: 370-372.
\n4. Antolov\u00e1 D, Miterp\u00e1kov\u00e1 M, Parali\u010dov\u00e1 Z. Case of human Dirofilaria repens infection manifested by cutaneous larva migrans syndrome. Parasitol Res 2018; 114: 2969-2973.
\n5. Klintebjerg K, Petersen E, Pshenichnaya NY, et al. Periorbital Dirofilaria repens imported to Denmark: A human case report. IDCases 2015; 2: 25-26.
\n6. Sa\u0142amatin RV, Pavlikovska TM, Sagach OS, et al. Human dirofilariasis due to Dirofilaria repens in Ukraine, an emergent zoonosis: epidemiological report of 1465 cases. Acta Parasitol 2013; 58: 592-598.<\/p>\n","protected":false},"excerpt":{"rendered":"

*A rare case of autochthonous human dirofilariasis with the manifestation of pseudotumor of the epididymis caused by helminth Dirofilaria repens   \u00davod Za ochorenie zn\u00e1me ako hum\u00e1nna dirofilari\u00f3za je zodpovedn\u00fd nitkovit\u00fd obl\u00fd helmint s ve\u013ekos\u0165ou 5 a\u017e 17 cm. Ide o zoon\u00f3zu, kde pren\u00e1\u0161a\u010dmi larv\u00e1lnych \u0161t\u00e1di\u00ed s\u00fa kom\u00e1re. \u010clovek je len ak\u00fdmsi ne\u0161pecifick\u00fdm pr\u00edle\u017eitostn\u00fdm hostite\u013eom,<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[1596],"tags":[1714,1718,1717],"class_list":["post-2219","post","type-post","status-publish","format-standard","hentry","category-parazitologia-en","tag-dirofilaria-repens-en","tag-genital-involvement","tag-human-dirofilariasis","typ_clanku-casuistry"],"acf":{"abstrakt":"

Dirofilariasis caused by the filarial nematode Dirofilaria repens is mainly a disease of dogs. Humans can also be accidentally infected. Mosquitoes transmit the infective larvae. Here we document a clinically rare case of human dirofilariasis in a 46-year-old man from south-western Slovakia. Genital involvement manifests itself as pseudotumor nodule affecting the epididymis. The ultrasound examination was indicated, and subsequently, surgical excision of the right epididymal nodule was performed. Based on microscopic histological examination and PCR-based detection, the helminth was identified as D. repens. The majority of D. repens infections were recorded in south-western regions of Slovak Republic, which are considered to be endemic areas for canine dirofilariasis.<\/p>\n

Keywords:<\/strong> Dirofilaria repens, human dirofilariasis, genital involvement<\/p>\n","casopis":[{"ID":2132,"post_author":"7","post_date":"2020-09-04 08:09:57","post_date_gmt":"2020-09-04 06:09:57","post_content":"SUPPLEMENT\r\n\r\nPri pr\u00edle\u017eitosti odbornej konferencie\r\n\r\nI. Aktu\u00e1lne probl\u00e9my hum\u00e1nnej parazitol\u00f3gie<\/strong>\r\n