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Mishra R, Tetarbe S, Bendre PS, Shah I. Difficult to treat liver abscesses in children - Do not forget parasitic infections. Trop Doct 2024; 54:172-175. [PMID: 38311934 DOI: 10.1177/00494755241227470] [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: 02/06/2024]
Abstract
Liver abscess (LA) is a significant health concern worldwide, particularly in tropical regions such as India, and is usually pyogenic or amoebic in origin. In rare cases it can be caused by parasites. We present two children with difficult-to-treat LAs, revealing underlying parasitic infections as the causative agents, implicated by eosinophilia, elevated immunoglobulin-E levels and exposure to domestic animals. In the first case, disseminated echinococcosis was diagnosed through imaging, serology and histopathology. The second case showed a relationship between LAs and Toxocara infection, evidenced by microscopic stool examination of a household cat.
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Affiliation(s)
- Ruchi Mishra
- Hepatology, B.J. Wadia Hospital for Children and Nawrosjee Wadia Maternity Hospital, Mumbai, India
| | - Shivangi Tetarbe
- Hepatology, B.J. Wadia Hospital for Children and Nawrosjee Wadia Maternity Hospital, Mumbai, India
| | - Pradnya Suhas Bendre
- Department of Paediatric Surgery, B.J. Wadia Hospital for Children, Mumbai, India
| | - Ira Shah
- Paediatric Infectious Diseases and Paediatric GI, Hepatology, B.J. Wadia Hospital for Children and Nawrosjee Wadia Maternity Hospital, Mumbai, India
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2
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Kuenzli E, Labhardt N, Balestra G, Weisser M, Zellweger MJ, Blum J. Staphylococcus aureus Endocarditis as a Complication of Toxocariasis-Associated Endomyocarditis With Fibrosis: A Case Report. Open Forum Infect Dis 2016; 3:ofw145. [PMID: 27800525 PMCID: PMC5084717 DOI: 10.1093/ofid/ofw145] [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: 03/24/2016] [Accepted: 07/11/2016] [Indexed: 11/29/2022] Open
Abstract
Complications associated with Toxocara canis infection are rare. We present a case of a patient with Staphylococcus aureus endocarditis as a complication of an endomyocardial fibrosis caused by T canis. The epidemiological, pathological, and clinical features of this rare complication are described here.
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Affiliation(s)
- Esther Kuenzli
- Division for Infectious Diseases and Hospital Epidemiology , University Hospital Basel and Swiss Tropical and Public Health Institute , Basel
| | | | | | - Maja Weisser
- Division for Infectious Diseases and Hospital Epidemiology
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Anwar MA, Gokozan HN, Ball MK, Otero J, McGwire BS. Fatal human eosinophilic meningo-encephalitis caused by CNS co-infection with Halicephalobus gingivalis and West Nile virus. Parasitol Int 2015; 64:417-20. [PMID: 26050925 DOI: 10.1016/j.parint.2015.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 11/26/2022]
Abstract
The saprophytic nematode Halicephalobus is a rare cause of fatal human meningo-encephalitis, and West Nile virus is neurotropic flavivirus implicated in a variety of clinical neurologic syndromes. Here we report a case of rapidly progressive CNS encephalopathy and death. Serologic, immuno-histochemical, histopathologic and nucleic acid studies demonstrate the presence of active Halicephalobus and West Nile virus in the CNS tissue. This is the first reported case of co-infection with these neurotropic pathogens.
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Affiliation(s)
- M A Anwar
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States
| | - H N Gokozan
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - M K Ball
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - J Otero
- Department of Pathology, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - B S McGwire
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University, Columbus, OH, United States.
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Pebam S, Goni V, Patel S, Kumar V, Rawall S, Bali K. A 12-year-old Child with Trichinellosis, Pyomyositis and Secondary Osteomyelitis. J Glob Infect Dis 2012; 4:84-8. [PMID: 22529635 PMCID: PMC3326967 DOI: 10.4103/0974-777x.93769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Trichinellosis is a parasitic infestation affecting the skeletal muscles. Cases of trichinellosis in humans have been reported from most regions of the world. However, a review of literature revealed only two reported cases of human trichinellosis in India. Further, a diagnosis of superimposed pyomyositis in trichinellosis with secondary osteomyelitis has not been reported to our knowledge. This article reports this rare case presentation in a 12-year-old child. Timely intervention helped prevent long-term morbidity in our patient. In our case report, we also discuss in detail the pathogenesis of such a condition and discuss the role of imaging modalities and an early magnetic resonance imaging (MRI) to diagnose the condition and start an early treatment.
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Affiliation(s)
- Sudesh Pebam
- Department of Orthopaedics, PGIMER, Chandigarh, India
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Fragoso RP, Monteiro MBM, Lemos EM, Pereira FEL. Anti-Toxocara antibodies detected in children attending elementary school in Vitoria, State of Espírito Santo, Brazil: prevalence and associated factors. Rev Soc Bras Med Trop 2012; 44:461-6. [PMID: 21860891 DOI: 10.1590/s0037-86822011000400012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 03/15/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the frequency of anti-Toxocara antibodies in serum from 7-year-old children attending elementary school in Vitória-ES, Brazil and to correlate these antibodies with socio-demographic factors, the presence of intestinal helminths, blood eosinophil numbers, past history of allergy or asthma, and clinical manifestations of helminth infections. METHODS The detection of anti-Toxocara antibodies was performed using an ELISA (Cellabs Pty Ltd)on serum from 391 children who had already been examined by fecal examination and blood cell counts. Data from clinical and physical examinations were obtained for all children. RESULTS The prevalence of anti-Toxocara antibodies was 51.6%, with no gender differences. No significant differences were observed between positive serology and the presence or absence of intestinal worms (60.3 and 51.7%, respectively; p = 0.286). The only variables significantly related to positive serology were onycophagy and the use of unfiltered water. Although eosinophilia (blood eosinophil count higher than 600/mm³) was significantly related to the presence of a positive ELISA result, this significance disappeared when we considered only children without worms or without a past history of allergy or asthma. No clinical symptoms related to Toxocara infection were observed. CONCLUSIONS There is a high prevalence of anti-Toxocara antibodies in children attending elementary schools in Vitória, which may be partially related to cross-reactivity with intestinal helminths or to a high frequency of infection with a small number of Toxocara eggs.
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Affiliation(s)
- Roberta Paranhos Fragoso
- Serviço de Pediatria, Hospital Universitário Cassiano Antonio de Moraes, Universidade Federal do Espírito Santo, Vitória, Brazil
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Lambertucci JR. Acute schistosomiasis mansoni: revisited and reconsidered. Mem Inst Oswaldo Cruz 2011; 105:422-35. [PMID: 20721485 DOI: 10.1590/s0074-02762010000400012] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Accepted: 10/16/2009] [Indexed: 11/22/2022] Open
Abstract
Acute schistosomiasis is a systemic hypersensitivity reaction against the migrating schistosomula and eggs. A variety of clinical manifestations appear during the migration of schistosomes in humans: cercarial dermatitis, fever, pneumonia, diarrhoea, hepatomegaly, splenomegaly, skin lesions, liver abscesses, brain tumours and myeloradiculopathy. Hypereosinophilia is common and aids diagnosis. The disease has been overlooked, misdiagnosed, underestimated and underreported in endemic areas, but risk groups are well known, including military recruits, some religious congregations, rural tourists and people practicing recreational water sports. Serology may help in diagnosis, but the finding of necrotic-exudative granulomata in a liver biopsy specimen is pathognomonic. Differentials include malaria, tuberculosis, typhoid fever, kala-azar, prolonged Salmonella bacteraemia, lymphoma, toxocariasis, liver abscesses and fever of undetermined origin. For symptomatic hospitalised patients, treatment with steroids and schistosomicides is recommended. Treatment is curative in those timely diagnosed.
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Diniz LM, Magalhães EFL, Pereira FEL, Dietze R, Ribeiro-Rodrigues R. Presence of intestinal helminths decreases T helper type 1 responses in tuberculoid leprosy patients and may increase the risk for multi-bacillary leprosy. Clin Exp Immunol 2010; 161:142-50. [PMID: 20491787 DOI: 10.1111/j.1365-2249.2010.04164.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Resistance to intracellular pathogens such as Mycobacterium leprae is dependent upon an effective T helper type 1 (Th1)-type immune response. On the other hand, intestinal helminths are known to subvert the host's immune response towards to either a Th2-type immune response or a regulatory T cell up-regulation, which may affect the host's ability to mount an effective response to mycobacteria. Here, we report a significant association between intestinal helminth infections and lepromatous leprosy [odds ratio (OR), 10.88; confidence interval (CI) 95%: 4.02-29.4; P<0.001]. We also observed that the frequency of intestinal helminths correlated strongly with the mycobacterial index (r=0.982, P<0.01). Corroborating with our hypothesis, intracellular levels of interferon-gamma were decreased significantly in leprosy patients co-infected with intestinal helminths when compared to leprosy patients without worms. Conversely, lepromatous leprosy patients with intestinal worms produced higher levels of both interleukin (IL)-4 and IL-10. Our results suggest that a pre-existing infection by intestinal helminths may facilitate the establishment of M. leprae infection or its progression to more severe forms of leprosy.
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Affiliation(s)
- L M Diniz
- Hospital da Santa Casa de Misericórdia, and Dermatology Department, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
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Monteiro MBCL, Fragoso R, Foletto S, Lemos EM, Pereira FEL. Intestinal helminthes and/or Toxocara infection are unrelated to anti-HBs titers in seven-year-old children vaccinated at birth with recombinant hepatitis B vaccine. Rev Soc Bras Med Trop 2007; 40:147-51. [PMID: 17568879 DOI: 10.1590/s0037-86822007000200001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Accepted: 03/20/2007] [Indexed: 11/22/2022] Open
Abstract
The aim of this investigation was to evaluate the possible effect of nematode infection on anti-HBs antibody levels in the serum of seven-year-old schoolchildren vaccinated at birth with the recombinant hepatitis B vaccine. Anti-HBs and anti HBc antibodies were evaluated in the sera of 100 schoolchildren with at least one intestinal nematode and/or a positive serological reaction for anti-Toxocara antibodies and in 95 schoolchildren without intestinal helminthiasis or serum anti-Toxocara antibodies. Both groups were from public elementary schools located on the urban periphery of Vitória, ES, Brazil. Among these 195 children, the median anti-HBs antibody titer was 31.3 IU/ml and the frequency of titers less than 10 IU/ml was 33.8% (95% CI: 27.1-40.4%). There were no significant differences between the medians of anti-HBs titers or the frequency of titers less than 10 IU/ml between the groups with or without helminthes (29.5 and 32.9 IU/ml and 33 and 34.7%, respectively; p>0.05). Even when the children with intestinal nematodes and/or anti-Toxocara antibodies and with blood eosinophil counts over 600/mm(3) were compared with children without infection from intestinal nematodes and without anti-Toxocara antibodies, with blood eosinophil counts less than 400 eosinophils/mm(3), these differences were not significant. None of the children presented anti-HBc antibodies. In conclusion, infections with intestinal nematodes and/or the presence of anti-Toxocara antibodies did not interfere with the anti-HBs antibody titers in seven-year-old children vaccinated at birth with the recombinant hepatitis B vaccine.
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Affiliation(s)
- Marisa B C L Monteiro
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espirito Santo, Vitória, ES
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Musso C, Castelo JS, Tsanaclis AMC, Pereira FEL. Prevalence of Toxocara-induced liver granulomas, detected by immunohistochemistry, in a series of autopsies at a Children's Reference Hospital in Vitoria, ES, Brazil. Virchows Arch 2007; 450:411-7. [PMID: 17333262 DOI: 10.1007/s00428-007-0388-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 01/05/2007] [Accepted: 02/12/2007] [Indexed: 10/23/2022]
Abstract
The aim of this investigation was to study the frequency of visceral larva migrans (VLM) granulomas in autopsies at a Children's Reference Hospital in Vitoria, ES Brazil, where anti-Toxocara antibodies are frequently detected in the serum of children admitted at the hospital. Two liver fragments from 310 autopsies of children aged between 1 and 15 years were paraffin embedded, and sections were stained with hematoxylin and eosin and submitted to detection of Toxocara antigens using a rabbit anti-Toxocara serum. Among the 24 cases with granulomatous lesions, ten had eosinophil-rich granulomas positively stained with the anti-Toxocara serum. Some were typical epithelioid granulomas, with a positive reaction in multinucleated giant cells, epithelioid cells, or necrotic debris. The results showed that VLM granulomas are the most frequent granulomatous hepatitis in children in our county. This agrees with the high prevalence of anti-Toxocara antibodies in the serum of children admitted to the Children's Reference Hospital. The 3.2% frequency of liver VLM granulomas in autopsies is less than the 30-39% frequency of positive serology in these children, probably reflecting the low larval burden in infected children.
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Affiliation(s)
- Carlos Musso
- Núcleo de Doenças Infecciosas, Centro Biomédico, UFES, Av Marechal Campos 1468, 29040-091, Vitória, ES, Brazil.
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Pecson BM, Barrios JA, Johnson DR, Nelson KL. A real-time PCR method for quantifying viable ascaris eggs using the first internally transcribed spacer region of ribosomal DNA. Appl Environ Microbiol 2006; 72:7864-72. [PMID: 17056687 PMCID: PMC1694259 DOI: 10.1128/aem.01983-06] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Worldwide, 1.4 billion people are infected with the intestinal worm Ascaris lumbricoides. As a result, Ascaris eggs are commonly found in wastewater and sludges. The current microscopy method for detecting viable Ascaris eggs is time- and labor-intensive. The goal of this study was to develop a real-time quantitative PCR (qPCR) method to determine the levels of total and viable Ascaris eggs in laboratory solutions using the first internally transcribed spacer (ITS-1) region of ribosomal DNA (rDNA) and rRNA. ITS-1 rDNA levels were proportional to Ascaris egg cell numbers, increasing as eggs developed from single cells to mature larvae and ultimately reaching a constant level per egg. Treatments causing >99% inactivation (high heat, moderate heat, ammonia, and UV) eliminated this increase in ITS-1 rDNA levels and caused decreases that were dependent on the treatment type. By taking advantage of this difference in ITS-1 rDNA level between viable, larvated eggs and inactivated, single-celled eggs, qPCR results were used to develop inactivation profiles for the different treatments. No statistical difference from the standard microscopy method was found in 75% of the samples (12 of 16). ITS-1 rRNA was detected only in samples containing viable eggs, but the levels were more variable than rDNA levels and ITS-1 rRNA could not be used for quantification. The detection limit of the rDNA-based method was approximately one larvated egg or 90 single-celled eggs; the detection limit for the rRNA-based method was several orders of magnitude higher. The rDNA qPCR method is promising for both research and regulatory applications.
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Affiliation(s)
- Brian M Pecson
- Department of Civil and Environmental Engineering, MS 1710, University of California, Berkeley, CA 94720-1710, USA
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Abstract
Liver abscesses are frequently observed in pediatric clinical practice in tropics and subtropics especially in developing countries. Children have unique set of predisposing factors which have been highlighted. Expected microbiology and setting for unusual organisms are mentioned. Clinical presentations', including importance of location and number of abscesses has been discussed. Role of each modality of treatment clarified. Importance and limitations of investigations and imaging explained and complications and mortality discussed.
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Affiliation(s)
- M P Sharma
- Department of Gastroenterology, Rockland Hospital, New Delhi, India.
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Wedrychowicz A, Goździk J, Krasowska-Kwiecień A, Kacińka E, Wiecha O, Kubiczek K, Ratajczak MZ. Manifestation of toxocariasis in children with neuroblastoma treated with autologous hematopoietic transplants. Pediatr Hematol Oncol 2006; 23:369-79. [PMID: 16728357 DOI: 10.1080/08880010600646738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Toxocariasis was diagnosed in 3 out of 22 children (14%) treated in our center with high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HSCT). The patients were coming from rural areas in the southeastern Poland and did not present any clinical symptoms of toxocariasis upon admission to the hospital. Although no neurological and ophthalmological abnormalities were noticed, the atypical form of toxacariasis was diagnosed based on elevated eosinophils counts, positive serological tests, and biochemical symptoms of liver damage. The authors conclude that toxocariasis should be taken into consideration in the differential diagnosis of eosinophilia in children undergoing high-dose chemotherapy and HSCT, especially if they are coming from rural areas.
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Affiliation(s)
- Anna Wedrychowicz
- Transplantation Centre, Department of Transplantation, University Children's Hospital, Polish-American Children's Hospital, Jagiellonian University, Cracow, Poland.
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