Anisakiasis is an emerging marine food-borne zoonosis resulting from the accidental ingestion of Anisakis larvae, through the consumption of raw or undercooked infected seafood products. The first case of human gastric hyperinfection by Anisakis simplex with an unusual and severe presentation, occurring in a Portuguese woman, is described in this article. Over 140 anisakid larvae were removed by gastroscopy. Massive infection is uncommon in areas where the consumption of raw fish is not part of the traditional diet, as is the case in Portugal. The increased consumption of raw seafood products is considered a health determinant in the rise in cases of anisakiasis. However, clinicians should be aware of the emergence of these infections, not only because of the new dietary habits of the population, but also because of the high prevalence of Anisakis larvae in the different fish species usually consumed by the population, collected on the Portuguese coast.

Giardia duodenalis prevalence is commonly as high as soil-transmitted helminths (STH), nevertheless is not considered for large-scale chemotherapy through mass drug administration (MDA) due to its short incubation period and frequent reinfections, its control being associated to improving access to water and sanitation. A study enrolling 444 children attending preschools was conducted in May 2011 during a deworming campaign. Faecal samples were obtained and analysed through microscopy of wet mounting and after Kato–Katz and formol-ether concentration techniques. The majority of children were infected with at least one pathogenic parasite (86.7%, 385 of 444). Ascaris lumbricoides and Trichuris trichiura (56.3%, 250 of 444 and 52.5%, 233 of 444, respectively) were the most frequent parasites followed by G. duodenalis infecting 41.7% (185 of 444) of the children. The present work aimed at obtaining updated information concerning intestinal parasite infections in children attending preschools in São Tomé and Príncipe and to contribute for the adequate management of the enteric infections.

Strongyloidiasis develops from the infection with Strongyloides stercoralis (Family: Strongylidae) and was recently considered a neglected tropical disease by the World Health Organization due to its global distribution and high burden of infection. Here, we present the cases of two patients under corticosteroid therapy after neurosurgical surgery who developed septic shock-like hyperinfection syndrome due to disseminated strongyloidiasis. The first case is a 77-year-old man from Cape Verde who was diagnosed with an extra-axial right parietal brain mass. He was given dexamethasone and was submitted to a biparietal craniotomy. His condition deteriorated and he was admitted to the intensive care unit (ICU), where he was diagnosed with disseminated strongyloidiasis with hyperinfection. Anthelmintic treatment and corticosteroid therapy were rapidly tapered and stopped. Neurological dysfunction persisted and the patient was transferred to the ward. The patient had died after complications of hospital-acquired pneumonia. The second case is a 47-year-old man from Guinea-Bissau who was diagnosed with a space-occupying lesion in the right temporal region and started treatment with dexamethasone. He underwent a craniectomy with partial excision of the lesion (high-grade glioma). Later his neurologic state worsened, and he was diagnosed with septic shock and hospital-acquired pneumonia. He was admitted to the ICU, the diagnosis of disseminated strongyloidiasis and hyperinfection syndrome was made and he initiated treatment with ivermectin and albendazole. Corticosteroid therapy was tapered. The patients clinical status deteriorated, and multiple opportunistic infections were diagnosed during the ICU stay, which lead him to die. Clinicians should have a high index of suspicion when in the presence of corticosteroid-treated patients with sepsis. Preventive strategies and subsequent treatment should be considered in patients with a risk of acquisition or dissemination. Treating severe strongyloidiasis is still a clinical challenge and a delayed diagnosis can significantly worsen the outcomes of the patients affected, as seen in the presented cases.

Introduction: Cytomegalovirus (CMV) remains a major cause of morbidity and mortality among solid organ transplant recipients, despite remarkable advances in its diagnosis, prevention and treatment [ 1 Dioverti MV , Razonable RR. Clinical utility of cytomegalovirus viral load in solid organ transplant recipients. Curr Opin Infect Dis. 2015;28(4):317–322. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar] ]. The two methods that are currently used to monitor CMV infection and disease in these patients are the pp65 antigenemia assay and the quantitative nucleic acid test (QNAT) [ 2 Kotton CN , Kumar D , Caliendo AM et al. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplant J. 2013;96(4):333–360. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar] ]. The purpose of this study is to compare two different types of QNAT (the Roche COBAS AmpliPrep/COBAS TaqMan CMV test, which is available commercially, and a laboratory-developed RT-PCR test) and one CMV pp65 antigenemia assay. Materials and methods: A total of 49 samples from 32 transplant recipients (28 renal and 4 cardiac transplants) were submitted to these three methodologies. Results: The results showed a significant agreement (concordance rates between 81.6% and 71.4%, and Cohen’s kappa coefficient values between 0.456 and 0.602, p < 0.001) and a moderate to high, significant (p < 0.01), correlation between these methods (Spearman’s coefficient value of 0.769 for pp65 antigenemia and COBAS, 0.546 for pp65 antigenemia and RT-PCR “in-house”, and 0.736 for COBAS and RT-PCR “in-house” comparison). The unexpected good results obtained with antigenemia is a consequence of decades of laboratory’s and operators’ experience with this technique. In addition, one third (33.3%) of all antigenemia positive samples had 1 or 2 positive cells. Discussion and conclusions: The results from this study showed significant agreement and correlation between the three methodologies. Therefore, we conclude that these can be used successfully for monitoring solid organ transplant recipients.