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Kawashima A, Yanagawa Y, Shimogawara R, Yagita K, Gatanaga H, Watanabe K. Amebiasis as a sexually transmitted infection: A re-emerging health problem in developed countries. Glob Health Med 2023; 5:319-327. [PMID: 38162428 PMCID: PMC10730925 DOI: 10.35772/ghm.2023.01064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/21/2023] [Accepted: 10/23/2023] [Indexed: 01/03/2024]
Abstract
Amebiasis, which is caused by Entamoeba histolytica (E. histolytica), is the second leading cause of parasite-related death worldwide. It manifests from asymptomatic carriers to severe clinical conditions, like colitis and liver abscesses. Amebiasis is commonly seen in developing countries, where water and food are easily contaminated by feces because of the poor sanitation. However, a recently challenge in many developed countries is the increase in domestic cases of invasive amebiasis as a sexually transmitted infection (STI amebiasis). In contrast to food-/ waterborne transmission of E. histolytica in developing countries, transmission of STI amebiasis occurs directly through human-to-human sexual contact (e.g., men who have sex with men and people who engage in oral-anal sex); in this setting, asymptomatic infected individuals are the main reservoir of E. histolytica. The Development of screening methods for the early diagnosis of asymptomatic E. histolytica infection is the key to epidemiologic control. Moreover, delay in diagnosis of severe cases (e.g., fulminant amebiasis) leads to death even in developed countries. It is also important to increase clinical awareness of domestically transmitted STI amebiasis in the clinical settings. This review considers the changing epidemiology and clinical manifestations of STI amebiasis, and finally discusses the future strategies for the better practice.
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Affiliation(s)
- Akira Kawashima
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
- The Joint Research Center for Human Retrovirus Infection Kumamoto University Campus, Kumamoto, Japan
| | - Yasuaki Yanagawa
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA, USA
| | - Rieko Shimogawara
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Kenji Yagita
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- The Joint Research Center for Human Retrovirus Infection Kumamoto University Campus, Kumamoto, Japan
| | - Koji Watanabe
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
- The Joint Research Center for Human Retrovirus Infection Kumamoto University Campus, Kumamoto, Japan
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Blok GCGH, Berger MY, Ahmeti AB, Holtman GA. What is important to the GP in recognizing acute appendicitis in children: a delphi study. BMC PRIMARY CARE 2023; 24:217. [PMID: 37872491 PMCID: PMC10591392 DOI: 10.1186/s12875-023-02167-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/30/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND For diagnostic research on appendicitis in registration data, insight is needed in the way GPs generate medical records. We aimed to reach a consensus on the features that GPs consider important in the consultation and medical records when evaluating a child with suspected appendicitis. METHODS We performed a three-round Delphi study among Dutch GPs selected by purposive sampling. An initial feature list was created based on a literature search and features in the relevant Dutch guideline. Finally, using a vignette describing a child who needed later reassessment, we asked participants to complete an online questionnaire about which consultation features should be addressed and recorded. RESULTS A literature review and Dutch guideline yielded 95 consultation features. All three rounds were completed by 22 GPs, with the final consensus list containing 26 symptoms, 29 physical assessments and signs, 2 additional tests, and 8 further actions (including safety-netting, i.e., informing the patient about when to contact the GP again). Of these, participants reached consensus that 37 should be actively addressed and that 20 need to be recorded if findings are negative. CONCLUSIONS GPs agreed that negative findings do not need to be recorded for most features and that records should include the prognostic and safety-netting advice given. The results have implications in three main domains: for research, that negative findings are likely to be missing; for medicolegal purposes, that documentation cannot be expected to be complete; and for clinical practice, that safety-netting advice should be given and documented.
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Affiliation(s)
- Guus C G H Blok
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands
| | - Marjolein Y Berger
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands
| | - Arjan B Ahmeti
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands
| | - Gea A Holtman
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, PO Box 196, Groningen, 9700 AD, The Netherlands.
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Malik S, Jagtiani T, Cenaj O, Rakhlin A. Amebic appendicitis: a case report. J Surg Case Rep 2023; 2023:rjac551. [PMID: 36685124 PMCID: PMC9851654 DOI: 10.1093/jscr/rjac551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/08/2022] [Indexed: 01/20/2023] Open
Abstract
Changing the paradigm of treatment of acute appendicitis to non-operative management can miss unusual etiologies that can only be diagnosed on pathologic analysis. Presented is a case of amebic appendicitis in which antibiotic management was dictated by post-operative pathology findings.
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Affiliation(s)
| | | | - Odise Cenaj
- Department of Pathology, Montefiore Nyack Hospital, Nyack, NY 10960, USA
| | - Aleksandr Rakhlin
- Correspondence address. Montefiore Nyack Hospital, 160 N Midland Ave, Nyack, NY, 10960, USA. Tel: 646-335-7526; E-mail:
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Aggarwal M, Sharma S, Tewari R, Gupta R, Naithani N. Acute amebic appendicitis in early pregnancy. Med J Armed Forces India 2022; 78:232-234. [PMID: 35463539 PMCID: PMC9023549 DOI: 10.1016/j.mjafi.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 01/17/2020] [Indexed: 11/24/2022] Open
Abstract
Parasitic infections of the intestine are a major health problem, which is found more prevalent in developing countries such as India. They are one of the important causes of morbidity and mortality among people all over the world. Acute amoebic appendicitis is a rare entity. We came across a case of acute appendicitis in a young pregnant woman, which revealed colonies of Entamoeba histolytica trophozoites in the mucosal epithelium and submucosal layer of the appendix with marked evidence of acute appendicitis. This report highlights acute appendicitis of amoebic origin and emphasises the importance of thorough examination of the appendix at various levels during histopathology and about the combined treatment of appendicectomy combined with antimicrobials as the treatment of choice. Appendicectomy removes the focus of infection, and antimicrobials reduce the incidence of septic complications.
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Abstract
Although rare in the developed world, amebiasis continues to be a leading cause of diarrhea and illness in developing nations with crowding, poor sanitation, and lack of clean water supply. Recent immigrants or travelers returning from endemic regions after a prolonged stay are at high risk of developing amebiasis. A high index of suspicion for amebiasis should be maintained for other high-risk groups like men having sex with men, people with AIDS/HIV, immunocompromised hosts, residents of mental health facility or group homes. Clinical presentation of intestinal amebiasis varies from diarrhea to colitis and dysentery. Amebic liver abscess (ALA) is the most common form of extraintestinal amebiasis. Various diagnostic tools are available and when amebiasis is suspected, a combination of stool tests and serology should be sent to maximize the yield of testing. Treatment with an amebicidal drug such as metronidazole/tinidazole and a luminal cysticidal agent such as paromomycin for clinical disease is indicated. However, for asymptomatic disease treatment with a luminal cysticidal agent to decrease chances of invasive disease and transmission is recommended.
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Affiliation(s)
- Shipra Gupta
- West Virginia University School of Medicine, One Medical Center Drive, HSC 9214, Morgantown, WV 26506, USA.
| | - Layne Smith
- West Virginia University School of Pharmacy, One Medical Center Drive, Morgantown, WV-26506, USA
| | - Adriana Diakiw
- West Virginia University School of Medicine, One Medical Center Drive, HSC 9214, Morgantown, WV 26506, USA
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Kitaoka A, Tanimura K, Yasuda Y, Nishioka K, Hirayama Y, Uemasu K, Iwashima D, Arita S, Kitai T, Hoshi S, Date E, Iizuka N, Takahashi KI. Successful treatment with metronidazole and paromomycin for fulminant amoebic colitis during cytotoxic chemotherapy in a patient with small-cell lung cancer. IDCases 2021; 26:e01337. [PMID: 34840954 PMCID: PMC8605421 DOI: 10.1016/j.idcr.2021.e01337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 64-year-old man with advanced small-cell lung cancer who developed fulminant amoebic colitis during cytotoxic chemotherapy. During the first cycle of carboplatin/etoposide treatment, febrile neutropenia and grade 4 neutropenia developed. Because diarrhea, abdominal pain, and bloody stool were observed, abdominal computed tomography was performed, showing intussusception, and extensive colectomy and colostomy were performed. Histopathology of the colon revealed gastrointestinal necrosis and perforation due to Entamoeba histolytica infection. Amoebiasis improved after treatment with metronidazole and paromomycin. The second cycle of carboplatin/etoposide with dose reduction was completed, resulting in a partial response to small-cell lung cancer. The results of this case suggest that paromomycin is an additional option for amoebiasis during cytotoxic chemotherapy, and persistent diarrhea during cytotoxic chemotherapy should alert clinicians to consider the development of amoebiasis.
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Affiliation(s)
- Aya Kitaoka
- Department of Respiratory Medicine, Kishiwada City Hospital, Kishiwada, Japan
| | - Kazuya Tanimura
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuto Yasuda
- Department of Respiratory Medicine, Kishiwada City Hospital, Kishiwada, Japan
| | - Kensuke Nishioka
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yutaka Hirayama
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiyoshi Uemasu
- Department of Respiratory Medicine, Kishiwada City Hospital, Kishiwada, Japan
| | - Daisuke Iwashima
- Department of Respiratory Medicine, Kishiwada City Hospital, Kishiwada, Japan
| | - Sou Arita
- Medical economics division, Health insurance bureau, Ministry of Health, Labour and Welfare, Japan
| | - Toshiyuki Kitai
- Department of Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, Japan
| | - Susumu Hoshi
- Department of Gastroenterology, Kishiwada City Hospital, Kishiwada, Japan
| | - Emi Date
- Department of Pathology, Kishiwada City Hospital, Kishiwada, Japan
| | - Norishige Iizuka
- Department of Pathology, Kishiwada City Hospital, Kishiwada, Japan
| | - Ken-Ichi Takahashi
- Department of Respiratory Medicine, Kishiwada City Hospital, Kishiwada, Japan
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Al-Balas H, Al-Saffar RS, Al-Balas M, Al-Wiswasy MK, Abu Salhiyeh A, Al-Sharqi Y, Yousuf MS, Bani-Hani K. Unusual histopathological findings in appendectomy specimens with clinical diagnosis of acute appendicitis: A retrospective cohort analysis. Ann Med Surg (Lond) 2021; 69:102720. [PMID: 34484720 PMCID: PMC8405965 DOI: 10.1016/j.amsu.2021.102720] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION While appendicitis is considered one of most common acute surgical conditions, several studies have reported abnormal histopathological findings in appendectomy specimens; however, sending all appendices to histopathology is not yet routinely done.Here we report many unusual findings. Those unusual findings played a role not only in confirming acute appendicitis as a cause of the presentation in some cases but also discovering etiologies that mimic it with great impact on its management. METHODS Between January 2011 and December 2017, a total of 1510 patients were operated with appendectomy for a primary diagnosis of acute appendicitis. Among them, a total of 72 patients had incidental histopathologic findings in association with acute appendicitis or other pathologies instead of acute appendicitis. A retrospective analysis for those 72 patients was performed with all data being retrieved from the electronic health record system. RESULTS Patients ages ranged between 4 and 71 years with a mean age equal to 23.1 years (SD = 14.2). Majority of patients were women (n = 52; 72.2%). Sixty of the seventy-two cases were seen in patients with negative appendectomies (n = 333) with an overall rate of 18% among this group of patients. The remaining 12 patients had additional findings in histopathology specimens beside acute appendicitis (n = 1131) with an overall rate of 1%. The most commonly reported pathologies were serositis, ovarian cysts, and Enterobius vermicularis in descending frequency. CONCLUSION Identification of unusual histopathological findings during microscopic examination of resected appendices is more common in female patients and in patients with negative appendectomy. histopathologic assessment of specimens will allow detection of congenital, infectious or malignant pathologies that mimic acute appendicitis clinically even in the absence appendicitis microscopically.
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Affiliation(s)
- Hamzeh Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
| | - Raith S. Al-Saffar
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
| | - Mahmoud Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
| | - Mohammad K.M. Al-Wiswasy
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
| | | | - Yasmeen Al-Sharqi
- Department of Histopathology, Prince Hamza Teaching Hospital, Amman, Jordan
| | - Mustafa Saad Yousuf
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
| | - Kamal Bani-Hani
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, 13133, Jordan
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Clinical features of amoebic appendicitis in children: A study of 23 cases. J Pediatr Surg 2021; 56:1362-1364. [PMID: 33461743 DOI: 10.1016/j.jpedsurg.2020.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/09/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
AIM OF THE STUDY To describe the clinical, surgical, and pathological features of children with acute appendicitis and amebiasis. MATERIALS AND METHODS The medical records of children diagnosed with appendicitis and amebiasis treated at Fundación Hospital la Misericordia were retrospectively reviewed. Patients were classified into two groups according to the location of the amoebas: the amoebic appendicitis (AA) group (when the amoebic infection involved the appendiceal wall), and the appendicitis with incidental amoebiasis (IA) group (when amoebas were only found in the appendiceal lumen). We compared demographics and outcomes. RESULTS We identified 23 children with appendicitis and amoebiasis. The mean age was 9 (3-15) years, and 52% were male. The main duration of the pain at the time of presentation was 1.8 (1-4) days. Fever and diarrhea were observed in 64% and 43% of the patients, respectively. Four patients had perforated appendicitis, all of them within the AA group. Anti-parasitic therapy was used only in 2 subjects (all other patients were diagnosed after discharge and were asymptomatic on follow up). AA was diagnosed in 11 patients and IA in 12. AA and IA patients shared similar characteristics regarding age, clinical findings, radiologic features, and preoperative laboratory results. Appendiceal necrosis and perforation were only found within the AA group (4 patients). CONCLUSIONS AA is a rare condition in children. It seems to have a greater risk of perforation than cases of appendicitis with IA, which is in agreement with the more severe histological findings in our series. Anti-parasitic treatment is not necessary in cases of AA or IA.
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Spectrum of CT findings in amebic colitis. Jpn J Radiol 2021; 39:558-563. [PMID: 33462730 DOI: 10.1007/s11604-021-01088-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
Entamoeba histolytica is distributed throughout the world. Invasive amebiasis affects millions of people globally, and the associated complications cause 40,000-100,000 deaths per year. In countries where fecal-oral transmission is unusual, amebic colitis is not common, and the infection may be seen in travelers to and emigrants from endemic areas. Without adequate treatment, amebic colitis may develop into fulminant and become rapidly fatal. With the current increase in global mobility, amebic colitis should be suspected even in patients not in the endemic areas. CT plays an important role in the diagnosis of amebic colitis by demonstrating the presence of colitis with the typical involvement of the cecum and rectum. Pathological features of atypical involvement are also demonstrated. Since preoperative diagnosis can reduce the mortality associated with necrotizing colitis, radiologists need to recognize the typical as well as atypical CT findings of amebic colitis. Considering this requirement, this paper aims to describe the histopathologic features of amebic colitis and to illustrate the spectrum of corresponding CT findings.
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Smith RS, Gray A, Croagh DG. Invasive amoebiasis: an unlikely mimic of appendicitis. ANZ J Surg 2020; 90:2095-2097. [PMID: 32413181 DOI: 10.1111/ans.16004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Rohan S Smith
- Department of HPB/Upper GI Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Andrew Gray
- Department of HPB/Upper GI Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Daniel G Croagh
- Department of HPB/Upper GI Surgery, Monash Medical Centre, Melbourne, Victoria, Australia
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Unusual Histopathological Findings in Appendectomy Specimens Obtained from 1683 Pediatric Patients with Suspected Acute Appendicitis. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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12
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Herrera C. G, Herrera C. A, Pontón P, Molina GA, Constante JE, Delgado JA. Amebiasis, a rare cause of acute appendicitis. J Surg Case Rep 2019; 2019:rjz076. [PMID: 30891179 PMCID: PMC6415623 DOI: 10.1093/jscr/rjz076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 02/22/2019] [Indexed: 11/13/2022] Open
Abstract
Acute appendicitis is one of the most common abdominal emergencies, even though most cases of appendicitis will be due to obstruction of the appendiceal lumen, in rare occasions and mostly due to poor sanitary conditions a parasitic infection may cause appendicitis. Entamoeba histolytica is a common parasite and has a broad clinical spectrum from an asymptomatic disease to a life-threatening condition. In rare occasions, trophozoites can invade the appendiceal wall causing appendicitis. Preoperative diagnosis of acute amebic appendicitis is usually difficult, yet surgical treatment as in non-amebic appendicitis is the treatment of choice. However, due to the increased rate of postoperative complications associated with acute amebic appendicitis, a course of nitroimidazoles, and increased awareness in basic sanitary measures is usually recommended. We present a case of a 29-year-old woman, she presented with abdominal pain and appendicitis was suspected. After successful surgery, pathology confirmed acute amebic appendicitis.
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Affiliation(s)
- Glenda Herrera C.
- Department of General Surgery, Hospital Metropolitano, Quito, Ecuador
| | | | - Patricia Pontón
- Department of Internal Medicine, Division of Pathology, Hospital Metropolitano, Quito, Ecuador
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Kinaci E, Kayaalp C. Systematic Review for Small-for-Size Syndrome After Liver Transplantation-Chamber of Secrets: Reply. World J Surg 2017; 41:343-344. [PMID: 27734080 DOI: 10.1007/s00268-016-3755-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Erdem Kinaci
- Inonu University, Liver Transplantation Institute, Malatya, Turkey
| | - Cuneyt Kayaalp
- Inonu University, Liver Transplantation Institute, Malatya, Turkey.
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Tanaka R, Furusyo N, Takeda R, Yamasaki S, Kusaga A, Ogawa E, Murata M, Nakanishi R, Maehara Y. A case of amebiasis with negative serologic markers that caused intra-abdominal abscess. J Infect Chemother 2017; 23:778-781. [PMID: 28527648 DOI: 10.1016/j.jiac.2017.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/03/2017] [Accepted: 04/20/2017] [Indexed: 11/15/2022]
Abstract
A 23-year-old Japanese woman presented with abdominal distention following fever, diarrhea, and abdominal pain during a stay in Taiwan. Serology for the detection of amebic-antibodies and stool microscopic examination were both negative. A computed tomography scan showed a 13 cm diameter abscess spreading from the lower abdominal wall to the pelvic retroperitoneal space. Needle aspiration of the abscess was done under computed tomography guidance, and microscopy of the aspirated fluid revealed trophozoites of Entamoeba. The patient was diagnosed as amebiasis with negative serologic markers that caused intra-abdominal abscess. Intravenous metronidazole treatment for two weeks did not result in any improvement of the abscess. After irrigation and drainage of the abscess, her symptoms resolved. This case report highlights that amebiasis should be considered when indicated by patient history, including travelers returning from endemic areas, and that further evaluation is necessary for diagnosis, even if the serology and stool test are negative.
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Affiliation(s)
- Rie Tanaka
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Norihiro Furusyo
- Department of General Internal Medicine, Kyushu University Hospital, Japan.
| | - Rinne Takeda
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Sho Yamasaki
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Akira Kusaga
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Eiichi Ogawa
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Masayuki Murata
- Department of General Internal Medicine, Kyushu University Hospital, Japan
| | - Ryota Nakanishi
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Science, Kyushu University, Japan
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Underestimated Amoebic Appendicitis among HIV-1-Infected Individuals in Japan. J Clin Microbiol 2016; 55:313-320. [PMID: 27847377 PMCID: PMC5228245 DOI: 10.1128/jcm.01757-16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/03/2016] [Indexed: 01/07/2023] Open
Abstract
Entamoeba histolytica is not a common causative agent of acute appendicitis. However, amoebic appendicitis can sometimes be severe and life threatening, mainly due to a lack of awareness. Also, its frequency, clinical features, and pathogenesis remain unclear. The study subjects were HIV-1-infected individuals who presented with acute appendicitis and later underwent appendectomy at our hospital between 1996 and 2014. Formalin-fixed paraffin-embedded preserved appendix specimens were reexamined by periodic acid-Schiff (PAS) staining and PCR to identify undiagnosed amoebic appendicitis. Appendectomies were performed in 57 patients with acute appendicitis. The seroprevalence of E. histolytica was 33% (14/43) from the available stored sera. Based on the medical records, only 3 cases were clinically diagnosed as amoebic appendicitis, including 2 diagnosed at the time of appendectomy and 1 case diagnosed by rereview of the appendix after the development of postoperative complications. Retrospective analyses using PAS staining and PCR identified 3 and 3 more cases, respectively. Thus, E. histolytica infection was confirmed in 9 cases (15.8%) in the present study. Apart from a significantly higher leukocyte count in E. histolytica-positive patients than in negative patients (median, 13,760 versus 10,385 cells/μl, respectively, P = 0.02), there were no other differences in the clinical features of the PCR-positive and -negative groups. In conclusion, E. histolytica infection was confirmed in 9 (15.8%) of the appendicitis cases. However, only 3, including one diagnosed after intestinal perforation, were diagnosed before the present analyses. These results strongly suggest there is frequently a failure to detect trophozoites in routine examination, resulting in an underestimation of the incidence of amoebic appendicitis.
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Abstract
Over one billion people worldwide harbor intestinal parasites. Parasitic intestinal infections have a predilection for developing countries due to overcrowding and poor sanitation but are also found in developed nations, such as the United States, particularly in immigrants or in the setting of sporadic outbreaks. Although the majority of people are asymptomatically colonized with parasites, the clinical presentation can range from mild abdominal discomfort or diarrhea to serious complications, such as perforation or bleeding. Protozoa and helminths (worms) are the two major classes of intestinal parasites. Protozoal intestinal infections include cryptosporidiosis, cystoisosporiasis, cyclosporiasis, balantidiasis, giardiasis, amebiasis, and Chagas disease, while helminth infections include ascariasis, trichuriasis, strongyloidiasis, enterobiasis, and schistosomiasis. Intestinal parasites are predominantly small intestine pathogens but the large intestine is also frequently involved. This article highlights important aspects of parasitic infections of the colon including epidemiology, transmission, symptoms, and diagnostic methods as well as appropriate medical and surgical treatment.
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Affiliation(s)
| | - Jennifer A. McQuade
- Department of Colorectal Surgery, Virginia Hospital Center, Arlington, Virginia
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Ito D, Hata S, Seiichiro S, Kobayashi K, Teruya M, Kaminishi M. Amebiasis presenting as acute appendicitis: Report of a case and review of Japanese literature. Int J Surg Case Rep 2014; 5:1054-7. [PMID: 25460473 PMCID: PMC4275826 DOI: 10.1016/j.ijscr.2014.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 10/02/2014] [Accepted: 10/09/2014] [Indexed: 11/16/2022] Open
Abstract
The overall mortality rate reported in the studies in Japan (25%) is considerably higher than that reported in a systematic review conducted of similar studies in other countries (3.3%). Japan is a low-risk area for amebiasis, and many physicians fail to consider amebiasis in the differential diagnosis of acute appendicitis. In all of the cases, the diagnosis occurred only after surgery. It is important to conduct further examinations, including those for amebiasis, when appendectomy does not resolve acute appendicitis.
INTRODUCTION Outside of these high-risk regions, acute amebic appendicitis is considerably rarer and the mortality rate is much higher than with non-amebic appendicitis. PRESENTATION OF CASE A 31-year-old woman presented with fever and right lower abdominal pain with no history of traveling abroad or sexual infection. Computed tomography revealed a dilated appendix and thickened cecal and ascending colon walls. She underwent an appendectomy for appendicitis. Owing to a lack of symptom resolution, we performed a pathologic examination of the appendix again that revealed multiple Entamoeba histolytica trophozoites; the serum amebic antibody was positive. She was treated postoperatively with metronidazole for amebiasis and discharged on postoperative day 12. DISCUSSION The mortality rate and frequency of severe postoperative intraabdominal complications were higher in the Japanese literature (1995–2013) (25% and 33%, respectively) than in other developed countries (3.3% and 19.4%, respectively). Japan is a low-risk area for amebiasis; many physicians fail to consider amebiasis in the differential diagnosis of acute abdomen. It is important to conduct further examinations, including those for amebiasis, when appendectomy does not resolve acute appendicitis. CONCLUSION We report a case of acute amebic appendicitis in a 31-year-old woman and review the ages at presentation, causative factors, treatments, and outcomes of 11 cases reported in Japan between 1995 and 2013.
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Affiliation(s)
- Daisuke Ito
- Department of Gastrointestinal Surgery, Showa General Hospital, Tokyo, Japan.
| | - Shojirou Hata
- Department of Gastrointestinal Surgery, Showa General Hospital, Tokyo, Japan
| | | | - Kaoru Kobayashi
- Department of Gastrointestinal Surgery, Showa General Hospital, Tokyo, Japan
| | - Masanori Teruya
- Department of Gastrointestinal Surgery, Showa General Hospital, Tokyo, Japan
| | - Michio Kaminishi
- Department of Gastrointestinal Surgery, Showa General Hospital, Tokyo, Japan
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