Search

Every year Christian pilgrims from around the world visit the holy sites located around the Sea of Galilee. Some become ill during their stay with infectious diseases that were acquired in their country of origin, and are hospitalized at Poriya Medical Center. They pose a diagnostic challenge due to language barriers, the rarity of these infections in Israel, and the fact that diagnostic tests are not readily available. All patient records from 2015 of Holy Land tourists hospitalized at Poriya Medical Center were screened for the diagnosis of imported zoonotic diseases that are not commonly diagnosed in Israel. Three patients who were on a Holy Land tour were hospitalized during 2015 with laboratory-confirmed diagnostically challenging zoonotic infectious diseases: a 91-year-old priest from Ethiopia diagnosed with relapsing fever due to Borrelia recurrentis, an 85-year-old retired mountaineer from New Hampshire diagnosed with human granulocytic anaplasmosis, and a 57-year-old farmer from central Brazil diagnosed with leptospirosis. These case reports emphasize the importance of considering imported zoonotic infectious diseases and obtaining appropriate diagnostic tests when treating Holy Land travelers to Israel.

Blood samples from 18 tickborne relapsing fever (TBRF) patients and Ornithodoros tholozani specimens were tested with a Borrelia flaB-PCR. Results were positive for all patients and 2%–40% of ticks. A 7–amino acid gap characterized all 9 sequenced flagellin gene amplicons. By phylogenetic analysis, Israel TBRF Borrelia sequences clustered separately from American and African groups.

Acute liver fluke infection results from eating raw fish illegally imported from Siberia., Liver fluke infection caused by Opisthorchiidae is a major public health problem in many parts of the Far East, Southeast Asia, and eastern Europe. However, with the growing volume of international travel and population migration, the infection is increasingly diagnosed in countries where the disease is not endemic, particularly in North America. We report an outbreak of acute opisthorchiasis in a family that was infected in a non–disease-endemic area after eating raw carp illegally imported from a highly disease-endemic area in Siberia. With the growing numbers of former Soviet Union citizens immigrating to other countries, western physicians need to be alert regarding Opisthorchis-associated pathology in this population. The epidemiology and biology of Opisthorchiidae in the former Soviet Union are reviewed.

We report seven cases of false-positive Plasmodium falciparum histidine-rich protein 2 (PfHRP2) malaria assay results in patients with acute schistosomiasis caused by Schistosoma mekongi . PfHRP2 assays were negative in travelers infected with Schistosoma mansoni or Schistosoma haematobium ( n = 13). Malaria was ruled out and rheumatoid factor was negative in all patients.

Based on the unusually high and stage-dependent susceptibility of Plasmodia to oxidant stress it has been proposed that during parasite development, increasing levels of redox-active forms of iron are gradually released. The purpose of this study was to examine this proposal by using an assay monitoring the levels of available forms of iron for redox reactions. Ascorbate-driven and iron-mediated degradation of adventitious DNA served as the basis for this functional assay. Incubation of DNA with lysate from infected RBC caused massive degradation, which was dose, time- and parasite-stage dependent. In contrast, lysate from non-infected RBC did not induce DNA degradation. Likewise, lysate only from infected RBC enhanced the aerobic oxidation of ascorbate. These effects on both reaction, DNA degradation and ascorbate oxidation, could be reconstructed with hemin, instead of lysate. Also, chelators exerted similar effects on both reactions. The results suggest that increased levels of redox-active forms of iron are liberated during parasite development. We propose that hemin or hemin-like structures are the appropriate candidates which could catalyze oxidative stress and deregulate the delicate redox balance of the host-parasite system.

The identification of the Tick Borne Relapsing Fever (TBRF) agent in Israel and the Palestinian Authority relies on the morphology and the association of Borrelia persica with its vector Ornithodoros tholozani. Molecular based data on B. persica are very scarce as the organism is still non-cultivable. In this study, we were able to sequence three complete 16S rRNA genes, 12 partial flaB genes, 18 partial glpQ genes, 16 rrs-ileT intergenic spacers (IGS) from nine ticks and ten human blood samples originating from the West Bank and Israel. In one sample we sequenced 7231 contiguous base pairs that covered completely the region from the 5′end of the 16S rRNA gene to the 5′end of the 23S rRNA gene comprising the whole 16S rRNA (rrs), and the following genes: Ala tRNA (alaT), Ile tRNA (ileT), adenylosuccinate lyase (purB), adenylosuccinate synthetase (purA), methylpurine-DNA glycosylase (mag), hypoxanthine-guanine phosphoribosyltransferase (hpt), an hydrolase (HAD superfamily) and a 135 bp 5′ fragment of the 23S rRNA (rrlA) genes. Phylogenic sequence analysis defined all the Borrelia isolates from O. tholozani and from human TBRF cases in Israel and the West Bank as B. persica that clustered between the African and the New World TBRF species. Gene organization of the intergenic spacer between the 16S rRNA and the 23S rRNA was similar to that of other TBRF Borrelia species and different from the Lyme disease Borrelia species. Variants of B. persica were found among the different genes of the different isolates even in the same sampling area.

Twelve Israeli travelers acquired schistosomiasis in Laos during 2002–2008, and 7 of them had acute schistosomiasis. The patients were probably exposed to Schistosoma mekongi in southern Laos, an area known to be endemic for schistosomiasis. Four possibly were infected in northern Laos, where reports of schistosomiasis are rare.

Onchocerciasis results from infestation by the nematode Onchocerca volvulus, and is characterized clinically by troublesome itching, skin lesions and eye manifestations. Since 1992, approximately 9,000 immigrants have arrived in Israel from the Kuwara province of northwest Ethiopia where the prevalence of onchocerciasis is particularly high.To determine whether onchocerciasis is the cause of cutaneous and ocular symptoms among recent immigrants from the Kuwara province in Ethiopia.We examined 1,200 recent immigrants from the Kuwara province residing at the Mevasseret Zion immigration center outside Jerusalem. Among them, patients with cutaneous signs suggestive of onchocerciasis underwent a skin-snip biopsy and a thorough eye examination.In the detailed skin examination performed in 83 patients, the most common skin finding was chronic papular onchodermatitis, found in more than 46 patients (55%); depigmentation and atrophy was found in 13 (15%) and 12 (14%), respectively. In 40 patients (48%), living microfilaria were detected in their skin snips. Of the 65 patients who underwent a through eye examination, 45 patients (66%) had ocular complaints. Corneal abnormalities were found in 55 of the 130 eyes (42%), active anterior segment intraocular inflammation and live microfilariae were found in 4 eyes (3%) and lens changes in 16 eyes (1%). Eleven eyes (9%) showed retinal or choroidal changes.Skin and eye manifestations associated with onchocerciasis are prevalent among symptomatic Ethiopians who immigrated to Israel from the Kuwara province.

The role of reactive oxygen species (ROS) generated by polymorphonuclear leucocytes (PMNs) in the host response against malaria was investigated. Non-activated human PMNs were added to cultures of P. falciparum in microtitre cells. Parasite viability was evaluated by the incorporation of radioactive hypoxanthine. Using PMN/RBC = 1/150 (starting parasitemia was 1%) the incorporation on the second day in culture was only 61% of the control cultures. An effect could be observed already after two hours of incubation (30% reduction at a 1/50 PMN/RBC ratio). A direct contact between the effector and target cells was obligatory for the expression of the damage. Parasites within G6PD-deficient erythrocytes were more sensitive to the PMNs than normal parasitized erythrocytes. This difference could be attributed to the production of reactive oxygen intermediates in the experimental system, since G6PD-deficient erythrocytes are generally more sensitive to oxidant stress. Salicylic acid was used as a scavenger and reporter molecule for hydroxyl radical fluxes. It is converted to the corresponding dihydroxybenzoic acid derivatives, which could be detected by HPLC. Uninfected NRBC or parasitized erythrocytes containing young ring forms could trigger the PMNs to produce much less ROS than the mature forms of the parasites. Other factors associated with PMNs may inactivate the parasites, such as phagocytosis, lysosomal enzymes or degradation toxic products of the PMNs. However our results indicate that increased oxidative stress induced by PMNs interfere with the growth of P. falciparum and could play a role in human evolution of abnormal erythrocytes.

The role of transition metals in paraquat toxicity was studied in cultures of Plasmodium falciparum. We showed that addition of copper led to an enhancement of the plasmodium killing, whereas addition of chelating agents. such as desferrioxamine and diethylenetriamine pentaacetic acid markedly reduced the toxic effects. Parsitized G6PD deficient erythrocytes were more sensitive than parasitized normal eryth-rocytes to copper and to the combination of copper and paraquat.

Oxidative stress has been incriminated as a deleterious factor in the development of malaria parasites. Various chemical reductones which can undergo cyclic oxidation and reduction, such as ascorbate have been shown to cause oxidative stress to red blood cells. This, naturally-occurring and redox-active compound, can induce the formation of active oxygen derived species, such as superoxide radicals (*O;), hydrogen peroxide (H,O,) and hydroxyl radical (OH.). The formation of the hydroxyl radical, the ultimate deleterious species, is mediated by the redox-active and available transition metals iron and copper in the Haber-Weiss reaction. During the development of the parasite, hemoglobin is progressively digested and a concurrent release of high levels of iron-containing breakdown products takes place within the red blood cell. Indications for the progressive increase in redox-active iron during the growth of P. falciparunr have bcen recently found in our lab: a) adventitious ascorbatc proved highly detrimental to the parasite when added to the mature forms. In contrast, if the parasitized erythrocytes were in the early phase following invasion, and only low levels of iron-containing structures had been liberated. then the observed effect was a small promotion of parasite development. b) erythrocytes containing mature parasites were more potent than erythrocytes containing ring forms as a source for redox-active iron in the ascorbate-driven metal-mediated degradation of DNA. The addition of extracts from parasitized erythrocytes and ascorbate to DNA causcd a dose and time dependent DNA degradation. Non-infected erythrocytes had no effect. These findings could also propose that the parasite-dependent accumulation of redox-active forms of iron within the erythrocytes serve as a biological clock triggering the rupture of the red blood cell membrane at the right moment, when the parasite reaches its maturity.

Goldenser J., Marva E., Spira D. T., Gabrielsen A. A. and Jensen J. B. 1985. Mitogenic and antigenic activity of Plasmodium falciparum in primate and rodent lymphocytes. International Journal for Parasitology 15: 435–440. Considerable reaction of human leucocytes to a wide range of concentrations of plasmodial preparations derived from in vitro cultures of Plasmodium falciparum was observed. Highest responses were recorded after 6 days in culture. This differed from the response to PHA or CON-A which peak with a narrow range of concentrations after 3 days in culture. Parasitized erythrocytes (PE) or parasites released from PE as well as soluble antigens obtained from the particulate preparations had a pronounced mitogenic activity which was unaffected by heating to 56°C for 1 h. Peripheral lymphocytes from man and monkey but not from rats reacted to P. falciparum preparations. Spleen cells obtained from normal rats did not react towards any P. falciparum preparation. Spleen cells of rats immune to P. berghei, responded to normal human erythrocytes but the response against P. falciparum antigens was much higher, indicating cross-reactivity with genus specific antigens. The combination of experimental procedures using human peripheral and rat spleen lymphocytes is suggested for differentiation between mitogenic and antigenic activity. Heat inactivation of some proteases present in the plasmodial preparations, while retaining mitogenic activity, may enable further purification of the mitogenic factors.

Synaptic plasma membrane vesicles isolated from rat brain were loaded with L-glutamate either passively, by using a freeze-thaw technique, or by active transport. Subsequently the ion dependency of glutamate efflux from these vesicles was studied. With each of the types of loading similar results were obtained. Efflux requires the simultaneous presence of internal sodium ions and external potassium ions. The process is also stimulated by chloride ions, but either internal or external chloride ions cause stimulation. Addition of unlabeled L-glutamate stimulates efflux about 2-fold. It is concluded that efflux of L-glutamate is in many aspects symmetrical with its influx [Kanner, B. I., & Sharon, I. (1978) Biochemistry 17, 3949--3954]. It appears that in order for L-glutamate to interact with the transporter, sodium has to be present on the same side as L-glutamate whereas potassium has to be simultaneously present on the opposite site. The simplest way to account for these and the previous data is to postulate that the L-glutamate transporter catalyzes sodium and L-glutamate cotransport, while it simultaneously catalyzes antiport of potassium.

The effects of ascorbate and copper on the development of Plasmodium falciparum were studied in two modes: pretreatment of uninfected erythrocytes followed by infection by P. falciparum and treatment of parasitized erythrocytes. Pretreatment of G6PD(+) cells with ascorbate caused a slight enhancement in parasite development, while in G6PD(-) cells a suppressive effect on the plasmodia was demonstrated. Copper alone interfered with parasite growth in both cell types. The combination of copper and ascorbate arrested parasite maturation, an effect which was more pronounced in G6PD(-) cells. Synergism between copper and ascorbate was better demonstrated following the treatment of infected erythrocytes: while ascorbate alone supported parasite development and copper alone had only a marginal suppressive effect, the combination of copper and ascorbate yielded a marked inhibition of parasite growth. Ascorbate proved destructive to the parasites in the presence of adventitious copper, or on the second day of the parasite life cycle. In these cases it acted as a pro-oxidant, while in other systems, in particular in the presence of a chelator, ascorbate acted as an antioxidant and promoted parasite growth. The understanding of the role of transition metals and free radicals in parasite development and injury could shed light on novel approaches to fight malaria.