Syphacia muris infection in rats attenuates colorectal carcinogenesis through oxidative stress and gene expression alterations. Implications for modulatory effects by Bryostatin-1

Accumulating evidence suggest that some infectious agents may interfere in the natural progression of neoplasia. This study examined the association between chronic infection with adult Syphacia muris parasites and 1,2-dimethylhydrazine (DMH)-induced colorectal carcinogenesis in rats. In addition, the conceivable therapeutic effect of Bryostatin-1, a potent extract of the marine Bryozoan, Bugulane ritina, was investigated against this combined effect.DMH administration has induced aberrant crypt foci (ACF), surrogate biomarkers for colorectal carcinogenesis, while the S. muris infection combined with DMH has significantly increased the total numbers of ACF. Nonetheless, treatment with Bryostatin-1 after infection has significantly reduced the ACF numbers particularly larger ones. This inhibition was concomitant with significant inhibition in the immunohistochemical levels of the ki67, Caspase-3 and IgM levels in colorectal epithelium, as well as serum levels of IgM and IgG. Additionally, treatment with Bryostatin-1 after S. muris + DMH has modulated enzymatic antioxidative markers levels of superoxide dismutase and catalase as well as the non-enzymatic antioxidant markers levels of reduced glutathione, lipid peroxidation, nitric oxide and total antioxidant capacity. Further, treatment with Bryostatin-1 has down-regulated the mRNA expression levels of COX-2 and APC genes in colorectal mucosa. In conclusion, infection with S. muris during colorectal carcinogenesis has significantly modulated the oxidative stress markers in the colorectum, while treatment with Bryostatin-1 has exerted significant curative potential. A mechanism could be explained that Bryostatin-1 treatment has reduced oxidative stress markers activities along with affecting host to parasite immunity possibly leading to changes in the COX-2 and APC expression, retarding cellular proliferation and subsequently reducing the colorectal carcinogenesis events.

Oxyuriasis-induced intestinal obstruction in a child--case report

PURPOSE

The presentation of an unusual case of the tumor of ileum wall induced by pinworm infection in a 5-years-old child.

MATERIAL AND METHODS

The record of a 4-years-old boy treated in the department of pediatric surgery was analyzed concerning the diagnostic difficulties. After 6 month from an episode of ileo-cecal intusussception successfully treated with a barium colon enema, the diagnosis of lymphoma was made and the resection of distant segment of small intestine was performed.

RESULTS

No clinical and laboratory features of oxyuriasis could be stated before the onset of disease, during hospitalization and in the follow-up period. The hypertrophied and activated lymphatic tissue with a non-specific inflammatory reaction to the pinworms were seen in the wall of ileum, appendix and mesenteric lymph nodes. No neoplastic cells were found in the microscopic study of ileum, appendix, mesenteric lymph nodes and peritoneal lavage fluid.

CONCLUSIONS

The proper diagnosis of oxyuriasis may be difficult when the course is atypical. The enterobius vermicularis infestation as an etiologic factor should be taken into account in any case of abdominal pathology. However, the methods routinely used in "acute abdomen" including examinations of blood, urine and stool, repeated ultrasound and CT, are not reliable. As the infestation may mimic neoplasm, the surgical treatment and microscopic examination can be necessary for the final diagnosis in some cases.

[Appendiceal oxyuriasis: a case report and review of the literature]

The authors describe a case of appendicular oxyuriasis and then go on to review the international literature on this condition. Nothing in the case report provides the surgeon with useful pointers which may help him distinguish between appendicular oxyuriasis and common appendicitis. This is in line with all the existing literature which yields no elements capable of suggesting an accurate preoperative diagnosis. Only anamnestic evidence of previous oxyuriasis can help the clinician in this direction. It should be noted, however, that there are no significant differences in postoperative morbidity between "common" acute appendicitis and appendicitis due to oxyuriasis, when the parasitosis is adequately treated.

Pre- and post-therapy blood lymphocyte levels in IgE-negative urticaria, associated with several parasitic or fungal diseases

115 patients with non-immune (IgE-negative) urticaria, related to parasitic (lambliasis, oxyuriasis, ascaridiasis) or fungal (candidiasis) associations were investigated-both before and one month after specific and antihistaminic therapy-concerning different percentage levels of blood lymphocyte sets and subsets, by means of flow cytometry. Before therapy, three kinds of immune deficiency patients were obtained, one in lambliasis and oxyuriasis, the second in ascaridiasis, and the third in candidiasis, respectively. Clinical, biological and immunological recovering after therapy exhibited some differences related to the presumed non-allergic etiology, i.e. better in lambliasis and oxyuriasis and worse in ascaridiasis and candidiasis.

Vulvovaginitis: causes and management

Over a period of 33 months in a paediatric accident and emergency department, the clinical pattern and possible causes of vulvovaginitis were studied prospectively in 200 girls presenting with genital discharge, irritation, pain, or redness. The major causes were poor hygiene and threadworms. The suspicion of sexual abuse arose in a few girls but no organisms of sexually transmitted disease were found. Urinary symptoms were common but only 20 patients had a significant bacteriuria and 40 had sterile pyuria. Specific skin problems occurred in 28 cases. Simple measures to improve hygiene and treatment of threadworms gave effective relief. Genital irritation caused urinary symptoms with no clinical evidence of infection, and it is advised that antibiotic treatment should await urine culture. Specific skin problems require help from a dermatologist. The possibility of sexual abuse must be considered especially if the vulvovaginitis is persistent or recurrent after adequate treatment.

Prevalence and symptoms of Enterobius vermicularis infections in a Peruvian shanty town

The prevalence and symptoms of pinworm infection were determined in a shanty town in Lima, Peru. In 206 families, pinworm infection rates were highest in primary school age children (42%). Approximately one-fourth of pre-school children and secondary school-age children were infected with pinworms. Two examinations detected 74% of patients who were positive after 5 examinations. Symptoms often attributed to pinworm infection, such as perianal itching enuresis, and teeth grinding, occurred in a similar proportion of infected children (15%, 17%, 13%, respectively) and non-infected subjects (11%, 13%, 11%, respectively). Enuresis was more common in primary school-age children with high pinworm egg counts than in their non-infected contemporaries. 52% (28/54) of children under 5 years old became reinfected within 6 months of effective treatment. In a community where water is scarce and hand washing is infrequent, the high rate of perianal itching is probably an important source of faecal-oral contamination. The low morbidity and high reinfection rate make routine treatment of pinworm infection in third world countries a low priority, except when clinically indicated.

Role of Enterobius vermicularis in the aetiology of appendicitis

An evaluation was made of the histological material obtained from all 1529 appendices removed during the last 5 years at Southmead Hospital, Bristol, in order to elucidate possible relationships between the incidence of Enterobius vermicularis and the origin of inflammation in the appendix. In total, 1419 appendices were removed as cases of clinical appendicitis and 110 in the course of another surgical procedure. E. vermicularis was identified in 2.7 per cent of patients with clinical appendicitis and was most commonly seen in appendices with either chronic inflammation or where the appendix was histologically normal. E. vermicularis was rarely associated with histological changes of acute appendicitis. No cases of E. vermicularis infestation occurred in appendices removed during the course of other surgical procedures. The results suggest that, although E. vermicularis may have a causal role in appendicular pain and chronic inflammation, it is rarely related to acute appendicitis.

Enterobius (Oxyuris) vermicularis of the pelvic peritoneum--a cause of infertility

A case of Enterobius (Oxyuris) vermicularis granulomatous disease of the pelvic peritoneum causing pelvic adhesions and infertility is presented and discussed. Since parasitic diseases are common in the developing countries, the infertility team has to bear in mind that a parasitic disease might be the main cause of infertility.

Long-term population dynamics of pinworms (Syphacia obvelata and Aspiculuris tetraptera) in mice

The population dynamics of concurrent infections of Syphacia obvelata and Aspiculuris tetraptera (Nematoda) in laboratory mice were investigated under conditions of constant re-exposure over periods of 56 and 115 days. The results indicate that A. tetraptera burdens equilibrate at a higher level than S. obvelata burdens and that both parasites become aggregated in the mouse population. Parasite burdens were higher following short-term (7 day) exposure of uninfected tracer mice to both parasites when compared with parasite burdens attained over long-term exposure, indicating probable development of immunity. A significant positive correlation was detected between numbers of immature S. obvelata and immature A. tetraptera for both experimental and tracer mice.

Disseminated intraperitoneal oxyuris granulomas

The threadworm, enterobius (oxyuris) vermicularis, is an nematode which may inhabit the human terminal ileum, colon and appendix. Its presence in ectopic sites is uncommon. We describe a case of generalized intraperitoneal oxyuris granulomas detected as an incidental finding at laparotomy for tuboovarian abscess.

Perianal abscess due to Enterobius vermicularis. Report of a case

A case of recurrent perianal abscess caused by Enterobius vermicularis infestation of the anal canal and glands in an 11-year-old boy is reported.

Pediatric vulvovaginitis

Childhood gynecologic problems are different from adult problems in physiology, disease, psychology, evaluation and management. The most common is vulvovaginitis. The child is susceptible to vulvovaginitis because of a relatively exposed vulva, a thin vaginal wall and poor hygiene. Additional problems are heat and moisture, clothing, coverings and possible sexual abuse. Most vulvovaginitis is primary, nonspecific vulvitis with secondary vaginitis. It is set off by poor hygiene and responds to keeping the vulva clean, cool and dry. Persistent or recurrent vulvovaginitis may be due to a variety of causes, including vulvar skin disease, a foreign body in the vagina, primary vaginitis, ectopic ureter and rhabdomyosarcoma. Vaginoscopy is indicated for recurrent vulvovaginitis or bleeding and for suspicion of a foreign body, neoplasm or congenital anomaly. The extent of evaluation depends on the anxiety of the child versus the extent of the problem, and therefore individualization is required.

Enterobiasis

Enterobiasis or pinworm infestation is an ubiquitous infection often seen in primary care settings. Incidence and prevalence are difficult to identify as it is believed that many cases go undiagnosed. Diagnosis, most commonly made in the school-aged child after complaints of nocturnal pruritus ani, can be made either by a cellulose tape test or by parental or self-report. A number of effective antihelminthics are available for treatment. It is thought that all close family members should be treated when a confirmed case exists and that retreatment should be given after a two-week interval to ensure eradication of the parasite. The nurse practitioner can be instrumental in providing treatment, education, support and reassurance to families with pinworms.

Granuloma of the anal canal due to Enterobius vermicularis. Report of a case

A case of a submucosal foreign body granuloma caused by Enterobius vermicularis in the wall of the anal canal of a 29-year-old man is reported.

Enterobius vermicularis infestation of the female genital tract causing generalised peritonitis. Case report

Enterobius (Oxyuris) vermicularis is the only nematode which infests man. It inhabits the large intestine and is of low pathogenicity. The ova are occasionally found in ectopic sites within the peritoneal cavity, usually as an asymptomatic granuloma. We describe the first patient to present with generalised peritonitis caused by rupture of a tubo-ovarian abscess containing the ova of Enterobius vermicularis.

Induction of lymphoma in athymic mice: a model for study of the human disease

A murine lymphoma, designated L1, was produced in immunologically deficient nude mice after chronic antigenic stimulation by infection with the pinworms Aspiculuris tetraptera and Syphacia obvelata. In vivo, L1 involves primarily the spleen and lymph nodes, with infiltration of liver, kidney, and bone marrow also observed. It is characterized by large clusters of B cells and null cells, and by rare T cells. The lymphoma cells express murine leukemia virus antigens (gp70 and p30) on the surface. L1 can be passaged successfully both in vivo and in vitro. The lymphoblasts that proliferate in vitro are null, but injecton back into the mouse produces a similar pattern of B cells, null cells, and occasional T cells as seen in the mouse-to-mouse transfers. Infectious viruses have been isolated from L1 cells and from tissue culture supernates and have been identified as a B-tropic murine leukemia virus and a xenotropic virus. The possibilities of this model for studying the etiology of human lymphoma are discussed.

Abdominal pain due to Enterobius vermicularis

The authors describe an unusual case of an 11-year-old girl who had right lower quadrant pain due to unilateral salpingitis, suppurative omentitis and periappendicitis. The etiologic agent was the parasite Enterobius vermicularis. A review of the literature revealed that pinworm may be the cause not only of appendicitis, but of inflammatory reactions in other intra-abdominal sites and that the frequency of this occurrence is probably higher than has previously been suspected.

[Vulvar granuloma due to Enterobius vermicularis (author's transl)]

The authors report a case of casual discovery of a enterobiasic vulvar granuloma arising on the left labia. This woman, living in Lille (France), 70 years had been treated by surgery and roentgentherapy for a well differentiated squamous carcinoma of the vulva. They consider the question of the genital localisation of Enterobius vermicularis in women and discuss the pathogenic hypothesis.

[Spontaneous stercoral fistula due to oxyurids: apropos of 1 case]

A spontaneous stercoral fistula containing pinworms was observed in a patient, 35 years after an appendicectomy. The various surgical complications of oxyuriasis are reviewed, in particular, the possibilities for the parasite to traverse the intestinal wall. In the case reported here, it appears that infiltration occurred in the external wall of the caecum.

Oxyuris granulomas of pelvic peritoneum and appendicular wall

Infestation with Enterobius (Oxyuris) vermicularis is very common but seldom produces lesions and even more rarely causes granulomas. Two cases of oxyuris granulomas/nodules), one in the serosa of ovaries and left fallopian tube in a female of 32-years and the other in the submucosa of the appendix in a 10-year old girl are identified by the presence of true necrotizing granulomas containing the parasite. The pathogenesis and differential diagnosis of abdominal granulomas is discussed.

The interaction between Entamoeba histolytica and Syphacia obvelata infection in mice

Mice naturally infected with Syphacia obvelata were challenged intracaecally with Entamoeba histolytica trophozoites. They showed a higher level of amoebic infection than mice without worms. Mice with the heaviest Syphacia infection were the most susceptible to amoebic infection. It appears that a concomitant infection with helminthic parasites residing in the caecum alters the outcome of an amoebic infection.

[Frequency of vulvovaginitis in girls with intestinal enterobiasis]

The study included 415 female patients with the diagnosis of enterobiasis seen at the Hospital del Niño, DIF. Vulvovaginitis was found in 78 cases (18%), with definite predominance in the school-age group. The clinical manifestations in order of frequency were: perianal and vulvar pruritus, abdominal pain, leukorrhea and vulvar edema. Graham's perianal and perineal smear method was performed with 100% positiveness in personal and 85% in perineal smears. The treatment should be directed to improve the family sanitary habites and the prescription of the choice drug to the patient and to his family. The following drugs are quite as effective: piperazine citrate, pyrvinium pamoate, pyrantel pamoate and mebendazole. The physician should use the drug that better fits the patients convenience, keeping in mind the easy determination of the dose and the cost in order to offer the patient and his family the best choice.

[Piperazine intoxication in long-term hemodialysis]

A 35-year-old patient with terminal renal failure who had received 30 mg piperazine hexahydrate/kg body weight daily for 10 days for oxyuriasis was subsequently admitted to hospital in precoma with severe clinical symptoms not unlike those observed in so-called dialysis dementia: loss of consciousness, dysarthria, apraxia, clonic spasms, tremor, muscular weakness, dropping of objects, inability to think clearly and/or hallucinations. The EEG showed disturbances with diffuse, multifocal delta waves. Under maintenance hemodialysis the patient became asymptomatic one week after discontinuation of the piperazine therapy. Piperazine is contraindicated in patients with renal failure.

Enterobius vermicularis in ectopic sites

We document six cases in which tissues were invaded by Enterobius vermicularis. These cases illustrate several mechanisms whereby the worms form granulomata in ectopic sites. In three cases, the worms passed through pre-existing breaches in the intestinal mucosa. In one case, a gravid worm migrated via the female genital tract to ther peritoneal cavity. In two other cases, male worms were found on the outer surface of the intestine, suggesting active penetration of the intestinal wall.

Unilateral salpingitis due to Enterobius vermicularis

A case of perforated unilateral salpingitis in which Enterobius vermicularis ova were identified in the inflammatory process is reported. Arguments for considering the parasite to be of etiologic significance in the production of the pathologic changes and clinical symptoms are presented. The infrequent occurrence of symptoms associated with ectopic localization of Enterobius vermicularis is emphasized by a review of the literature.

[A rare finding at gynaecological laparotomy: ovarian pregnancy and pinworm abscess (author's transl)]

A case of concommitant ovarian pregnancy and pinworm abscess is described. The histology and the incidence of Oxyuriasis in the female genital tract are discussed. The clinical symptoms and the management of the condition are also discussed.