Nora Pierangeli - Academia.edu (original) (raw)

Papers by Nora Pierangeli

Parasitology

Most human cystic echinococcosis (CE) cases worldwide are attributed to Echinococcus granulosus s... more Most human cystic echinococcosis (CE) cases worldwide are attributed to Echinococcus granulosus sensu stricto (s.s), followed by the G6 and G7 genotypes. While E. granulosus s.s. has a cosmopolitan distribution, the G6 genotype is restricted to areas where camels and goats are present. Goats are the primary livestock in the Neuquén province in Argentina where the G6 genotype has been reported to be responsible for a significant percentage of CE human cysts genotyped. In the present study, we genotyped 124 Echinococcus cysts infecting 90 CE-confirmed patients. Echinococcus granulosus s.s. was identified in 51 patients (56.7%) with 81 cysts and the G6 genotype in 39 patients (43.3%) harbouring 43 cysts. Most CE cases ≤18 years were male suggesting pastoral work could be a risk factor for the infection. Echinococcus granulosus s.s. was significantly found more frequently in the liver (32/51 patients) and the G6 genotype in the lungs and extrahepatic localizations (27/39). The patients ...

Archivos Argentinos de Pediatria

Infant botulism (IB) is the most common form of human botulism in Argentina. Our objective was to... more Infant botulism (IB) is the most common form of human botulism in Argentina. Our objective was to describe the main aspects of diagnosis and management of patients with IB admitted to the pediatric intensive care unit (PICU). Methods. Observational, descriptive, and retrospective study. The PICU database with IB diagnosis in 2005-2020 period was used. Demographic variables, diagnostic methods, days of conventional mechanical ventilation (CMV), non-invasive ventilation (NIV), length of stay in the PICU and mortality upon hospital discharge were recorded. Results. In total, 21 patients with IB were recorded; 14 were male, their median age was 5 months (IQR: 2-6 m). Diagnosis was made by bioassay, and the toxin was identified in the serum of 12 patients. Only 1 patient did not require CMV; 1 patient had a tracheostomy; 18 patients received antibiotics; 5 received NIV. No patient was administered antitoxin and no patient died. The median length of stay in the hospital was 66 days (IQR: 42-76); in the PICU, 48 days (IQR: 29-78); and the median use of CMV, 37 days (IQR: 26-64). The delay until diagnostic confirmation was 15.8 ± 4.8 days. All patients were diagnosed using the bioassay technique, which resulted in a diagnostic delay that exceeds the recommended period for the administration of a specific treatment. No patient received a specific treatment. IB was related to a low mortality, but also to prolonged use of MV and length of hospital stay, which were associated with cross infections and frequent antibiotic use.

Revista Argentina de Zoonosis y Enfermedades Infecciosas Emergentes, Aug 1, 2015

Veterinary Parasitology: Regional Studies and Reports

Fil: Lazzarini, Lorena Evelina. Universidad Nacional del Comahue. Facultad de Ciencias Medicas; A... more Fil: Lazzarini, Lorena Evelina. Universidad Nacional del Comahue. Facultad de Ciencias Medicas; Argentina.

International Journal of Infectious Diseases, 2018

Background: Influenza A and B (Flu A/B), parainfluenza (PIV) and respiratory syncytial virus (RSV... more Background: Influenza A and B (Flu A/B), parainfluenza (PIV) and respiratory syncytial virus (RSV) cause lower and upper respiratory tract disease (LRD-URD) with significant clinical impact on patients with hematological malignancies (HM) or hematopoietic stem cell transplantation (HSCT). Rhinoviruses (HRV) are being increasingly detected in these infections, although their clinical impact remains a matter of debate. Our objective was to describe and compare clinical characteristics and outcomes of patients with HM and HSCT with LRD-URD caused by HRV versus non-HRV: Flu A/B, PIV and RSV. Methods & Materials: Prospective observational study. We compared HRV (G1) vs. Flu A/B, PIV and RSV (G2) respiratory infections in patients with HM and HSCT between January 2013 and September 2017. Chi-square analysis and Kruskal-Wallis test were used for categorical and continuous variables, respectively. Results: We enrolled 114 episodes: 45 in G1, 69 in G2. Both groups had patients with similar hematological diseases and stages, being lymphoma and acute leukemia the most frequent. Steroid therapy (20% vs 50.7%, p = 0.001) was significantly higher in G2, while use of biologic agents (40% vs 17.4%, p = 0.007), lymphopenia (33% vs 16.2% p = 0.034) and clinical presentation during preengraftment (20% vs 5.8%, p = 0.032) was higher in G1. Rhinorrhea was the most common symptom in G1 (71.1% vs 46.4%, p = 0.009). Other symptoms had similar frequencies in both groups. Over 50% of all infections presented as LRD (52% vs 50.7%, p = 0.968). Hypoxemia presented in similar rates (28.9% vs 27.5%, p = 0.875). The most common tomographic infiltrates were alveolar pattern and bilateral extension. In G1, co-pathogens in respiratory specimens were isolated in three patients (6.7% vs 0% p = 0.053) and other three had detectable plasma CMV viral load (6.7% vs 0% p = 0.012). Hospitalization was required in 58.8% of cases, with no significant difference between both groups. The 30-day overall mortality rate due to G1 and G2 infections were 6.7% and 7.2%, respectively (p = 1). Conclusion: Patients with HM or HSCT and HRV infections had similar clinical picture and outcome to common respiratory viruses, with significant morbidity. Therefore, active diagnostic approaches are required, especially in patients with lymphopenia or use of biologic agents.

Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases, Jan 21, 2018

Cystic echinococcosis (CE), a zoonotic disease caused by tapeworms of the species complex Echinoc... more Cystic echinococcosis (CE), a zoonotic disease caused by tapeworms of the species complex Echinococcus granulosus sensu lato, represents a substantial global health and economic burden. Within this complex, E. granulosus sensu stricto (genotypes G1 and G3) is the most frequent causative agent of human CE. Currently, there is no fully reliable method for assigning samples to genotypes G1 and G3, as the commonly used mitochondrial cox1 and nad1 genes are not sufficiently consistent for the identification and differentiation of these genotypes. Thus, a new genetic assay is required for the accurate assignment of G1 and G3. Here we use a large dataset of near-complete mtDNA sequences (n = 303) to reveal the extent of genetic variation of G1 and G3 on a broad geographical scale and to identify reliable informative positions for G1 and G3. Based on extensive sampling and sequencing data, we developed a new method, that is simple and cost-effective, to designate samples to genotypes G1 and...

Revista latinoamericana de microbiología

The frequency of intestinal parasites (IP) in 69 children between 2 and 14 years of age was studi... more The frequency of intestinal parasites (IP) in 69 children between 2 and 14 years of age was studied within the city of Neuquén, Patagonia, Argentina in relation to socioeconomic, cultural and environmental conditions. Soil type was determined and contamination with IP was investigated in 75 soil samples. Frequency of IP in children was 50.7%. Blastocystis hominis was the most frequent species (24.6%). Simultaneous infection with 2 to 4 species was found in 47,5% of the infected children. Statistical association was found between parasitic infection and family hygienic level (p < 0.001). Socioeconomic level was defined as lower middle class, however, infrastructure and public services were adequate. The climate is continental semiarid and the soil is sandy with a low organic matter level. Intestinal protozoan organisms were found in 33.3% of soil samples and Sarcocystis sp. was the most frequent species (14.6%). The parasites present in soil are related to the environmental condit...

Human cystic echinococcosis is a highly endemic zoonotic disease in the province of Neuquén, Pata... more Human cystic echinococcosis is a highly endemic zoonotic disease in the province of Neuquén, Patagonia Argentina, although a hydatid control programme has been carried out since 1970. Human infection due to Echinococcus canadensis (G6 genotype) is frequent in Neuquén. However, the reservoir for this species remains undetermined in a region where camels are absent. We investigated the fertility, viability and molecular epidemiology of hydatid cysts obtained from local goats, pigs and sheep in order to identify the possible reservoirs of E. canadensis (G6). We also analyzed isolates from infected dogs. A total of 67 isolates were identified by the DNA sequencing of the mitochondrial cytochrome c oxidase subunit 1 gene. Cysts from sheep (n = 16), goats (n = 23) and pigs (n = 18) and adult worms from 10 infected dogs were analyzed. The fertility of the hydatid cysts was 78.6%; 90.4% and 94.4% for sheep, goats and pigs, respectively. We detected E. canadensis (G6) in 21 of 23 goat samples and in 1 dog isolate, E. canadensis (G7) in all the pig isolates, E. granulosus sensu stricto (G3) in 1 sheep and the G1 genotype in 15 sheep, 2 goats and 9 dog samples. The G1 haplotypes included the common sheep strain sequence and 2 microvariants of this sequence. E. granulosus sensu stricto (G3) is described for the first time in South America. We conclude that goats act as reservoir for E. canadensis (G6) in Neuquén, and that control strategies may have to be adapted to local molecular epidemiology to improve the control of parasite transmission.

Parasitología latinoamericana, 2005

En poblaciones urbanas y periurbanas, la presencia, persistencia y diseminación de parásitos inte... more En poblaciones urbanas y periurbanas, la presencia, persistencia y diseminación de parásitos intestinales (PI) se relacionan en forma directa con las características geográficas y ecológicas específicas del lugar 1-4 así como con las condiciones de saneamiento básico disponibles 5,6 ,

Veterinary Parasitology, 2010

Tropical Medicine and International Health, 2003

Objetivo Se determinó la presencia de huevos, larvas, quistes y ooquistes de pará sitos intestina... more Objetivo Se determinó la presencia de huevos, larvas, quistes y ooquistes de pará sitos intestinales en suelo de un barrio periurbano de la ciudad de Neuquén durante un añ o con el objeto de evaluar sus fluctuaciones estacionales considerando los datos climá ticos y las características edá ficas de la zona en estudio.

Parasitology Research, 2013

In Argentina, hydatid disease caused by Echinococcus granulosus is widespread. The south of Bueno... more In Argentina, hydatid disease caused by Echinococcus granulosus is widespread. The south of Buenos Aires province, Argentina, is one of the three regions where hydatidosis is endemic. Although domestic dogs and sheep are considered to be the main hosts for E. granulosus, the potential role of wildlife in the local transmission of E. granulosus has not been investigated. The aim of this study was to estimate the hydatidosis/echino coccosis prevalence in European hare (Lepus europaeus) and Pampas fox (Lycalopex gymnocercus), two abundant species with a strong predator-prey relationship in rural areas of Buenos Aires province using different diagnostic tests. A total of 61 fox intestines were examined, finding that 52 (85.2 %) harbored at least one helminth species. However, no adult or immature form of Echinococcus sp. was found in the intestinal contents. Coproparasitological analysis and Copro-ELISA followed by Copro-PCR were used as supplementary diagnostic tests. Only one (1.7 %) of 59 fecal samples was positive to Taeniidae eggs by coproparasitological analysis, but this same sample was negative by the Copro-ELISA test. The analysis by Copro-ELISA showed 6 of 57 (10.6 %) positive samples, but the Copro-PCR tests carried out on these samples were negative to E. granulosus. A total of 6,808 lungs, 3,576 livers, and 3,542 hearts of hunted hares were examined and palpated, but no structure resembling hydatid cysts were detected. Our results suggest that hares and Pampas foxes are not currently important wild reservoirs of E. granulosus in the studied area.

Parasitology International, 2007

The present study is the first comprehensive analysis of human cystic echinococcosis (CE) epidemi... more The present study is the first comprehensive analysis of human cystic echinococcosis (CE) epidemiological data carried out in the province of Neuquén, Patagonia Argentina, after 34 years of uninterrupted control program. A retrospective study of all the official records of confirmed human CE cases between 1995 and 2004 was carried out. A total of 1107 cases were reported. The overall mean annual incidence (MAI) was 24.4 per 100,000 inhabitants for the total population and 9.7/100,000 in the 0-14 year group. Distribution of cases by age and sex as well as frequency of cyst locations was analysed. Children accounted for 13.3% of total cases, indicating active transmission of the disease. Territorial distribution of cases was highly heterogeneous: MAI per 100,000 ranged from 7.9 in the Metropolitan Sanitary Area to 78.4 in the western rural areas. Higher values were recorded in small communities as Pilo Lil (800/100,000). MAI showed a significant decrease from 1995 to 1999 (43.9-18.8) but remains stable from 2000 to 2004 (15.9-15.5). These results suggest that standard control measures, despite long-term implementation, are not able to produce a sustained improvement of the epidemiological status of the disease. Further studies about local transmission cycles, definite and intermediate hosts present, Echinococcus granulosus strains or cultural behaviours in small communities are required in order to adequate the control actions in Neuquén.

Journal of Helminthology, 2013

Cystic echinococcosis caused by Echinococcus granulosus sensu lato is one of the most important h... more Cystic echinococcosis caused by Echinococcus granulosus sensu lato is one of the most important helminth zoonoses in the world; it affects both humans and livestock. The disease is endemic in Argentina and highly endemic in the province of Neuquén. Considerable genetic and phenotypic variation has been demonstrated in E. granulosus, and ten different genotypes (G1–G10) have been identified using molecular tools. Echinococcus granulosus sensu lato may be considered a species complex, comprised of E. granulosus sensu stricto (G1–G3), E. equinus (G4), E. ortleppi (G5) and E. canadensis (G6–G10). In endemic areas, the characterization of cystic echinococcosis molecular epidemiology is important in order to apply adequate control strategies. A cut-off value for larval large hook total length to distinguish E. granulosus sensu stricto isolates from those produced by other species of the complex was defined for the first time. Overall, 1780 larval hooks of 36 isolates obtained from sheep (...

Objective: To determine the presence of eggs larva cysts and oocysts of intestinal parasites in t... more Objective: To determine the presence of eggs larva cysts and oocysts of intestinal parasites in the soil of a suburb of Neuquen city during 1 year in order to evaluate their seasonal fluctuations in relation to climatic data and soil characteristics in the studied area. Methods: A total of 107 soil samples were processed for parasite isolation by sedimentation and flotation methods during the four seasons of the year. Meteorological data were registered and physical chemical and structural characteristics of the soil were analysed. Results: About 28.9% of the soil samples were positive for at least one parasite form. Six protozoa species (cysts of Entamoeba sp. Enteromonas sp. Endolimax sp. Giardia sp. Iodamoeba sp. and coccidia oocysts) were recovered but neither larvae nor eggs of human or animal helminths parasites were detected. The percentage of contaminated soil samples and the diversity of species showed a marked decrease in the warm and dry months of the summer. The soil was...

Veterinary Parasitology, 2016

Echinococcus granulosus sensu lato (E. granulosus sl) must be considered as a species complex, co... more Echinococcus granulosus sensu lato (E. granulosus sl) must be considered as a species complex, comprising Echinococcus granulosus sensu stricto (E. granulosus ss, genotypes G1-G3), Echinococcus equinus (G4), Echinococcus ortleppi (G5) and Echinococcus canadensis (G6-G10) although the species status of E. canadensis is still controversial. These genotypes closely match the intermediate hosts associated strains described in earlier times among which E. canadensis G6 corresponds to the camel strain. As there are no studies concerning the development of adult stages of the G6 genotype from non-camel origin, the aims of the present study were: to characterize for the first time the development of E. canadensis G6 in dogs experimentally infected with protoscoleces derived from goats, to describe the resultant adult morphology, to evaluate the growth of their rostellar hooks from larval to adult stages and to determine the prepatent period of the strobilar stage of E. canadensis G6 derived from goats. The development of the strobilar stage of E. canadensis G6 genotype of goat origin was examined by studying the growth (variation of the total worm length) and segmentation in experimentally infected dogs at 14, 25, 35 and 56days post infection. A morphological characterization of 35-day-old worms as well as of larval and adult rostellar hooks was also carried out by conventional optical microscopic observations and/or by scanning electron microscopy. The prepatent period of the strobilar stage was assessed by microscopic examination of faeces from 2 infected dogs. Our results were compared with published data from the camel and other strains. The roles of the host, genotype and species in morphological and developmental features as well as the taxonomic position of E. canadensis G6 were discussed. The prepatent period of E. canadensis G6 genotype of goat origin was determined as at least, 41days. The obtained results contribute to increase the knowledge about the biology and genetics of E. granulosus sl complex and are also of practical usefulness for the design of disease control strategies.

Parasitology Research

Human cystic echinococcosis caused by the larval stage of Echinococcus granulosus sensu lato (s.l... more Human cystic echinococcosis caused by the larval stage of Echinococcus granulosus sensu lato (s.l.) is a highly endemic disease in the province of Neuquén, Patagonia, Argentina. Human infections with E. granulosus sensu stricto (s.s.) G1 and Echinococcus canadensis G6 were reported in Neuquén in previous studies, whereas four genotypes were identified in livestock: G1, G3, G6, and G7. The aim of this study was to identify the genotypes of E. granulosus s.l. isolates from humans of Neuquén province, Patagonia, Argentina, through the 2005-2014 period. Twenty six hydatid cysts were obtained from 21 patients. The most frequent locations were the liver and lungs. Single cysts were observed in 81.0% of patients, and combined infection of liver and lungs was detected in 9.5% of cases. Partial sequencing of mitochondrial cytochrome c oxidase subunit 1 (cox1) and NADH dehydrogenase subunit 1 (nad1) genes identified the presence of E. granulosus s.s. G1 (n = 11; 42.3%) including three different partial sequences; E. canadensis G6 (n = 14; 53.8%) and E. canadensis G7 (n = 1; 3.9%). Coinfection with G1 and G7 genotypes was detected in one patient who harbored three liver cysts. Most of the liver cysts corresponded to G1 and G6 genotypes. This study presents the first report in the Americas of a human infection with E. canadensis G7 and the second worldwide report of a coinfection with two different species and genotypes of E. granulosus s.l in humans. The molecular diversity of this parasite should be considered to redesign or improve the control program strategies in endemic regions.

International journal for parasitology, Jan 18, 2018

Echinococcus granulosus sensu stricto (s.s.) is the major cause of human cystic echinococcosis wo... more Echinococcus granulosus sensu stricto (s.s.) is the major cause of human cystic echinococcosis worldwide and is listed among the most severe parasitic diseases of humans. To date, numerous studies have investigated the genetic diversity and population structure of E. granulosus s.s. in various geographic regions. However, there has been no global study. Recently, using mitochondrial DNA, it was shown that E. granulosus s.s. G1 and G3 are distinct genotypes, but a larger dataset is required to confirm the distinction of these genotypes. The objectives of this study were to: (i) investigate the distinction of genotypes G1 and G3 using a large global dataset; and (ii) analyse the genetic diversity and phylogeography of genotype G1 on a global scale using near-complete mitogenome sequences. For this study, 222 globally distributed E. granulosus s.s. samples were used, of which 212 belonged to genotype G1 and 10 to G3. Using a total sequence length of 11,682 bp, we inferred phylogenetic ...