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Abdullah R, Azam M, Clement D, Al-Katib S. Magnetic Resonance Cholangiopancreatography (MRCP) Findings in a Patient With AIDS Cholangiopathy and Cryptosporidiosis. Cureus 2023; 15:e45869. [PMID: 37885561 PMCID: PMC10597870 DOI: 10.7759/cureus.45869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/28/2023] Open
Abstract
AIDS cholangiopathy is a rare condition characterized by intra- and extra-hepatic ductal strictures causing biliary obstruction primarily in individuals with advanced HIV infection and low clusters of differentiation 4 (CD4) count. This case report presents a male patient with a history of HIV, poor adherence to antiretroviral therapy (ART), and chronic cryptosporidiosis infection, who exhibited clinical and radiological findings consistent with advanced immunocompromise and AIDS cholangiopathy. The patient presented with respiratory symptoms, weight loss, renal dysfunction, and elevated liver enzymes. Imaging studies, including ultrasound and magnetic resonance cholangiopancreatography (MRCP), revealed diffuse biliary dilatation and stricturing, indicative of cholangiopathy. Subsequent endoscopic retrograde cholangiopancreatography (ERCP) with stent placement was performed to manage the biliary obstruction. This case highlights the importance of considering AIDS cholangiopathy in HIV patients with poor ART compliance who present with biliary obstruction symptoms or cholestatic liver enzyme abnormalities. Prompt diagnostic evaluation using MRCP or ERCP can aid in confirming the diagnosis and guiding appropriate therapeutic interventions, including endoscopic management and initiation of ART.
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Affiliation(s)
- Rasheed Abdullah
- Radiology, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Mustafa Azam
- Radiology, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Desiree Clement
- Diagnostic Radiology and Molecular Imaging, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Sayf Al-Katib
- Diagnostic Radiology and Molecular Imaging, Corewell Health William Beaumont University Hospital, Royal Oak, USA
- Radiology, Oakland University William Beaumont School of Medicine, Rochester, USA
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Innate Immunity Stimulation during the COVID-19 Pandemic: Challenge by Parvulan. J Immunol Res 2022; 2022:4593598. [PMID: 35528612 PMCID: PMC9076318 DOI: 10.1155/2022/4593598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/22/2022] [Indexed: 11/17/2022] Open
Abstract
Aim. We report an open spontaneous anecdotical retrospective survey of Corynebacterium parvum administration to 4000 fragile immune-depressed and multimorbid patients treated with a killed C. parvum strain to enhance innate immunity, integrating the adaptative immune response for long-standing antinfectious resistance. Methods. A total of 4000 patients (1900 men and 2100 women) with mild, moderate, or chronic disease, appealing to our Second Opinion Medical Consultation Network, signed an informed consent form and were injected subcutaneously with C. parvum. The treatment was followed up to 6 months, completing the short form of the medical outcome health survey questionnaire (SF-36) directly by the patients or their parents and monitoring their health status regularly via telemedicine (Skype, WhatsApp, mail, etc.) or outpatients visits. Results. The main efficacy endpoints, as assessed by the SF-36 questionnaire are: significant improvements in the mental and physical role functioning score (
), better general health; social role performance (
), vitality (
), and a significant pain reduction (
). A quick (48-72 hours) symptoms improvement and/or complete regression of the herpetic eruptions was observed in 1000 affected patients with disappearance or relieve of herpetic neuralgia (reduced in 80% of cases); also full recovery or frequency reduction (30%) of recurrent cystitis and prostatitis in 120 affected patients. Last but not least, a life quality improvement in 100 oncologic patients of overall 200 cases. A significant increase in the lymphocyte count (
), mainly helper and killer lymphocytes, was noted 6 months after Parvulan injection vs. the baseline. The asymptomatic SARS-CoV-2 patients who were incidentally enrolled in our survey were tested at the sixth month for antibodies against SARS-CoV-2, and 14 patients had high levels of SARS-CoV-2 antibodies. The incubating COVID infections of the Parvulan-injected patients even if frail and multimorbid recovered in short term (48-96 hours) with a benign clinical course, without need of drugs administration except for the variants, such as Delta and Omicron, whose infections lasted on average one week and required some antipyretics and low-dose steroids for a few days. Conclusions. Our results confirm that C. parvum is quite safe and effective in supporting immune-compromised patients when epidemic or pandemic events increase the life risk and any kind of infection and complication rate. Further double-blind placebo evidence-based studies are urgently required, and our numerically substantial not sponsored spontaneous observation is exclusively intended to promote further evidence-based double-blind institutional studies.
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Mahadik JD, Masand RP, Jain S. Mucosal Papillary Hyperplasia in Gallbladder: A Clue for Infectious Etiology in HIV Patients. J Glob Infect Dis 2021; 13:105-107. [PMID: 34194181 PMCID: PMC8213085 DOI: 10.4103/jgid.jgid_214_20] [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: 06/27/2020] [Revised: 09/09/2020] [Accepted: 10/15/2020] [Indexed: 11/18/2022] Open
Abstract
Gallbladder specimens are ditzel in surgical pathology and opportunistic diseases like cryptosporidiosis where they are easy to miss. We describe three cases of gallbladders with mucosal papillary hyperplasia with acute and chronic inflammation, all of which revealed cryptosporidiosis on complete histological evaluation. The patients were found to be HIV positive on further chart review. In the absence of clinical history, which is often the case with gallbladder specimens, the finding of mucosal papillary hyperplasia can be a reactive response to an infectious cause and can serve as a helpful clue to look for organisms with patience at higher magnification.
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Affiliation(s)
- Juhi Devendra Mahadik
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Ramya Prakash Masand
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
| | - Shilpa Jain
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA
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Widespread occurrence of Cryptosporidium infections in patients with HIV/AIDS: Epidemiology, clinical feature, diagnosis, and therapy. Acta Trop 2018; 187:257-263. [PMID: 30118699 DOI: 10.1016/j.actatropica.2018.08.018] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 01/02/2023]
Abstract
Cryptosporidium infection is a serious threat for HIV/AIDS patients, causing severe diarrhea and even death. The overall prevalence of Cryptosporidium in HIV/AIDS patients was calculated as approximately 8.69% (7,799/89,724), with higher prevalence observed in individuals with diarrhea, individuals with low CD4+ T-lymphocyte counts, and antiretroviral therapy-naïve individuals. Cryptosporidium infection was not significantly associated with patient age or gender, national development levels, or continent of residence. Over the period from 2007 to 2017, Cryptosporidium prevalence was 10.09% (3,282/32,517); this figure was higher than that observed in each of the previous observation periods (1985-1995 and 1996-2006), suggesting that the prevalence of cryptosporidiosis has been increasing over time in HIV/AIDS patients. Ten Cryptosporidium species and genotypes have been identified from 1,252 isolates, with C. hominis, C. parvum, and C. meleagridis accounting for 93.53% of infections. Five subtypes each of C. hominis (Ia, Ib, Id, Ie, and If), C. parvum (IIa to IIe), and C. meleagridis (IIIa to IIIe) have been described by sequence analyses of the 60-kDa glycoprotein (gp60) gene. Variation in the clinical manifestations observed in HIV/AIDS patients might be attributed to infection by different Cryptosporidium species, genotypes and subtypes, as well as different sites of infection. New molecular and immunological diagnostic techniques are in development or already commercially available. High-throughput screening methods for development of new or repurposed therapeutics as well as novel parasite genetic manipulation strategies offer hope for improving human cryptosporidiosis therapies. Painstaking efforts by researchers as well as support from governments and funding agencies will be required to make lasting achievements in this field.
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K.S. R, Kumar K.L. R. Intestinal Cryptosporidiosis and the Profile of the CD4 Counts in a Cohort of HIV Infected Patients. J Clin Diagn Res 2013; 7:1016-20. [PMID: 23905093 PMCID: PMC3708188 DOI: 10.7860/jcdr/2013/5339.3062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 02/25/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cryptosporidium is an infectious enteric pathogen which is capable of causing life-threatening illnesses in immunocompromised patients. AIMS This prospective study was planned to know the frequency of intestinal cryptosporidiosis in HIV infected patients and its correlation with their immune status. Also, the conventional diagnostic methods were compared with the copro-antigen detection test by using Enzyme Linked Immuno Sorbent Assay (ELISA). SETTINGS AND DESIGN This was a prospective cohort study. METHODS AND MATERIAL Three consecutive stool samples which were collected from 90 HIV seropositive patients and 50 seronegative controls were screened for cryptosporidiosis by wet mount, direct modified ZN (Ziehl Neelsen) staining, modified ZN staining with formol ether concentration and copro-antigen detection by ELISA. Their immune statuses were measured by CD4 + cell counting. Statistical Analytical Tests which were Used: Odds ratio, Chi square test, Fisher extract test. RESULTS Cryptosporidiosis was detected in 15 HIV seropositive cases. 13 cases had CD4 cell counts of < 100 cells/ μL. The formol ether concentration technique resulted in an increased number of oocysts/oil immersion field in 8 cases. ELISA was positive in 2 cases which were shown to be negative by modified ZN staining. All the controls were negative for cryptosporidium. CONCLUSIONS Cryptosporidiosis is an opportunistic infection in HIV infected people who present with diarrhoea. The wet mount technique, though it is simple and inexpensive, is insensitive for the detection of cryptosporidium. The conventional modified ZN staining and the modified ZN staining with concentration have a sensitivity and a specificity of 85.71% and 98.84% respectively. The copro antigen detection by ELISA which has a greater sensitivity and specificity, is a useful tool in epidemiological studies.
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Affiliation(s)
- Rashmi K.S.
- Assistant Professor, Department of Microbiology, KIMSH & RC, Bangalore, India
| | - Ravi Kumar K.L.
- Professor & HOD, Department of Microbiology, KIMSH & RC, Bangalore, India
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Activity of an anti-inflammatory drug against cryptosporidiosis in neonatal lambs. Vet Parasitol 2008; 155:308-13. [PMID: 18579312 PMCID: PMC7131681 DOI: 10.1016/j.vetpar.2008.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 05/08/2008] [Accepted: 05/15/2008] [Indexed: 11/23/2022]
Abstract
The efficacy of the anti-inflammatory drug Bobel-24 against experimental infection by Cryptosporidium parvum was evaluated in neonatal lambs. The animals were treated by oral administration of the drug at 50 or 500 mg/kg of body weight. The prophylactic/therapeutic treatment was started 4 h before inoculation of the lambs with oocysts and was continued for eight consecutive days. The therapeutic treatment was initiated at the onset of diarrhoea, after confirmation of infection, and was continued for six consecutive days. Infection was monitored by daily examination of faecal samples from the first day until 30 days post-inoculation. The criteria considered in evaluating development of the infection and the drug activity were: oocyst shedding, presence of diarrhoea and weight gain at 15 and 30 days post-inoculation. Bobel-24 was effective as a prophylactic/therapeutic treatment at the lowest dose (50 mg/kg of body weight); in the group treated with this dose of drug there was a longer prepatent period, a shorter patent period and a lower intensity of oocyst excretion than in the untreated control group, and the differences were all statistically significant (P < 0.05). Moreover, one animal did not excrete oocysts, and two lambs had diarrhoea, for only 1 and 2 days. In the group treated with the higher dose of the drug, the diarrhoea lasted for a significantly shorter period (P < 0.05) than in the untreated group.
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Mirzaei M. Prevalence of Cryptosporidium sp. infection in diarrheic and non-diarrheic humans in Iran. THE KOREAN JOURNAL OF PARASITOLOGY 2007; 45:133-7. [PMID: 17570977 PMCID: PMC2526311 DOI: 10.3347/kjp.2007.45.2.133] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
For evaluation of the prevalence of Cryptosporidium sp. infection in diarrheic and non-diarrheic humans in Iran, fecal specimens from diarrheic (n = 129) and non-diarrheic humans (n = 271) were collected and examined for the presence of Cryptosporidium sp. oocysts. The presence of Cryptosporidium sp. oocysts was determined by Ziehl- Neelsen acid-fast staining. Humans were grouped according to their age as follows: younger than 15, 16-25, 26-35, 36-50, and over 51 years. The results showed that the overall prevalence of infection in all 400 samples was 10.8%, but the prevalence (25.6%) in diarrheic humans was higher than that (3.7%) in non-diarrheic humans. Oocysts of Cryptosporidium sp. were detected in the feces of 21.4%, 9.3%, 8.8%, 6.7% and 5.7% of different age groups, respectively. The intensity of oocysts was significantly higher in diarrheic humans than in non-diarrheic ones. There was a significant association between Cryptosporidium sp. infection and occurrence of diarrhea (P < 0.05). The results indicate that Cryptosporidium sp. infection is prevalent in diarrheic humans in Iran.
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Affiliation(s)
- Mohammad Mirzaei
- Department of Pathobiology, School of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman 76169-133, Iran.
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Wang XJ, Wei JG, Wang CM, Wang YC, Wu QZ, Xu JK, Yang XX. Effect of cholesterol liposomes on calcium mobilization in muscle cells from the rabbit sphincter of Oddi. World J Gastroenterol 2002; 8:144-9. [PMID: 11833091 PMCID: PMC4656607 DOI: 10.3748/wjg.v8.i1.144] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the influence of cholesterol liposome on the Ca2+ mobilization of cultured muscle cells in rabbit sphincter of Oddi’s.
METHODS: New Zealand rabbit was sacrificed and the sphincter of Oddi (SO) segement was obtained aseptically. The SO segment was cut into pieces and cultured in DMEM solution. Then the smooth muscle cells were subcultured, and the 4th-7th passage cells were used for further investigation. The intracellular Ca2+ increase was measured under confocal microscope after the addition of 20 mmol·L-1 KCl, 10-7 mol·L-1 acetylcholine and 10-7 mol·L-1 cholecystokinin, and different antagonists were added to analyze the Ca2+ mobilization pathway. After the cells were incubated with 1 g·L-1 cholesterol liposome (CL)(molar ratio was-2:1), the intracellular Ca2+ increase was measured again to determine the effect of CL on cellular Ca2+ mobilization.
RESULTS: The resting cellular calcium concentration of cultured SO cell was 108 nmol·L-1± 21 nmol·L-1. The intracellular Ca2+ increases induced by 20 mmol·L-1 KCl, 10-7 mol·L-1 ACh and 10-7 mol·L-1 CCK were 183% ± 56%, 161% ± 52% and 130% ± 43%, respectively. When the extracellular Ca2+ was eliminated by 2 mmol·L-1 EGTA and 5 μmol·L-1 verapamil, the intracellular Ca2+ increases induced by KCl, ACh and CCK were 20% ± 14%, 82% ± 21% and 104% ± 23%, respectively. After the preincubation with heparin, the Ca2+ increases were 62% ± 23% and 23% ± 19% induced by ACh and CCK, as for preincubation with procaine they were 72% ± 28% and 85% ± 37% induced by ACh and CCK, respectively. Pretreatment with CL for 18 h, the resting cellular Ca2+ concentration elevated to 152 nmol·L-1± 26 nmol·L-1, however, the cellular Ca2+ increase percentages in response to these agonists were 67% ± 32%, 56% ± 33% and 34% ± 15%.
CONCLUSION: KCl elicite the SO cellular Ca2+ increase depends on influx of extracellular Ca2+, ACh evoked the SO celllular Ca2+ increase is through the mobilization of intracellular Ca2+ pool and influx of extracellular Ca2+ as well, CCK excites the SO cells mainly through mobilization of intracellular IP3-sensitive Ca2+ store. After the incorporation with cholesterol liposome, KCl,ACh and CCK induced cellular Ca2+ increase percentages decreased.
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Affiliation(s)
- Xin-Jiang Wang
- Department of Radiology, Tangdu Hospital, the Fourth Military Medical University, Xi'an 710038, Shaanxi Province,China.
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Ran XZ, Su YP, Wei YJ, Ai GP, Cheng TM, Lin Y. Influencing factors of rat small intestinal epithelial cell cultivation and effects of radiation on cell proliferation. World J Gastroenterol 2001; 7:140-2. [PMID: 11819751 PMCID: PMC4688692 DOI: 10.3748/wjg.v7.i1.140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- X Z Ran
- Institute of Combined Injury, PLA School of Preventive Medicine, Third Military Medical University, Chongqing 400038, China.
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