Inmunodeficiencia variable común: afectación digestiva de un trastorno sistémico / [Common variable immunodeficiency: digestive involvement of a systemic disease].

Common variable immunodeficiency is characterized by a primary deficiency in antibody production that is clinically manifested by respiratory recurrent infections and gastrointestinal diseases (infectious, inflammatory and neoplastic). Above 50

of the patients have diarrhea and 10

develop idiopathic malabsorption and weight loss. We present the case of a 34-year-old woman submitted to our service for chronic diarrhea, abdominal pain and bloating and history of recurrent respiratory infections since childhood. The laboratory assessment showed severe hypoproteinemia and confirmed low IgG, IgA and IgM levels. Upper gastrointestinal endoscopy and videocapsule endoscopy showed a nodular duodenum with multiple polypoid-like formations all through the small bowel. Histology confirmed chronic duodenitis and Giardia lamblia infection. With the diagnosis of common variable immunodeficiency, monthly intravenous gammaglobulin infusion was initiated and metronidazole was indicated for Giardia lamblia infection achieving excellent clinical and laboratory response.

Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy / Perfil clínico, endoscópico e histopatológico de casos de duodenite parasitária diagnosticados por endoscopia digestiva alta

CONTEXT: Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. OBJECTIVE: To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. METHODS: Recorded biopsies archive at "Complexo Hospitalar Professor Edgar Santos" , a general teaching Hospital in the state of Bahia, Northeast Brazil, from January 1995 to January 2009, were reviewed. One thousand ten duodenal biopsy reports were found. Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected. RESULTS: Eleven biopsies showed parasites, including cases of Cryptosporidium sp. and Strongyloides stercoralis. Vomiting (91 percent), abdominal pain (78 percent), diarrhea (78 percent) and weight loss (78 percent) were usual symptoms. Seventy-five percent had duodenal mucosa changes on endoscopy, while 25 percent have no changes. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed. Villus atrophy and reactive epithelium were usual in Strongyloides cases. CONCLUSIONS: No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.

CONTEXTO: Parasitas intestinais podem induzir alterações histopatológicas, que têm sido estudadas em subgrupos com diagnóstico firmado de parasitose. Não há estudo disponível com base mais ampla, sem diagnóstico prévio. OBJETIVO: Descrever os achados clínicos e histopatológicos de parasitoses diagnosticadas por biopsia em pacientes submetidos a endoscopia digestiva alta. MÉTODO: Laudos de biopsias realizadas de janeiro de 1995 a janeiro de 2009, no Complexo Hospitalar Professor Edgar Santos, hospital geral universitário localizado no nordeste brasileiro, foram revisados. Mil e dez laudos de biopsia duodenal foram revistos. Biopsias positivas para parasitas tiveram suas lâminas revisadas e fotografadas. Todos os blocos de biopsia selecionados como casos foram recuperados e revisados por experiente patologista. Dados clínicos, laboratoriais e endoscópicos foram coletados. RESULTADOS: Onze biopsias mostraram parasitas, incluindo casos de Cryptosporidium sp. e Strongyloides stercoralis. Vômitos (91 por cento), dor abdominal (78 por cento), diarreia (78 por cento) e perda ponderal (78 por cento) foram sintomas comuns. Setenta e cinco por cento apresentaram alterações na mucosa duodenal à endoscopia, enquanto 25 por cento não apresentaram modificações. Anemia e hipoalbuminemia foram importantes dados laboratoriais. Foi observada associação com infecção pelo HIV. Atrofia de vilosidades e epitélio reativo foram comuns nos casos de S. stercoralis. CONCLUSÕES: Nenhum achado endoscópico ou histopatológico foi patognomônico. Um por cento das biopsias duodenais por via endoscópica mostraram parasitas.

Duodenitis por strongyloides stercoralis simulando lesion polipoide de duodeno / Strongyloides stercoralis Duodenitis by simulating polypoid lesion of duodenum

La Strongyloidiasis es una parasitosis intestinal producida por un nematodo de distribución mundial, es endémica en zonas tropicales, el parasito penetra a través de los pies en forma de larva filariforme presente en suelos infectados. Puede presentar manifestaciones Dermatológicas, Respiratorias y Gastrointestinales, siendo estas ultimas de variado espectro, que van desde síntomas vagos e inespecíficos hasta Enteritis Invasiva. Los métodos convencionales de examen de heces seriados o radiología no son lo suficientemente sensibles ni específicos. La endoscopia ha aumentado la posibilidad de hacer mejores diagnósticos, así como la biopsia gástrica y duodenal; de hecho se considera a los hallazgos endoscópicos como marcadores de severidad de la infección. Presentamos el caso de un paciente con síntomas dispépticos y hallazgos endoscópicos e histológicos de Duodenitis por Strongyloides Stercoralis. El paciente recibió tratamiento con Ivermectina.

The intestinal strongyloidiasis is a parasitic disease caused by a global distribution nematode endemic in tropical areas, penetrates through the feet in the form of larvae present in infested soil filariform. May present with dermatological, respiratory and gastrointestinal tracts, the latter being varied spectrum of symptoms ranging from vague to invasive enteritis. Conventional methods of serial stool examination, radiology are not sensitive enough nor specific. Endoscopy has increased the possibility of better diagnosis, as well as gastric and duodenal biopsy, in fact considered the endoscopic findings as markers of severity of infection. We report the case of a patient with dyspeptic symptoms with endoscopic and histological findings of Duodenitis for Strongyloides Stercoralis. He was treated with Ivermectin.

Dyspepsia in acute falciparum malaria: a clinico-pathological correlation.

Gastrointestinal symptoms are common in acute falciparum malaria. Dyspepsia often occurs in such patients and sometimes it is exceptionally severe. However, the pathogenesis of the dyspeptic symptoms in malaria has not been clearly defined. Upper gastrointestinal endoscopy was performed in 40 patients with acute falciparum malaria in order to correlate the dyspeptic symptoms with the macroscopic (endoscopic) and microscopic (histologic) pathology of stomach and duodenum. The patients were divided into a dyspeptic group (n = 20, male/female ratio = 17/3, age range 18-50 years, mean age = 28.85 + 9.14 years), and a non-dyspeptic group (n = 20, male/female ratio = 16/4, age range 15-47, mean age 26.05 + 9.98 years). The findings revealed that dyspepsia correlated with topographic endoscopic pangastritis (p = 0.0014), the category of endoscopic antral gastritis (p = 0.013), and the histologic severity of antral gastritis (p = 0.0434). The results suggested that gastritis should be considered in acute falciparum malaria patients presenting with dyspepsia.

Duodenitis: histopathological and endoscopic study: critical analysis of parasitic duodenits and white spot

In the study we examined several types of chronic duodenitis, such as, nonspecific, parasitic and those associated to other pathologies, in order to verify the amin histopathological alterations; to correlate endoscopical alterations on light microscopy; to analyze the "white spot" of the duodenal mucosa in parasitic diseases and other types of duodenitis. In 213 endoscopies with 2130 biopsies, we found chronic duodenitis as a difuse process in 91.5 per cent of the cases. Histopathological and morphological correlations show 78.3 per cent "agreement", 18 per cent "false negative" and 3.7 per cent "false positive". However, normal mucosa occured in 86,3 per cent of "false negative"; erosive duodenal pathology was 10.8 per cent of the total cases being classified into: "autonomous" - 26 per cent, "simultaneous" - 9 per cent, portal hypertension - 13 per cent, giardiasis-9 per cent and strongyloidiasis-39 per cent; complete erosions, located in the duodenal bulb, were suggestive of parasitic diseases