Perforación cecal por angiostrongiliasis en un adulto mayor / Cecal perforation due to angiostrongyliasis in an elderly patient

La angiostrongiliasis abdominal es una enfermedad parasitaria causada por el género Angiostrongylus costaricensis, un nematodo que infecta a los humanos a través de las secreciones de caracoles o babosas, sus huéspedes definitivos. Costa Rica es el país que se considera más endémico, se ha evidenciado en distintas revisiones que la mayoría de los casos se presentan en niños y personas del sexo masculino. Presentación del caso. Se trata de una mujer de 74 años, que consultó por dolor abdominal agudo, de cuatro días de evolución, acompañado de náuseas, vómitos e hiporexia. Los exámenes de laboratorio reportaron leucocitosis leve y examen general de orina negativo. La ultrasonografía abdominal reportó una masa sólida, heterogénea, mal circunscrita en flanco derecho, esto llevó a la sospecha de una apendicitis aguda. Intervención terapéutica. Se realizó una laparotomía exploradora, con la extirpación de una tumoración de colon perforado que abarcaba desde el ciego hasta el tercio proximal de colon ascendente, además, se realizó una anastomosis de íleo transversa, sin mayor complicación. Evolución clínica. Se manejó con antibióticos y analgésicos, fue dada de alta a los nueve días posteriores al procedimiento, sin complicaciones menores. La biopsia reportó huevos de parásitos consistentes con Angiostrongylus sp

bdominal angiostrongyliasis is a parasitic disease caused by the genus Angiostrongylus costaricensis, a nematode that infects humans through the secretions of snails or slugs, its definitive hosts. Costa Rica is considered the most endemic country, and it has been shown in different reviews that most cases occur in children and males. Case presentation. The patient was a 74-year-old woman who consulted for acute abdominal pain, with four days of evolution, accompanied by nausea, vomiting, and hyporexia. Laboratory tests reported mild leukocytosis and a negative general urine test. Abdominal ultrasonography reported a solid heterogeneous mass, poorly circumscribed in the right lateral abdomen, which led to the suspicion of acute appendicitis. Treatment. An exploratory laparotomy was performed, with the removal of a perforated colon tumor that spanned from the cecum to the proximal third of the ascending colon, in addition, a transverse ileum anastomosis was performed, without further complication. Outcome. She was managed with antibiotics and analgesics and was discharged nine days after the procedure, without complications. The biopsy showed parasite eggs consistent with Angiostrongylus sp

Prevalence of Angiostrongylus cantonensis and Angiostrongylus costaricensis in Achatina fulica snails in the municipality of São Bernardo do Campo (SP, Brazil) / Prevalência de Angiostrongylus cantonensis e Angiostrongylus costaricensis em caramujos Achatina fulica na cidade de São Bernardo do Campo (SP, Brasil)

Angiostrongylus cantonensis e Angiostrongylus costaricensis são nematoides parasitas que residem em roedores e usam gastrópodes como hospedeiros intermediários. Achatina fulica, conhecida como caramujo-gigante-africano, é um hospedeiro intermediário que desempenha importante papel na dispersão de A. cantonensis e A. costaricensis, patógenos zoonóticos que causam, respectivamente, meningoencefalite eosinofílica e angiostrongilíase abdominal em humanos. O objetivo deste estudo foi o de coletar caramujos (A. fulica, n=90) de oito regiões diferentes (Rudge Ramos, Baeta Neves, Planalto, Demarchi, Dos Alvarengas, Batistini, Montanhão, Rio Grande) da cidade de São Bernardo do Campo (SP) para detecção molecular de A. cantonensis ou A. costaricensis pela técnica de reação em cadeia da polimerase (PCR). As amostras foram processadas em pools (n=25) segundo a região de coleta. Com exceção da região de Baeta Neves, as demais apresentaram caramujos infectados com larvas de nematoides. Seis regiões apresentaram amostras positivas para A. cantonensis. Quatorze (56%) das 25 amostras em pool apresentaram larvas de nematoides, e 52% delas (13/25) foram positivas para A. cantonensis. Nenhuma amostra positiva para A. costaricensis foi encontrada. A presença de A. fulica naturalmente infectada por A. cantonensis deve servir como um alerta para as autoridades de saúde pública sobre o risco potencial de infecção para humanos.(AU)

Angiostrongylus costaricensis, un parásito neotropical cuyo diagnóstico y tratamiento siguen siendo controversiales

La angiostrongilosis abdominal es una parasitosis esporádica, que ocurre en países del neotrópico, especialmente en Costa Rica. Es una enfermedad cuyo diagnóstico es infrecuente y su tratamiento controversial. Se presenta un caso de un adulto que muestra un malestar generalizado, dolor abdominal y una intensa eosinofilia que lleva a la detección de una masa en la fosa iliaca inferior derecha. El diagnóstico definitivo se hace mediante la prueba de Morera y el tratamiento incluye el uso de azitromicina y metronidazol, no obstante no se usan antihelmínticos ni se realiza cirugía. El caso descrito pone de manifiesto que tanto el diagnóstico como el tratamiento de esta enfermedad parasitaria continúan siendo inciertos. No se descarta que exista un subregistro importante de esta parasitosis o que los síntomas sean confundidos con otras patologías.

Abdominal angiostrogyliasis is a sporadic parasitosis that occurs in Neotropical countries, mainly in Costa Rica. It is a disease with an infrequent diagnosis and a controversial treatment. We discuss a case of an adult that presents a severe generalized discomfort, abdominal pain and an intense eosinophilia that leads to the detection of a mass at the right lower quadrant. Definitive diagnosis is achieved by the Morera Test and the treatment includes the use of azythromicin and metronidazole: no antihelmintic drugs or surgery were used. The case shows that both the diagnosis and treatment of this parasitosis are uncertain. An important underreporting of the disease may occur, as well as confusion of the symptoms with other pathologies.

Characterisation of the vascular pathology in Sigmodon hispidus (Rodentia: Cricetidae) following experimental infection with Angiostrongylus costaricensis (Nematoda: Metastrongylidae)

BACKGROUND Angiostrongylus costaricensis is a nematode that causes human abdominal angiostrongyliasis, a disease found mainly in Latin American countries and particularly in Brazil and Costa Rica. Its life cycle involves exploitation of both invertebrate and vertebrate hosts. Its natural reservoir is a vertebrate host, the cotton rat Sigmodon hispidus. The adult worms live in the ileo-colic branches of the upper mesenteric artery of S. hispidus, causing periarteritis. However, there is a lack of data on the development of vasculitis in the course of infection. OBJECTIVE To describe the histopathology of vascular lesions in S. hispidus following infection with A. costaricensis. METHODS Twenty-one S. hispidus were euthanised at 30, 50, 90 and 114 days post-infection (dpi), and guts and mesentery (including the cecal artery) were collected. Tissues were fixed in Carson’s Millonig formalin, histologically processed for paraffin embedding, sectioned with a rotary microtome, and stained with hematoxylin-eosin, resorcin-fuchsin, Perls, Sirius Red (pH = 10.2), Congo Red, and Azan trichrome for brightfield microscopy analysis. FINDINGS At 30 and 50 dpi, live eggs and larvae were present inside the vasa vasorum of the cecal artery, leading to eosinophil infiltrates throughout the vessel adventitia and promoting centripetal vasculitis with disruption of the elastic layers. Disease severity increased at 90 and 114 dpi, when many worms had died and the intensity of the vascular lesions was greatest, with intimal alterations, thrombus formation, iron accumulation, and atherosclerosis. CONCLUSION In addition to abdominal angiostrongyliasis, our data suggest that this model could be very useful for autoimune vasculitis and atherosclerosis studies.

Proteolytic activity in the adult and larval stages of the human roundworm parasite Angiostrongylus costaricensis

Angiostrongylus costaricensis is a nematode that causes abdominal angiostrongyliasis, a widespread human parasitism in Latin America. This study aimed to characterize the protease profiles of different developmental stages of this helminth. First-stage larvae (L1) were obtained from the faeces of infected Sigmodon hispidus rodents and third-stage larvae (L3) were collected from mollusks Biomphalaria glabrata previously infected with L1. Adult worms were recovered from rodent mesenteric arteries. Protein extraction was performed after repeated freeze-thaw cycles followed by maceration of the nematodes in 40 mM Tris base. Proteolysis of gelatin was observed by zymography and found only in the larval stages. In L3, the gelatinolytic activity was effectively inhibited by orthophenanthroline, indicating the involvement of metalloproteases. The mechanistic class of the gelatinases from L1 could not be precisely determined using traditional class-specific inhibitors. Adult worm extracts were able to hydrolyze haemoglobin in solution, although no activity was observed by zymography. This haemoglobinolytic activity was ascribed to aspartic proteases following its effective inhibition by pepstatin, which also inhibited the haemoglobinolytic activity of L1 and L3 extracts. The characterization of protease expression throughout the A. costaricensis life cycle may reveal key factors influencing the process of parasitic infection and thus foster our understanding of the disease pathogenesis.

Abdominal angiostrongyliasis with involvement of liver histopathologically confirmed: a case report / Angiostrongiliasis abdominal con lesión hepática histopatológicamente confirmada

Human abdominal angiostrongyliasis is a zoonotic disease caused by ingestion of the L3 larvae of Angiostrongylus costaricensis. The human infection gives rise to a pathological condition characterized by acute abdominal pain, secondary to an inflammatory granulomatous reaction, marked eosinophilia and eosinophilic vasculitis. Most commonly this disease is limited to intestinal location, primary ileocecal, affecting the mesenteric arterial branches and intestinal walls. We present one of the few cases reported around the world with simultaneous involvement of the intestines and liver, including proved presence of nematodes inside the hepatic arteriole.

La enfermedad conocida como angiostrongiliasis abdominal humana es una zoonosis causada por la ingestión del estadio larval L3 de Angiostrongylus costaricensis. En el ser humano, esta infección provoca un estado patológico caracterizado por dolor abdominal agudo, secundario a una reacción inflamatoria granulomatosa; eosinofilia marcada y vasculitis eosinofílica. Comúnmente el cuadro se encuentra limitado a una localización intestinal, predominantemente ileocecal, que compromete las ramas de la arteria mesentérica y la pared intestinal. Presentamos uno de los pocos casos reportados alrededor del mundo con hallazgos simultáneos en intestino e hígado; se incluye la demostración histológica del nemátodo dentro de la arteriola hepática.

Use of heterologous antigens for the immunodiagnosis of abdominal angiostrongyliasis by an enzyme-linked immunosorbent assay

Angiostrongylus costaricensis has a broad geographic distribution spanning from North to South America and the infections of vertebrates with this nematode can result in abdominal complications. Human infections are diagnosed by histological or serological methods because the isolation of larvae from feces is not feasible, as most parasites become trapped in intestinal tissues due to intense eosinophilic inflammation. Because A. costaricensis is difficult to maintain in the laboratory, an immunodiagnostic IgG enzyme-linked immunosorbent assay (ELISA) using antigens from the congeneric Angiostrongylus cantonensis species was evaluated against a panel of serum samples from patients who were histologically diagnosed with A. costaricensis infections. Sera from uninfected individuals and individuals infected with other parasites were used as controls. The sensitivity and specificity of the assay were estimated at 88.4 percent and 78.7 percent, respectively. Because the use of purified or cloned antigens has not been established as a reliable diagnostic tool, the use of heterologous antigens may provide a viable alternative for the development of an ELISA-based immunodetection system for the diagnosis of abdominal angiostrongyliasis.

Susceptibility and morbidity between male and female Swiss mice infected with Angiostrongylus costaricensis: Susceptibilidade e morbidade entre camundongos Swiss machos e fêmeas infectados com Angiostrongylus costaricensis

The gender of vertebrate hosts may affect the outcome of parasitic infections. An experimental murine infection with Angiostrongylus costaricensis was followed with determinations of body weight, fecal larval elimination, number and length of adult worms, number of macroscopic intestinal lesions, and mortality. Groups of male and female Swiss mice were infected with 10 3rd-stage A. costaricensis larvae per animal. The results indicate there are no significant differences related to gender of the host, except for higher length of worms developed in male mice.

O sexo dos hospedeiros vertebrados pode influenciar no resultado de infecções parasitárias. A infecção experimental de camundongos com Angiostrongylus costaricensis foi acompanhada com observação do peso corporal, eliminação de larvas nas fezes, número e comprimento dos vermes adultos, número de lesões macroscópicas nos intestinos e mortalidade. Grupos de camundongos Swiss machos e fêmeas foram infectados cada um com 10 larvas de terceiro estágio de A. costaricensis. Os resultados indicam que não há diferenças significativas relacionados ao sexo dos hospedeiros, exceto pelo maior comprimento dos vermes nos hospedeiros machos.

Attractionof Schistosoma mansoni Sambon, 1907 miracidia to Biomphalaria glabrata (Say, 1818) in the presence of Angiostrongylus costaricensis Morera and Céspedes, 1971 infection / Atração de miracídios de Schistosoma mansoni Sambon, 1907 por Biomphalaria glabrata (Say, 1818) infectada por Angiostrongylus costaricensis Morera and Céspedes, 1971

The attraction exerted by Biomphalaria glabrata infected with Angiostrongylus costaricensis on Schistosoma mansoni miracidia of the BH strain was tested, using a glass apparatus composed by two circular chambers connected to a channel. One mollusk or a sample of a snail conditioning water (SCW) was placed in one of the chambers, randomly selected, and the remaining of the apparatus was filled with chlorine-free water. Ten miracidia were placed in the centre of the channel and their behaviour was observed for 15 minutes. Ten replicates were made for each treatment (snail or SCW), using different specimens of mollusks or different samples of SCW. Mollusks infected with A. costaricensis attracted significantly less S. mansoni miracidia than non-infected B. glabrata. In addition, miracidia were also significantly more attracted to SCW from mollusks infected with A. costaricensis.

Utilizando-se um artefato de vidro composto por duas câmaras unidas por um canal, testamos a atração miraxonal exercida por Biomphalaria glabrata infectada por Angiostrongylus costaricensis sobre miracídios de Schistosoma mansoni da linhagem BH. Um molusco ou uma amostra de sua água de condicionamento (SCW) foi colocado aleatoriamente em uma das câmaras, sendo o restante do artefato preenchido com água declorada. Dez miracídios foram colocados no centro do canal e seu comportamento foi observado por 15 minutos. Foram feitas dez replicações de cada experimento utilizando-se espécimes de moluscos ou de amostras de SCW diferentes. Moluscos infectados com A. costaricensis atraíram significativamente menos miracídios de S. mansoni que B. glabrata não infectada. Além disso, miracídios foram significativamente mais atraídos pela SCW de moluscos infectados com A. costaricensis.

Attractionof Schistosoma mansoni Sambon, 1907 miracidia to Biomphalaria glabrata (Say, 1818) in the presence of Angiostrongylus costaricensis Morera and Céspedes, 1971 infection

The attraction exerted by Biomphalaria glabrata infected with Angiostrongylus costaricensis on Schistosoma mansoni miracidia of the BH strain was tested, using a glass apparatus composed by two circular chambers connected to a channel. One mollusk or a sample of a snail conditioning water (SCW) was placed in one of the chambers, randomly selected, and the remaining of the apparatus was filled with chlorine-free water. Ten miracidia were placed in the centre of the channel and their behaviour was observed for 15 minutes. Ten replicates were made for each treatment (snail or SCW), using different specimens of mollusks or different samples of SCW. Mollusks infected with A. costaricensis attracted significantly less S. mansoni miracidia than non-infected B. glabrata. In addition, miracidia were also significantly more attracted to SCW from mollusks infected with A. costaricensis.

Utilizando-se um artefato de vidro composto por duas câmaras unidas por um canal, testamos a atração miraxonal exercida por Biomphalaria glabrata infectada por Angiostrongylus costaricensis sobre miracídios de Schistosoma mansoni da linhagem BH. Um molusco ou uma amostra de sua água de condicionamento (SCW) foi colocado aleatoriamente em uma das câmaras, sendo o restante do artefato preenchido com água declorada. Dez miracídios foram colocados no centro do canal e seu comportamento foi observado por 15 minutos. Foram feitas dez replicações de cada experimento utilizando-se espécimes de moluscos ou de amostras de SCW diferentes. Moluscos infectados com A. costaricensis atraíram significativamente menos miracídios de S. mansoni que B. glabrata não infectada. Além disso, miracídios foram significativamente mais atraídos pela SCW de moluscos infectados com A. costaricensis.

Abdominal angiostrongyliasis: report of two cases with different clinical presentations / Angiostrongilíase abdominal: relato de dois casos com diferentes apresentações clínicas

Abdominal angiostrongyliasis is a sporadic infectious disease caused by the nematode Angiostrongylus costaricensis. It usually presents as acute abdomen, secondary to mesenteric ischemia, and pronounced eosinophilia. In some cases its course is insidious and transient, and the diagnosis is suspicious. The disease is confirmed by the detection of A. costaricensis elements in surgical specimen. The treatment is supportive, with avoidance of antihelminthic administration due to a possible erratic migration followed by worsening of the disease. We report two cases, both with intense eosinophilia and serum IgG-ELISA positive to A. costaricensis. The first case presented ileal perforation and was surgically treated. The second one showed hepatic nodules at ultrasound and was only symptomatically treated, evolving to an apparent protracted resolution. These two cases exemplify different clinical forms of the disease, one of them with liver involvement.

A angiostrongilíase abdominal é doença esporádica decorrente da infecção pelo nematódeo Angiostrongylus costaricensis. Costuma manifestar-se como abdome agudo secundário a isquemia mesentérica, além de marcada eosinofilia. Pode também apresentar-se de forma insidiosa e transitória, exigindo alta suspeita clínica para o diagnóstico. A doença é confirmada pela identificação de elementos do A. costaricensis em peças cirúrgicas. O tratamento é apenas de suporte, devendo-se evitar o uso de anti-helmínticos pela possibilidade de migração errática do verme com piora do quadro. Aqui foram apresentados dois casos, ambos com acentuada eosinofilia e ELISA-IgG sérico positivo para A. costaricencis. O primeiro caso cursou com perfuração ileal e foi tratado cirurgicamente. O segundo caso apresentou nódulos hepáticos ao ultrassom e foi tratado sintomaticamente, evoluindo para lenta resolução. Estes dois casos exemplificam diferentes formas de apresentação clínica da doença, uma delas com envolvimento hepático.

Individual serological follow-up of patients with suspected or confirmed abdominal angiostrongyliasis

Abdominal angiostrongyliasis (AA) is a zoonotic nematode infection caused by Angiostrongylus costaricensis, with widespread occurrence in the Americas. Although the human infection may be highly prevalent, morbidity is low in Southern Brazil. Confirmed diagnosis is based on finding parasitic structures in pathological examination of biopsies or surgical resections. Serology stands as an important diagnostic tool in the less severe courses of the infection. Our objective is to describe the follow up of humoral reactivity every 2-4 weeks up to one year, in six individuals with confirmed (C) and ten suspected (S) AA. Antibody (IgG) detection was performed by ELISA and resulted in gradually declining curves of reactivity in nine subjects (56 percent) (4C + 5S), that were consistently negative in only three of them (2C + 1S) after 221, 121 and 298 days. Three individuals (2C + 1S) presented with low persistent reacitivity, other two (1C + 1S) were serologically negative from the beginning, but also presenting a declining tendency. The study shows indications that abdominal angiostrongyliasis is usually not a persistent infection: although serological negativation may take many months, IgG reactivity is usually declining along time and serum samples pairing may add valuable information to the diagnostic workout.

Angiostrongiliasis: Reporte de un caso / Angiostrongiliasis: Report of a case

Se presenta el caso de un niño de 9 años, costarricense, con angioestrongiliasis, el cual consultó por dolor abdominal de un año de evolución. La anamnesis demostró deficiencias en hábitos de higiene. El examen físico revela dolor en fosa iliaca derecha sin masas palpables. El examen serológico demostró la existencia de una importante eosinofilia, los análisis coproparasitoscópicos fueron negativos, presentaba anemia leve. La prueba de laboratorio test de Morera fue positiva.

The following is the case of a 9 yearoldCosta Rican male child withangiostrongyliasis, who consulteddue to an abdominal pain with yearof evolution. The medical history ofthe child demonstrated deficienciesin his hygiene habits. The physicalexamination revealed pain in theright iliac fossa without any palpablemass. The serological test showed theexistence of a relevant eosinophilia; the fecal stool analysis was negative.Yet, the boy suffered from anemia.The result of Morera Blood forangiostrongilos test was positive.

Behavior of Angiostrongylus costaricensis in planorbids

Some terrestrial mollusks are natural hosts of Angiostrongylus costaricensis. In the laboratory, this nematode can be maintained in certain planorbids, which are aquatic mollusks and intermediate hosts of Schistosoma mansoni. Mollusks can be infected with Angiostrongylus costaricensis by ingestion of or active penetration by the first-stage larvae. In this work we assessed the ability of Biomphalaria glabrata to attract first-stage larvae of A. costaricensis. Movement of the nematode larvae towards the mollusks was observed after 15 min, 30 min and 1 h. B. glabrata did not attract the first-stage larvae of A. costaricensis in any of the three intervals. The susceptibility of two populations of Biomphalaria tenagophila to infection by A. costaricensis was also determined. One population was genetically selected for the susceptibility to S. mansoni while the other was not. Third-stage larvae were recovered from the snails 30 days after exposure of the two populations to 120 first-stage larvae. All the mollusks were infected. However, a significantly higher number of third-stage larvae were recovered in mollusks not genetically selected.

Alguns moluscos terrestres são hospedeiros naturais do Angiostrongylus costaricensis. No laboratório, esse nematódeo pode ser mantido em planorbídeos, que são moluscos aquáticos e hospedeiros intermediários do Schistosoma mansoni. Os moluscos podem ser infectados com A. costaricensis por ingestão ou por penetração ativa de larvas de primeiro estágio. Neste trabalho, testamos a habilidade de Biomphalaria glabrata em atrair larvas de primeiro estágio de A. costaricensis. A movimentação das larvas do nematódeo em direção aos moluscos foi observada após 15 minutos, 30 minutos e 1 hora. B. glabrata não atraiu as larvas de primeiro estágio de A. costaricensis nos três intervalos de tempo. Verificamos também a suscetibilidade de duas populações de Biomphalaria tenagophila à infecção por A. costaricensis. Uma população era selecionada geneticamente para a susceptibilidade ao S. mansoni, enquanto a outra não o era. Larvas de terceiro estágio foram recuperadas dos moluscos 30 dias após a exposição das duas populações a 120 larvas de primeiro estágio. Todos os moluscos estavam infectados. Entretanto, um número significativamente maior de larvas de terceiro estágio foi recuperado em moluscos não geneticamente selecionados.

Angiostrongylus costaricensis and the intermediate hosts: observations on elimination of L3 in the mucus and inoculation of L1 through the tegument of mollucs

A infecção acidental humana por Angiostrongylus costaricensis pode resultar em doença abdominal de variada gravidade. Veronicelídeos são os principais moluscos hospedeiros intermediários do Angiostrongylus costaricensis, nematódeo parasita de roedores. Foi comparada a cinética de eliminação de larvas de terceiro estágio (L3) no muco através da infecção experimental de Phyllocaulis variegatus, P. soleiformis e P. boraceiensis. Um máximo de 2 L3/g/dia foi observado no muco, enquanto o número de larvas isoladas dos tecidos fibromusculares variou 14 e 448. A injeção das larvas no hiponoto ou na cavidade tegumentar estabeleceu infecção produtiva. A via intra-cavitária permite melhor controle de inóculo e envolve procedimento mais simples. Titulação preliminar da dose infectante para P. variegatus sugere que os inóculos devem ficar entre 1000 e 5000 L1. Os dados também reforçam a importância de P. variegatus como hospedeiro intermediário do A. costaricensis.

Human accidental infection with Angiostrongylus costaricensis may result in abdominal disease of varied severity. Slugs from the Veronicellidae family are the main intermediate hosts for this parasitic nematode of rodents. Phyllocaulis variegatus, Phyllocaulis soleiformis and Phyllocaulis boraceiensis were experimentally infected to describe the kinetics of L3 elimination in the mucus secretions of those veronicelid species. A maximum of 2 L3/g/day was found in the mucus, while the number of L3 isolated from the fibromuscular tissues varied from 14 to 448. Productive infection was established by inoculations in the hyponotum or in the body cavity, through the tegument. Intra-cavity injection is a less complex procedure and permits a better control of inocula. A preliminary trial to titrate the infective dosis for P. variegatus indicated that inocula should range between 1000 and 5000 L1. The data also confirmed the importance of P. variegatus as an intermediate host of A. costaricensis.