Comparative study on presentation of biliary ascariasis with dead and living worms

Ascariasis is a common parasitic infestation in Asia and Latin America. The most serious presentation is biliary and pancreatic ascariasis [BPA]. The aim of the present study was to compare the clinical presentation of BPA with dead worms with that with living worms. We included 138 consecutive cases of BPA that occurred during the period January 2005 to July 2009. All the patients had endoscopically proven BPA consisting of living or dead worms. Comparison was done by chi-square and independent t tests. The age [mean +/- SD] of the patients was 36.8 +/- 16.1 years. Prevalence ratio between male and female patients was 1:5. Ninety eight patients contained living worms and 40 had dead worms. Males were more prone to develop dead worm BPA. The commonest presentation was biliary colic [131; 94.9%]; others were acute cholangitis [30; 21.7%], obstructive jaundice [19; 13.8%], choledocholithiasis [20; 14.5%], acute pancreatitis [10; 7.2%], acute cholecystitis [6; 4.3%], liver abscess [2; 1.4%], hepatolithiasis [3; 2.2%], stricture of common bile duct [2; 1.4%], pancreatic abscess [1; 0.7%] and cirrhosis of liver [1; 0.7%]. Choledocholithiasis, hepatolithiasis, liver abscess and cirrhosis were associated only with dead worms. We could successfully remove all the worms with endoscopic interventions, but 5 patients required surgical intervention as there were strictures and stones within the biliary tree or Ascaris were in gallbladder. Recurrences of stone and cholangitis occurred only in those with dead worms. Biliary ascariasis with dead worms is more dangerous than that with living worms. Endoscopic or surgical intervention may be required repeatedly in those with dead worms

Using pig biliary system, in vivo propagation of Enterocytozoon bieneusi, an AIDS-related zoonotic pathogen

A microsporidian parasite Enterocytozoon bieneusi is the most common microorganism recognized in AIDS patients, and slow scientific progress is attributed to our inability to propagate the parasite. We report upon the development of a system of propagation using the pig biliary system. The parasite spores were continuously detected in the bile samples post onset of spore shedding in the gall bladder, which suggests that this organism maintain persistent infection in the biliary system and that the hepatobiliary tree may represent a reservoir of infection. In conclusion the biliary tree is an adequate niche for the propagation of E. bieneusi. This work has also resulted in the development of a procedure of ultrasound-guided cholecystocentesis for aspirating biles. This is a simple and non-surgical procedure, and creates no signs of clinical complications in the livers and the gall bladders after dozens of separate attempts. Thus, this is a very useful and safe technique for the aspiration of bile from live animals.

Human fasciolosis: a study on the relation of infection intensity and treatment to hepatobiliary affection

Seventeen patients with established fasciolosis and ten normal controls were enrolled in this study. The fasciola patients were divided according to infection intensity into two groups [four patients with high intensity and thirteen patients with low intensity] as assessed by egg counts coupled with ultrasonography for detecting worms in the biliary system. Aspartate and alanine aminotransferases [AST and ALT] levels were similar to those of the controls within the accepted normal limits before and after treatment, denoting the absence of hepatocellular injury. Total serum bile acids, individual bile acids [cholic acid [CA] and chenodeoxycholic acid [CDCA], gamma glutamyl transpeptidase [GGT] and serum alkaline phosphatase [SAP]] were significantly higher among all patients as compared to controls, denoting a degree of cholestatic lesion in those patients. Patients with high infection intensity revealed higher parameters than those with low intensity, the difference was not significant. One month after treatment, there was a significant improvement in the cholestasis indicating parameters in all fasciola cases compared to the pretreatment ones. This indicated the effective role of the drug on the hepatobiliary function. However, the levels were still different from the controls. In fasciola infection, total and individual serum bile acids in conjunction with GGT and SAP evaluated the hepatobiliary status and detected any minor abnormalities, especially in anicteric subjects

Parasitic disease of the liver and biliary tree

Several parasites infest liver or biliary tree, either during their maturation stages or as adult worms. biliary tree parasites may cause pancreatitis, cholecystitis, biliary tree obstruction, recurrent cholangitis, biliaiy tree strictures and some may lead to cholangiocarcinoma. This review discusses the hepatobilialy parasites, and shows our experience in diagnosis and management of these parasites. Ultrasonography of the liver is diagnostic in schistosomiasis, hydatid cysts, amebic liver abscess, ascariasis and other biliary tree parasites showing bile duct dilatation. Percutaneous aspiration under ultrasonography guidance of hydatid liver cysts or amebic abscess are effective measures in management. Endoscopic retrograde cholangiopancreatography [ERCP] is safe and effective in diagnosis and management of biliary tree parasites