1
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Horwich BH, Dieterich DT. Phenotypes of Primary Sclerosing Cholangitis and Differential Diagnosis. Clin Liver Dis 2024; 28:143-155. [PMID: 37945155 DOI: 10.1016/j.cld.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Primary sclerosing cholangitis is a heterogenous immune-mediated disorder characterized by chronic inflammation and stricturing of the bile ducts. Though the driving pathophysiologic mechanisms remain elusive, there are several observed clinical phenotypes of the disease. The distribution of bile duct involvement, presence of concomitant inflammatory bowel disease, significant infiltration of IgG4-positive plasma cells, and overlapping features with other autoimmune disease has significant implications for prognosis and treatment. As there remains no pathognomonic finding for primary sclerosing cholangitis, a broad differential diagnosis and extensive evaluation of other underlying causes is critical to appropriate management.
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Affiliation(s)
- Brian H Horwich
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, PO Box 1076, New York, NY 10029, USA
| | - Douglas T Dieterich
- Division of Liver Diseases, Institute for Liver Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg 5-04, New York, NY 10029, USA.
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2
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Ni HH, Lu Z, Yang CL, Lv YT, Lu CX, Xiang BD. Clonorchis sinensis on the prognosis of patients with spontaneous rupture of Hepatocellular Carcinoma: An inverse probability of treatment weighting analysis. PLoS Negl Trop Dis 2024; 18:e0011987. [PMID: 38381766 PMCID: PMC10911612 DOI: 10.1371/journal.pntd.0011987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/04/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND We examined the impact of the Clonorchis sinensis (C. sinensis) infection on the survival outcomes of spontaneous rupture Hepatocellular Carcinoma (srHCC) patients undergoing hepatectomy. METHODS Between May 2013 and December 2021, 157 consecutive srHCC patients who underwent hepatectomy were divided into an no C. sinensis group (n = 126) and C. sinensis group (n = 31). To adjust for differences in preoperative characteristics an inverse probability of treatment weighting (IPTW) analysis was done, using propensity scores. Overall survival (OS) and recurrence-free survival (RFS) were compared before and after IPTW. Multivariate Cox regression analysis was performed to determine whether the C. sinensis infection was an independent prognostic factor after IPTW. RESULTS In original cohort, the no C. sinensis group did not show a survival advantage over the C. sinensis group. After IPTW adjustment, the median OS for the C. sinensis group was 9 months, compared to 29 months for the no C. sinensis group. C. sinensis group have worse OS than no C. sinensis group (p = 0.024), while it did not differ in RFS(p = 0.065). The multivariate Cox regression analysis showed that C. sinensis infection and lower age were associated with worse OS. CONCLUSIONS The C. sinensis infection has an adverse impact on os in srHCC patients who underwent hepatectomy.
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Affiliation(s)
- Hang-Hang Ni
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
- Department of Hepatobiliary Surgery, Zhongshan City People’s Hospital, Zhongshan, People’s Republic of China
| | - Zhan Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Cheng-Lei Yang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Yu-Ting Lv
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Chun-Xiu Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
| | - Bang-De Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, People’s Republic of China
- Key Laboratory of Early Prevention and Treatment for Regional High-Frequency Tumors, Ministry of Education, Nanning, People’s Republic of China
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3
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Oehm AW, Gori F, Schnyder M. Case report: Infection with Dicrocoelium dendriticum in a Japanese Chin dog. Vet Parasitol Reg Stud Reports 2023; 46:100931. [PMID: 37935534 DOI: 10.1016/j.vprsr.2023.100931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 11/09/2023]
Abstract
Dicrocoelium dendriticum is a trematode colonising the bile ducts of herbivores. Coproscopic findings in dogs are usually considered gastrointestinal passages of eggs after ingestion of unheated liver tissue or infected ruminant faeces. Here, a Japanese Chin presented with diarrhoea and weight loss. Eggs comparable to D. dendriticum were detected in faeces and infection was confirmed via PCR and by ruling out differential diagnoses. Egg excretion continued for a period of 10 months. Praziquantel (50 mg/kg body weight [BW]) was administered orally for four consecutive days. Egg excretion 10 days after treatment entailed further treatments with 100 mg/kg BW, again for four days. Faecal samples were negative ten days and four weeks afterwards, diarrhoea resolved, and the dog gained weight. In cases of repeated coproscopic positivity for D. dendriticum, an infection with dogs acting as definitive hosts should be considered. Treatment with praziquantel at a higher dosage may be required.
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Affiliation(s)
- Andreas W Oehm
- Institute of Parasitology, Vetsuisse Faculty of Zurich, University of Zurich, Winterthurerstrasse 266A, 8057 Zurich, Switzerland.
| | - Francesca Gori
- Institute of Parasitology, Vetsuisse Faculty of Zurich, University of Zurich, Winterthurerstrasse 266A, 8057 Zurich, Switzerland
| | - Manuela Schnyder
- Institute of Parasitology, Vetsuisse Faculty of Zurich, University of Zurich, Winterthurerstrasse 266A, 8057 Zurich, Switzerland
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4
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Liau MYQ, Toh EQ, Shelat VG. Opisthorchis viverrini-Current Understanding of the Neglected Hepatobiliary Parasite. Pathogens 2023; 12:795. [PMID: 37375485 DOI: 10.3390/pathogens12060795] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Opisthorchiasis due to Opisthorchis viverrini infection continues to be a significant public healthcare concern in various subregions of Southeast Asia, particularly in Thailand, Laos, Cambodia, Myanmar, and Vietnam. The main mode of transmission is via consumption of raw or undercooked fish, which is deeply embedded in the culture and tradition of the people living near the Mekong River. After ingestion, the flukes migrate to the bile ducts, potentially causing many hepatobiliary complications, including cholangitis, cholecystitis, cholelithiasis, advanced periductal fibrosis and cholangiocarcinoma. Several mechanisms of opisthorchiasis-associated cholangiocarcinogenesis have been proposed and elucidated in the past decade, providing insight and potential drug targets to prevent the development of the sinister complication. The gold standard for diagnosing opisthorchiasis is still via stool microscopy, but the advent of novel serological, antigen, and molecular tests shows promise as more convenient, alternative diagnostic methods. The mainstay of treatment of opisthorchiasis is praziquantel, while treatment of opisthorchiasis-associated cholangiocarcinoma depends on its anatomic subtype and resectability. Thus far, the most successful fluke control programme is the Lawa model based in Thailand, which raised awareness, incorporated education, and frequent surveillance of intermediate hosts to reduce transmission of opisthorchiasis. Development of vaccines using tetraspanins shows promise and is currently ongoing.
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Affiliation(s)
- Matthias Yi Quan Liau
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore
| | - En Qi Toh
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore 308232, Singapore
| | - Vishalkumar Girishchandra Shelat
- Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
- Surgical Science Training Centre, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
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5
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Li YK, Zhao JF, Yang CL, Zhan GH, Zhang J, Qin SD, Zhou M, Li MJ, Huang JT, Kong FY, Huang H, Chen JH, Xiang BD. Effects of Clonorchis sinensis combined with Hepatitis B virus infection on the prognosis of patients with Hepatocellular Carcinoma following Hepatectomy. PLoS Negl Trop Dis 2023; 17:e0011012. [PMID: 36638133 PMCID: PMC9879467 DOI: 10.1371/journal.pntd.0011012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/26/2023] [Accepted: 12/09/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This study aimed to determine the impact of co-infection of Clonorchis sinensis (CS) and hepatitis B virus (HBV) on the prognosis of patients with hepatocellular carcinoma (HCC) following hepatectomy. METHODS The clinicopathological information of 946 patients with HCC following hepatectomy was retrospectively analyzed. The patients were divided into four groups depending on whether they had CS infection and/or HBV infection: double-negative group (infected with neither CS nor HBV), simple CS group (infected with only CS), simple HBV group (infected with only HBV), and double-positive group (co-infected with CS and HBV). Kaplan-Meier curves were used to evaluate the overall survival (OS) and recurrence-free survival (RFS), while log-rank tests were used to compare survival rates. Further, Cox regression was used to perform both univariate and multivariate survival analyses to identify variables linked to the prognosis of HCC. RESULTS The median overall survival (OS) and recurrence-free survival (RFS) in the double-positive, simple CS, simple HBV, and double-negative groups were 27 months and 9 months, 20 months and 7 months, 44 months and 12 months, and 42 months and 17 months, respectively. The double-positive group's 1-year, 3-year, and 5-year OS and RFS rates were 79.2% and 46.9%, 62.6% and 28.4%, 47.8%, and 12.2%, respectively. The simple CS group's 1-year, 3-year, and 5-year OS and RFS rates were 86.3% and 41.5%, 56.5% and 27.7%, 50.2%, and 18.5%, respectively. The simple HBV group's 1-year, 3-year, and 5-year OS and RFS rates were 89.8% and 56.0%, 72.5% and 30.5%, 63.8%, and 19.9%, respectively. The double-negative group's 1-year, 3-year, and 5-year OS and RFS rates were 91.5% and 62.3%, 76.1% and 32.9%, 64.0%, and 22.4%, respectively. Further, according to a Cox multivariate analysis, tumor size (> 5cm), Edmonson grade (III-IV), BCLC-C stage, and tumor satellite focus were independent risk factors for RFS and OS in patients with HCC. CONCLUSION Patients with HCC and Clonorchis sinensis infection experience a poor prognosis after hepatectomy, regardless of whether they are co-infected with HBV.
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Affiliation(s)
- Yuan-Kuan Li
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Tumor Hospital, Guangxi, China
| | - Jing-Fei Zhao
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Tumor Hospital, Guangxi, China
| | - Cheng-Lei Yang
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Tumor Hospital, Guangxi, China
| | - Guo-Hua Zhan
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Tumor Hospital, Guangxi, China
| | - Jie Zhang
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Tumor Hospital, Guangxi, China
| | - Shang-Dong Qin
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Tumor Hospital, Guangxi, China
| | - Min Zhou
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Tumor Hospital, Guangxi, China
| | - Min-Jun Li
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Tumor Hospital, Guangxi, China
| | - Jun-Tao Huang
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Tumor Hospital, Guangxi, China
| | - Feng-Yao Kong
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Tumor Hospital, Guangxi, China
| | - Hai Huang
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Wuming Hospital, Guangxi, China
| | - Jia-Hao Chen
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Wuming Hospital, Guangxi, China
| | - Bang-De Xiang
- Department of Hepatobiliary Surgery, Guangxi Medical University Affiliated Tumor Hospital, Guangxi, China
- * E-mail:
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6
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Anwer M, Kumar A, Uddin M, Ahmed F. Mummified Ascaris in Calculus Gallbladder: a Rare Case Report. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03673-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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7
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Gall bladder Ascariasis: A rare entity. IDCases 2021; 26:e01333. [PMID: 34815938 PMCID: PMC8592861 DOI: 10.1016/j.idcr.2021.e01333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/05/2021] [Accepted: 11/05/2021] [Indexed: 12/02/2022] Open
Abstract
Gall bladder ascariasis is a rare entity. The causative organism for gall bladder ascariasis is Ascaris lumbricoides It usually presents as acute acalculous cholecystitis. Conservative management with anti-helminthic drugs is preferred while sometimes the patient may need surgical intervention.
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8
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Nechi S, Gharbi G, Douggaz A, Boughdir M, Chaabane A, Mfarrej MK, Chelbi E. Bile duct infestation with Enterobius vermicularis diagnosed after cholecystectomy: About two case reports. Clin Case Rep 2021; 9:e05038. [PMID: 34765211 PMCID: PMC8572329 DOI: 10.1002/ccr3.5038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 10/16/2021] [Indexed: 11/18/2022] Open
Abstract
Intestinal infestation with Enterobius vermicularis is common, especially in the developing countries. However, its migration in the bile ducts is rare, often diagnosed after cholecystectomy. More investigations are needed to define its involvement in symptoms presented by patients and the likelihood of complications.
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Affiliation(s)
- Salwa Nechi
- Department of PathologyMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarNabeulTunisia
| | - Ghada Gharbi
- Faculty of Medicine of TunisUniversity of Tunis El ManarNabeulTunisia
- Department of GastroenterologyMohamed Taher Maamouri HospitalNabeulTunisia
| | - Amel Douggaz
- Department of PathologyMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarNabeulTunisia
| | - Malak Boughdir
- Faculty of Medicine of TunisUniversity of Tunis El ManarNabeulTunisia
- Department of surgeryMohamed Taher Maamouri HospitalNabeulTunisia
| | - Abir Chaabane
- Department of PathologyMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarNabeulTunisia
| | - Mohamed Karim Mfarrej
- Department of PathologyMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarNabeulTunisia
| | - Emna Chelbi
- Department of PathologyMohamed Taher Maamouri HospitalNabeulTunisia
- Faculty of Medicine of TunisUniversity of Tunis El ManarNabeulTunisia
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9
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Ebrahimi B, Hosseini SV, Haghighat N, Moeinvaziri N, Amini M, Sobhani Z, Hosseini B. Presence of Parasite in the Gastrointestinal Tract of a Patient Undergoing Single Anastomosis Sleeve Ileal Bypass (SASI) Surgery: Case Report. Obes Surg 2021; 31:4640-4642. [PMID: 34081273 DOI: 10.1007/s11695-021-05504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Bahareh Ebrahimi
- Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Neda Haghighat
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nader Moeinvaziri
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, 32279711-071, Iran
| | - Masoud Amini
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, 32279711-071, Iran
| | - Zahra Sobhani
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Babak Hosseini
- Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Surgery, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, 32279711-071, Iran.
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10
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Abstract
Hepatosplenic candidiasis and other fungal infections of the liver are uncommon in healthy individuals; however, high index of suspicion is essential in immunocompromised patients with prolonged fever. Parasitic infections are protozoan or helminthic; their distribution and epidemiology are variable among different world regions. Clonorchiasis, opisthorchiasis, fascioliasis, and ascariasis are helminthic infections that commonly involve the biliary systems. Signs and symptoms of cholangitis require prompt management to relieve biliary obstruction; addition of antihelminthic agents is essential. Parasitic infections are mostly transmitted to humans by fecally contaminated food and water. Proper hand and food sanitation measures are essential in preventing disease transmission.
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Affiliation(s)
- Sirina Ekpanyapong
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
| | - K Rajender Reddy
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA 19104, USA.
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11
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Incidencia y distribución geográfica de pacientes hospitalizados con fascioliasis en España. Enferm Infecc Microbiol Clin 2020; 38:257-262. [DOI: 10.1016/j.eimc.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/06/2019] [Accepted: 08/31/2019] [Indexed: 11/22/2022]
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12
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Pandey T, Ghosh A, Todur VN, Rajendran V, Kalita P, Kalita J, Shukla R, Chetri PB, Shukla H, Sonkar A, Lyngdoh DL, Singh R, Khan H, Nongkhlaw J, Das KC, Tripathi T. Draft Genome of the Liver Fluke Fasciola gigantica. ACS OMEGA 2020; 5:11084-11091. [PMID: 32455229 PMCID: PMC7241025 DOI: 10.1021/acsomega.0c00980] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/23/2020] [Indexed: 05/22/2023]
Abstract
Fascioliasis, a neglected foodborne disease caused by liver flukes (genus Fasciola), affects more than 200 million people worldwide. Despite technological advances, little is known about the molecular biology and biochemistry of these flukes. We present the draft genome of Fasciola gigantica for the first time. The assembled draft genome has a size of ∼1.04 Gb with an N50 and N90 of 129 and 149 kb, respectively. A total of 20 858 genes were predicted. The de novo repeats identified in the draft genome were 46.85%. The pathway included all of the genes of glycolysis, Krebs cycle, and fatty acid metabolism but lacked the key genes of the fatty acid biosynthesis pathway. This indicates that the fatty acid required for survival of the fluke may be acquired from the host bile. It may be hypothesized that the relatively larger F. gigantica genome did not evolve through genome duplications but rather is interspersed with many repetitive elements. The genomic information will provide a comprehensive resource to facilitate the development of novel interventions for fascioliasis control.
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Affiliation(s)
- Tripti Pandey
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Arpita Ghosh
- Eurofins
Genomics India Pvt. Ltd., Doddanekkundi, Bengaluru 560048, India
| | - Vivek N. Todur
- Eurofins
Genomics India Pvt. Ltd., Doddanekkundi, Bengaluru 560048, India
| | - Vijayakumar Rajendran
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Parismita Kalita
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Jupitara Kalita
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Rohit Shukla
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Purna B. Chetri
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Harish Shukla
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Amit Sonkar
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Denzelle Lee Lyngdoh
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Radhika Singh
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Heena Khan
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Joplin Nongkhlaw
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Kanhu Charan Das
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
| | - Timir Tripathi
- Molecular
and Structural Biophysics Laboratory, Department of Biochemistry, North-Eastern Hill University, Shillong 793022, India
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13
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Thakur R, Singh BB, Jindal P, Aulakh RS, Gill JPS. The Clean India Mission: Public and animal health benefits. Acta Trop 2018; 186:5-15. [PMID: 29949730 DOI: 10.1016/j.actatropica.2018.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/21/2018] [Accepted: 06/23/2018] [Indexed: 12/20/2022]
Abstract
The Clean India Mission is a national campaign that aims for complete elimination of open defecation from the country. In India, 564 million people do not have access to toilets and defecate in the open environment. The 'Millennium development goals' have given increased weightage to elimination of open defecation for improving health, nutrition and productivity of developing country populations. The Indian economy bears an estimated annual total loss (in terms of health, education, access time and tourism) of US$ 54 billion due to lack of toilets, poor hygiene and over US$ 38.5 billion in treatment costs for diseases occurring due to poor hygiene. Out of 1415 human pathogens, at least more than 10% of pathogens are transmitted through the faecal-oral route. The practice of open defecation helps pathogens persist in the environment and cause diseases. This review focuses on the current status and harms of open defecation, as well as the public and animal health benefits of implementing 'The Clean India Mission' in India.
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Affiliation(s)
- Rashmi Thakur
- School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, Punjab, India
| | - Balbir Bagicha Singh
- School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, Punjab, India.
| | - Prateek Jindal
- School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, Punjab, India
| | - Rabinder Singh Aulakh
- School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, Punjab, India
| | - Jatinder Paul Singh Gill
- School of Public Health & Zoonoses, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, 141004, Punjab, India
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14
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Rana SS, Mewara A, Guleria S, Sharma R. Unusual filling defect in bile duct. Endosc Ultrasound 2018. [PMID: 29536954 PMCID: PMC6032696 DOI: 10.4103/eus.eus_95_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Abhishek Mewara
- Department of Medical Parasitology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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15
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Lübbert C, Schneitler S. Parasitic and infectious diseases of the biliary tract in migrants and international travelers. Expert Rev Gastroenterol Hepatol 2016; 10:1211-1225. [PMID: 27677833 DOI: 10.1080/17474124.2016.1240614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In recent years, global and regional crises have led to extraordinary worldwide migration, accompanied by an increase in long-distance travel from Western countries. Both are linked to a rising incidence of rare parasitic and infectious diseases in first world countries, including in the biliary tract. Areas covered: A selective literature research in PubMed was performed to review the most important parasitic and infectious biliary diseases, which are caused by a wide variety of pathogens and may be latent over long periods, with chronic courses leading to cholangitis, hepatic failure or development of cholangiocarcinoma. Parasites such as Ascaris, Fasciola and Clonorchis/Opisthorchis are particularly important and may trigger biliary diseases or predisposition for bacterial superinfections. Viral or protozoal cholangitis is mainly a problem of impaired immunity. Expert commentary: Currently, these entities are still rare in migrants and long-distance travelers. However, a significant increase in Western countries has to be expected. Incidences are most likely underestimated because of protracted clinical latency. Diagnosis depends on the relevant pathogens, the host's immune status and the extent or distribution of biliary obstruction. Modern tomographic methods, ERCP and specific microbiological/parasitological/virological tests are of crucial diagnostic importance. Antimicrobial/antiparasitic/antiviral therapy along with ERCP and interventional sonography/radiology provide effective treatment options.
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Affiliation(s)
- Christoph Lübbert
- a Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology , Leipzig University Hospital , Leipzig , Germany.,b Interdisciplinary Center for Infectious Diseases , Leipzig University Hospital , Leipzig , Germany
| | - Sophie Schneitler
- a Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology , Leipzig University Hospital , Leipzig , Germany
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16
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Bansal R, Rosberger S, Policar M. A unique case of ascending cholangitis. Eur J Intern Med 2016; 34:e7-e8. [PMID: 27157828 DOI: 10.1016/j.ejim.2016.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 02/05/2016] [Accepted: 04/10/2016] [Indexed: 11/23/2022]
Affiliation(s)
- Raghav Bansal
- Division of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, USA.
| | - Sonam Rosberger
- Department of Radiology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, USA
| | - Maurice Policar
- Department of Infectious Disease, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, USA
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17
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18
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Abstract
Ascariasis lumbricoides is one of the most common helminthic infestations in humans. Despite the fact that the prevalence of ascariasis in developed countries has been decreasing, biliary ascariasis can cause serious complications, such as acute cholangitis, pancreatitis, and liver abscess. Here we presented a rare ascariasis-related complication-hepatolithiasis.A 60-year-old female patient had symptoms of recurrent cholangitis. Abdominal computed tomography scan revealed left intrahepatic duct stones with left liver lobe atrophy. Endoscopic retrograde cholangiopancreatography was performed, but the stones could not be removed due to left main intrahepatic duct stenosis. The patient was treated with left hemi-hepatectomy. Unexpectedly, Ascaris ova were found on the histopathological examination. She received antihelminthic therapy orally and was on regular follow-up without any complications.Our study indicates that clinicians should be aware of biliary ascariasis in patients with hepatolithiasis, though not living in endemic areas.
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Affiliation(s)
- Chen-Fang Lee
- From the Department of Liver and Transplantation Surgery (C-FL, W-CL); and Department of Pathology (R-CW, T-CC), Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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19
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Ha JS, Choi HJ, Moon JH, Lee YN, Tae JW, Choi MH, Lee TH, Cha SW. Endoscopic Extraction of Biliary Fascioliasis Diagnosed Using Intraductal Ultrasonography in a Patient with Acute Cholangitis. Clin Endosc 2015; 48:579-82. [PMID: 26668810 PMCID: PMC4676668 DOI: 10.5946/ce.2015.48.6.579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/14/2015] [Accepted: 03/15/2015] [Indexed: 11/22/2022] Open
Abstract
Fasciola hepatica infection may result in biliary obstruction with or without cholangitis in the chronic biliary phase. Because clinical symptoms and signs of F. hepatica are similar to other biliary diseases that cause bile duct obstruction, such as stones or bile duct malignancies, that are, in fact, more common, this condition may not be suspected and diagnosis may be overlooked and delayed. Patients undergoing endoscopic retrograde cholangiopancreatography or endoscopic ultrasonography for the evaluation of bile duct obstruction may be incidentally detected with the worm, and diagnosis can be confirmed by extraction of the leaf-like trematode from the bile duct. Intraductal ultrasonography (IDUS) can provide high-resolution cross-sectional images of the bile duct, and is useful in evaluating indeterminate biliary diseases. We present a case of biliary fascioliasis that was diagnosed using IDUS and managed endoscopically in a patient with acute cholangitis.
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Affiliation(s)
- Ji Su Ha
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Hyun Jong Choi
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Jong Ho Moon
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Yun Nah Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Jae Woong Tae
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Moon Han Choi
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Tae Hoon Lee
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
| | - Sang-Woo Cha
- Digestive Disease Center and Research Institute, Department of Internal Medicine, Soonchunhyang University School of Medicine, Bucheon and Seoul, Korea
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20
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Pramanik S, Ghosh S, Roy A, Mukherjee R, Mukherjee AK. Phase composition and morphological analysis of human gallstones using IR spectroscopy, scanning electron microscopy and X-ray Rietveld analysis. Z KRIST-CRYST MATER 2015. [DOI: 10.1515/zkri-2015-1881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Quantitative phase composition and morphological characterization of 12 human gallbladder stones (GS1–GS12) retrieved from patients of eastern India have been carried out using IR-spectroscopy, powder X-ray diffraction (PXRD) and scanning electron microscopy (SEM). The FTIR spectra indicated that the primary composition of gallstones studied was cholesterol. X-ray powder diffraction study revealed cholesterol monohydrate (CHM) as the major crystalline phase in GS1–GS12. The Rietveld analysis showed that nine of the gallstones were composed exclusively of CHM, while the remaining three stones contained in addition to CHM, small amounts (4.2–10.6 wt%) of calcium carbonate as aragonite and vaterite. The crystallite size of CHM in GS1–GS12 varied between 82(6) and 249(3) nm. The SEM images of gallstones showed different crystal habits of CHM such as plates, thin rods, rectangular and hexagonal blocks, which resulted into different levels of agglomeration at the mesoscopic scale. Presence of numerous parasitic eggs with a typical muskmelon surface in three gallstones (GS2, GS7 and GS9) suggests possible association between the liver fluke infection and biliary stone formation in these patients. To the best of our knowledge, the study constitutes the first report of X-ray quantitative phase analysis of gallstones using the Rietveld methodology.
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Affiliation(s)
- Samiran Pramanik
- Department of Physics, Jadavpur University, Jadavpur, Kolkata-700032, West Bengal, India
| | - Soumen Ghosh
- Department of Physics, Gour Mahavidyalaya, Malda-732142, West Bengal, India
| | - Arkaprovo Roy
- Department of Surgery, Malda Medical College and Hospital, Malda-732101, West Bengal, India
| | - Ramanuj Mukherjee
- R.G. Kar Medical College and Hospital, Kolkata-700004, West Bengal, India
| | - Alok Kumar Mukherjee
- Department of Physics, Jadavpur University, Jadavpur, Kolkata-700032, West Bengal, India
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21
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Biliary Ascariasis Mimicking Colonic Tumor Infiltration of the Biliary System. Indian J Surg Oncol 2015; 6:280-1. [PMID: 27217679 DOI: 10.1007/s13193-015-0395-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 03/04/2015] [Indexed: 12/13/2022] Open
Abstract
Ascariasis is a common problem in developing countries with poor hygiene and sanitation. It is endemic in India and usually seen in the northern states. Biliary ascariasis is an uncommon cause of obstructive jaundice. We present a case of carcinoma of hepatic flexure of colon in which the patient developed biliary ascariasis and posed a diagnostic challenge as it mimicked tumor infiltration of the biliary system.
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22
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Integrated control programmes for schistosomiasis and other helminth infections in P.R. China. Acta Trop 2015; 141:332-41. [PMID: 24361182 DOI: 10.1016/j.actatropica.2013.11.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 10/26/2013] [Accepted: 11/30/2013] [Indexed: 02/08/2023]
Abstract
The prevalence of human schistosomiasis and soil-transmitted helminthiasis (STH) has decreased significantly in the People's Republic of China (P.R. China), particularly after 2005 when the national control programmes were reinforced by forming of integrated control strategies. Furthermore, social-economic development also contributed to the decrease of schistosome and soil-transmitted helminth infections. The prevalence of the zoonotic helminthiasis, including clonorchiasis and echinococcosis, on the other hand, is either underestimated or has in fact increased due to changes in social and environmental factors. In comparison with the control strategies in force and their effects on those four kinds of helminthiasis, the challenges and control priorities for the potential transfer from control to elimination of each disease is reviewed, to provide evidence for policy-makers to act upon.
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23
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Shah U. Infections of the Liver. DISEASES OF THE LIVER IN CHILDREN 2014. [PMCID: PMC7121352 DOI: 10.1007/978-1-4614-9005-0_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The portal vein carries blood from the gastrointestinal tract to the liver and in so doing carries microbes as well. The liver may therefore be involved in infections with a myriad number of microbial organisms. While some of these infections most commonly occur in the immunocompromised host, others affect the immune competence. Hepatic infections may be primary in nature or secondary, as part of systemic or contagious disease. The purpose of this chapter is to provide a brief overview of the various infections of the liver in the pediatric patient.
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24
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Higuchi R, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Windsor JA, Mayumi T, Yoshida M, Miura F, Kimura Y, Okamoto K, Gabata T, Hata J, Gomi H, Supe AN, Jagannath P, Singh H, Kim MH, Hilvano SC, Ker CG, Kim SW. TG13 miscellaneous etiology of cholangitis and cholecystitis. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:97-105. [PMID: 23307005 DOI: 10.1007/s00534-012-0565-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper describes typical diseases and morbidities classified in the category of miscellaneous etiology of cholangitis and cholecystitis. The paper also comments on the evidence presented in the Tokyo Guidelines for the management of acute cholangitis and cholecystitis (TG 07) published in 2007 and the evidence reported subsequently, as well as miscellaneous etiology that has not so far been touched on. (1) Oriental cholangitis is the type of cholangitis that occurs following intrahepatic stones and is frequently referred to as an endemic disease in Southeast Asian regions. The characteristics and diagnosis of oriental cholangitis are also commented on. (2) TG 07 recommended percutaneous transhepatic biliary drainage in patients with cholestasis (many of the patients have obstructive jaundice or acute cholangitis and present clinical signs due to hilar biliary stenosis or obstruction). However, the usefulness of endoscopic naso-biliary drainage has increased along with the spread of endoscopic biliary drainage procedures. (3) As for biliary tract infections in patients who underwent biliary tract surgery, the incidence rate of cholangitis after reconstruction of the biliary tract and liver transplantation is presented. (4) As for primary sclerosing cholangitis, the frequency, age of predilection and the rate of combination of inflammatory enteropathy and biliary tract cancer are presented. (5) In the case of acalculous cholecystitis, the frequency of occurrence, causative factors and complications as well as the frequency of gangrenous cholecystitis, gallbladder perforation and diagnostic accuracy are included in the updated Tokyo Guidelines 2013 (TG13). Free full-text articles and a mobile application of TG13 are available via http://www.jshbps.jp/en/guideline/tg13.html.
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Affiliation(s)
- Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
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25
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Abstract
Infection of the biliary tract, or cholangitis, is a potentially life-threatening condition. Bile duct stones are the most common cause of biliary obstruction predisposing to cholangitis. The key components in the pathogenesis of cholangitis are biliary obstruction and biliary infection. Several underlying mechanisms of bactibilia have been proposed. Characteristic clinical features of cholangitis include abdominal pain, fever, and jaundice. A combination of clinical features with laboratory tests and imaging studies are frequently used to diagnose cholangitis. Endoscopic retrograde cholangiopancreatography is the best diagnostic test. Less invasive imaging tests may be performed initially in clinically stable patients with uncertain diagnoses.
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Affiliation(s)
- Rajan Kochar
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, USA
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26
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Abstract
Liver disease is an important source of morbidity among ill returning travelers. Jaundice is one of the most common and obvious symptoms of liver disease, the differential diagnosis of which is extensive, especially in travelers. Jaundice in travelers can arise from both infectious and noninfectious causes. We herein summarize the most common parasitic etiologies that may lead to jaundice in the returned traveler, visitors of friends and relatives, or new immigrants, and describe the etiology, epidemiology, and pathogenesis of clinical features of each.
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Affiliation(s)
- Wilson W Chan
- Calgary Laboratory Services, Calgary, Alberta, Canada
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27
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Qiao T, Ma RH, Luo XB, Luo ZL, Zheng PM. Cholecystolithiasis is associated with Clonorchis sinensis infection. PLoS One 2012; 7:e42471. [PMID: 22905137 PMCID: PMC3414519 DOI: 10.1371/journal.pone.0042471] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 07/05/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The objective of this study was to analyze gallbladder stones for direct evidence of a relationship between Clonorchis sinensis infection and gallbladder stones formation. METHODOLOGY We investigated one hundred eighty-three gallbladder stones for the presence of Clonorchis sinensis eggs using microscopy, and analyzed their composition using Fourier transform infrared spectroscopy. We confirmed the presence of Clonorchis sinensis eggs in the gallbladder stones using real-time fluorescent PCR and scanning electron microscopy. PRINCIPAL FINDINGS Clonorchis sinensis eggs were detected in 122 of 183 gallbladder stones based on morphologic characteristics and results from real-time fluorescent PCR. The proportion of pigment stones, cholesterol stones and mixed gallstones in the egg-positive stones was 79.5% (97/122), 3.3% (4/122) and 17.2% (21/122), respectively, while 29.5% (18/61), 31.1% (19/61) and 39.3% (24/61) in the egg-negative stones. The proportion of pigment stone in the Clonorchis sinensis egg-positive stones was higher than in egg-negative stones (P<0.0001). In the 30 egg-positive stones examined by scanning electron microscopy, dozens or even hundreds of Clonorchis sinensis eggs were visible (×400) showing a distinct morphology. Many eggs were wrapped with surrounding particles, and in some, muskmelon wrinkles was seen on the surface of the eggs. Also visible were pieces of texture shed from some of the eggs. Some eggs were depressed or without operculum while most eggs were adhered to or wrapped with amorphous particles or mucoid matter (×3000). CONCLUSION Clonorchis sinensis eggs were detected in the gallbladder stones which suggests an association between Clonorchis sinensis infection and gallbladder stones formation, especially pigment stones.
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Affiliation(s)
- Tie Qiao
- Laboratory of Gallbladder Diseases, Institute of Gallbladder Disease of Panyu, Guangzhou, People's Republic of China.
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28
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Fürst T, Duthaler U, Sripa B, Utzinger J, Keiser J. Trematode Infections. Infect Dis Clin North Am 2012; 26:399-419. [DOI: 10.1016/j.idc.2012.03.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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29
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Vítek L, Carey MC. New pathophysiological concepts underlying pathogenesis of pigment gallstones. Clin Res Hepatol Gastroenterol 2012; 36:122-9. [PMID: 21978438 PMCID: PMC3311771 DOI: 10.1016/j.clinre.2011.08.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 08/29/2011] [Indexed: 02/04/2023]
Abstract
Pigment gallstones, which are much less frequent than cholesterol stones, are classified descriptively as "black" or "brown". They are composed mostly of calcium hydrogen bilirubinate, Ca(HUCB)(2), which is polymerized and oxidized in "black" stones but remains unpolymerized in "brown" stones. Black stones form in sterile gallbladder bile but brown stones form secondary to stasis and anaerobic bacterial infection in any part of the biliary tree, including the gallbladder. Other calcium salts coprecipitate in both stone types; crystalline calcium phosphate and/or carbonate in the case of "black" stones and amorphous calcium salts of long chain saturated fatty acids ("soaps") in the case of "brown" stones. Cholesterol is present in variable proportions in "brown" more than "black" stones and in the latter, the bile sterol may be totally absent. The "scaffolding" of both stone types is a mixed mucin glycoprotein matrix secreted by epithelial cells lining the biliary tree. The critical pathophysiological prerequisite for "black" stone formation is "hyperbilirubinbilia" (biliary hypersecretion of bilirubin conjugates). It is due principally to hemolysis, ineffective erythropoiesis, or pathologic enterohepatic cycling of unconjugated bilirubin. Endogenous biliary β-glucuronidase hydrolysis of bilirubin conjugates in gallbladder bile provides HUCB(-) molecules that precipitate as insoluble salts with ionized Ca. Putatively, reactive oxygen species secreted by an inflamed gallbladder mucosa are responsible for transforming the initial soft yellow precipitates into hard black [Ca(HUCB)(2)](n) polymers. Despite "brown" gallstones being soft and amenable to mechanical removal, chronic anaerobic infection of the biliary tree is often markedly resistant to eradication.
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Affiliation(s)
| | - Martin C. Carey
- Corresponding author: Department of Medicine, Gastroenterology Division, Thorn Building, Room 1430, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA, , Phone: 617-732-5822, Fax: 617-730-5807
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30
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Vokřál I, Jirásko R, Jedličková V, Bártíková H, Skálová L, Lamka J, Holčapek M, Szotáková B. The inability of tapeworm Hymenolepis diminuta and fluke Dicrocoelium dendriticum to metabolize praziquantel. Vet Parasitol 2011; 185:168-74. [PMID: 21996005 DOI: 10.1016/j.vetpar.2011.09.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 08/30/2011] [Accepted: 09/15/2011] [Indexed: 11/18/2022]
Abstract
Biotransformation enzymes can, to a certain extent, protect parasitic worms against the toxic effects of anthelmintics and can contribute to drug-resistance development. The objective of our work was (1) to find and identify phase I and II metabolites of the anthelmintic praziquantel (PZQ) formed by the lancet fluke (Dicrocoelium dendriticum) and the rat tapeworm (Hymenolepis diminuta) and (2) to compare PZQ metabolites in helminths with PZQ biotransformation in rat as host species. Ultra high performance liquid chromatography/tandem mass spectrometry (UHPLC/MS/MS) was used for this purpose. During in vitro incubations, mitochondria-like and microsomes-like fractions (prepared from homogenates of adult worms or from rat liver homogenate) were incubated with 10 and 100 μM PZQ. Liquid/liquid extraction was used for samples during in vitro experiments. In the ex vivo study, living D. dendriticum and H. diminuta adults were incubated in RPMI-1640 medium in the presence of 50 nM or 100 nM PZQ for 24h. After incubation, the worms were removed from the medium and homogenized. Homogenates of worms, medium from the incubation of worms or rat hepatocytes and rat urine (collected during 24h after oral PZQ administration) were separately extracted using solid-phase extraction. The results showed that both D. dendriticum and H. diminuta enzymatic systems are not able to metabolize PZQ. On the other hand, thirty one different phase I and four phase II PZQ metabolites were detected in rat samples using UHPLC/MS/MS analyses. These results show that our experimental helminths, as the members of tapeworm and fluke groups of parasites, are not able to deactivate PZQ, and that the biotransformation enzymes of the studied helminths do not contribute to PZQ-resistance.
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Affiliation(s)
- Ivan Vokřál
- Faculty of Pharmacy, Charles University, Heyrovského 1203, CZ-50005 Hradec Králové, Czech Republic
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31
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Kim RD, Kim JS, Watanabe G, Mohuczy D, Behrns KE. Liver regeneration and the atrophy-hypertrophy complex. Semin Intervent Radiol 2011; 25:92-103. [PMID: 21326550 DOI: 10.1055/s-2008-1076679] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The atrophy-hypertrophy complex (AHC) refers to the controlled restoration of liver parenchyma following hepatocyte loss. Different types of injury (e.g., toxins, ischemia/reperfusion, biliary obstruction, and resection) elicit the same hypertrophic response in the remnant liver. The AHC involves complex anatomical, histological, cellular, and molecular processes. The signals responsible for these processes are both intrinsic and extrinsic to the liver and involve both physical and molecular events. In patients in whom resection of large liver malignancies would result in an inadequate functional liver remnant, preoperative portal vein embolization may increase the remnant liver sufficiently to permit aggressive resections. Through continued basic science research, the cellular mechanisms of the AHC may be maximized to permit curative resections in patients with potentially prohibitive liver function.
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Affiliation(s)
- Robin D Kim
- Department of Surgery, Division of General and GI Surgery, University of Florida, Gainesville, Florida
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32
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Abstract
Parasitic infections of the biliary tract are a common cause of biliary obstruction in endemic areas. This article focuses on primary biliary parasites: Ascaris lumbricoides, Clonorchis sinensis, Opisthorchis viverrini, Opisthorchis felineus, Dicrocoelium dendriticum, Fasciola hepatica, and Fasciola gigantica. Tropical and subtropical countries have the highest incidence and prevalence of these infections. Diagnosis is made primarily through direct microscopic examination of eggs in the stool, duodenal, or bile contents. Radiologic imaging may show intrahepatic ductal dilatation, whereas endoscopic retrograde cholangiopancreatography can be used diagnostically and therapeutically. However, oral treatment is inexpensive and effective for most of these parasites and can prevent untoward consequences. Primary and alternative treatments are available and are reviewed in this article.
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33
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Uddin MH, Li S, Bae YM, Choi MH, Hong ST. Strain variation in the susceptibility and immune response to Clonorchis sinensis infection in mice. Parasitol Int 2011; 61:118-23. [PMID: 21763454 DOI: 10.1016/j.parint.2011.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 06/29/2011] [Accepted: 07/01/2011] [Indexed: 10/18/2022]
Abstract
Mice have shown various susceptibility to infection by Clonorchis sinensis. To compare the intra-specific variation in the host-parasite relationship of C. sinensis, 6 strains of mice (ICR, BALB/c, C57BL/6, DDY, CBA/N, and C3H/HeN) with 3 different haplotypes were evaluated on their susceptibility. The worm recovery rate and immunological responses were observed after 4 and 8 weeks of infection with 30 metacercariae. The highest worm recovery rate was observed as 20.7% in the C3H/HeN strain after 4 weeks of infection along with histopathological changes. The rate was 10.0% in C57BL/6 mice after 8 weeks. ICR, BALB/c, and CBA/N showed elevated levels of IgE at both time points when compared to the rest of the strains. The serum IgG1 and IgG2a levels were elevated in most of the strains; however, the C57BL/6 strain showed a lower level of IgG2a that indicated the IgG1 predominance over IgG2a. The production of IL-4 after concanavalin-A stimulation of splenocytes slightly increased among the mouse strains except C3H/HeN after 4 or 8 weeks of infection, but each strain produced high levels of IFN-γ after 8 weeks, which implied mixed Th1/Th2 responses. ICR, DDY, CBA/N, and C3H/HeN strains showed a significantly increased level of IL-10 after 8 weeks as compared to C57BL/6. All of the strains showed an increased level of IL-13 and suggested fibrotic changes in the mice. In conclusion, mice are insusceptible to infection with C. sinensis; however, the C57BL/6, BALB/c and ICR strains are relatively susceptible after 8 weeks of infection among the six strains. Worm expulsion may be one of the causes of low susceptibility of C3H/HeN mice strain at the 8th week. Elevated IgE, IFN-γ, and IL-13 of infected mice suggest both Th1 and Th2 responses that may be related to the low host susceptibility.
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Affiliation(s)
- Md Hafiz Uddin
- Department of Parasitology and Tropical Medicine, Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul 110-799, Republic of Korea
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Jeandron A, Rinaldi L, Abdyldaieva G, Usubalieva J, Steinmann P, Cringoli G, Utzinger J. Human infections with Dicrocoelium dendriticum in Kyrgyzstan: the tip of the iceberg? J Parasitol 2011; 97:1170-2. [PMID: 21736477 DOI: 10.1645/ge-2828.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Dicrocoelium dendriticum is the causative agent of a rare food-borne zoonosis of the human biliary tract, dicrocoeliasis, for which few human prevalence data are available. Infection occurs through the ingestion of ants containing metacercariae, whereas pseudo-infections (presence of D. dendriticum eggs in stool in the absence of adult worms) are due to the consumption of infected animal liver. Here, results from a cross-sectional survey carried out among 138 children aged 2-15 yr in a peri-urban area of Kyrgyzstan are reported. Each child provided 1 stool sample that was subjected to the FLOTAC technique. Eggs of D. dendriticum were diagnosed in 11 children (prevalence 8.0%; 95% confidence interval 4.5-13.7%). Although no distinction could be made between true and pseudo-infections, the prevailing animal husbandry system and the diet and hygienic conditions of the study area suggest that the social-ecological system in Kyrgyzstan is conducive for human transmission of D. dendriticum. There is a need to investigate the epidemiology of dicrocoeliasis in Kyrgyzstan, placing emphasis on the distinction between true and pseudo-infections.
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Affiliation(s)
- Aurelie Jeandron
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
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Goral V, Senturk S, Mete O, Cicek M, Ebik B, Kaya B. A case of biliary Fascioliasis by Fasciola gigantica in Turkey. THE KOREAN JOURNAL OF PARASITOLOGY 2011; 49:65-8. [PMID: 21461271 PMCID: PMC3063928 DOI: 10.3347/kjp.2011.49.1.65] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 01/29/2011] [Accepted: 01/29/2011] [Indexed: 11/29/2022]
Abstract
A case of Fasciola gigantica-induced biliary obstruction and cholestasis is reported in Turkey. The patient was a 37- year-old woman, and suffered from icterus, ascites, and pain in her right upper abdominal region. A total of 7 living adult flukes were recovered during endoscopic retrograde cholangiopancreatography (ERCP). A single dose of triclabendazole was administered to treat possible remaining worms. She was living in a village of southeast of Anatolia region and had sheeps and cows. She had the history of eating lettuce, mallow, dill, and parsley without washing. This is the first case of fascioliasis which was treated via endoscopic biliary extraction during ERCP in Turkey.
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Affiliation(s)
- Vedat Goral
- Department of Gastroenterology, Dicle University School of Medicine, Diyarbakir, Turkey.
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Proteomic analysis of excretory secretory products from Clonorchis sinensis adult worms: molecular characterization and serological reactivity of a excretory-secretory antigen-fructose-1,6-bisphosphatase. Parasitol Res 2011; 109:737-44. [PMID: 21424807 DOI: 10.1007/s00436-011-2316-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Accepted: 02/23/2011] [Indexed: 01/29/2023]
Abstract
Clonorchis sinensis is a food-borne zoonotic parasite that resides in bile ducts and causes clonorchiasis, which may result in cholelithiasis, cholecystitis, hepatic fibrosis, and liver tumors. Although total excretory secretory products (ESP) of C. sinensis adults induce hepatic fibrosis in vivo in rats, the causative mechanism is not well understood. To study components of the ESP, C. sinensis culture medium was collected and analyzed using shotgun LC-MS/MS. We identified a total of 110 proteins, including glycometabolic enzymes (such as fructose-1,6-bisphosphatase (FBPase) and enolase), detoxification enzymes (such as glutamate dehydrogenase, dihydrolipoamide dehydrogenase and cathepsin B endopeptidase), and a number of RAB family proteins. To identify a potential causative agent for hepatic fibrosis, we expressed and purified a recombinant FBPase, a 1,041-bp gene product that encodes a 41.7-kDa protein with prototypical FBPase domains and that can form a tetramer with a molecular mass of 166.8 kDa. In addition, we found that FBPase is an antigen present in the ESP and in circulation. Immunofluorescence showed that FBPase localizes to the intestinal cecum and vitellarium in C. sinensis adults. Our results describe the components of the excretory secretory products from C. sinensis adult worms and suggest that FBPase may be an important antigen present in the ESP of C. sinensis and may lay the foundation for additional studies on the development of clonorchiasis-associated hepatic fibrosis.
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Percutaneous transhepatic lithotripsy with the holmium: YAG laser for the treatment of refractory biliary lithiasis. Surg Laparosc Endosc Percutan Tech 2010; 19:106-9. [PMID: 19390274 DOI: 10.1097/sle.0b013e31819fa5d5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Fourteen patients who failed at least 1 endoscopic retrograde cholangiopancreatograpy attempt underwent Holmium laser biliary lithotripsy between 2003 and 2007. Ten had prior biliary surgeries, 7 harbored multiple stones, and 6 had common bile duct strictures. Mean age at surgery was 63.6 years (50 to 80 y), biggest stone burden 30 mm, mean operative time 58.4 minutes (24 to 105), and stone free rate 85.7%. One patient had postoperative bleeding from the choledochostomy tube that eventually resolved spontaneously and 3 patients had postoperative cholangitis managed conservatively. Neither conversions to open surgery nor mortality was recorded. Two patients were diagnosed with cholangiocarcinoma missed by previous endoscopic retrograde cholangiopancreatograpy. After a mean follow-up of 18.9 months (2 to 43) no de novo strictures were recorded. Percutaneous choledochoscopy with holmium laser lithotripsy is a safe and effective minimally invasive technique to treat complex biliary stone disease and may preclude high-risk open biliary tract surgery.
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Keshishian J, Brantley SG, Brady PG. Biliary Fascioliasis Mimicking Sphincter of Oddi Dysfunction. South Med J 2010; 103:366-8. [DOI: 10.1097/smj.0b013e3181d413d8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
A 17-year-old girl presented with features of biliary obstruction. Magnetic resonance cholangi-pancreatography revealed typical linear signals in common bile duct, which appears like Ascaris lumbricoides. The diagnosis was confirmed by endoscopic removal of the worm.
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Affiliation(s)
- Mohammad A Hashmi
- EKO CT and MRI Scan Centre, At Medical College and Hospitals Campus, 88-College Street, Kolkata-700 073, India
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Chuang YH, Lan RY, Gershwin ME. The immunopathology of human biliary cell epithelium. Semin Immunopathol 2009; 31:323-31. [PMID: 19533127 DOI: 10.1007/s00281-009-0172-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 06/02/2009] [Indexed: 12/15/2022]
Abstract
Bile ducts lined with biliary epithelial cells, or cholangiocytes, are the main components of the biliary system in liver. Cholangiocytes participate in the production and transport of bile substances, as well as participate in immune responses. Cholangiocytes protect against pathogens by expressing toll-like receptors and anti-microbial peptides; act as antigen-presenting cells by expressing human leukocyte antigen molecules and costimulatory molecules; recruit leukocytes to the target site by expressing adhesion molecules, cytokines, and chemokines; and induce apoptosis of leukocytes to limit the immune responses. Several cholangiopathies result from dysfunctions of the biliary system. They can broadly be divided into autoimmune, genetic, infectious, drug, and ischemic-injury-induced categories. The pathogenesis of many of these cholangiopathies is unclear and treatment is limited. Further understanding of the complexity of the biliary system is critical for medical advancements in this field.
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Affiliation(s)
- Ya-Hui Chuang
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Abstract
PURPOSE OF REVIEW Hepatobiliary flukes--Fasciola, Opisthorchis, Clonorchis- are a major public health problem in east Asia, east Europe, Africa and Latin America. The present review focuses on current knowledge of clinical, diagnostic and treatment aspects caused by hepatobiliary flukes that can be applied to current protocols in endemic areas. RECENT FINDINGS Specific risk factors and geographic areas for these flukes have been heavily reported recently, with millions of people infected worldwide. Human cases in nonendemic areas, related to immigration and the international food trade (i.e. raw vegetables and fish), have also been reported. Diagnostic imaging changes include track-like lesions that are a characteristic feature of acute fascioliasis on computed tomography scanning of the liver. Newly available diagnostic serological tests may detect early infection and, therefore, help reduce severe clinical complications such as recurrent cholangitis, cholecystitis, hepatic tumours, cysts, calcification, cholelithiasis, pancreatitis, most importantly, cholangiocarcinoma related to Opisthorchis viverrini and possibly Clonorchis sinensis, and liver fibrosis associated with Fasciola hepatica infections. Highly effective antiparasitic treatment is available for all flukes. SUMMARY There is a better understanding of risk factors, clinical manifestations and complications, novel diagnosis tests and effective treatment, which together should help reduce the morbidity and mortality of these infections.
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Zhang H, Chung BS, Li S, Choi MH, Hong ST. Changing patterns of serum and bile antibodies in re-infected rats with Clonorchis sinensis. THE KOREAN JOURNAL OF PARASITOLOGY 2008; 46:17-22. [PMID: 18344672 DOI: 10.3347/kjp.2008.46.1.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Rats develop strong resistance to re-infection and super-infection by Clonorchis sinensis. The present study investigated the antibodies present in the sera and bile juice of rats that were primary infected and re-infected with C. sinensis. The serum level of specific IgG antibodies, which were elevated 2 wk of the primary infection, peaked at 4 wk and subsequently remained unchanged even during re-infection. The total IgE level in serum increased slowly from 388 ng / ml to 3,426 ng / ml beginning 2 wk after the primary infection, and remained high up to 8 wk but dropped to a normal level (259 ng / ml) after treatment. In resistant re-infected rats, the serum IgE level increased rapidly and peaked within 1 wk, whereas no increase was observed in immunosuppressed rats. The serum level of specific IgA antibodies was elevated beginning 1 wk after infection, and decreased 4 wk after treatment. The total bile IgA level unchanged during the primary infection but increased in treated and re-infected rats. The elevated levels of serum IgE and bile IgA indicate that these immunoglobulins may be correlated with the development of resistance to re-infection by C. sinensis in rats.
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Affiliation(s)
- Hongman Zhang
- Department of Parasitology and Tropical Medicine, Institute of Endemic Diseases, Seoul National University College of Medicine, Seoul, Republic of Korea
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Tang SJ, Jazrawi SF. Electronic clinical challenges and images in GI. ERCP in biliary fascioliasis (with video). Gastroenterology 2008; 134:e7-8. [PMID: 18471495 DOI: 10.1053/j.gastro.2008.03.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Shou-Jiang Tang
- Department of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Factors in the resistance of rats to re-infection and super-infection by Clonorchis sinensis. Parasitol Res 2008; 102:1111-7. [DOI: 10.1007/s00436-008-0878-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 01/05/2008] [Indexed: 10/22/2022]
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Kim YJ, Choi MH, Hong ST, Bae YM. Proliferative effects of excretory/secretory products from Clonorchis sinensis on the human epithelial cell line HEK293 via regulation of the transcription factor E2F1. Parasitol Res 2007; 102:411-7. [PMID: 18026993 DOI: 10.1007/s00436-007-0778-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 10/24/2007] [Indexed: 11/26/2022]
Abstract
Clonorchis sinensis is one of the most prevalent parasitic helminths of humans in East Asia. Although several complications in bile duct epithelial cells are caused by C. sinensis infection, the mechanism is not clearly understood. To clarify the effects of C. sinensis excretory-secretory products (ES products) on bile duct epithelial cells, we investigated their effects on the human embryonic kidney epithelial cell line HEK293 in vitro. Our results show that ES products alter the proportion of cells in each stage of the cell cycle and induce HEK293 cell proliferation. Among cell cycle-related proteins, the expression of cyclin E increased markedly after treatment with ES products, indicating that the G1/S transition occurred. In addition, the expression of the transcription factor E2F1 was up-regulated by the addition of ES products. Small interfering RNA (siRNA) was used to demonstrate that the transcription factor E2F1 is a key factor in the control of cell proliferation in HEK293 cells. The present results demonstrate that ES products from C. sinensis stimulate cell proliferation by inducing E2F1 expression. We suggest that the ES products released from C. sinensis during infection may play an important role in the development of cholangiocarcinoma via the overgrowth of the bile duct epithelium.
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Affiliation(s)
- Young Ju Kim
- Department of Parasitology and Tropical Medicine, Seoul National University College of Medicine, 103 Daehangno, Jongno-gu, Seoul 110-799, South Korea
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