Biliary ascariasis- atypical infestation of ascaris lumbricoides

Ascaris lumbricoides is the most frequent parasitic infestation in developing countries. Its usual habitat is small intestine. The less frequent sites are biliary tree, gall bladder, appendix and pancreas. This is a report of 36 year old woman who presented with the symptoms of acute cholangitis in whom at endoscopic retrograde cholangiopancreatography, worm was removed from bile duct through duodenal papilla

Hepatobiliary fascioliasis: Clinical and radiological features

Fascioliasis is a worldwide but unevenly distributed zoonosis caused by the trematode Fasciola hepatica that infects domesticated herbivores. Fasciolosis also occurs accidentally in humans by ingestion of metacercaria-laden freshwater or water plants. Human infections are common in developing countries and are not rare in Europe. The clinical course has been conventionally described in two phases: an acute phase of hepatic parenchymal invasion of an immature worm larva [parenchy-mal phase] and a stationary phase after residence in the bile duct and production of eggs [ductal phase]. We report a 34 years old woman from Ilam, western Iran with hepatic disorder, RUQ pain, and jaundice. The diagnosis was made by sonography, CT scan and serologic studies. Serologic exam [ELISA] was positive and CT findings were compatible with fascioliasis

Imaging diagnosis of clonorchiasis

Among several diagnostic tools for clonorchiasis (Clonorchis sinensis infection), radiologic examinations are commonly used in clinical practices. During the 2 past decades, many reports regarding imaging findings of clonorchiasis were introduced. The basic imaging finding of clonorchiasis is diffuse dilatation of the peripheral intrahepatic bile ducts, without dilation of the large intrahepatic or extrahepatic bile ducts. By this finding, however, active clonorchiasis cannot be differentiated from cured infection. Some recent radiologic studies suggested specific findings of active clonorchiasis. Besides direct demonstration of worms, increased periductal echogenicity on sonography and periductal enhancement on dynamic contrast-enhanced CT or MR imaging possibly represent active clonorchiasis. Those images of the liver clonorchiasis are known to be correlated with worm burdens (EPG counts) in their frequency and also severity. The images of cholangiocarcinoma associated with clonorchiasis show both the tumor with obstruction images and diffuse dilatation of the peripheral intrahepatic bile ducts. Radiological images can be a good practical alternative diagnostic method of clonorchiasis.

Acute cholecystitis caused by Clonorchis sinensis.

We are reporting a case of a 43-year-old Chinese male from Hong Kong, who came to see a doctor complaining of acute onset of severe upper abdominal pain. A diagnosis of acute cholecystitis was made and an emergency cholecystectomy was carried out. On opening the common bile duct, lancet-shaped worms were seen emerging from it. About 45 adult worms were collected and sent to the Department of Parasitology University of Malaya for identification. The worms were identified as Clonorchis sinensis. After the operation the patient was treated with praziquantel and he had an uneventful recovery.

Estudio de viabilidad de escólices de quistes hidatídicos hepáticos humanos / Viability study of scolices of human hydatid liver cysts

El adecuado control de la hidatidosis en general, requiere conocer algunos aspectos relacionados con la supervivencia de los agentes infectantes, especialmente de los escólices. El objetivo de este trabajo, es evaluar la viabilidad de los escólices de quistes hidatídicos humanos de localización hepática. Estudiar la asociación entre las características clínicas al momento de la cirugía y el porcentaje de viabilidad de los escólices. Los criterios de viabilidad utilizados fueron: forma ovoide, invaginados, ganchos rostrales y corpúsculos calcáreos intactos, movimientos vibratorios presentes y ausencia de tinción con colorantes vitales. Los criterios para certificar mortalidad de los escólices fueron dos o más de los siguientes hechos: inmovilidad, alteración de los ganchos rostrales y de los corpúsculos calcáreos, rotura de membrana y pérdida de la forma ovoide y fácil tinción con el colorante vital (azul de tripan al 1,5 por ciento). Se estudiaron de esta forma 16 quistes, con un diámetro promedio de 16,2 cm. Siete lesiones (44 por ciento) de tipo univesicular, 5 (31 por ciento) multivesiculares y 4 (25 por ciento) quistes abscedados. En 7 oportunidades (44 por ciento), se evidenció comunicación a la vía biliar; y se constató viabilidad en 9 de los 16 quistes (56 por ciento). Las muestras con mayor porcentaje de escólices viables fueron los quistes multivesiculares, principalmente a expensas de las vesículas hijas. Se constató que los quistes multivesiculares eran viables en el 100 por ciento de los casos, a diferencia de los univesiculares con un 57 pir ciento y los abscedados con 0 por ciento (p= 0,01)

Ultrasound diagnosis of biliary ascariasis.

Two patients with right upper quadrant pain underwent real time ultrasound examination and biliary ascariasis was diagnosed. One case was confirmed by endoscopic retrograde cholangiopancreatography with removal of the parasites, and the other by intravenous cholangiography. Patients with ascariasis in the bile duct occasionally presenting with atypical right upper quadrant abdominal pain can be diagnosed accurately by real time ultrasound, which shows the movement of the worms.

Biliary ascariasis

Out of 38 patients who were operated for obstructive jaundice during a 4 years period Ascaris lumbricoid was found in the bile ducts of 3 patients. In one patient who responded to conservative management, there was strong evidence that the obstructive jaundice was due to the presence of round worm in the bile duct. This makes a total of 4 cases of biliary ascariasis in 39 patients of obstructive jaundice, a high prevalence rate of 10.26%

Ascaris em via biliar / Ascaris in the bile duct

A ascaridíase é uma das mais comuns parasitoses em seres humanos. Ascaris adultos, que sao usualmente achados no intestino, podem entrar na ampola de Vater se o esfincter de Oddi estiver ineficiente. Os vermes podem migrar para os ductos biliares e provocar estase biliar. Os autores apresentam um caso de áscaris em via biliar associado a coledocolitíase, enfatizando aspectos clínicos e diagnóstico.

Liver morphology with enphasis on bile ducts changes and survival analysis in mice submitted to multiple Schistosoma mansoni infections and chemotherapy

Numa tentativa de estar o mais próximo possível a pacientes infectados e tratados nas áreas endêmicas de esquistosomose (S. mansoni) e também para obter um período mais longo de seguimento, camundongos foram repetidamente infectado com um número baixo de cercarias. Dados de sobrevivência e variáveis histológicas tais como granuloma esquistosomótico, alteraçöes portais, necrose hepatocelular, regeneraçäo hepática, pigmento esquistosomótico, fibrose periductal e principalmente, alteraçöes dos ductos biliares foram analisados nos animais infectados tratados e näo tratados. Aa terapêutica por oxamniquina ns animais repetidamente infectados prolonga a sobrevivência de maneira singificante (Chi-quadrado 9,24, p = 0,0024), portanto confirmando resultados anteriores com um modelo semelhante mas com um período mais curto de seguimento. Ainda, a mortalidadade decresce rapidamente depois do tratamento, sugerindo uma abrupta reduçäo na gravidade das lesöes hepáticas. O fígado foi anida estudados sob o ponto de vista morfológico imunohistoquímico. Fibrose portal, com um quadro que lembra a fibrose humana do tipo Symmers está presente na fase tardia da infecçäo. As alteraçöes de ductos biliares säo muito próximas daquelas descritas na esquistosomose manônica humana. Antígeno esquistomótico foi observado e, uma célula isolada do revestimento alterado de ductos biliares. A patogênese das alteraçöes ductais e sua possível relaçäo com a infecçäo parasitária e/ou seus antígenos foi discutida

Fasciolasis en vesícula y vías biliares en el Hospital Regional del Cusco durante 16 años. / Fasciolasis in gallbladder and biliary ducts in Hospital Regional del Cusco,during 16 years.

Hemos presentado 18 casos de fasciolasis de la vesícula y vías biliares tratados quirúrgicamente en un período de 16 años en el Hospital Regional del Cusco. El diagnóstico pre-operativo correcto no fue hecho en ninguno. La eosinofilia presente nos debe hacer pensar en una parasitosis. Además de la extirpación de los parásitos y de la vesícula cuando hay cálculos o de su remoción, en el colédoco, el tratamiento se complementa con clohidrato de emetina, la evolución ha sido satisfactoria y en todos los casos se han recuperado y se encuentran gozando de buen salud.