Parasitos e/ou comensais intestinais em pacientes neoplásicos submetidos à quimioterapia / Parasitic and/or intestinal commensals in the neoplastic patients undergoing chemotherapy

O objetivo deste trabalho foi verificar a freqüência de parasitos e/ou comensais intestinais em pacientes neoplásicos submetidos à quimioterapia. As amostras de fezes foram analisadas pelo método de Lutz (1919) e Rugai (1954), em triplicata. O trabalho foi composto por três grupos, o primeiro (GI) formado por pacientes neoplásicos não submetidos à quimioterapia, o segundo (GII) formado por pacientes que estavam em tratamento quimioterápico, e o terceiro grupo (GIII) constituído por pacientes que terminaram a quimioterapia. Um total de 30 pacientes (GI ­5, GII-18 e GIII-7) foram triados no Hospital Regional de Assis do Sistema Único de Saúde da cidade de Assis, São Paulo. Dados complementares sobre tratamento antiparasitário e tipo de tumor foram obtidos por questionário. A positividade foi de 66,7% (20 casos) para parasitos e/ou comensais intestinais. Os helmintos encontrados foram: Ascaris lumbricoides (36,7%), Ancilostomídeos (20%) e Hymenolepis diminuta (3,3%). Entre os protozoários destacaram-se: Giardia lamblia (46,7%), Entamoeba coli (6,7%), E. histolytica/E. dispar (3,3%), Endolimax nana (3,3%) e Iodameba butschlii (3,3%). A elevada freqüência de parasitos e/ou comensais intestinais em pacientes neoplásicos pode ser atribuída a higiene pessoal inadequada e ausência de imunidade a re-infecções e ao pouco conhecimento da profilaxia para infecção por protozoários e helmintos. Os resultados obtidos indicam a necessidade da adoção de um novo critério para os pacientes neoplásicos submetidos à quimioterapia realizando primeiramente diagnóstico parasitológico, tratamento e acompanhamento de cura das parasitoses intestinais neste grupo de risco.

The objective of this study was to verify the prevalence of intestinal parasites and/or commensals in the neoplastic patients undergoing chemotherapy. Stool samples were analyzed by the method of Lutz (1919) and Rugai (1954), in triplicate. This work was composed of three groups, the first one (GI) formed by neoplastic patients that are not undergoing chemotherapy, the second (GII) comprised patients who were undergoing chemotherapy, and the third group (GIII) consisting of patients who completed chemotherapy. A total of 30 patients (GI-5, GII-18 and GIII-7) were screened at the Assis Regional Hospital of the Unified Health System of Assis, São Paulo.Additional information on antiparasitic treatment and tumor type were obtained by questionnaire. The positivity was 66.7% (20 cases) for intestinal parasites and/or commensals. The helminths were Ascaris lumbricoides (36.7%), Hookworms (20%) and Hymenolepis diminuta (3.3%). Among the highlights are protozoan Giardia lamblia (46.7%), Entamoeba coli (6.7%), E. histolytica /dispar (3.3%), Endolimax nana (3.3%) and Iodameba butschlii (3.3%). The high frequency of intestinal parasites and/or commensals in the neoplastic patients can be attributed to poor personal hygiene and lack of immunity to reinfection and poor knowledge of the prophylaxis of infection by protozoa and helminths. The results indicate the necessity of adopting a new criterion for neoplastic patients undergoing chemotherapy, primarily performing parasitological diagnosis, treatment and monitoring of cure of intestinal parasitic infections in this risk group.

Cytological diagnosis of bancroftian filariasis in lesions clinically anticipated as neoplastic.

Filariasis is a common disabling parasitic disease in this region and cytological diagnosis is often not required. Cytology has important role in diagnosis of sub-clinical filariasis. Most cases of cytologically diagnosed filariasis are clinically unanticipated. Microfilaria, ova and fragments of adult worm of Wuchereria bancrofti, in exfoliative as well as aspiration cytology have been reported and are useful in cytological detection of bancroftian filariasis. Microfilaria is frequently detected in association with neoplasm, although the role in tumorogenesis is controversial. The objective of the study was to investigate importance of cytology in diagnosis of filariasis in lesions clinically anticipated to be of neoplastic and to review the cytomorphology of bancroftian filaria and its association with neoplasm. This is a retrospective study carried out in cytology department of Tribhuvan University Teaching Hospital. 14 cases of cytological specimen out of 4291 (0.3%) showed microfilaria; 12 cases were from FNAC from different sites and 2 cases were from pleural fluid. 2 cases showed ova in addition to microfilaria and one of them in addition showed fragment of adult worm. Microfilaria in 4 cases of FNAC and one case ofpleural fluid were associated with malignant cells.

Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?

Cutaneous manifestations in disseminated strongyloidiasis are infrequent but should raise the suspicion for its diagnosis. We retrospectively evaluated the charts of six patients with cancer and a proven diagnosis of disseminated strongyloidiasis. All patients had received prophylaxis with albendazole before starting antineoplastic therapy, which included high-dose steroids. They presented with septic shock, acute respiratory failure and characteristic purpuric periumbilical skin lesions. Strongyloides larvae were identified in tracheal aspirates (n=5), gastric aspirates (n=4), lung (n=2) and skin biopsies (n=2). All patients died despite antihelminthic therapy and intensive care support.

Toxoplasma infection in selected patients in Kathmandu, Nepal.

Seroprevalence of Toxoplasma infections in 272 patients with ocular diseases (uveitis, retinochoroiditis), malignancy (including leukemia), women with bad obstetric history (BOH) and others (patients with fever, lymphadenitis and encephalitis) have been was studied. Toxoplasma antibodies were detected by microlatex agglutination and IgM ELISA techniques. Overall, 50.7% (138/272) patients included in this study had Toxoplasma antibodies, out of which 5.7% (8/138) had IgM antibodies. Patients with malignancy had highest positive rate [68.7% (22/32)] followed by group of others. Of the different groups, women with BOH had highest Toxoplasma IgM positive rate [25.0%; (2/8)].

Diagnosis of toxoplasmosis in children with malignancy

The study aimed at the diagnosis of toxoplasmosis in 73 children with malignancy; 31 with lymphoma [22 with Hodgkin's and 9 with non- Hodgkin's lymphoma] and 42 with leukemia [34 with acute lymphoblastic leukemia and 8 with acute myelogenic leukemia]. In positive cases, toxoplasmosis was manifested by any of the following; fever, lymph node enlargement, neurological manifestations and/or hepatosplenomegaly. The indirect hemagglutination test [IHA] for toxoplasmosis detected four [5.4%] positive cases with malignancy [two with Hodgkin's lymphoma, one with non-Hodgkin's lymphoma and one with acute lymphoblastic leukemia]. The immunoglobulin M enzyme-linked immunosorbent assay [IgM ELISA] detected only one [1.4%] case with Hodgkin's lymphoma. Immunoglobulin G [IgG] ELISA detected six [8.2%] positive cases [three with Hodgkin's lymphoma, one with non-Hodgkin's lymphoma and two cases with acute lymphoblastic leukemia]. Polymerase chain reaction for detection of parasite DNA in blood [PCR] was the most useful in diagnosing toxoplasmosis with malignancy, as it was able to detect nine [12.3%] positive cases [five [6.8%] with Hodgkin's lymphoma, one [1.4%] with non-Hodgkin's lymphoma and three [4.1%] with acute lymphoblastic leukemia]. No positive toxoplasmosis cases were detected with acute myelogenic leukemia by any of the above methods

Toxoplasmosis en niños con patologias oncológicas: estudio prospectivo de 200 casos / Toxoplasmosis in children with oncological pathology: prospective study in 200 cases

Se realizó un estudio clínico serológico prospectivo en 200 niños con patología oncológica para determinar la frecuencia y riesgo de toxoplasmosis en esta población. El estudio se efectuó por reacción de inmunofluorescencia indirecta para T. gondii, considerándose títulos positivos aquellos * 1:16. De ellos, 75 (37,5%) presentaron serología positiva, 53 (26,5%) títulos bajos, 15 (7,5%) títulos medianos y 7 (3,5%) títulos altos. De acuerdo a la patología de base 41,6% de los tumores óseos presentó toxoplasmosis, el 35,2% de las leucemias y el 30% de los linfomas. Todos los niños seropositivos fueron controlados periódicamente mediante examen clínico y relación de inmunofluorescencia indirecta en suero. Se demuestra que los niños oncológicos tienen un riesgo 2,86 veces mayor de presentar toxoplasmosis (p < 0,05) con un intervalo de confianza de 1,884,32; aquéllos con tumores óseos presentan un riesgo 4,4 veces mayor. En relación a lo descrito para población normal, en cambio, los pacientes portadores de linfoma no presentaron mayor riesgo de toxoplasmosis que la población pediátrica sin esta patología

Importancia del estudio de la toxoplasmosis en pacientes con emfermedades neoplásicas / Toxoplasmosis studies in patients with neoplastic diseases its importance

Se estudiaron 81 individuos a los cuales se les realizó historia clínica completa previa revisión de su historia, anotando: sexo; edad, lugar de nacimiento, procedencia, signos vitales. Se trató de conocer la frecuencia de infección por Toxoplasms Gondii, en una población de pacientes inmunosuprimidos hospitalizados, mediante la determinación de anticuerpos anti-toxoplasma por la reacción de inmunofluorecencia indirecta (RAFT); y en un grupo de pacientes no inmunosuprimidos de la población general. Establecer correlación entre el factor de inmunosupresión y la positividad a la reacción de anticuerpos fluorescentes; y establecer normas para el diagnóstico de toxoplasmosis en los pacientes inmunosuprimidos