Colonic basidiobolomycosis with liver involvement masquerading as gastrointestinal lymphoma: a case report and literature review

Abstract Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal tract. This study reported a 5-year-old boy with gastrointestinal basidiobolomycosis that had been misdiagnosed as gastrointestinal lymphoma. He was treated by surgical resection and a combination of posaconazole and amphotericin B deoxycholate with an acceptable response and no recurrence.

Bacteriemias por Streptococcus gallolyticus (ex S. bovis) y su relación con patología colónica o hepatobiliar y endocarditis / Streptococcus gallolyticus (ex S. bovis) bacteremia and its relationship with colonic or hepatobiliary disease and endocarditis

Background: Bacteremia due to Streptococcus bovis (now S. gallolyticus) has been traditionally associated to colon or hepatobiliar disease and endocarditis but there is no information on this matter in Chile. Aims: To describe clinical features of adult patients suffering bacteremia by S. bovis/S. gallolyticus, identify the source of the bacteremia and the frequency of endocarditis. Methods: Retrospective-descriptive study using laboratory records. Results: Between January 2003 and August 2014, 23 S. bovis/S. gallolyticus bacteremic events were identified among 22 patients. Mean age was 72.7 years (range 46-96). Co-morbidities were frequent (9.1 to 47.6%). The primary source of bacteremia was intestinal in 52.2%; hepatobiliar in 17.4% and in 34.8% it was not elucidated. Six patients had infective endocarditis (26.1%) and one patient had espondylodiscitis (4.3%). S. bovis represented 39.1% of isolates (all until 2008), S. gallolyticus subsp pasteurianus 39.1% and, S. gallolyticus subsp infantarius and S. gallolyticus subsp gallolyticus 8.7% each one, respectively. Association studies between the bacteremic source or endocarditis with specific S. gallolyticus subspecies were limited by the small number of isolates. Seven patients (30.4%) underwent surgical interventions. In-hospital mortality reached 21.7% (n = 5). Conclusions: Although infrequent, bacteremic events by S. gallolyticus/S. bovis have increased in-hospital mortality, require surgical intervention and affect older patients with co-morbidities. Near two-thirds suffer from colonic or hepatobiliary disease that act as the primary source of bacteremia. In addition, near one fourth is affected by infective endocarditis. Detection of S. gallolyticus/S. bovis in blood cultures prompts a thorough clinical evaluation in order to clarify the source of the bloodstream infection and the presence of complications.

Antecedentes: Los cuadros de bacteriemia por Streptococcus bovis (actualmente S. gallolyticus) han sido tradicionalmente asociados a patología colónica o hepatobiliar y endocarditis pero no se conoce de estudios en Chile que hayan abordado este tema. Objetivos: Describir aspectos clínicos de pacientes adultos afectados por bacteriemias por S. bovis/S. gallolyticus, identificar la fuente de la bacteriemia y la frecuencia de endocarditis. Métodos: Diseño de tipo retrospectivo, descriptivo, con el registro de casos bacteriemia. Resultados: Entre enero de 2003 y agosto de 2014 se identificaron 23 eventos de bacteriemia por S. bovis/S. gallolyticus en 22 pacientes. La edad promedio fue de 72,7 años (rango 46-96). La prevalencia de diferentes co-morbilidades fue elevada (9,1 a 47,6%). El foco primario de la bacteriemia fue intestinal en 52,2%, hepatobiliar en 17,4% y, en 34,8% no se aclaró el foco. Seis pacientes presentaron endocarditis infecciosa (26,1%) y uno espondilodiscitis (4,3%). S. bovis representó 39,1% de los aislados (todos hasta el 2008), S. gallolyticus subsp pasteurianus 39,1%, S. gallolyticus subsp infantarius y S. gallolyticus subsp gallolyticus 8,7%, respectivamente. Los estudios de asociación estuvieron limitados por el bajo número de aislados. Siete pacientes (30,4%) debieron ser intervenidos quirúrgicamente. La mortalidad hospitalaria fue de 21,7% (n: 5). Conclusiones: Aunque infrecuentes, los eventos de bacteriemia por S. gallolyticus/S. bovis tienen una elevada mortalidad hospitalaria, requieren con frecuencia procedimientos quirúrgicos y afectan a pacientes mayores con co-morbilidades. Cerca de dos tercios padecen de una patología colónica o hepatobiliar que actúa como foco primario y cerca de un cuarto presenta endocarditis infecciosa. La detección de este grupo bacteriano en los hemocultivos requiere una evaluación para establecer el origen de la bacteriemia y la presencia de complicaciones.

Hematoma intraparenquimatoso hepático post- colangiopancreatografía retrógrada endoscópica sobreinfectado por Citrobacter freundii y Klebsiella pneumoniae BLEE / [Intraparenchymal hepatic haematoma after endoscopic retrograde cholangiopancreotography overinfected by Citrobacter freundii and Klebsiella pneumoniae BLEE].

This case report describes a 37-year-old woman who develops an intraparenchymal hepatic haematoma after an endoscopic retrograde cholangiopancreatography with papillotomy and stone extraction. The procedure requires the passage of a guidewire. The patient develops acute abdominal pain 72 hours later and a magnetic resonance shows a hematoma of 124 x 93 mm. She remains under observation. Twenty one days later she complains of upper right abdominal pain and fever. Consequently, a percutaneous drainage is performed isolating Citrobacter freundii and Klebsiella pneumoniae BLEE. The patient has a good evolution.

Targeting the microbiota in the management of gastrointestinal and liver disease / Apuntando a la microbiota en el manejo de las enfermedades gastrointestinales y hepáticas

Thanks to rapid advances in technology the details of the human microbiome and its functions in health and disease are being progressively revealed. Though many reports have linked various disease states with an altered microbiome and while some associations between the microbiome and disease states are well established, many of these studies are largely descriptive and the changes reported in the microbiome have yet to be shown to be causative. A number of strategies are available to modify the microbiota; some such as the use of antibiotics for specific indications, are well established, others such as the use of probiotics and prebiotics in a variety of disease states are supported by more limited data. Fecal transplantation has emerged as an exciting, albeit rather drastic, intervention for intestinal and, perhaps, other disorders. Other approaches, such as the isolation, purification and formulation of small molecules with specific biological actions, derived from the microbiota look very promising.

Gracias al rápido avance de la tecnología los detalles del microbioma humano y sus funciones en salud y enfermedad están siendo conocidos progresivamente. A pesar que muchos reportes han relacionado varios estados de enfermedad con un microbioma alterado y mientras algunas asociaciones entre el microbioma y estados de enfermedad están bien establecidas, muchos de estos estudios son solo descriptivos y los cambios reportados en el microbioma todavía tienen que demostrarse que son la causa. Existen muchas estrategias para cambiar la microbiota; algunas como el uso de antibióticos para indicaciones específicas, están muy bien determinadas, otras, como el uso de probióticos y prebióticos en una gran variedad de enfermedades, están sustentadas en data más limitada. El trasplante fecal ha surgido como una alternativa muy emocionante, aunque algo drástica, para las enfermedades intestinales y quizás también para otras patologías. Otros abordajes como el aislamiento, purificación y formulación de pequeñas moléculas con acciones biológicas específicas, derivados de la microbiota aparecen como muy prometedoras.

The presence of Helicobacter pylori in the liver depends on the Th1, Th17 and Treg cytokine profile of the patient

The hypothesis that Helicobactermight be a risk factor for human liver diseases has arisen after the detection of Helicobacter DNA in hepatic tissue of patients with hepatobiliary diseases. Nevertheless, no explanation that justifies the presence of the bacterium in the human liver has been proposed. We evaluated the presence of Helicobacterin the liver of patients with hepatic diseases of different aetiologies. We prospectively evaluated 147 patients (106 with primary hepatic diseases and 41 with hepatic metastatic tumours) and 20 liver donors as controls. Helicobacter species were investigated in the liver by culture and specific 16S rDNA nested-polymerase chain reaction followed by sequencing. Serum and hepatic levels of representative cytokines of T regulatory cell, T helper (Th)1 and Th17 cell lineages were determined using enzyme linked immunosorbent assay. The data were evaluated using logistic models. Detection of Helicobacter pylori DNA in the liver was independently associated with hepatitis B virus/hepatitis C virus, pancreatic carcinoma and a cytokine pattern characterised by high interleukin (IL)-10, low/absent interferon-γ and decreased IL-17A concentrations (p < 10-3). The bacterial DNA was never detected in the liver of patients with alcoholic cirrhosis and autoimmune hepatitis that are associated with Th1/Th17 polarisation. H. pylori may be observed in the liver of patients with certain hepatic and pancreatic diseases, but this might depend on the patient cytokine profile.

Histoplasmosis hepática. A propósito de un caso / Hepatic histoplasmosis. A propos of a case

Durante un brote epidémico de trasmisión hídrica de hepatitis viral A en el área de Versalles, Matanzas, ocurrido entre octubre 2006 y marzo 2007 se incluyó con diagnóstico presuntivo de esta enfermedad al paciente P.A.P M/B, de 45 años de edad, que ingresó en el Servicio de Medicina Interna del Hospital Provincial José Ramón López Tabrane por presentar además de los síntomas típicos, un síndrome febril prolongado; como dato de interés se recogió su dedicación al cuidado de aves de corral. Se realizaron estudios virológicos para virus A,B,C y E los cuales resultaron negativos, el resto de los complementarios confirmaban lesión hepática por lo que se indicó laparoscopia con biopsia hepática y se llegó al diagnóstico de histoplasmosis hepática. Se comenzó tratamiento con Itraconazol con evolución clínica satisfactoria y regresión de las lesiones hepáticas.

During an epidemic sprout of hydric transmission of hepatitis A occurred in Matanzas, Versalles area., between October 2006 and March 2007, the patient P.A.P male, white of 45 years old, which one entered in Medicines Service of the José Ramón López Tabrane Hospital was included with presumptive diagnosis of this disease. The patient presented in addition to typical symptoms, a feverish prolonged syndrome and as fact of interest gathered his dedication to care of poultry bird. The virological studies for virus A, B, C, and E proved to be negative, the rest of the complementary were confirming hepatic lesion, thats why laparoscopia with hepatic biopsy was indicated and it took place the diagnosis of hepatic histoplasmosis. Treatment began with Itraconazol with clinical satisfactory evolution and regression of hepatic injuries.

Disseminated histoplasmosis in an immunocompetent individual--a case report.

We report a rare case of disseminated histoplasmosis in a immunocompetent young adult person involving bone marrow, liver, spleen and oral cavity. He presented with oral ulcers, weight loss and pancytopenia. His bone marrow aspiration examination revealed Histoplasma capsulatum.

Hepatic and small bowel mucormycosis after chemotherapy in a patient with acute lymphocytic leukemia

Mucormycosis is a rare but invasive opportunistic fungal infection with increased frequency during chemotherapy-induced neutropenia. The clinical infections due to Mucor include rhinocerebral, pulmonary, cutaneous, gastrointestinal and disseminated diseases. The first two are the most common diseases and all entities are associated with a high mortality rate. Still hepatic involvement of Mucor is rarely reported. We experienced a case of hepatic and small bowel mucormycosis in a 56-year-old woman after induction chemotherapy for B-cell acute lymphocytic leukemia. Initial symptoms were a high fever unresponsive to broad spectrum antibiotics and pain in the left lower abdominal quadrant. It was followed by septic shock, deterioration of icterus and progressively elevated transaminase. An abdominal CT demonstrated multiple hypodense lesions with distinct margins in both lobes of liver and pericolic infiltration at small bowel and ascending colon. Diagnosis was confirmed by biopsy of the liver. The histopathology of the liver showed hyphae with the right-angle branching, typical of mucormycosis. The patient was managed with amphotericin B and operative correction of the perforated part of the small bowel was performed. However, the patient expired due to progressive hepatic failure despite corrective surgery and long-term amphotericin B therapy.

Helicobacter pylori among Egyptian patients with chronic liver, diseases a comparative study

80 patients subjected to upper gastrointestinal endoscopy were enrolled. They were divided according to their liver status into 2 groups. The 1st group included patients with liver cirrhosis and the 2nd group included patients who had no liver affection. Gallbladder diseases were excluded by abdominal ultrasound examinations. Endoscopic antral mucosal biopsies were used for H. Pylori screening by both culture and urease test, and for histopathological examinations. Both groups were matched as regards age, sex and socioeconomic conditions. Culture was positive in 42.2% and 40.7% of patients in both groups, respectively, [P >0.05]. Urease test showed positive results in 58% and 76.6% in both groups, respectively, [P >0.05]. H. pylori prevalence showed no significant differences between both studied groups as regards age, sex or type of gastric lesions. Furthermore, liver status in patients with chronic liver diseases does not play a role in the distribution of infection. The study showed the high prevalence of H. pylori among Egyptians and the absence of a relation between H. pylori and chronic liver diseases

Efect of helicobacter pylori on urea/ammonia ratio in gastric juice and blood ammonia levels in patients with chronie liver diseases

Helicobacter pylori HP has high urease activity which enables it to hydrolyze gastric juice urea produciug ammonia. It has been proposed that infection with HP in patient with advanced liver disease may implicate an increased level of blood ammonia which have a non benign effect in the pathogenesis of hepatic encephalopathy. To investigate this hypothesis, the present work measured the blood ammonia and the urease activity of HP using Urea/ Ammonia ratio [U/A] in gastric juice of patients suffering from chronic liver disease associated with HP infection. Gastric juice aspiration, gastric biopsies and blood samples were taken from 27 patients with chronic liver disease and portal hypertension. Their liver affection was classified into Child A[14], Child B[6] and Child C [7]. The HP was identified using 3 kinds of tests, rapid urease, rapid latex and enzyme Immunoassay tests. The intragastric and blood ammonia levels were measured by an ultraviolet method, gastric urea was determined using an enzymatic method. It was found that all patients harboured HP organism, the ammonia levels correlated with the severity of the liver affection [p<0.01]. Comparing the mean ammonia levels of the severest stage of liver disease [Child C] with the mild stage [Child A], it showed a high significant mean value in both the blood and gastric juice [p<0.01], The moderate stage [Child B] had its mean ammonia values higher than Child A, but it was only the blood level which was significantly higher [p<0.05]. U /A ratio in gastric juice were 1.1, 0.6 and 0.4 in Child A, B and C respectively, showing statistical significant decrease between Child B and C when compared with Child A group [p<0.01]. U/A ratio in gastric juice may be a good indicator of HP infection and related to the Child score. It was concluded that due to HP infection there is an increased urease enzyme production leading to increased ammonia intragastrically. This may have a local damaging effect on the gastric mucosa. There is also an increased absorption and accumulation of ammonia in the blood of patients with chronic liver disease, as a result of liver decompensation. Thus eradication of HP infection in these patients may minimize the development of complications and decrease the incidence of encephalopathy

Helicobacter pylori infection and hyperammonaemia in patients with chronic liver diseases

Thirty six patients with chronic liver diseases [either schistosomal or post-viral or mixed] and eight normal subjects, as a control group, were investigated. The chronic liver diseased patients were classified according to Child-Pugh classification into three main groups; group A = 8 patients, group B = 14 patients and group C = 14 patients. Patients were subjected to upper gastroduodenoscopy, diagnosis of H. pylori infection by pyloriset-EIA-G test and estimation of fasting blood ammonia level 2 weeks after neomycin therapy for eradication of gut flora. Diagnosis of H. pylori infection and blood ammonia level were done to the control group. It was concluded that the patient with chronic liver disease has a high H. pylori infection rate and those infected are at higher risk of hyperammonemia and hepatic encephalopathy, especially group B and C child classification. So, eradication of H. pylori infection in those patients may triggered the improvement of hepatic encephalopathy

prospective study of bacterial infections in patients with liver cirrhosis

One hundred hospitalized patients with cirrhosis were included in a prospective and sequential study, to verify the prevalence and most frequent causes of bacterial infection. The differences in clinical and laboratory data between the two groups were analyzed: Group 1, 60 patients who developed bacterial infection and group II, 40 patients without bacterial infection. The prevalence or commutative frequency of the development of bacterial infection during one hopsitalization was 60%. Among these, the most frequent types of infection were: Urinary tract infection U. T. I. [30.85%], respiratory infection [26.34], and spontaneous bacterial peritonitis SBP [14.35%]. Community infections were more frequent [49.64%] than nosocomial infections [35.42%] and they occurred sequentially in 14.74% of the case. Clinical and biochemical parameters in bacterial infection were generally correlated with the severity of liver disease. During hospitalization, the mortality rate of group I was 38.20%, whereas in group II, it was [8.94%]. SBP and respiratory infections were the most severe types of infections, with high mortality rates 30%, and 43% respectively. Urinary tract infections with active urinary bilharziases constitutes 20% of the total urinary tract infection cases. These results indicate that bacterial infection is a severe complication in the course of liver cirrhosis

Brucella bacterascites

Brucella was cultured simultaneously from the ascitic fluid and blood of a febrile patient who had decompensated chronic liver disease, portal hypertension and ascites. Many bacteria have been isolated in bacterascites and spontaneous bacterial peritonitis but Brucella has not yet been recorded

Hepatitis C virus infection in chronic liver disease in Bombay.

To find out the prevalence of antibody of hepatitis C virus (anti-HCV) in patients with chronic liver disease in Bombay, sera from 126 patients (93 men, 33 women; aged 9-70 years, mean 39.7) with chronic liver disease (cirrhosis 103, cirrhosis with hepatocellular carcinoma 3, chronic active hepatitis 20) were tested for HBsAg and anti-HCV antibody. HBsAg positive sera were tested for anti-delta antibody and IgM anti-HBc. All the tests were carried out by ELISA. Of 126 patients, 51 (40.5%) were HBsAg positive, 49 (38.8%) alcoholic and 21 (16.6%) anti-HCV positive. The prevalence of anti-HCV in HBsAg positive, alcoholic and cryptogenic (HBV negative and no alcohol) liver disease patients was 13.7%, 14.7% and 20.5% respectively. Of 21 anti-HCV antibody positive patients, 8 (38%) had received blood transfusions previously. HCV is present in 15-20% of patients with chronic liver disease in Bombay.

study of cell mediated immunity and presence of cryptosporidium in cases of chronic liver disease

Twenty five cases presenting with chronic liver disease were studied for the occurrence of cryptosporidium and for cellular immunity by MIT and opsonophagocytic activity. In no case cryptosporidium was detected and T-cell function was found to be suppressed by MIT in all cases while opsonophagocytic activity was found to intact in all comparison to controls