Multimodal imaging-guided diagnosis, management and follow-up of a case of diffuse unilateral subacute neuroretinitis.

A 45-year-old woman presented with diminished vision in the left eye. Visual acuity was 6/9 and fundus showed a very large live nematode near the macula along with inflammatory outer retinal lesions in the periphery. We diagnosed the case as diffuse unilateral subacute neuroretinitis and treated with immediate focal photocoagulation of the worm along with oral antihelminthic drugs and corticosteroids. The report highlights the importance of prompt laser and steroids in achieving good structural as well as the functional outcome, and the added significance of advanced imaging techniques in prognosticating such patients.

Identification of Lamanema chavezi Becklund 1963 infection in a llama (Lama glama) in the United States.

Infection with Lamanema chavezi, a parasitic nematode of New World camelids, was diagnosed by examination of feces and formalin-fixed liver from a 14-month-old female llama (Lama glama) that died after a 6-week illness. Infection with L. chavezi was initially suspected when a granuloma containing an unidentified nematode was detected microscopically in the hepatic parenchyma from a necropsy specimen. The subsequent diagnosis of L. chavezi infection was based on the morphologic features of 2 immature nematodes dissected from individual hepatic granulomas, characteristics of eggs detected in feces of the llama by centrifugal flotation in sugar solution (specific gravity: 1.30), development of third-stage larvae within the eggs after incubation of the llama feces at room temperature for ≥30 days, and the morphology of third-stage larvae released from the embryonated eggs. Collectively, these findings indicate that the llama, born and raised in Oregon, harbored an autochthonous L. chavezi infection. Eggs identified as L. chavezi were also detected by centrifugal flotation of pelleted feces from 3 of 7 herd mates of the llama indicating this parasite is endemic in the Oregon herd. The findings reported herein serve to alert diagnosticians and veterinary practitioners to the occurrence of L. chavezi in New World camelids in the United States and describe diagnostic features of this potential pathogen.

Thoracic manifestations of tropical parasitic infections: a pictorial review.

Parasitic infections are distributed worldwide and affect hundreds of millions of individuals-primarily those living in endemic areas or in regions with a high rate of immigration from endemic areas-causing significant morbidity and mortality. A broad spectrum of parasitic infections (eg, amebiasis, malaria, trypanosomiasis, ascariasis, strongyloidiasis, dirofilariasis, cystic echinococcosis, schistosomiasis, paragonimiasis) frequently affect the lungs, mediastinum, and thoracic wall, manifesting with abnormal imaging findings that often make diagnosis challenging. Although most of these infections result in nonspecific abnormalities, familiarity with their imaging features as well as their epidemiologic, clinical, and physiopathologic characteristics may be helpful to the radiologist in formulating an adequate differential diagnosis.

Use of computer tomography for imaging of Crassicauda grampicola in a Risso's dolphin (Grampus griseus).

A mature male Risso's dolphin (Grampus griseus) stranded along the coasts of Friuli Venezia Giulia, northeast Italy, in May 2001. Parasitic infection with Crassicauda grampicola is often found in the tympanic bullae and pterygoid sinuses in many of the Risso's dolphins examined from the same area. For this reason, it was decided to perform computed tomography of the head to assess this imaging technique for the diagnosis of crassicaudosis in dolphins. A full postmortem examination confirmed the pathologic findings of the computed tomography scan. This technique can be considered a useful adjunct in the diagnosis of cranial crassicaudosis in live dolphins.

Comparative study of X-ray computerised tomography and conventional X-ray methods in diagnosis of swimbladder infection in eels caused by Anguillicola crassus.

To date, swimbladder lesions due to Anguillicola crassus infection of the European eel Anguilla anguilla have so far been studied only by conventional X-ray methods. This is the first study to report the use of computerised tomography (CT) for studying lesions induced by anguillicolosis. Of 50 eels caught by electrofishery from Lake Balaton, Hungary, in autumn 2002 and pre-selected by a conventional X-ray method, 22 specimens were examined with a Siemens Somatom Plus S40 spiral CT scanner. Tomograms, radiographs and photographs of 5 of these, showing anguillicolosis-induced swimbladder lesions of varying severity, are presented. Computerised tomograms provide information on the inner structure, air content and wall thickness of the swimbladder as well as on the number of worms it contains. When the swimbladder is not severely affected or not completely filled with worms, computerised tomography provides adequate data on the shape of the swimbladder, thickness of the swimbladder wall and the location of worms in the lumen. However, in more severe cases, i.e. when the swimbladder is tightly packed with worms or contains no air as a result of wall-thickening, this method fails to determine the number and location of helminths or the thickness of the swimbladder wall.

Anisakiasis of the colon: radiologic and endoscopic features in six patients.

The radiologic and endoscopic findings in six patients with anisakiasis of the colon were analyzed. The diagnosis was based on the demonstration of Anisakis larvae at radiography or on elevated serum levels of antibodies to this parasite. All patients reported abdominal symptoms 12-23 hours after the ingestion of raw fish. Double-contrast barium enema examination, performed 2-4 days after the onset of syptoms in all the patients, revealed that the right side of the colon was frequently affected by edema, which was radiographically demonstrated as luminal narrowing and thumbprinting. In addition, the worm was shown at radiography in four patients. Colonoscopy, performed 1-7 days after the onset of symptoms, revealed edematous mucosa, characterized by narrowing and multiple smooth and round protrusions, in all four of the patients studied, but it failed to demonstrate the worm in any patient. The authors believe that the demonstration of these features, together with a history of raw fish ingestion, is essential for the diagnosis of this disorder.

Anisakiasis in Hawaii: a radiological diagnosis.

Human anisakiasis, an increasing medical problem in Japan, was recently identified in 7 people in Hawaii. We report an 8th case occurring in an individual who had consumed a large amount of raw squid sushi at a restaurant. The diagnosis of anisakiasis in this patient was made after the parasite was identified by X-ray. To our knowledge, radiographic demonstration of the anisakiasis parasite has not been reported in Hawaii previously.

Intestinal capillariasis: indigenous cases from Chiang Mai and Phayao provinces, Thailand.

Two cases of intestinal capillariasis were presented from new locations in northern Thailand, i.e., Phayao and Chiang Mai provinces. Both of them had chronic voluminous diarrhea and malabsorption. It was believed that they acquired the infection indigenously. Both adult worms and their eggs, presented in the feces, were identified as Capillaria philippinensis but with morphological variation. The infection was treated effectively with a prolonged administration of mebendazole.

Sequential mesenteric arteriography in pony foals during repeated inoculations of Strongylus vulgaris and treatments with ivermectin.

Semiselective mesenteric arteriography was performed at regular intervals (inoculation weeks [IW] 0, 11, 18, and 24) in 9 of 10 pony foals raised to be free of parasites. Fifty infective larvae (L3) of Strongylus vulgaris were administered weekly for 4 weeks, then every 2 weeks through the 20th week. Three ponies were given ivermectin (oral paste, 0.2 mg/kg of body weight) treatment at IW 8, 16 and 24. Four ponies were inoculated, but did not receive ivermectin, and a third group of 2 ponies acted as uninoculated controls. Control ponies did not have gross or arteriographic lesions, whereas the inoculated untreated ponies had gross and progressive arteriographic lesions typical of verminous arteritis. Arteriographic lesions in the ivermectin-treated inoculated ponies were not as severe those in the untreated inoculated group, and there was either a partial resolution or a lack of progression of arteriographic lesions in all treated ponies. One untreated inoculated pony did not have progressive arterial lesions as did the 3 others in the group, and may develop resistance to the parasite.

Anisakiasis confirmed by radiography of the large intestine.

As yet, there has been no report of acute anisakiasis of the large intestine diagnosed by radiographic demonstration of the larvae. We present such a case, in which roentgenologic examination revealed Anisakis larvae in the ascending colon.

[Abdominal angiostrongyloidiasis. 6 cases observed in Paraná and in Santa Catarina, Brazil]. / Angiostrongiloidiase abdominal. seis casos observados no Paraná e em Santa Catarina, Brasil.

The author presents a clinical and anatomopathologic study of six cases of abdominal angiostrongyloidiasis seen in the southeast part of the state of Paraná and western part of the state of Santa Catarina--Brazil. The importance of the disease, in our region is such that it should be considered in the differential diagnosis of acute abdominal conditions in children and adults. The number of cases in the last two years have increased probably related to the extensive use of pesticides on corps.

Intestinal anisakiasis: clinical and radiologic features.

We report the clinical and radiologic features of 12 patients with acute intestinal anisakiasis. Diagnosis of anisakiasis was made immunologically by positive antibody to Anisakis larvae and a recent history of raw fish intake. Severe abdominal pain was a major symptom in these patients-half experienced fluid levels indicating ileus on plain x-ray films of the abdomen. Radiologic findings included irregular thickening of the jejunum, ileum, or colon, with mucosal edema and luminal narrowing with dilatation of the proximal intestine. In two cases a thread-like filling defect suggesting a worm was visualized on the x-ray film. These findings were interpreted as anisakiasis. Although ileus developed in some patients, all were treated and cured completely without surgery.

Radiographic study of acute gastric anisakiasis.

The radiographic findings from 226 patients with acute gastric anisakiasis are reviewed. Suggestive but indeterminate findings such as coarse and broad gastric folds caused by mucosal edema were demonstrated in 224 patients (98%). In 179 patients (88%) mucosal edema was so extensive that it occupied more than half of the entire gastric wall. The most diagnostic radiographic finding, present in 139 patients, was the appearance of a threadlike filling defect about 3 cm in length, showing an anisakis larva itself. Careful demonstration of these radiographic findings is useful for the diagnosis of acute gastric anisakiasis.