Comparative morphometric evaluation of hepatic hemosiderosis in wild Magellanic penguins (Spheniscus magellanicus) infected with different Plasmodium spp. subgenera / Avaliação morfométrica comparativa da hemossiderose hepática em pinguins-de-Magalhães (Spheniscus magellanicus) de vida livre infectados por diferentes subgêneros de Plasmodium spp

Abstract Avian malaria is one of the most important diseases of captive penguins. We employed morphometric techniques to evaluate hepatic hemosiderosis in rehabilitating wild Magellanic penguins (Spheniscus magellanicus) that were negative (n = 9) or naturally infected by different subgenera of Plasmodium spp. (n = 24), according with: Plasmodium subgenera (Haemamoeba, Huffia, Other lineages, and Unidentified lineages), severity of Plasmodium histopathological lesions, and concurrent diseases, age class (juvenile or adult plumage), sex (male, female or not determined), body score (emaciated, thin, good, excellent, not available), molt, presence or absence of oil contamination upon admission, iron supplementation, and rehabilitation center. The percentage of the area occupied by hemosiderin was called 'Index of Hepatic Hemosiderosis (IHH)'. Plasmodium-positive females presented significantly higher IHH values (17.53 ± 12.95%) than males (7.20 ± 4.25%; p = 0.041). We observed higher levels of congestion (p = 0.0182) and pneumonia (p = 0.0250) severity between Unidentified lineages vs. Huffia. We believe that the hepatic hemosiderosis observed in this study was multifactorial, the result of pathological processes caused by malaria, molting, hemoglobin and myoglobin catabolism during migration, anemia, concomitant diseases, and iron supplementation, all possibly potentiated by decreased liver mass. Further studies are needed to clarify the mechanisms of these hypotheses.

Resumo Malária aviária é uma das mais relevantes doenças em pinguins cativos. Foram aplicadas técnicas morfométricas para avaliar a hemossiderose hepática em pinguins-de-Magalhães (Spheniscus magellanicus ) de vida livre em reabilitação negativos (n = 9) e naturalmente infectados por diferentes subgêneros de Plasmodium spp. (n = 24), quanto a: subgênero de Plasmodium (Haemamoeba , Huffia, Outras Linhagens, e Linhagens não identificadas), severidade das lesões histopatológicas causadas por Plasmodium e doenças concomitantes, faixa etária (plumagem juvenil ou adulta), sexo (macho, fêmea, indeterminado), condição corporal (emaciado, magro, bom, excelente, indisponível), muda, presença/ausência de óleo a admissão, suplementação de ferro, e centro de reabilitação. A porcentagem da área ocupada por hemossiderina foi denominada "Índice de Hemossiderose Hepática (IHH)". Fêmeas Plasmodium -positivas apresentaram IHH significativamente mais elevado que machos, respectivamente, 17,53 ± 12,95% e 7,20 ± 4,25% (p = 0,041). Níveis mais elevados de congestão (p = 0,0182) e pneumonia (p = 0,0250) foram observados entre Linhagens não identificadas vs. Huffia. Possivelmente, a hemossiderose hepática observada nesse estudo seja multifatorial, resultado de processos patológicos causados por malária, muda, catabolismo de hemoglobina e mioglobina durante a migração, anemia, doenças concomitantes e suplementação de ferro, potencialmente intensificados por massa hepática reduzida. Estudos complementares são necessários para esclarecer os mecanismos de tais hipóteses.

Alterações angiográficas e pressóricas determinadas pela esplenectomia e ligadura da veia gástrica esquerda em portadores de esquistossomose mansônica / Angiografic and pressoric changes determined by splenectomy with left gastric vein ligature in mansoni schistosomiasis

RACIONAL: Na esquistossomose mansônica na forma hepatoesplênica ocorre fibrose hepática difusa que associada à congestão venosa do sistema porta resulta em hepatoesplenomegalia. Pode produzir hemorragia digestiva alta por rotura das varizes de esôfago e do estômago ou lesões pépticas da mucosa gastroduodenal. OBJETIVO: Estudar os efeitos da esplenectomia e ligadura da veia gástrica esquerda sobre a hemodinâmica portohepática. MÉTODO: Vinte e três portadores de esquistossomose mansônica na forma hepatoesplênica foram estudados prospectivamente, antes e cerca de duas semanas após a operação, através de estudos angiográficos dos diâmetros da artéria hepática comum e própria, artéria esplênica, artéria mesentérica superior, veia porta, veia mesentérica superior e veia gástrica esquerda. Foram aferidas as pressões da veia cava inferior, venosa central, da veia hepática livre, da veia hepática ocluída e sinusoidal. RESULTADOS: A ligadura da veia gástrica esquerda determinou acréscimo significante nas seguintes variáveis: diâmetros da artéria hepática comum e própria; diâmetro da veia mesentérica superior; o acréscimo não foi significante nas seguintes medidas: pressão venosa central e diâmetro da artéria mesentérica superior. Ela promoveu decréscimo não significante nas variáveis: pressão da veia cava inferior; pressão da veia hepática livre; pressão da veia hepática ocluída; pressão sinusoidal; diâmetro da veia porta. CONCLUSÃO: A ligadura da veia gástrica esquerda, na maioria dos casos, não determina alterações hemodinâmicas significantes do sistema porta capazes de quebrar o equilíbrio hemodinâmico funcional, que caracteriza a esquistossomose mansônica na forma hepatoesplênica.

BACKGROUND: In hepatosplenic schistosomiasis occurs diffuse hepatic fibrosis associated with venous congestion of the portal system resulting in hepatosplenomegaly. It can produce digestive hemorrhage caused by rupture of esophageal and stomach varices or peptic gastroduodenal mucosal lesions. AIM: To study the effects of splenectomy and ligature of the left gastric vein on portohepatic hemodynamics. METHOD: Twenty-three patients with hepatosplenic schistosomiasis mansoni were studied before and about two weeks after operation through angiographic diameter of the common and proper hepatic artery, splenic artery, superior mesenteric artery, portal vein, superior mesenteric vein and left gastric vein. The pressures of the inferior vena cava and central venous pressure, free hepatic vein, the hepatic sinusoidal and occluded vein were measured. RESULTS: The splenectomy and ligature of the left gastric vein determined low morbidity and null mortality. It determined significant addition to the following variables: diameters of the common and proper hepatic artery; diameter of the superior mesenteric vein. It determined non significant increase on the following measurements: right atrial pressure and diameter of the superior mesenteric artery. It determined non significant decrease to the following variables: inferior vena cava pressure; free hepatic vein pressure; occluded hepatic vein pressure; sinusoidal pressure, diameter of the portal vein. CONCLUSION: Splenectomy and ligature of the left gastric vein do not determine portal hemodynamic changes capable of breaking the functional hemodinamic balance that characterizes the hepatosplenic mansoni schistosomiasis.

Hepatobiliary fascioliasis in non-endemic zones: a surprise diagnosis

Fascioliasis is a zoonotic infection caused by Fasciola hepatica. Because of population migration and international food trade, human fascioliasis is being an increasingly recognised entity in nonendemic zones. In most parts of Asia, hepatobiliary fascioliasis is sporadic. Human hepatobiliary infection by this trematode has two distinct phases: an acute hepatic phase and a chronic biliary phase. Hepatobiliary infection is mostly associated with intense peripheral eosinophilia. In addition to classically defined hepatic phase and biliary phase fascioliasis, some cases may have an overlap of these two phases. Chronic liver abscess formation is a rare presentation. We describe a surprise case of hepatobiliary fascioliasis who presented to us with liver abscess without intense peripheral eosinophilia, a rare presentation of human fascioliasis especially in non-endemic zones

Carbohydrates detection in the hepatic egg - granuloma system using lectin histochemistry

This study aims to evaluate the egg-granuloma system in hepatic tissues using lectin histochemistry in experimental Schistosomiasis. Eight Swiss mice were infected with a local strain of Schistosoma mansoni, being submitted forty days later to a perfusion after which slices of liver were prepared. The tissue samples were incubated with the following peroxidase conjugated lectins: Peanut agglutinin (PNA), Wheat Germ agglutinin (WGA), and Concanavalin A (Con A). All lectins recognized the glycoconjugates in the adult worm tegument. In the hepatic tissue, WGA presented the highest staining followed by PNA and Con A. The PNA presented the most intense staining of the egg-granuloma system while WGA stained the hepatic sinusoid cells and Con A bound preferentially the fibrosis rings of granuloma and the surrounding hepatic parenquima. WGA and PNA indicated the presence of residues of N-acetyl-glucosamine and galactose in the surface of Schistosoma mansoni eggs in the hepatic granulomas. In conclusion, using PNA, Con A and WGA our study presented different aspects of the egg-granuloma and Tegument of Schistosoma mansoni as well as indicated differences in the peri-ovular granulomas indicating alterations in the cellular mechanism of expression of surface carbohydrates during progression of the Schistosomiasis.

El objetivo del estudio fue evaluar el sistema de los huevos de los granulomas en los tejidos hepáticos, utilizando histoquímica de lectinas esquistosomiasis. Ocho ratones suizos experimentales fueron infectados con una cepa local de Schistosoma mansoni y luego a los cuarenta días fueron sometidos a la perfusión y se prepararon cortes de hígado. Las muestras de los tejidos fueron incubadas con las siguientes peroxidasas lectinas conjugadas: aglutinina de maní (PNA), aglutinina de germenn de trigo (WGA), Concanavalin A (Con A). Todas las lectinas reconocieron las glicoconjugadas en el tegumento del gusano adulto. El tejido hepático con WGA presentó mayor coloración seguido de PNA y Con A. El PNA presentó la más intensa tinción de los huevos mientras el granuloma del sistema WGA tiñó las células hepáticas sinusoides y las Con A estuvieron siempre presentes en los anillos de la fibrosis y alrededor de los granulomas hepáticos del parénquima. WGA y PNA indicaron la presencia de residuos de N - acetil - glucosamina y galactosa en la superficie de los huevos de Schistosoma mansoni en los granulomas hepáticos de esquistosomiasis.

Hematoma subcapsular hepático por fasciolasis / Hepatic subcapsular hematoma caused by fascioliasis

Hepatic fasciolasis is a worldwide spread zoonoses mainly affecting cattle-raising countries. It is caused by the trematode Fasciola hepßtica and it is characterized by abdominal pain, fever, nausea and vomitus, weight loss, diahrrea, paleness, general malaise, and hypereosinophilia. Immunological diagnosis as well as stool eggs count may be performed. Hepatic subcapsular and intraparenchymatous hematoma is an infrequent complication of human fascioliasis. Nevertheless, for establishing a proper diagnosis and treatment, any suspicion of its presence must be carefully discarded through, clinical epidemiology, laboratory and imaging exams and procedures. The aim of this study is to expand knowledge on this unfrequently dealt pathology in medical literature by presenting four case reports related to patients undergoing a two-year treatment. All of them had been referred from Departamento de Cajamarca, Peru.

La fasciolasis hepática es una zoonosis mundialmente difundida, sobre todo en los países productores de ganado; causada por la fasciola hepática. Se manifiesta por dolor abdominal, fiebre, nauseas y vómitos, baja de peso, diarrea, palidez, malestar general e hipereosinofilia. El diagnóstico es inmunológico y también puede hacerse por recuento de huevos en heces. El hematoma subcapsular e intraparenquimatoso hepático es una complicación rara de la fasciolasis humana pero se debe tener un alto índice de sospecha uniendo epidemiología, clínica, laboratorio e imaginologia para un adecuado diagnóstico y tratamiento. El propósito de reportar estos casos es dar a conocer una patología poco frecuente en la literatura, con una casuística de cuatro pacientes tratados en el lapso de dos años, todos referidos del Departamento de Cajamarca.

Malaria por Plasmodium falciparum en el servicio de medicina del Hospital San Camilo de San Felipe / Malaria by Plasmodium falciparum in the medicine service of San Camilo Hospital of San Felipe

Paciente de 36 años (camionero), sin antecedentes mórbidos de importancia, que luego de un viaje por Brasil, inicia cuadro de malestar general, poliartralgia y gran decaimiento. Consultando a la semana por sensación febril e ictericia en el Hospital de los Andes. Se constata fiebre, compromiso del estado general, ictericia, destacando en los exámenes de laboratorio: elevación de las transaminasas, fosfatasas alcalinas, hiperbilirrubinemia y disminución de hematocrito y plaquetas. Se lo hospitaliza con el diagnóstico de Síndrome Febril Ictérico Obs: Hepatitis viral, malaria o fiebre amarilla. Evoluciona con caída de su hematocrito y plaquetas, manteniéndose las pruebas hepáticas alteradas. Se realizan exámenes directos e indirectos para diagnóstico de Malaria, confirmándose con la visualización de trofozoítos de Plasmodium falciparum e indirectamente por detección en sangre de pLDH mediante optiMAL IT kit. Se inicia terapia con Cloroquina, con buena respuesta sintomática, con recuperación de plaquetas, mantención del Hematocrito y normalización de las pruebas hepáticas. La malaria por P. falciparum se describe como aquella que ocasiona las formas más graves y con compromiso hepático. Se destaca que ante la facilidad de transporte de personas de áreas endémicas, se hace más factible la aparición de casos en áreas no endémicas como en este servicio. Debido al riesgo, se debe estar preparado para la toma de muestras adecuadas que permitan la certificación en centros que como en éste, llegan pacientes extranjeros. El diagnóstico del paciente se hizo de forma expedita debido a una buena anamnesis, la que orientó claramente al diagnóstico de certeza.

The situation of hepatosplenic schistosomiasis in Brazil today

Specific chemotherapy against schistosomiasis together with environmental changes occuring in endemic areas of Brazil are causing a revolution in the clinico-pathological presentation of the disease when comparing to date from 10 to 15 years ago. To update the subject, an inquire was made among the most experienced Brazilian investigators in this field. They agree that a decrease of about 50 to 70 per cent in prevalence, and an even higher decrease in incidence are taking place in Brazil today. The prevalence of schistosome-infection has decreased in some areas and increased in other, with spreading sometimes occuring to peri-urban regions, indicating that schistosomiasis control depends on the application of multiple measures. General clinical and pathological manifestation related to hepatosplenic disease, such as ascites, gastric hemorrhages, big-spleen syndrome, cor pulmonale, glomerulopathy, etc. are also less severe nowadays than they used to be in the past.

Helicobacter pylori among Egyptian patients with chronic liver, diseases a comparative study

80 patients subjected to upper gastrointestinal endoscopy were enrolled. They were divided according to their liver status into 2 groups. The 1st group included patients with liver cirrhosis and the 2nd group included patients who had no liver affection. Gallbladder diseases were excluded by abdominal ultrasound examinations. Endoscopic antral mucosal biopsies were used for H. Pylori screening by both culture and urease test, and for histopathological examinations. Both groups were matched as regards age, sex and socioeconomic conditions. Culture was positive in 42.2% and 40.7% of patients in both groups, respectively, [P >0.05]. Urease test showed positive results in 58% and 76.6% in both groups, respectively, [P >0.05]. H. pylori prevalence showed no significant differences between both studied groups as regards age, sex or type of gastric lesions. Furthermore, liver status in patients with chronic liver diseases does not play a role in the distribution of infection. The study showed the high prevalence of H. pylori among Egyptians and the absence of a relation between H. pylori and chronic liver diseases

Experimental studies on early treatment of schistosomal infection with artemether.

An early treatment with artemether given in appropriate regimens was tested in mice, rabbits and dogs for prevention purposes. Artemether was administered intragastrically (ig) to the hosts on day 7 after infection with Schistosoma japonicum cercariae at a single dose, and the same dose of artemether was repeated every 1 or 2 weeks for 2-4 times. As a result, most of the female worms were killed before their oviposition with female worm reduction rates of 90-100%, resulting in protection of the host from damage induced by schistosome eggs. When rabbits were treated ig with artemether 10 mg kg-1 on day 7 after infection, followed by repeated dosing every week for 4 times, some parameters related to acute schistosomiasis, such as temperature, eosinophil count and eggs in the feces were negative, and low specific antigen and antibody levels in serum were seen. Further study showed that the appropriate regimens of Artemether were also effective in early treatment of reinfection with cercariae. When rabbits infected with 48-52 cercariae once every other day for 5 times were treated ig with artemether 15 mg kg-1, followed by repeated dosing every 1 or 2 week for 2- 3 times, the female worm reduction rates were 92.1-98.4%. Histopathological examination of the livers showed that the above-mentioned early treatment with Artemether exhibited a promising protective effect on dogs and rabbits. The major features included normal appearance of the liver resembling those of uninfected dogs and rabbits; few or no dispersed miliary egg tubercles appeared on the surface of the liver; the structure of the hepatic lobules was normal with normal arrangement of the liver bundles; few or no eggs appeared in the portal vein area and there was apparent diminution of total egg granuloma, comprising inflammatory, fibrous or scarred egg granuloma. On the basis of above-mentioned results, early treatment with Artemether could be recommended for field trial for controlling acute schistosomiasis, reducing infection rate and intensity of infection.