E Pozio

Istituto Superiore di Sanità, Roma, Latium, Italy

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Publications (392)933.51 Total impact

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    ABSTRACT: Trichinella spp. are zoonotic parasites transmitted to humans by the consumption of raw or insufficiently cooked meat of different animal species. The most common source of infection for humans is meat from pigs and wild boar (Sus scrofa). The aim of the present work was to evaluate the incidence of Trichinella spp. infections in wild boar hunted in Latvia over a 38 year interval (1976 to 2013). A total 120,609 wild boars were individually tested for Trichinella spp. by trichinoscopy and, in case of negativity, by artificial digestion of 25 g muscles, in the 1976-2005 period, and by artificial digestion of 25-50 g muscles in the 2006-2013 period. Trichinella spp. larvae were identified at the species level by multiplex PCR. In the study period, the overall prevalence of infected wild boar was 2.5%. Trichinella britovi was the predominant (90%) species. The incidence of Trichinella spp. infection in wild boar exhibited two different trends. From 1976 to 1987, the incidence of infected/hunted wild boar increased from 0.23% to 2.56%, then it decreased to 0.19 in 1994. Thereafter, the incidence fluctuated between 0.05% and 0.37%. A statistically significant (P < 0.05) correlation (r = 0.54; p = 0.0199) was found between the trend of Trichinella spp. incidence in hunted wild boar and the number of snow cover days from 1976 to 1993. From 1997 to 2013, the estimated wild boar population of Latvia increased by 4.9 times and the hunting bag by 9.7 times, with a stable incidence of Trichinella spp. in the population. It follows that the biomass of Trichinella spp. larvae and of T. britovi, in particular, increased. The incidence trends of Trichinella spp. in wild boar could be related to the role played by the snow in reducing the thermal shock and muscle putrefaction which increases the survival of the larvae in muscle tissues of carrion in the 1976-1993 period; and, in the 1997-2013 period, to the increased biomass of Trichinella spp. due to the increased carnivore populations, which are the main reservoirs of these parasites.
    Parasites & Vectors 12/2015; 8(1):753. DOI:10.1186/s13071-015-0753-1 · 3.25 Impact Factor
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    ABSTRACT: Several species of protozoa cause acute or chronic gastroenteritis in humans, worldwide. The burden of disease is particularly high among children living in developing areas of the world, where transmission is favored by lower hygienic standards and scarce availability of safe water. However, asymptomatic infection and polyparasitism are also commonly observed in poor settings. Here, we investigated the prevalence of intestinal protozoa in two small fishing villages, Porto Said (PS) and Santa Maria da Serra (SM), situated along the river Tietê in the State of São Paolo, Brazil. The villages lack basic public infrastructure and services, such as roads, public water supply, electricity and public health services. Multiple fecal samples were collected from 88 individuals in PS and from 38 individuals in SM, who were asymptomatic at the time of sampling and had no recent history of diarrheal disease. To gain insights into potential transmission routes, 49 dog fecal samples (38 from PS and 11 from SM) and 28 river water samples were also collected. All samples were tested by microscopy and PCR was used to genotype Giardia duodenalis, Blastocystis sp., Dientamoeba fragilis and Cryptosporidium spp. By molecular methods, the most common human parasite was Blastocystis sp. (prevalence, 45% in PS and 71% in SM), followed by D. fragilis (13.6% in PS, and 18.4% in SM) and G. duodenalis (18.2% in PS and 7.9% in SM); Cryptosporidium spp. were not detected. Sequence analysis revealed large genetic variation among Blastocystis samples, with subtypes (STs) 1 and 3 being predominant, and with the notable absence of ST4. Among G. duodenalis samples, assemblages A and B were detected in humans, whereas assemblages A, C and D were found in dogs. Finally, all D. fragilis samples from humans were genotype 1. A single dog was found infected with Cryptosporidium canis. River water samples were negative for the investigated parasites. This study showed a high carriage of intestinal parasites in asymptomatic individuals from two poor Brazilian villages, and highlighted a large genetic variability of Blastocystis spp. and G. duodenalis.
    Parasites & Vectors 12/2015; 8(1). DOI:10.1186/s13071-015-0714-8 · 3.25 Impact Factor
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    ABSTRACT: Nematode worms of the genus Trichinella are zoonotic parasites circulating in most continents, including Europe. In Spain, Trichinella spiralis and Trichinella britovi are highly prevalent in wildlife but seldom in domestic pigs. In Portugal, only T. britovi was documented in wild carnivores. In the period 2006-2013 in Spain, 384 (0.0001%) pigs and 1399 (0.20%) wild boars (Sus scrofa) were positive for Trichinella spp. larvae, which were identified as T. spiralis or T. britovi. In 2014, Trichinella pseudospiralis larvae were isolated from a wild boar hunted in the Gerona province, Cataluña region, North-East of Spain, near the border to France. This is the first report of T. pseudospiralis in the Iberian peninsula, which suggests a broad distribution area of this zoonotic nematode in Europe. Since larvae of this Trichinella species do not encapsulate in the host muscles, they can be detected only by artificial digestion of muscle samples. T. pseudospiralis is the only Trichinella species infecting both mammals and birds. Birds can spread this pathogen over great distances including islands triggering new foci of infections in areas previously considered at low risk for this pathogen. Copyright © 2015 Elsevier B.V. All rights reserved.
    Veterinary Parasitology 04/2015; DOI:10.1016/j.vetpar.2015.04.004 · 2.55 Impact Factor
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    ABSTRACT: Trichinellosis is a zoonotic parasitic disease with a worldwide distribution. The aim of this work was to describe the epidemiological and clinical data of five outbreaks of trichinellosis, which affected ethnic minorities living in remote mountainous areas of northwestern Vietnam from 1970 to 2012. Trichinellosis was diagnosed in 126 patients, of which 11 (8.7%) were hospitalized and 8 (6.3%) died. All infected people had consumed raw pork from backyard and roaming pigs or wild boar at wedding, funeral, or New Year parties. The short incubation period (average of 9.5 days), the severity of the symptoms, which were characterized by diarrhea, abdominal pain, fever, myalgia, edema, weight loss, itch, and lisping, and the high mortality suggest that patients had ingested a high number of larvae. The larval burden in pigs examined in one of the outbreaks ranged from 70 to 879 larvae/g. These larvae and those collected from a muscle biopsy taken from a patient from the 2012 outbreak were identified as Trichinella spiralis. Data presented in this work show that the northern regions of Vietnam are endemic areas for Trichinella infections in domestic pigs and humans. © The American Society of Tropical Medicine and Hygiene.
    The American journal of tropical medicine and hygiene 04/2015; DOI:10.4269/ajtmh.14-0570 · 2.74 Impact Factor
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    ABSTRACT: Taenia solium taeniasis/cysticercosis is a neglected zoonotic disease complex occurring primarily in developing countries. Though claimed eradicated from the European Union (EU), an increasing number of human neurocysticercosis cases is being detected. Risk factors such as human migration and movement of pigs/pork, as well as the increasing trend in pig rearing with outside access are discussed in this review. The entry of a tapeworm carrier into the EU seems a lot more plausible than the import of infected pork. The establishment of local transmission in the EU is presently very unlikely. However, considering the potential changes in risk factors, such as the increasing trend in pig farming with outdoor access, the increasing human migration from endemic areas into the EU, this situation might change, warranting the establishment of an early warning system, which should include disease notification of taeniasis/cysticercosis both in human and animal hosts. As currently human-to-human transmission is the highest risk, prevention strategies should focus on the early detection and treatment of tapeworm carriers, and should be designed in a concerted way, across the EU and across the different sectors. Copyright © 2015 Elsevier B.V. All rights reserved.
    Veterinary Parasitology 03/2015; DOI:10.1016/j.vetpar.2015.03.006 · 2.55 Impact Factor
  • Edoardo Pozio
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    ABSTRACT: Nematodes of the genus Trichinella are widely distributed throughout the world in omnivorous and carnivorous animals (mammals, birds, and reptiles) and in incidental hosts. To prevent the transmission of these zoonotic parasites to humans, meat samples from Trichinella spp. susceptible animals are tested at the slaughterhouse or in game processing plants. The aim of the present review was to collect documented cases on Trichinella infected animals, meat, or meat derived products which reached the international trade or were illegally introduced from one to another country in personal baggage. In the course of the last 60 years in the international literature, there have been 43 reports of importation of Trichinella spp. infected animals or meat, most of which (60%, 26/43) related to live horses or their meat. Meat or meat derived products from pigs, wild boar and bears, account only for 18.6% (8/43), 4.7% (3/43), and 14.3% (6/43), respectively. However, only live horses or their meat intended for human consumption, meat from a single wild boar, and live polar bears caught in the wild for zoos, were imported through the international market; whereas, meat from pigs, wild boars and bears were illegally introduced in a country in personal baggage. Trichinella infected animals or meat which were officially or illegally introduced in a country were the source of 3443 Trichinella infections in humans in a 40-year period (1975-2014). Most of these infections (96.8%) have been linked to horsemeat consumption, whereas meat from pigs, wild boars and bears accounted only for 2.2%, 0.7% and 0.3% of cases, respectively. This review shows the Trichinella spp. risk in the international animal and meat trade has been linked mainly to horses and only one time to wild boar, if they carcasses are not adequately tested, whereas pigs and other wild animals or their derived products infected with Trichinella spp. are unlikely to reach the international market by the official animal and meat trade. Copyright © 2015 Elsevier B.V. All rights reserved.
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    ABSTRACT: Background Parasites of the genus Trichinella are zoonotic nematodes common in carnivores throughout the world. We determined the prevalence and species of Trichinella infections in Florida panthers (Puma concolor coryi).Methods Tongues from Florida panthers were collected at necropsy and examined by pepsin-HCl artificial digestion for infection with Trichinella spp. DNA was extracted from larvae and multiplex PCR using Trichinella species-specific primers was used to genotype the worms.Results Trichinella spp. larvae were detected in 24 of 112 (21.4%; 14.6%¿30.3%) panthers. Sixteen of the panthers (14.3%) were infected with T. pseudospiralis, 1 (0.9%) was infected with T. spiralis, and 2 (1.8%) had mixed infections of T. pseudospiralis and T. spiralis. Trichinella spp. larvae from 5 panthers were not identified at the species level due to degraded DNA.Conclusions This is the highest prevalence of T. pseudospiralis detected in North America up to now and suggests the Florida panther is a key mammalian reservoir of this parasite in southern Florida. Trichinella pseudospiralis can infect both mammals and birds indicting the source of infection for Florida panthers could be broader than believed; however, birds represent a small percentage (0.01%) of the cat¿s diet. Since wild pigs (Sus scrofa) can be parasitized by both T. pseudospiralis and T. spiralis and that these swine can comprise a large portion (~40%) of a panther¿s diet in Florida, we believe that Florida panthers acquired these zoonotic parasites from feeding on wild pigs.
    Parasites & Vectors 02/2015; 8(1):67. DOI:10.1186/s13071-015-0674-z · 3.25 Impact Factor
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    ABSTRACT: Serology to monitor Trichinella spp. infection in pigs reared in controlled system has been claimed as a possible diagnostic tool. However, no international biological standards or reference materials exist to validate in house tests or commercial kits, and to improve the inter-laboratory comparability for the serological detection of anti-Trichinella IgG in pigs. In this work, potential reference sera have been prepared from four experimentally infected pigs. Sera were tested, aliquot, lyophilized, and maintained at +4 °C. Since one of the prerequisites for the development of any reference material is to plan and execute stability studies, isochronous studies for short and long term stability testing were carried out to evaluate the possible degradation effects of transportation and storage. The stability of the lyophilized serum samples at +4 °C, was arbitrarily assumed. For the short term stability study, two units were stored at -20 °C, +4 °C, +20 °C, and +50 °C for 0, 1, 2 and 4 weeks, and then tested in duplicate. For the long term stability study, the same number of units and replicates per unit were stored at -80 °C, -20 °C, and +4 °C, for 0, 6, 12, 18 and 24 months. In both studies, unit samples were selected randomly and tested on the same day under repeatability conditions. The linear regression versus time for each serum at each studied temperature was analyzed and then slopes were tested for significance. Further, uncertainty of the short and long term stability was calculated for a shelf life period of one week and three years, respectively. For all sera but one, and for all the studied temperatures but +50 °C, the data from the short term stability study indicate the absence of a significant trend that would hint at degradation. The slopes of the regression lines did not significantly vary from zero. Even if the uncertainty of the short term stability was variable among serum samples, the rate of degradation was considered acceptable. For the long term stability, slopes of the regression lines of two serum samples significantly varied from zero, indicating a trend of possible degradation during storage. The percentage of degradation deducted from the uncertainty of the long term study varied; however, two serum samples showed the lower rate of degradation at all the assayed temperatures. The most suitable temperatures for dispatching serum samples are -20 °C, +4 °C and +20 °C; whereas, -20 °C and -80 °C are suitable temperatures for serum storage.
    Veterinary Parasitology 01/2015; 208(3-4). DOI:10.1016/j.vetpar.2015.01.012 · 2.55 Impact Factor
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    ABSTRACT: Human Cystic Echinococcosis (CE) is estimated in 2-3 million global cases. CE diagnosis and clinical management are based on imaging and serology, which lacks sensitivity and does not provide cyst stage information. This study aimed to evaluate tools for improving diagnosis by analysing the Interleukin (IL)-4-response to Antigen B (AgB) of Echinococcus granulosus. Whole blood (WB) and peripheral blood mononuclear cells were stimulated with AgB. IL-4 levels were measured by enzyme-linked immunosorbent assay. WB 1-day stimulation resulted the best experimental condition for evaluating AgB IL-4-response. IL-4 levels were significantly higher in CE patients than healthy donors (p ≤ 0.0001). A ROC analysis showed significant area under the curve (AUC) results (AUC, 0.85; p = 0.0001) identifying an IL-4 level cut-off point ≥0.39 pg/mL which predicted CE with 71.4% sensitivity and 93.3% specificity. Moreover, we found that IL-4 levels were significantly increased in patients with active cysts compared to those with inactive cysts (p ≤ 0.0001). ROC analysis showed significant AUC results (0.94; p = 0.0001) with a cut-off point of 4.6 pg/mL which predicted active cysts with 84.6% sensitivity and 92% specificity. We found immunological correlates associated with CE and biological cyst activity. Copyright © 2014 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
    Journal of Infection 10/2014; 70(3). DOI:10.1016/j.jinf.2014.10.009 · 4.02 Impact Factor
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    ABSTRACT: In the present study we sequenced or re-sequenced, assembled and annotated 15 mitochondrial (mt) genomes representing the 12 currently recognised taxa of Trichinella using a deep sequencing-coupled approach. We then defined and compared the gene order in individual mt genomes (∼ 14 to 17.7 kb), evaluated genetic differences among species/genotypes and re-assessed the relationships among these taxa using the mt nucleic acid or amino acid sequence data sets. In addition, a rich source of mt genetic markers was defined that could be used in future systematic, epidemiological and population genetic studies of Trichinella. The sequencing-bioinformatic approach employed herein should be applicable to a wide range of eukaryotic parasites.
    International Journal for Parasitology 09/2014; DOI:10.1016/j.ijpara.2014.08.010 · 3.40 Impact Factor
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    ABSTRACT: The wild boar is an important source of trichinellosis for people in European countries as a large number of hunted animals escape veterinary control. In November 2012, uncooked sausages made with meat from wild boar were consumed by 38 persons in a village of the Lucca province (Tuscany region, Italy). Of them, 34 were serologically positive, 32 developed clinical signs and symptoms of trichinellosis, and two were asymptomatic. Trichinella britovi larvae were detected in vacuum-packed sausages made with the same batch of sausages consumed raw which had been prepared with meat from wild boar hunted in the Lucca province. As no case of trichinellosis had been reported in this region during the last 20 years, the regional public health authority considered the risk for this zoonosis to be negligible and put in place a surveillance programme on Trichinella spp. in indicator animals (mainly foxes and including wild boar for private consumption), by testing only a percentage of heads. The experience from this outbreak shows that the definition of a region with a negligible risk for Trichinella infection is not applicable to wild boar and stresses the need to test all Trichinella-susceptible wild animals intended for human consumption and to implement risk communication to consumers and hunters.
    Zoonoses and Public Health 08/2014; DOI:10.1111/zph.12148 · 2.07 Impact Factor
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    ABSTRACT: Trichinella spiralis and Trichinella pseudospiralis exhibit differences in the host-parasite relationship such as the inflammatory response in parasitized muscles. Several studies indicate that matrix metalloproteinases (MMPs) represent a marker of inflammation since they regulate inflammation and immunity. The aim of this study was to evaluate the serum levels of gelatinases (MMP-9 and MMP-2) in mice experimentally infected with T. spiralis or T. pseudospiralis, to elucidate the involvement of these molecules during the inflammatory response to these parasites. Gelatin zymography on SDS polyacrilamide gels was used to assess the serum levels and in situ zymography on muscle histological sections to show the gelatinase-positive cells.In T. spiralis infected mice, the total MMP-9 serum level increased 6 days post infection whereas, the total MMP-2 serum level increased onward. A similar trend was observed in T. pseudospiralis infected mice but the MMP-9 level was lower than that detected in T. spiralis infected mice. Significant differences were also observed in MMP-2 levels between the two experimental groups. The number of gelatinase positive cells was higher in T. spiralis than in T. pseudospiralis infected muscles. We conclude that MMP-9 and MMP-2 are markers of the inflammatory response for both T. spiralis and T. pseudospiralis infections.This article is protected by copyright. All rights reserved.
    Parasite Immunology 08/2014; 36(10). DOI:10.1111/pim.12138 · 1.85 Impact Factor
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    ABSTRACT: Abstract Trichinella spiralis and Trichinella britovi are the two most common species of the genus Trichinella persisting in the European wildlife. To investigate the spatial distribution of these Trichinella spp. and the factors influencing their circulation in Hungary, 3304 red foxes (Vulpes vulpes) and 0.29 million wild boars (Sus scrofa) were tested for Trichinella sp. infection in Hungary from 2006 to 2013. Trichinella spp. larvae from 68 (2.06%) foxes and 44 (0.015%) wild boars were identified by a multiplex PCR as T. britovi or T. spiralis. The locality of origin of foxes and wild boars were recorded in a geographic information system database. There was no correlation between environmental parameters in the home range of foxes and wild boars and the T. spiralis larval counts, but there was a positive correlation between the boundary zone of Hungary and T. spiralis infection (P < 0.0001; odds ratio: 24.1). These results indicate that the distribution of T. spiralis in the Hungarian wildlife is determined by the transborder transmission of the parasite from the surrounding endemic countries. Multiple regression analysis was performed with environmental parameter values and T. britovi larval counts. Based on the statistical analysis, non-agricultural areas (forests, scrubs, herbaceous vegetation and pastures) and the mean annual temperature (P < 0.0001; odds ratios: 9.53 and 0.61) were the major determinants of the spatial distribution of T. britovi in Hungary. The positive relationship with non-agricultural areas can be explained by the generalist feeding behaviour including scavenging of foxes in these areas. The negative relationship with the mean annual temperature can be attributed to the slower decomposition of wildlife carcasses favouring a longer survival of T. britovi larvae in the host carrion and to the increase of scavenging of foxes.
    Veterinary Parasitology 08/2014; DOI:10.1016/j.vetpar.2014.04.024 · 2.55 Impact Factor
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    ABSTRACT: The objective of this study was to assess the presence of anti-Trichinella IgG in the serum of persons from ethnic minorities from northwest Vietnam with clinical signs and symptoms that are compatible with trichinellosis. A total of 645 persons were enrolled, of which 200 people lived in two villages where outbreaks of human trichinellosis had been documented in 2004 and 2008, and 445 people who were hospitalized in the Dien Bien and Son La provincial hospitals without a definitive diagnosis. Presence of anti-Trichinella IgG was demonstrated in serum samples by a standardized Enzyme-linked Immunosorbant Assay (ELISA); positive serum samples were subjected to Western Blot (WB) for confirmation. Seven (3.5%; 95% CI: 1.4 - 7.1) persons from the villages and seven (1.6%; 95% CI: 0.6 - 3.2) hospitalized patients, tested positive by both ELISA and WB. Fever (N=13), eosinophilia (N=12), myalgia (N=9), facial oedema (N=9) and leukocytosis (N=8) were the most common clinical signs and symptoms in the serologically positive persons. The concomitant occurrence of facial oedema and myalgia among the enrolled persons from the villages, accounted for 75% of the positive predictive value (PPV) and 99.5% of the negative predictive value (NPV), suggesting that they could be used for suspecting trichinellosis when serology is not available. The high prevalence (1.6 - 3.5%) of anti-Trichinella IgG in persons from Vietnamese provinces where T. spiralis is circulating in pigs strongly supports the need to develop control programmes to eliminate the infection from pigs and for consumers' education and protection.
    Acta Tropica 07/2014; 139. DOI:10.1016/j.actatropica.2014.07.012 · 2.52 Impact Factor
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    ABSTRACT: Several outbreaks of trichinellosis associated with the consumption of raw pork have occurred in Laos since 2004. This cross-sectional study was conducted in four provinces of northern Laos to investigate the seroepidemiology of trichinellosis in the human population and determine the prevalence and species of Trichinella infection in the domestic pig population. Serum samples and questionnaire data were obtained from 1419 individuals. Serum samples were tested for Trichinella antibodies by ELISA using larval excretory-secretory (ES) antigens and a subset of 68 positive samples were tested by western blot. The seroprevalence of Trichinella antibodies was 19.1% (95% confidence interval (CI) = 17.1-21.1%). The risk of having antibodies detected by ELISA using ES antigens increased with age, being of Lao-Tai ethnicity, living in Oudomxay province and being male. Tongue and diaphragm muscle samples were collected from 728 pigs and tested for Trichinella larvae by the artificial digestion method. Trichinella larvae were isolated from 15 pigs (2.1%) of which 13 were identified as T. spiralis by molecular typing; the species of the two remaining isolates could not be determined due to DNA degradation. Trichinella spp. are endemic in the domestic environment of northern Laos and targeted preventative health measures should be initiated to reduce the risk of further outbreaks occurring.
    PLoS Neglected Tropical Diseases 07/2014; 8(7):e3034. DOI:10.1371/journal.pntd.0003034 · 4.49 Impact Factor
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    ABSTRACT: Trichinellosis is a cosmopolitan foodborne disease that may result in severe health disorders and even death. Despite international awareness of the public health risk associated with trichinellosis, current data on its public health impact are still lacking. Therefore we assessed, for the first known time, the global burden of trichinellosis using the Disability-Adjusted Life Year (DALY) metric. The global number of DALYs due to trichinellosis was estimated to be 76 per billion persons per year (95% credible interval (CrI): 38-129). The World Health Organization (WHO) European Region was the main contributor to this global burden, followed by the WHO region of the Americas and the WHO Western Pacific region. The global burden of trichinellosis is much lower than that of other foodborne parasitic diseases and is in sharp contrast to the high budget allocated to prevent the disease in many industrialized countries. To decrease the uncertainty around the current estimates, more knowledge is needed on the level of underreporting of clinical trichinellosis in different parts of the world.
    International Journal for Parasitology 06/2014; 45(2-3). DOI:10.1016/j.ijpara.2014.05.006 · 3.40 Impact Factor
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    IX ATIt Conference, Civitella Alfedena (AQ); 05/2014

Publication Stats

8k Citations
933.51 Total Impact Points

Institutions

  • 1986–2015
    • Istituto Superiore di Sanità
      • Department of Infectious, Parasitic and Immune-mediated Diseases
      Roma, Latium, Italy
  • 2001–2013
    • Università di Pisa
      Pisa, Tuscany, Italy
    • Texas Tech University Health Sciences Center
      • Department of Pathology
      Lubbock, TX, United States
    • Texas A&M University - Kingsville
      NQI, Texas, United States
  • 2010–2012
    • Croatian Veterinary Institute
      Zagrabia, Grad Zagreb, Croatia
    • National Institute of Health Dr. Ricardo Jorge
      Oporto, Porto, Portugal
  • 2009
    • Belcolle Hospital, Viterbo
      Viterbo, Latium, Italy
    • Bundesinstitut für Risikobewertung
      • Department of Biological Safety
      Berlín, Berlin, Germany
  • 2008
    • University of Novi Sad
      Varadinum Petri, Autonomna Pokrajina Vojvodina, Serbia
    • Agenzia di Sanità Pubblica della Regione Lazio
      Roma, Latium, Italy
    • University of Zimbabwe
      • Department of Paraclinical Veterinary Studies
      Harare, Harare Province, Zimbabwe
  • 2006
    • Ankara Atatürk Training and Research Hospital
      Engüri, Ankara, Turkey
    • University of Milan
      • Department of Animal Pathology, Hygiene and Veterinary Public Health DIPAV
      Milano, Lombardy, Italy
  • 2005
    • Hospital Infantil de México Federico Gómez
      Ciudad de México, Mexico City, Mexico
    • Dokuz Eylul University
      • Department of Pediatrics
      İzmir, Izmir, Turkey
  • 1993–2004
    • University of Pavia
      Ticinum, Lombardy, Italy
  • 2003
    • Gyeongsang National University
      • Department of Parasitology and Institute of Health Sciences
      Chinju, South Gyeongsang, South Korea
  • 2002
    • University of Helsinki
      • Faculty of Veterinary Medicine
      Helsinki, Uusimaa, Finland
  • 1998–2001
    • National Institute for Public Health and the Environment (RIVM)
      • Centre for Public Health Forecasting (cVTV)
      Utrecht, Provincie Utrecht, Netherlands
    • Chulalongkorn University
      • Department of Parasitology
      Bangkok, Bangkok, Thailand
  • 2000
    • University of Camerino
      Camerino, The Marches, Italy
  • 1997
    • Universidad de Extremadura
      Ara Pacis Augustalis, Extremadura, Spain
  • 1990–1997
    • Università degli Studi di Perugia
      • Department of Experimental Medicine and Biochemical Sciences
      Perugia, Umbria, Italy
  • 1996
    • Sapienza University of Rome
      Roma, Latium, Italy
  • 1995
    • Ministry of Health, Italy
      Roma, Latium, Italy
  • 1989
    • Università degli studi di Parma
      Parma, Emilia-Romagna, Italy
  • 1985
    • Università degli Studi G. d'Annunzio Chieti e Pescara
      Chieta, Abruzzo, Italy
  • 1983
    • Università degli studi di Cagliari
      Cagliari, Sardinia, Italy