Idiopathic non-cirrhotic portal hypertension in a patient with Talaromyces marneffei infection: a case report

BACKGROUND

The etiopathogenesis of idiopathic non-cirrhotic portal hypertension (INCPH) is so far poorly understood. Altered immunity, blood diseases, infections, congenital defects and drug exposure have been documented in a part of patients with INCPH owing to increased recognition of the disorder in patients with HIV, or various haematological disorders or autoimmune diseases. We aim to discuss the possible etiopathogenesis of INCPH.

CASE PRESENTATION

We reported that a patient with intestinal infection of T. Marneffei and hyper-IgE syndrome, a group of rare primary immunodeficiency disorders, was finally diagnosed with INCPH for gastroesophageal variceal bleeding. The diagnosis was mainly based on histopathological features. Transjugular intrahepatic portosystemic shunt was performed and there was no recurrence of melena during the six-month follow-up.

CONCLUSION

In the context of immunodeficiency, INCPH may associated with intestinal infections. Thus, screening for enterogenic infection and immunological disorders in patients with unexplained portal hypertension is necessary.

POLIBD survey results

Background

There are several studies which evaluated the number of infections caused by enteric pathogens, including Clostridioides difficile in patients with inflammatory bowel disease (IBD). Our aim was to assess the prevalence of intestinal infections among patients suffering from IBD, when admitted to the hospital due to exacerbation of the disease.

Results

The performed, retrospective analysis covered test results for C. difficile toxins A and B along with rectal swab cultures sampled from patients, treated in a tertiary IBD center in Poland, between 2017 and 2019. Main objective was to estimate the presence of any infection, which could imitate or co-exist along with the exacerbation of the IBD. All in all 1471 patients had microbiological tests performed, including 1112 tested for C. difficile toxins A and B; and 359 patients who had rectal swab culture. Positive test results for C. difficile toxins A and B were reported in 358 cases, positive results from rectal swab culture were confirmed altogether in case of 25 samples. As far as patients with IBD are concerned, positive results for C. difficile toxins A and B were detected in 82 cases, positive results in rectal swab culture from patients with IBD were reported in 20 cases.

Conclusion

Intestinal infections were reported in 14.9% of patients (102/685) with IBD symptoms. Positive test results for C. difficile toxins A and B and rectal swab cultures among patients without IBD symptoms were reported in 35.7% of cases (281/786). Intestinal superinfections may complicate the clinical picture of IBD patients, increasing the diagnostic and therapeutic burden. Appropriate early procedures are thus needed in these patients.

Prevalence and associated risk factors of intestinal helminthic infections in children from Lorestan province, Western Iran

BACKGROUND

Intestinal helminthic infections are among the most important global socioeconomic and health problems. This study aimed to estimate the frequency of intestinal parasites in 366 children aged 2 to 15 years referred to the main pediatric health center of Lorestan Province, Iran.

METHODS

Microscopic analysis was performed on 366 stool samples. We applied direct smear, scotch tape, and formol-ether methods. Moreover, a questionnaire was filled in by parents or guardians of the children.

RESULTS

The results showed that 36 children (9.8%) were infected with at least one or more intestinal parasites. The most prevalent parasites were Enterobius vermicularis (6.8%), Hymenolepis nana (1.9%), and Ascaris lumbricoides (0.55%), in the order of their appearance. Statistical analysis showed that several risk factors were significantly associated with the prevalence intestinal helminthic parasites, including male sex (OR = 2.9; 95% CI: 1.2-6.2; p < 0.05), residing in rural regions (OR = 4.2; 95% CI: 2.1-10.6; p < 0.001), no handwashing habit before eating (OR = 5.2; 95% CI: 2.2-12.5; p < 0.001), and consuming raw or unwashed vegetables and fruits (OR = 4.8; 95% CI: 2.3-11.2; p < 0.001).

CONCLUSION

The present study showed a high overall frequency of intestinal helminthic infections among the children in Lorestan province, Iran. The results of the risk factor analysis suggest that improving environmental hygiene and health education would be important for effective control of intestinal parasitic infections.

Dietary intake from complementary feeding is associated with intestinal barrier function and environmental enteropathy in Brazilian children from the MAL-ED cohort study

A child’s diet contains nutrients and other substances that influence intestinal health. The present study aimed to evaluate the relations between complementary feeding, intestinal barrier function and environmental enteropathy (EE) in infants. Data from 233 children were obtained from the Brazilian site of the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development Project cohort study. Habitual dietary intake from complementary feeding was estimated using seven 24-h dietary recalls, from 9 to 15 months of age. Intestinal barrier function was assessed using the lactulose–mannitol test (L–M), and EE was determined as a composite measure using faecal biomarkers concentrations – α-1-antitrypsin, myeloperoxidase (MPO) and neopterin (NEO) at 15 months of age. The nutrient adequacies explored the associations between dietary intake and the intestinal biomarkers. Children showed adequate nutrient intakes (with the exception of fibre), impaired intestinal barrier function and intestinal inflammation. There was a negative correlation between energy adequacy and L–M (ρ = −0·19, P < 0·05) and between folate adequacy and NEO concentrations (ρ = −0·21, P < 0·01). In addition, there was a positive correlation between thiamine adequacy and MPO concentration (ρ = 0·22, P < 0·01) and between Ca adequacy and NEO concentration (ρ = 0·23; P < 0·01). Multiple linear regression models showed that energy intakes were inversely associated with intestinal barrier function (β = −0·19, P = 0·02), and fibre intake was inversely associated with the EE scores (β = −0·20, P = 0·04). Findings suggest that dietary intake from complementary feeding is associated with decreased intestinal barrier function and EE in children.

[Globalization: challenges in abdominal surgery for migrants and refugees]

The increasing number of refugees, migrants and international travelers influences the surgical spectrum of abdominal diseases. The aim of this review is to familiarize surgeons with specific diseases which are endemic in the patients' countries of origin and are likely to be diagnosed with increasing incidence in Germany. Low levels of hygiene in the countries of origin or refugee camps is associated with a high incidence of numerous infections, such as helminth infections, typhoid fever or amoebiasis, which if untreated can cause surgical emergencies. Historically, some of them were common in Germany but have been more or less eradicated because of the high socioeconomic standard. Echinococcosis and Chagas disease are frequently treated surgically while schistosomiasis can mimic intestinal cancer. Abdominal tuberculosis presents in a variety of abdominal pathologies and frequently causes diagnostic uncertainty. Sigmoid volvulus has a very low incidence among Europeans, but is one of the most common abdominal surgical conditions of adults in endemic countries. The number of patients who eventually undergo surgery for these conditions might be relatively low; however, surgeons must be aware of them and consider them as differential diagnoses in refugees and migrants with acute or chronic abdominal symptoms.

Antagonistic effect of isolated probiotic bacteria from natural sources against intestinal Escherichia coli pathotypes

Background

Probiotics are live microorganisms which are beneficial bacteria that are normal flora of the digestive system which, in determined amounts, show beneficial effects on host health, and can balance gastrointestinal microflora. Digestive tract diseases such as diarrhea are one of the major causes of child mortality in developing countries. Different pathotypes of Escherichia coli cause diarrhea that affects children, therefore reduction of these colonization strains in humans or animals can decline gastrointestinal disorders such as diarrhea.

Objective

The aim of this study was to determine the antimicrobial effect of probiotic bacterial strains isolated from different natural sources against 4 pathotypes of pathogenic E. coli using disk and well diffusion methods.

Methods

This cross-sectional study was conducted from December 2013 to July 2014 on Martyr Chamran University in Ahwaz city. A total of 13 probiotic colonies isolated from 20 samples of traditional dairy products including yogurt, cheese and milk, and 20 samples of vegetables including carrots and cabbages (red and white), of which 5 isolates were selected to determine the antimicrobial effect against 4 Escherichia coli pathotypes, randomly. The antimicrobial effect was evaluated using two methods: disk diffusion and well diffusion tests and measuring growth inhibition zones of probiotics against 4 pathotypes of pathogenic E. coli.

Results

Obtained results showed growth inhibition effects of all 5 probiotic strains against Escherichia coli pathotypes in both used methods. But in comparison Lactobacillus plantarum had higher growth inhibitory effects in both methods.

Conclusion

results of this study demonstrated high antimicrobial effect of probiotic bacteria against pathogenic Escherichia coli strains. It indicated a positive and beneficial role of probiotics in human health and prevention of illness.

Yersinia pseudotuberculosis supports Th17 differentiation and limits de novo regulatory T cell induction by directly interfering with T cell receptor signaling

Adaptive immunity critically contributes to control acute infection with enteropathogenic Yersinia pseudotuberculosis; however, the role of CD4⁺ T cell subsets in establishing infection and allowing pathogen persistence remains elusive. Here, we assessed the modulatory capacity of Y. pseudotuberculosis on CD4⁺ T cell differentiation. Using in vivo assays, we report that infection with Y. pseudotuberculosis resulted in enhanced priming of IL-17-producing T cells (Th17 cells), whereas induction of Foxp3⁺ regulatory T cells (Tregs) was severely disrupted in gut-draining mesenteric lymph nodes (mLNs), in line with altered frequencies of tolerogenic and proinflammatory dendritic cell (DC) subsets within mLNs. Additionally, by using a DC-free in vitro system, we could demonstrate that Y. pseudotuberculosis can directly modulate T cell receptor (TCR) downstream signaling within naïve CD4⁺ T cells and Tregs via injection of effector molecules through the type III secretion system, thereby affecting their functional properties. Importantly, modulation of naïve CD4⁺ T cells by Y. pseudotuberculosis resulted in an enhanced Th17 differentiation and decreased induction of Foxp3⁺ Tregs in vitro. These findings shed light to the adjustment of the Th17-Treg axis in response to acute Y. pseudotuberculosis infection and highlight the direct modulation of CD4⁺ T cell subsets by altering their TCR downstream signaling.