An extremely uncommon case of parasitic infection presenting as eosinophilic ascites in a young patient

Acute-Onset Eosinophilic Gastroenteritis and Ascites Secondary to Occult Toxocariasis

Eosinophilic gastroenteritis is a rare entity, and although usually idiopathic, it may arise from gastrointestinal infections. We report a case of a 33-year-old woman from Vietnam presenting with acute abdominal pain, new-onset eosinophilic ascites, peripheral eosinophilia, and a positive Toxocara antibody. The patient had no recent international travel, known animal host contact, or other toxocariasis risk factors. She was treated with ivermectin and mebendazole with complete resolution of symptoms. This case emphasizes the consideration of a broad differential for eosinophilic ascites, including atypical presentations of infectious pathogens.

Causes of eosinophilic ascites – A systematic review

Background . In the last years an uprising interest for a relatively unknown entity, eosinophilic ascites (EA), has been recorded.

Our aim is to investigate the potential causes of EA development, as well as clinical, laboratory, endoscopic and radiologic features, management and outcome in these patients.

Methods . The following research was performed on PubMed (MEDLINE) database using the medical subject headings [Mesh] terms “Ascites” AND “Eosinophils”.

Results . A total of 284 results, dating from 1962 onwards, were found and abstracts were examined. 131 papers were excluded and the remaining 153 publications, consisting in case reports and series of cases, were analyzed.

From 171 patients with EA, 127 subjects (74%) had EGE, 17 (10%) parasitic and fungal infections, 11(7%) Hypereosinophilic syndrome and 16 patients (9%) less common diseases (eosinophilic pancreatitis, chronic eosinophilic leukemia, myelofibrosis, T-cell lymphoma, Churg Strauss Syndrome, Systemic lupus erythematosus, Familial paroxysmal polyserositis and Ménétrier’s disease). High eosinophil blood count and IgE levels as well as gastrointestinal symptoms are frequent. The diagnosis is based on ascitic fluid analysis, imaging and endoscopic biopsies. Therapy with corticosteroids results in resolution of eosinophilic ascites in almost all patients.

Conclusion . In most cases, in the absence of allergy, parasitic infections, malignancy, hematological disorders, peritoneal tuberculosis, inflammatory bowel disease or autoimmune disease, EA develops as a manifestation of eosinophilic gastroenteritis.

Nanoformulations of albendazole as effective anticancer and antiparasite agents

Initially emerging as a widely used clinical antiparasitic drug, albendazole (ABZ) has been increasingly recognized as an effective anticancer agent due to its outstanding advantage, in other words, low toxicity to normal cells but high effectiveness against parasites and some tumors. The major challenge is its poor water solubility and subsequently low bioavailability. This article thus first reviews the brief achievements in using ABZ to treat parasites and cancers, and summarizes the basic mechanisms of action of ABZ. Then this article critically reviews recent nanotechnological strategies, in other words, formulating/conjugating it with carriers into nanoformulations, in practices of improving aqueous solubility and efficacy in treatment of tumors and parasites. Our expert opinions in this field are provided for more effective delivery of ABZ to treat tumors and parasites in vivo.

Eosinophilic Gastroenteritis and Colitis: a Comprehensive Review

Eosinophilic gastrointestinal disorders, including eosinophilic esophagitis, gastroenteritis, and colitis, refer to a spectrum of clinical diseases that present with variable degrees of infiltration of the gastrointestinal tract by eosinophils in the absence of other known causes of tissue eosinophilia. Clinical symptoms and laboratory findings are usually non-specific and may or may not be accompanied by peripheral blood eosinophilia. The extent of eosinophilic infiltration of the gastrointestinal wall varies from mucosal to transmural and serosal involvement. Diagnosis requires presence of gastrointestinal symptoms, demonstration of gastrointestinal eosinophilia by biopsy, and exclusion of other known causes of tissue eosinophilia. Many studies have pointed toward the eosinophil as the major offender; however, the exact functional role of the eosinophil in the pathogenesis of eosinophilic gastrointestinal disorders remains unclear. The roles of T-helper-2 cytokines and other mediators, such as eotaxin-1 and interleukin-5, have gained significant importance in the pathobiology of eosinophilic gastrointestinal disorders. Current understanding of treatment is based on case reports and a few case series, as there is a lack of large prospective studies. Steroids are currently the mainstay of therapy, but the roles of other drugs such as leukotriene inhibitors, mast cell stabilizers, interleukin-5 inhibitors, and anti-immunoglobulin E, along with other targets in the immune pathway, are currently being explored.

Significance of Diagnosing Parasitic Infestation in Evaluation of Unexplained Eosinophilia

BACKGROUND

The evaluation of unexplained eosinophilia in an asymptomatic individual has always been a diagnostic challenge and requires understanding about a wide range of probable causative agents. Helminthic infestation and schistosomiasis are the main parasitic causes of eosinophilia. Therefore, the availability of simple and accurate diagnostic tests for detection of parasitic infections can prove to be valuable in early diagnosis and solving the mystery of unexplained eosinophilia.

MATERIALS AND METHODS

In the present study we attempt to find an association between relative eosinophilia and parasitic infections and also to find the parasites responsible for eosinophilia in a substantial number of cases. A retrospective study for the presence of eosinophilia was done on 621 cases positive for parasitic infestation.

RESULTS

Among a total of 621 cases of parasitic infestation only 66 (10.6%) cases were found to have relative eosinophilia. The parasites found to be responsible for eosinophilia were Trichuris trichiura, Ascaris lumbricoides, Strongyloides stercoralis, filarial worm and hook worm.

CONCLUSION

From the study it is concluded that eosinophilia is not a universal finding in cases with parasitic infestation. Although presence of eosinophilia can serve as one of the many diagnostic clues to look for the presence of helminthic infestation if other non-infectious causes of eosinophilia are ruled out.