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Lamour D, Farrow RA, Pierre J, Puebla D, Khalil P. Diagnosis of Cutaneous Larva Migrans using Point of Care Ultrasound. POCUS JOURNAL 2024; 9:33-35. [PMID: 38681149 PMCID: PMC11044923 DOI: 10.24908/pocus.v9i1.17470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Larva migrans is a cutaneous parasitic infection that occurs when an immature hookworm larva inadvertently penetrates the dermis of a human, typically on the extremities. Traditionally, a clinical diagnosis is made when a tortuous/serpiginous eruption is seen superficially in the skin with complaints of intense pruritus. Point of care ultrasound (POCUS) is a useful diagnostic tool for soft tissue complaints in the emergency department (ED). We describe a case of an 18-year-old woman who presented to the ED with foot pruritis four days after walking on the beach barefoot. POCUS examination revealed several motile structures in the dermis of the patient's foot, confirming our suspicion of cutaneous larva migrans. The patient was then placed on an oral anthelmintic and her symptoms resolved shortly after.
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Affiliation(s)
- Daniella Lamour
- Nicklaus Children's HospitalMiami, FLUSA
- Florida Atlantic UniversityBoca Raton, FLUSA
- Mount Sinai Medical CenterMiami, FLUSA
| | | | - Jean Pierre
- Florida Atlantic UniversityBoca Raton, FLUSA
| | - Daniel Puebla
- Nicklaus Children's HospitalMiami, FLUSA
- Mount Sinai Medical CenterMiami, FLUSA
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2
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Pal D. An atypical tale of Loffler syndrome in the tropics. Trop Doct 2024; 54:217. [PMID: 38115744 DOI: 10.1177/00494755231222515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Dipankar Pal
- Infectious Disease Resident, Department of Infectious Diseases, Christian Medical College, Vellore, India
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Henke K, Perunovic Cicovic T, Ziaka M. Case report: Probable toxocariasis in a Swiss adult patient with hypereosinophilic syndrome and multiorgan involvement. SAGE Open Med Case Rep 2023; 11:2050313X231198321. [PMID: 37667742 PMCID: PMC10475260 DOI: 10.1177/2050313x231198321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/12/2023] [Indexed: 09/06/2023] Open
Abstract
Hypereosinophilic syndromes are a heterogeneous group of rare diseases characterized by eosinophil-related organ damage and peripheral blood hypereosinophilia. Hypereosinophilic syndromes may occur secondary to a variety of clinical entities, for example, drug hypersensitivity reactions, parasitic infections, autoimmune disorders, and malignancies. Toxocariasis is a parasitic infection caused by the larval stage of the Toxocara species. It is usually a childhood disease and invades organs such as the liver but can affect any organ. Hypereosinophilic syndrome and multiorgan involvement are very rare manifestations of Toxocara infection, especially in adults. However, the disease may be underdiagnosed because of different factors, including a lack of laboratory infrastructure in some countries, a lack of uniform case definitions, and limited surveillance infrastructure, with its estimation constituting a challenge. We, therefore, present a probable case of hypereosinophilic syndrome with multiorgan involvement secondary to infection with Toxocara canis in a 79-year-old Swiss female patient with a medical history of ischemic cerebrovascular insult and a curatively resected non-small-cell bronchial carcinoma, successfully treated with albendazole and steroids.
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Affiliation(s)
- Katrin Henke
- Department of Internal Medicine, Hospital of Thun, Thun, Switzerland
| | | | - Mairi Ziaka
- Department of Internal Medicine, Hospital of Thun, Thun, Switzerland
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Kraft DC, Naeem M, Mansour J, Beal MA, Bailey TC, Bhalla S. Body Imaging of Bacterial and Parasitic Zoonoses: Keys to Diagnosis. Radiographics 2023; 43:e220092. [PMID: 36729948 DOI: 10.1148/rg.220092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Zoonotic infections, which are transmitted from animals to humans, have been a substantial source of human disease since antiquity. As the human population continues to grow and human influence on the planet expands, humans frequently encounter both domestic and wild animals. This has only increased as deforestation, urbanization, agriculture, habitat fragmentation, outdoor recreation, and international travel evolve in modern society, all of which have resulted in the emergence and reemergence of zoonotic infections. Zoonotic infections pose a diagnostic challenge because of their nonspecific clinical manifestations and the need for specialized testing procedures to confirm these diagnoses. Affected patients often undergo imaging during their evaluation, and a radiologist familiar with the specific and often subtle imaging patterns of these infections can add important clinical value. The authors review the multimodality thoracic, abdominal, and musculoskeletal imaging findings of zoonotic bacterial (eg, Bartonella henselae, Pasteurella multocida, Francisella tularensis, Coxiella burnetii, and Brucella species), spirochetal (eg, Leptospira species), and parasitic (eg, Echinococcus, Paragonimus, Toxocara, and Dirofilaria species) infections that are among the more commonly encountered zoonoses in the United States. Relevant clinical, epidemiologic, and pathophysiologic clues such as exposure history, occupational risk factors, and organism life cycles are also reviewed. Although many of the imaging findings of zoonotic infections overlap with those of nonzoonotic infections, granulomatous diseases, and malignancies, radiologists' familiarity with the imaging patterns can aid in the differential diagnosis in a patient with a suspected or unsuspected zoonotic infection. © RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- David C Kraft
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Muhammad Naeem
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Joseph Mansour
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Michael A Beal
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Thomas C Bailey
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
| | - Sanjeev Bhalla
- From the Department of Radiology, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas 75246-2017 (D.C.K.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (J.M.); and Mallinckrodt Institute of Radiology (M.A.B., S.B.) and Department of Infectious Diseases (T.C.B.), Washington University School of Medicine, St Louis, Mo
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5
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Al-Tawfiq JA, Kim H, Memish ZA. Parasitic lung diseases. Eur Respir Rev 2022; 31:31/166/220093. [DOI: 10.1183/16000617.0093-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/20/2022] [Indexed: 12/02/2022] Open
Abstract
Parasitic lung diseases are caused by a number of parasites as a result of transient passage in the lung or as a result of an immunologic reaction. The clinical presentation may be in the form of focal or cystic lesions, pleural effusion or diffuse pulmonary infiltrates. With increasing globalisation, it is important to consider parasitic infections in the differential diagnosis of lung diseases. This is particularly important since early identification and prompt therapy result in full cure of these conditions. In this review, we summarise the most common parasitic lung diseases.
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Jõgi NO, Kitaba N, Storaas T, Schlünssen V, Triebner K, Holloway JW, Horsnell WGC, Svanes C, Bertelsen RJ. Ascaris exposure and its association with lung function, asthma, and DNA methylation in Northern Europe. J Allergy Clin Immunol 2021; 149:1960-1969. [PMID: 34996616 DOI: 10.1016/j.jaci.2021.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Ascaris infections, with a worldwide prevalence above 10%, can cause respiratory pathology. However, long-term effects on lung function in humans are largely unknown. OBJECTIVE We investigated the associations of Ascaris exposure with lung function, asthma, and DNA methylation. METHODS Serum Ascaris IgG antibodies were measured in 671 adults aged 18 to 47 years (46% women) from Aarhus, Bergen, and Tartu RHINESSA study centers. Seropositivity was defined as IgG above the 90th percentile. Linear and logistic regressions were used to analyze Ascaris seropositivity as associated with lung function and asthma, adjusted for age, height, and smoking and clustered by center. DNA methylation in blood was profiled by a commercial methylation assay. RESULTS Ascaris seropositivity was associated with lower FEV1 (-247 mL; 95% CI, -460, -34) and higher odds for asthma (adjusted odds ratio, 5.84; 95% CI, 1.67, 20.37) among men but not women, also after further adjusting for house dust mite sensitivity, consistent across study centers. At a genome-wide level, Ascaris exposure was associated with 23 differentially methylated sites in men and 3 in women. We identified hypermethylation of the MYBPC1 gene, which can regulate airway muscle contraction. We also identified genes linked to asthma pathogenesis such as CRHR1 and GRK1, as well as a differentially methylated region in the PRSS22 gene linked to nematode infection. CONCLUSION Ascaris exposure was associated with substantially lower lung function and increased asthma risk among men. Seropositive participants had sex-specific differences in DNA methylation compared to the unexposed, thus suggesting that exposure may lead to sex-specific epigenetic changes associated with lung pathology.
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Affiliation(s)
- Nils O Jõgi
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Negusse Kitaba
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Torgeir Storaas
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | - Vivi Schlünssen
- Department of Public Health, Environmental Occupation, and Health, Danish Ramazzini Centre, Aarhus University, Aarhus, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Kai Triebner
- Department of Clinical Science, University of Bergen, Bergen, Norway; Core Facility for Metabolomics, University of Bergen, Bergen, Norway
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - William G C Horsnell
- Institute of Infectious Disease and Molecular Medicine/Division of Immunology, University of Cape Town, Cape Town, South Africa; Institute of Microbiology and Infection, University of Birmingham, Birmingham, United Kingdom; Laboratory of Molecular and Experimental Immunology and Neurogenetics, CNRS-University of Orléans and Le Studium Institute for Advanced Studies, Orléans, France.
| | - Cecilie Svanes
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway; Centre for International Health, University of Bergen, Bergen, Norway
| | - Randi J Bertelsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Oral Health Centre of Expertise in Western Norway, Bergen, Norway
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Matsumoto N, Tsubouchi H, Setoguchi K, Horiguchi T, Shigekusa T, Tsuchida S, Matsuo A, Oda Y, Yanagi S, Maruyama H, Nakazato M. Clinico-radiologic Characteristics of Pulmonary Visceral Larva Migrans Caused by Ascaris suum. Intern Med 2021; 60:2899-2903. [PMID: 33814489 PMCID: PMC8502646 DOI: 10.2169/internalmedicine.6109-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Visceral larva migrans (VLM) caused by Ascaris suum is a major health problem in pig farming regions. The clinical characteristics of pulmonary VLM caused by A. suum, however, are unclear. We assessed the clinico-radiologic features of this disease. Methods Medical records, including the results of chest radiography and high-resolution computed tomography (HRCT), were retrospectively reviewed from January 2000 through June 2019, at the University of Miyazaki Hospital and Kyoritsuiin Hospital in Miyazaki Prefecture, Japan. Results Seven patients with VLM caused by A. suum were identified. All seven patients had a unique habit of consuming raw foods, such as organic vegetables, chicken, turkey, wild boar, and venison. All but one patient, who had eosinophilic pneumonia with a fever and severe fatigue, had only mild or no respiratory symptoms. All 7 patients had remarkable eosinophilia (median, 1,960/μL) and high serum IgE levels (median, 1,346 IU/mL). Chest HRCT revealed multiple nodules and multiple nodular ground-glass opacities in 57% and 29% of the patients, respectively. The pulmonary lesions were located predominantly in subpleural areas. All seven patients were treated with albendazole, which led to improvement within two to three months. Neither eggs nor parasites were detected in the feces or sputum of any patient. Conclusion Consumption of raw organic vegetables or raw meat is a possible route of A. suum infection. Infected patients exhibit mild respiratory symptoms, and multiple nodules with a halo in the subpleural area are a common finding on chest HRCT. Treatment with albendazole was effective in these cases.
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Affiliation(s)
- Nobuhiro Matsumoto
- Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Hironobu Tsubouchi
- Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Kensuke Setoguchi
- Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Takanori Horiguchi
- Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Takafumi Shigekusa
- Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Shinpei Tsuchida
- Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Ayako Matsuo
- Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Yasuharu Oda
- Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Shigehisa Yanagi
- Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
| | - Haruhiko Maruyama
- Division of Parasitology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki, Japan
| | - Masamitsu Nakazato
- Neurology, Respirology, Endocrinology and Metabolism, Department of Internal Medicine, University of Miyazaki, Japan
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8
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Głuchowska K, Dzieciątkowski T, Sędzikowska A, Zawistowska-Deniziak A, Młocicki D. The New Status of Parasitic Diseases in the COVID-19 Pandemic-Risk Factors or Protective Agents? J Clin Med 2021; 10:2533. [PMID: 34200502 PMCID: PMC8200987 DOI: 10.3390/jcm10112533] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/21/2021] [Accepted: 06/02/2021] [Indexed: 12/14/2022] Open
Abstract
It is possible that parasites may influence the course of COVID-19 infection, as either risk factors or protective agents; as such, the current coronavirus pandemic may affect the diagnosis and prevention of parasitic disease, and its elimination programs. The present review highlights the similarity between the symptoms of human parasitoses and those of COVID-19 and discuss their mutual influence. The study evaluated selected human parasitoses with similar symptoms to COVID-19 and examined their potential influence on SARS-CoV-2 virus invasion. The available data suggest that at least several human parasitoses could result in misdiagnosis of COVID-19. Some disorders, such as malaria, schistosomiasis and soil-transmitted helminths, can increase the risk of severe infection with COVID-19. It is also suggested that recovery from parasitic disease can enhance the immune system and protect from COVID-19 infection. In addition, the COVID-19 pandemic has affected parasitic disease elimination programs in endemic regions and influenced the number of diagnoses of human parasitoses.
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Affiliation(s)
- Kinga Głuchowska
- Department of General Biology and Parasitology, Medical University of Warsaw, 02-004 Warsaw, Poland; (K.G.); (A.S.)
| | - Tomasz Dzieciątkowski
- Chair and Department of Medical Microbiology, Medical University of Warsaw, 02-004 Warsaw, Poland;
| | - Aleksandra Sędzikowska
- Department of General Biology and Parasitology, Medical University of Warsaw, 02-004 Warsaw, Poland; (K.G.); (A.S.)
| | | | - Daniel Młocicki
- Department of General Biology and Parasitology, Medical University of Warsaw, 02-004 Warsaw, Poland; (K.G.); (A.S.)
- Witold Stefański Institute of Parasitology, Polish Academy of Sciences, 00-818 Warsaw, Poland;
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Hermanns V, Flick H, Lingscheid T. Seltene parasitäre Infektionen der Lunge. DER PNEUMOLOGE 2020; 17:330-337. [PMID: 32837495 PMCID: PMC7374075 DOI: 10.1007/s10405-020-00336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Pulmonale parasitäre Infektionen kommen weltweit vor, werden jedoch aufgrund der Seltenheit in Deutschland in den wenigsten Fällen differenzialdiagnostisch in Betracht gezogen. Parasitäre Lungenerkrankungen können unterschiedlichste pulmonale Manifestationen hervorrufen und sollten bei unklaren Befunden oder fehlendem Therapieansprechen differenzialdiagnostisch mit bedacht werden, um diese heilbaren Erkrankungen so früh wie möglich zu erkennen.
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Matrix metalloproteinases activation in Toxocara canis induced pulmonary pathogenesis. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:1147-1153. [PMID: 32826193 DOI: 10.1016/j.jmii.2020.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/21/2020] [Accepted: 07/31/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Toxocara canis, a source of visceral larva migrans, causes toxocariasis and induces respiratory symptoms. The reasons by which the pulmonary pathological alteration in the lungs infected with T. canis remain unclear. METHODS The involvement of the pulmonary pathological alteration by histology, enzyme activity, and Western blot analysis in the lungs of BALB/c mice after the infection of 2000 embryonated eggs. RESULTS The pathological effects gradually increased after the infection culminated in severe leukocyte infiltration and hemorrhage from days 4-14 post-inoculation. Gelatin zymography using substrate showed that the relative activity of matrix metalloproteinase (MMP) -9 and MMP-2 significantly increased in T. canis-infected mice. Western blot analysis indicated that the MMPs protein level of fibronectin monomer significantly increased in T. canis-infected mice compared with that in uninfected control. T. canis larvae mainly initiated leukocyte infiltration and hemorrhage in the lungs. CONCLUSION These phenomena subsequently induced the activities of MMPs in parallel with the pathological changes in early stage pulmonary inflammation. In conclusion, T. canis larval migration activated the MMPs and caused pulmonary pathogenesis.
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Abstract
Several imaging modalities have now been employed to visualize the manifestations of larval Toxocara infection in hepatic, neurologic, ocular, renal, and other anatomical sites. This report reviews the usefulness and value of these individual imaging methods in diagnosis and follow-up of the different cases causing eosinophilic (granulomatous) infiltrations the liver, lungs, brain, heart, and eyes. Imaging provides a means of assisting in diagnosis and management in this infection where diagnosis by biopsy is often unlikely to capture an actual larva for the purpose of making a definitive diagnosis on the basis of larval morphology or DNA detection.
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Affiliation(s)
- Christoph F Dietrich
- Department of Internal Medicine (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland.
| | - Carmen Cretu
- Department of Parasitology, Carol Davila University of Medicine and Pharmacy, Colentina Clinical Hospital, Bucharest, Romania
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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12
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Fiorentini LF, Bergo P, Meirelles GSP, Capobianco J, Mohammed TL, Verma N, Marchiori E, Irion KL, Hochhegger B. Pictorial Review of Thoracic Parasitic Diseases: A Radiologic Guide. Chest 2020; 157:1100-1113. [PMID: 31978430 DOI: 10.1016/j.chest.2019.12.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/02/2019] [Accepted: 12/14/2019] [Indexed: 01/15/2023] Open
Abstract
Parasitoses are infectious diseases of global distribution, with predominance in areas of poor sanitation. Parasites cause damage through direct tissue injury and the inflammatory response generated by their migration and establishment in various organs. Thoracic involvement by parasitic disease can generate both specific and nonspecific clinical, laboratorial, and radiologic manifestations, which often makes their diagnosis challenging. The correct diagnosis is crucial for definition of treatment, which sometimes requires rapid intervention. Based on a literature review of the last few decades, this article aimed to characterize the main radiologic findings related to thoracic manifestations of parasitic diseases, correlating them with radiographic and tomographic images of patients with confirmed diagnosis of such pathologies. The included parasitic diseases are malaria, Chagas disease, toxoplasmosis, amoebiasis, ascariasis, toxocariasis, strongyloidiasis, dirofilariasis, cysticercosis, echinococcosis, schistosomiasis, and paragonimiasis.
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Affiliation(s)
- Luís F Fiorentini
- Department of Imaging, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
| | - Pedro Bergo
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Nupur Verma
- Department of Radiology, University of Florida, Gainesville, FL
| | - Edson Marchiori
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Klaus L Irion
- Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom
| | - Bruno Hochhegger
- Department of Imaging, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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13
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CT Halo sign: A systematic review. Eur J Radiol 2020; 124:108843. [PMID: 32007819 DOI: 10.1016/j.ejrad.2020.108843] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE The CT Halo sign or Halo sign (HS) refers to ground-glass opacity surrounding a nodule or mass in the lung parenchyma. We conducted a systematic review to find the etiological associations of HS. We also evaluated the diagnostic performances of HS for invasive fungal infections (IFI) in immunosuppressed patients. METHOD The systematic review was conducted as per PRISMA guidelines. We searched the PubMed and EMBASE database till June 2018 without any restrictions. Only case reports, case series and original articles published in English language were included. A database created from the electronic searches was compiled and subsequent analysis was done. [PROSPERO registration: CRD42018094739] RESULTS: 168 studies were eligible, which included 51 case reports, 15 prospective studies, 102 retrospective studies. A total of 1977 patients (out of 6371) with HS were identified with age range between <1year-94years. The most common diagnosis in the immunosuppressed, mixed, immunocompetent and not specified groups were IFI (86.9 %, n = 1194), Cryptococcosis (51.6 %, n = 124), Cryptococcosis (40 %, n = 20) and lung neoplasms (81.8 %, n = 36) respectively. 14 studies (11 retrospective, 3 prospective) were included in quantitative analysis. The pooled sensitivity(sn), specificity(sp) and odd's ratio (OR) of HS for diagnosing IFI were 50.4 %, 91 % and 6.61 respectively. Also, HS could not reliably differentiate IPA from mucormycosis in the pooled analysis. CONCLUSIONS HS can be seen in a large number of diverse conditions both in immunosuppressed and immunocompetent population. In immunosuppressed patients HS is specific for IFI but cannot rule it out. Additionally, it cannot reliably distinguish between IPA and mucormycosis.
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14
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Thevenet F, Beltramo G, Georges M, Foignot C, Spanjaard M, Bonniaud P. Halo Sign and Eosinophilia: What Is Your Diagnosis? Respiration 2017; 95:258-259. [PMID: 29268265 DOI: 10.1159/000485137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/09/2017] [Indexed: 11/19/2022] Open
Abstract
Blood eosinophilia associated with transient and migrating nodules with a halo sign on chest computed tomography scan should suggest larva migrans related to toxocariasis or ascaris suum.
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Affiliation(s)
- Florent Thevenet
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre Hospitalo-Universitaire de Bourgogne, Dijon, France.,INSERM, LNC UMR866, LipSTIC LabEx team, Dijon, France
| | - Guillaume Beltramo
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre Hospitalo-Universitaire de Bourgogne, Dijon, France.,INSERM, LNC UMR866, LipSTIC LabEx team, Dijon, France.,Université Bourgogne Franche-Comté, Dijon, France
| | - Marjolaine Georges
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre Hospitalo-Universitaire de Bourgogne, Dijon, France.,Université Bourgogne Franche-Comté, Dijon, France
| | - Clément Foignot
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre Hospitalo-Universitaire de Bourgogne, Dijon, France.,Université Bourgogne Franche-Comté, Dijon, France
| | - Maximilien Spanjaard
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre Hospitalo-Universitaire de Bourgogne, Dijon, France.,Université Bourgogne Franche-Comté, Dijon, France
| | - Philippe Bonniaud
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre Hospitalo-Universitaire de Bourgogne, Dijon, France.,INSERM, LNC UMR866, LipSTIC LabEx team, Dijon, France.,Université Bourgogne Franche-Comté, Dijon, France
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15
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Martínez-Pérez J, Vandekerckhove E, Vlaminck J, Geldhof P, Martínez-Valladares M. Serological detection of Ascaris suum at fattening pig farms is linked with performance and management indices. Vet Parasitol 2017; 248:33-38. [DOI: 10.1016/j.vetpar.2017.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 10/11/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
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16
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Editorial Office of Asian Biomedicine. Editorial. Control of neglected tropical diseases: the need to integrate knowledge, social, and political processes. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0806.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Jorge D, Strady C, Guy B, Deslée G, Lebargy F, Dury S. [Multiple pulmonary opacities revealing toxocariasis]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:273-276. [PMID: 27368139 DOI: 10.1016/j.pneumo.2016.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 03/04/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Toxocariasis is a parasitosis which complicates the accidental infestation of the humans by larvae of a roundworms belonging of the genus Toxocara. In adults, the discovery is often incidental during a hypereosinophilia check-up. Clinical signs are not specific and depend on affected organs. CASE REPORT We report the case of a 53-year-old-woman who has consulted for a recent cough, after spontaneous resolution of abdominal pain. The laboratory examination isolated an hypereosinophilia and the liver sonography showed two hypoechogenic nodules. The CT-scan found bilateral lung nodules with ground glass halo. Broncho-alveolar lavage identified an eosinophilic alveolitis. Positive serologic results for toxocariasis and western blot results allowed to conclude to the diagnosis of pulmonary and hepatic toxocariasis. CONCLUSION Although rare, pulmonary toxocariasis should be suspect in any lung eosinophilia, especially if the patient has never traveled.
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Affiliation(s)
- D Jorge
- Service des maladies respiratoires, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51 092 Reims cedex, France
| | - C Strady
- Groupe Courlancy, Cabinet d'infectiologie, Clinique Saint-André, 51100 Reims, France
| | - B Guy
- Groupe Courlancy, Cabinet de pneumologie, Clinique Saint-André, 51100 Reims, France
| | - G Deslée
- Service des maladies respiratoires, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51 092 Reims cedex, France; Unité 903, Inserm, 51100 Reims, France
| | - F Lebargy
- Service des maladies respiratoires, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51 092 Reims cedex, France; EA 4683, université de médecine et de pharmacie, 51100 Reims, France
| | - S Dury
- Service des maladies respiratoires, hôpital Maison-Blanche, CHU de Reims, 45, rue Cognacq-Jay, 51 092 Reims cedex, France; EA 4683, université de médecine et de pharmacie, 51100 Reims, France.
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KOMIYA N, KUBO K, OHMUNE K, OTSU S. A Case Diagnosed Toxocariasis After the Intiation of Treatment with Steroids for Eosinophilic Granulomatosis with Polyangitis (EGPA). ACTA ACUST UNITED AC 2016. [DOI: 10.11150/kansenshogakuzasshi.90.825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nobuhiro KOMIYA
- Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center
| | - Kenji KUBO
- Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center
| | - Kouhei OHMUNE
- Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center
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19
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Pulmonary Toxocariasis: Initial and Follow-Up CT Findings in 63 Patients. AJR Am J Roentgenol 2015; 204:1203-11. [DOI: 10.2214/ajr.14.13700] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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20
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Gemmell A. Toxocariasis as a cause of multiple pulmonary nodules in a paediatric patient. BMJ Case Rep 2015; 2015:bcr-2014-207073. [PMID: 25564589 DOI: 10.1136/bcr-2014-207073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Andrew Gemmell
- Department of Radiology, Plymouth Hospitals NHS Trust, Devon, UK
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21
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Differential Chest Computed Tomography Findings of Pulmonary Parasite Infestation Between the Paragonimiasis and Nonparagonimiatic Parasite Infestation. J Comput Assist Tomogr 2015; 39:956-61. [DOI: 10.1097/rct.0000000000000310] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Craig JM, Scott AL. Helminths in the lungs. Parasite Immunol 2014; 36:463-74. [PMID: 25201409 DOI: 10.1111/pim.12102] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 01/21/2014] [Indexed: 12/21/2022]
Abstract
Parasitic helminths infect well over one billion people and typically cause chronic and recurrent infections that exert a considerable toll on human health and productivity. A significant number of important intestinal- and tissue-dwelling helminth parasites have evolved a scripted migration through select organ systems. Of specific interest here are the helminth parasites that interact with respiratory tissues and the pulmonary immune system. This review will consider the nature of the interactions between helminth parasites and the lung environment, as well as the consequences of these interactions on the evolution of parasitism and host immunity.
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Affiliation(s)
- J M Craig
- Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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23
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Chest CT findings of toxocariasis: Correlation with laboratory results. Clin Radiol 2014; 69:e285-90. [DOI: 10.1016/j.crad.2014.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/24/2014] [Accepted: 01/29/2014] [Indexed: 11/21/2022]
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24
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Pulmonary toxocariasis: a case report and literature review. Infection 2014; 42:575-8. [PMID: 24452526 DOI: 10.1007/s15010-014-0587-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/09/2014] [Indexed: 10/25/2022]
Abstract
Toxocariasis is a parasitic disease caused by Toxocara canis or T. cati. We report a patient with toxocariasis who presented with dyspnea, high-grade eosinophilia, and bilateral pulmonary nodules. To further characterize the pulmonary manifestations of toxocariasis, we have reviewed 11 previously published pulmonary toxocariasis cases. The most common pulmonary symptoms in our review were cough and dyspnea, and the most common finding on chest imaging was bilateral pulmonary nodules. Risk factors for Toxocara infection primarily included exposure to dogs. Most patients received albendazole and responded well. A high index of suspicion is needed to diagnose this otherwise preventable parasitic disease.
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Infections. RADIOLOGY ILLUSTRATED: PEDIATRIC RADIOLOGY 2014. [PMCID: PMC7124155 DOI: 10.1007/978-3-642-35573-8_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Lower respiratory tract infection is a very common illness in children and is a significant cause of morbidity and mortality. Clinical signs and symptoms are nonspecific especially in infants and younger children and some even present with nonrespiratory complaints. Infectious agents causing pneumonia is not limited to viruses and bacteria, but it could also be due to Mycoplasma, Mycobacteria, fungi, protozoa, and parasites. Coinfection with two or more microbial agents can also occur. The etiologic agent of lower respiratory infection in a child is often difficult to obtain, but the patient’s age can help narrow the possible cause. Microbiological tests are important but could be difficult to obtain especially in younger children. Various medical imaging modalities not only play an important role as an aid in diagnosis but can also help during and after therapy. Imaging can also help evaluate complications to pneumonia and exclude other causes of respiratory distress including underlying developmental anomalies, foreign body, gastroesophageal reflux disease, and aspiration. In this chapter, the imaging modalities utilized in the detection of pulmonary infections will be discussed. The spectrum of typical imaging findings for various etiologic agents in both immunocompetent and immunocompromised children will be presented.
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26
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Dabrowska J, Walski M, Dybicz M, Doligalska M. Comparative ultrastructural studies of the alterations to mouse lung parenchyma during Trichinella spiralis or Toxocara canis infection. Parasite Immunol 2013; 34:455-63. [PMID: 22803684 DOI: 10.1111/j.1365-3024.2012.01381.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Trichinella spiralis and Toxocara canis larvae migrated through the lung and induced many alterations in the lung parenchyma. Using electron microscopy, we identified and described the histopathological changes. These changes resulted from mechanical damage or from local inflammatory reactions provoked by larvae. The pattern of changes was described between 6 and 12 days post-infection (DPI) with T. spiralis larvae, and between 21 and 28 DPI with T. canis. The ultrastructural studies demonstrated that T. spiralis larvae migrating through the lungs evoked mainly destruction of type I epithelial cells, destruction of lamellar bodies of epithelial cells or extracellular alveolar lining layer. The severity of these changes was dependent on the number of infective larvae (400 or 800 T. spiralis larvae) and possibly the result of mechanical damage in the lung parenchyma. In contrast, infection with T. canis larvae initiated mainly eosinophilic perivasculitis and vasculitis as well as macrophage accumulation in the lung, which were additionally impacted by numerous crystalloid inclusions in macrophages. Trichinella spiralis larvae and T. canis larvae induced different pathological changes in the lungs of infected mice.
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Affiliation(s)
- J Dabrowska
- Department of General Biology and Parasitology, Biostructure Centre, Medical University of Warsaw, Warsaw, Poland.
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Abstract
This review starts with discussions of several infectious causes of eosinophilic pneumonia, which are almost exclusively parasitic in nature. Pulmonary infections due specifically to Ascaris, hookworms, Strongyloides, Paragonimus, filariasis, and Toxocara are considered in detail. The discussion then moves to noninfectious causes of eosinophilic pulmonary infiltration, including allergic sensitization to Aspergillus, acute and chronic eosinophilic pneumonias, Churg-Strauss syndrome, hypereosinophilic syndromes, and pulmonary eosinophilia due to exposure to specific medications or toxins.
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28
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Georgiadou SP, Sipsas NV, Marom EM, Kontoyiannis DP. The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin Infect Dis 2011; 52:1144-55. [PMID: 21467021 DOI: 10.1093/cid/cir122] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The halo sign is a CT finding of ground-glass opacity surrounding a pulmonary nodule or mass. The reversed halo sign is a focal rounded area of ground-glass opacity surrounded by a crescent or complete ring of consolidation. In severely immunocompromised patients, these signs are highly suggestive of early infection by an angioinvasive fungus. The halo sign and reversed halo sign are most commonly associated with invasive pulmonary aspergillosis and pulmonary mucormycosis, respectively. Many other infections and noninfectious conditions, such as neoplastic and inflammatory processes, may also manifest with pulmonary nodules associated with either sign. Although nonspecific, both signs can be useful for preemptive initiation of antifungal therapy in the appropriate clinical setting. This review aims to evaluate the diagnostic value of the halo sign and reversed halo sign in immunocompromised hosts and describes the wide spectrum of diseases associated with them.
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Affiliation(s)
- Sarah P Georgiadou
- Infectious Diseases Unit, Pathophysiology Department, Laikon General Hospital and Medical School, National and Kapodistrian University of Athens, Athens, Greece
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29
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Kreitmann L, Collet F, Gouello JP, Lemyze M. Cough syncope and multiple pulmonary nodules. Intern Emerg Med 2011; 6:377-9. [PMID: 21318612 DOI: 10.1007/s11739-011-0532-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 01/24/2011] [Indexed: 01/15/2023]
Affiliation(s)
- Louis Kreitmann
- Department of Respiratory and Critical Care Medicine, Schaffner Hospital, Lens, France
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30
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Shlopov BV, French SW. Inflammatory myofibroblastic tumor of the lung with unique histological pattern and association with Sjögren's disease and systemic lupus erythematosus. Exp Mol Pathol 2011; 91:509-14. [PMID: 21669196 DOI: 10.1016/j.yexmp.2011.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 05/26/2011] [Indexed: 10/18/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) of the lung is a rare condition. Radiological properties and clinical presentation of this disease can mimic malignant process. We present a case of IMT of the lung in a 58 year old female patient with a single lung nodule. Tumor was unencapsulated, firm, and well circumscribed. Microscopically tumor had multinodular structure with single or multiple small blood vessels in the center of each nodule surrounded in circular pattern by connective tissue containing spindle cells embedded into the thick layers of extracellular matrix. Extracellular matrix was identified as type I and type III collagen fibrils embedded into type IV collagen and laminin. The tumor was surrounded by T-, B-lymphocytes and polyclonal plasma cells. Histological organization of this lesion's stromal component was unique, but cell composition was similar to inflammatory pseudotumor of the lung. In addition, tumor tissue sections exhibited strong positivity for IgG, weak positivity for IgA, 1Cq, but were negative for IgM, and C3. Mutational analysis of the EGFR, KRAS genes and ALK locus rearrangement were performed and did not reveal any mutations. This is the first report of an IMT associated with Sjögren's disease, systemic lupus erythematosus and Non-Hodgkin lymphoma developing in the lungs. Patient was clinically followed up for 18 months and no recurrence of the tumor observed.
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Affiliation(s)
- Boris V Shlopov
- Department of Pathology and Laboratory Medicine, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90509, USA
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31
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Pulmonary ascariasis: two cases in Austria and review of the literature. Wien Klin Wochenschr 2011; 122 Suppl 3:94-6. [PMID: 20924692 DOI: 10.1007/s00508-010-1445-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Ascariasis is the most common helminthic infection, with an estimated worldwide prevalence of 25%. The estimated mortality ranges from 0.8 to 1%. Second stage larvae pass through the intestinal wall and migrate via the portal vein system to the liver and then proceed to the lungs, where they may produce pneumonia and eosinophilia. Symptoms include wheezing, dyspnea, nonproductive cough, hemoptysis, and fever. Two cases of pulmonary ascariasis in Austrian males are reported. Both patients presented with dyspnea, nonproductive cough, fever, and eosinophilia (19 and 26%). One patient additionally had pulmonary infiltrates. Recent travel history was unremarkable in both individuals. Serology for Ascaris was positive twice in both patients, while microscopic examination of stool was negative for helminthic ova. Extensive diagnostic procedures were performed to rule out possible differentials for the patients symptoms. Both patients responded well to antiparasitic treatment with albendazole 400 mg and mebendazole 100 mg q12h for 3 days, respectively. This report highlights the importance of considering parasitic infection in patients presenting with eosinophilia and pulmonary symptoms also in Austria.
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Lim YJ, Kim JH, Oh SH, Jeon SC, Koh HC, Lee YH. Pulmonary toxocariasis masquerading as metastatic tumor nodules in a child with osteosarcoma. Pediatr Blood Cancer 2009; 53:1343-5. [PMID: 19637318 DOI: 10.1002/pbc.22213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A 14-year-old male, who completed chemotherapy following limb salvage surgery for osteosarcoma approximately 2 years ago, was seen for routine follow-up. A CT scan revealed new scattered multifocal nodular lesions. An ultrasonography-guided percutaneous needle biopsy was done to confirm pulmonary metastasis of the underlying osteosarcoma. The lung biopsy showed findings of eosinophilic pneumonia with no evidence of malignancy. Peripheral eosinophilia was also noted. When a more thorough history revealed frequent intake of raw cow liver, we diagnosed pulmonary toxocariasis by ELISA for specific serum IgG antibody.
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Affiliation(s)
- Yeon-Jung Lim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
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MRI findings of spinal visceral larva migrans of Toxocara canis. Eur J Radiol 2009; 75:236-40. [PMID: 19447576 DOI: 10.1016/j.ejrad.2009.04.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Revised: 03/21/2009] [Accepted: 04/15/2009] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study is to investigate the MRI findings of visceral larva migrans (VLS) of Toxocara canis in spinal cord. MATERIALS AND METHODS We retrospectively reviewed spinal MRI findings in eight patients with serologically proven Toxocara canis between 2005 and 2008. We evaluated the location, length, extent and migration of the lesion, MR signal intensity (SI), enhancement pattern, and swelling of the spinal cord. We evaluated clinical features including presenting symptoms and signs and treatment response. RESULTS Total 8 patients (M=8; age range 36-79 years) were included. The lesions were located in the cervical or thoracic spinal cord in all patients. All lesions showed high SI and minimal or mild swelling of involved spinal cord on T2WI and focal nodular enhancement on posterior or posterolateral segment of spinal cord. The length of involved lesion was relatively short in most patients. There was a migration of lesion in one patient. In spite of albendazole or steroid treatment, neurological symptoms or signs were not significantly improved in all patients. CONCLUSION Although all lesions show non-specific imaging findings like non-tumorous myelopathy mimicking transverse myelitis, single lesion, focal nodular enhancement on posterior or posterolateral segment of spinal cord, relatively short segmental involvement and migration of lesion may be characteristic findings of spinal VLM of Toxocara canis. In addition, the reluctant response to the treatment may be characteristic of spinal VLM of Toxocara canis.
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Abstract
A boy with bilateral retinoblastoma underwent metastatic surveillance for increased risk of systemic and central nervous system metastasis because of the extensive choroid and optic nerve invasion in his enucleated eye. Two years after finishing chemotherapy, surveillance MRI showed multiple new liver, lung and spinal cord lesions. High Toxocara antibody titers, eosinophilia, and elevated IgE levels supported a diagnosis of toxocariasis, rather than retinoblastoma metastasis. This is the first report of early, asymptomatic spinal cord toxocariasis diagnosed incidentally through metastatic surveillance.
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Hirakawa E, Suetsugu T, Tanoue A, Takagi K, Shinmura M, Machida K, Fukuoka T, Niina K. Pulmonary Eosinophilia Caused by Visceral Larva due to Ascaris Suum. ACTA ACUST UNITED AC 2009; 98:144-6. [DOI: 10.2169/naika.98.144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Eiji Hirakawa
- Department of Internal Medicine, Kagoshima City Hospital
| | | | - Asako Tanoue
- Department of Internal Medicine, Kagoshima City Hospital
| | - Kouichi Takagi
- Department of Internal Medicine, Kagoshima City Hospital
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Yoshikawa M, Nishiofuku M, Moriya K, Ouji Y, Ishizaka S, Kasahara K, Mikasa KI, Hirai T, Mizuno Y, Ogawa S, Nakamura T, Maruyama H, Akao N. A familial case of visceral toxocariasis due to consumption of raw bovine liver. Parasitol Int 2008; 57:525-9. [DOI: 10.1016/j.parint.2008.08.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 08/04/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
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Imaging of Parasitic Diseases of the Thorax. IMAGING OF PARASITIC DISEASES 2008. [PMCID: PMC7120608 DOI: 10.1007/978-3-540-49354-9_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A broad spectrum of parasitic infections frequently affects the lungs, mediastinum, and thoracic wall, manifesting with abnormal imaging findings that often make diagnosis challenging. Although most of these infections result in nonspecific abnormalities, familiarity with their imaging features and the diagnostic pathways help the radiologist to formulate an adequate differential diagnosis and to guide diagnosticians in reaching a definitive diagnosis.
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Abd El Bagi M. Imaging of Parasitic Diseases of the Musculoskeletal System and Soft Tissues. IMAGING OF PARASITIC DISEASES 2007:159-177. [DOI: 10.1007/978-3-540-49354-9_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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40
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Morsy H, Mogensen M, Thomsen J, Thrane L, Andersen PE, Jemec GBE. Imaging of cutaneous larva migrans by optical coherence tomography. Travel Med Infect Dis 2007; 5:243-6. [PMID: 17574147 DOI: 10.1016/j.tmaid.2006.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2006] [Revised: 11/27/2006] [Accepted: 12/07/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cutaneous larva migrans is a parasitic skin eruption caused by migration of larvae of various nematodes. Diagnosis of cutaneous larva migrans is currently based on the clinical signs of the creeping eruption. We are investigating a new diagnostic technology called optical coherence tomography (OCT) , which is potentially able to visualize structures in the skin with an 8 microm resolution. This technology could therefore potentially allow rapid, non-invasive, in vivo diagnosis of infestations. METHOD Clinical cases of cutaneous larva migrans (n=3) were studied. All patients had a characteristic itching, serpinginous eruption typical of cutaneous larva migrans. The parasites were acquired on beach holidays in Thailand and Malaysia. All skin lesions were imaged by an OCT system developed at Risoe National Laboratory, Denmark. RESULT Two out of three patients showed a round to oval structure (diameter 0.3-0.5mm) in the epidermis, Thus distinct OCT morphology in skin areas affected by cutaneous larva migrans was demonstrated. The larvae were not visualized in any of the patients. CONCLUSION This study demonstrates that OCT a novel optical imaging technology, can image the larva tunnel in the skin with adequate spatial resolution, but not the larvae itself. OCT has a potential in imaging of skin infestations.
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Affiliation(s)
- Hanan Morsy
- Department of Dermatology, University of Copenhagen, Roskilde Hospital, Roskilde, Denmark.
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41
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Abstract
PURPOSE OF REVIEW Parasitic pneumonia is being increasingly reported from many parts of the world due to globalization and travel across the continents. This review outlines the recent developments in the diagnosis and management of parasitic pneumonias. RECENT FINDINGS A polymerase chain reaction that can differentiate pathogenic Entamoeba histolytica from nonpathogenic species has been reported. It has been observed that pulmonary infection with Leishmania donovani can occur in immunodeficient and lung transplant patients. Acute respiratory distress syndrome, seen in severe falciparum malaria, has also been observed in vivax malaria. A study has demonstrated the return of chloroquine-sensitive falciparum malaria several years after chloroquine treatment was discontinued. Pulmonary hypertension has been reported in Schistosoma hematobium, S. mansoni and S. japonicum infections. Strongyloides hyperinfection and disseminated disease are frequently reported in immunocompromised individuals. Parenteral ivermectin is found to be useful in the treatment of disseminated strongyloidiasis. A chronic mild interstitial lung disease has been found to persist in tropical pulmonary eosinophilia despite treatment. Studies are in progress to develop vaccines against amoebiasis, malaria and hookworm infections. SUMMARY Parasitic pneumonia can sometimes be life threatening. If proper diagnosis is made early, the pneumonia can be treated successfully with currently available drugs.
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