Update on the major imported helminth infections in travelers and migrants.

Helminth infections cause considerable morbidity worldwide and may be frequently underdiagnosed especially in areas of lower endemicity. Patients may harbor latent infections that may become symptomatic years or decades after the initial exposure and timely diagnosis may be critical to prevent complications and improve outcomes. In this context, disease in special populations, such as immunosuppressed patients, may be of particular concern. Heightened awareness and recent diagnostic developments may contribute to the correct management of helminth infections in nonendemic regions. A review of the main helminth infections in travelers and migrants (strongyloidiasis, taeniasis-neurocysticercosis and schistosomiasis) is presented, focusing on epidemiology, developments in diagnosis, treatment and prevention.

Prevalence and clinical outcomes of Plasmodium falciparum and intestinal parasitic infections among children in Kiryandongo refugee camp, mid-Western Uganda: a cross sectional study.

BACKGROUND: The prevalence of Plasmodium falciparum and Intestinal Parasitic Infections (IPIs) - with the corresponding pathogenesis among children remain uncertain. This study aimed at determining the prevalence and the outcomes (including anaemia) of the respective infections and co-infections. Anaemia is a condition in which the number of red blood cells transporting oxygen to the various body parts is not sufficient to meet the needs of the body. METHODS: This was a cross sectional study conducted among 476-refugee camp school children. Kato-Katz technique was used to screen stool samples for intestinal parasites. Microscopy was used for malaria testing while the portable Haemoglobin (Hb) calorimeter was used to measure haemoglobin concentration. RESULTS: The overall prevalence of the mixed infections was 63.03%. Plasmodium falciparum was most prevalent of the single infections 262(55.04%) followed by Taenia spp. 14 (2.9%), Schistosoma mansoni 12(2.5%), Giardia lamblia 7 (2.9%), Trichuris trichiura 2(0.4%), Hookworm 2(0.4%) and Strongyloides stercoralis 1(0.2%). The odds of developing simple or uncomplicated malaria infection or anaemia was 14 times higher in individuals with dual co-infection with Plasmodium falciparum + Taenia sp. compared to single parasitic infection (Odds = 14.13, P = 0.019). Co-infection with Plasmodium falciparum + Taenia spp, was a strong predictor of Malaria and anaemia. CONCLUSION: This study shows that Plasmodium falciparum and Taenia spp. co-infections is a stronger predictor of malaria and anaemia. The prevalence of malaria and anaemia remains higher than the other regions in Uganda outside restricted settlements. The findings of this study underline the need for pragmatic intervention programmes to reduce burden of the co-infections in the study area and similar settlements.

[About a cresol intoxication]. / A propos d'une intoxication aux crésols.

Cresols are phenol derivatives commonly used as surface disinfectants. Ingestion may cause local mucocutaneous damage and extensive systemic toxicity : central nervous, cardiovascular, hematological, hepatic, renal and pulmonary. We describe the case of a 33-year-old woman who swallowed, without suicidal intent, 50 to 70 cm3 of a 50% cresol solution. Coma occurred within 5 minutes of ingestion, she presented a bradypnea with desaturation, and the SMUR team performed on-site an orotracheal intubation. On arrival at the hospital, the patient had typical caustic lesions around her mouth. Immediate management consisted of ventilatory support, instillation of activated charcoal by nasogastric tube, empirical intravenous methylene blue and effective vascular filling. Within one hour of admission, she developed hypotension, ventricular arrhythmias, and acute renal failure. Toxic hepatitis occurred within 24 hours. The 24-hour gastroscopy showed erosive esophagitis and erythematous gastropathy and duodenopathy. No urine or blood dosage can be performed. The patient left the hospital on the fifth day and her liver function normalized after one month. The treatment of phenol poisoning consists primarily of rapid decontamination and the support of vital functions. Diagnostic assays are not available routinely and anamnesis, as well as some semiological cardinal points, is essential.

Les crésols sont des dérivés de phénol communément utilisés comme désinfectants de surfaces. Leur ingestion peut causer des dommages cutanéomuqueux locaux ainsi qu'une toxicité systémique étendue : nerveuse centrale, cardiovasculaire, hématologique, hépatique, rénale et pulmonaire. Nous décrivons le cas d'une femme de 33 ans ayant ingéré sans intention suicidaire, 50 à 70 cm3 d'une solution crésolique à 50 %. Le coma est survenu dans les 5 min suivant l'ingestion, elle présentait une bradypnée avec désaturation et l'équipe de SMUR a procédé à l'intubation orotrachéale sur place. A l'arrivée à l'hôpital, la patiente présentait des lésions caustiques typiques sur le pourtour de la bouche. La prise en charge immédiate a consisté en une assistance ventilatoire, instillation de charbon activé par sonde nasogastrique, bleu de méthylène empirique intraveineux et remplissage vasculaire efficace. Dans l'heure suivant son admission, elle a présenté une hypotension artérielle, des troubles de rythme ventriculaire et une insuffisance rénale aiguë. Une hépatite toxique s'est révélée dans les 24 h suivantes. La gastroscopie à 24 h mettra en évidence une oesophagite érosive et une gastropathie et duodénopathie érythémateuses. Aucun dosage urinaire ou sanguin n'a pu être pratiqué. La patiente quittera l'hôpital au cinquième jour et sa fonction hépatique se normalisera après un mois. Le traitement de l'intoxication aux phénols consiste avant tout en une décontamination rapide ainsi qu'en le support des fonctions vitales. Les dosages diagnostiques ne sont pas disponibles en routine et l'anamnèse, ainsi que quelques points sémiologiques cardinaux, sont primordiaux.

Endoscopy as a diagnostic and therapeutic alternative technique of taeniasis.

Despite a low incidence in developed countries, gastrointestinal taeniasis should be suspected in patients with abdominal pain, diarrhea, anemia, and/or malabsorption of unknown origin, even more so if they come from endemic regions or areas with poor hygienic and alimentary habits. Diagnosis is traditionally reached by identifying the parasite in stools, but more recently both serological and immunological approaches are also available. Based on a patient diagnosed by gastroscopy, a literature review was undertaken of patients diagnosed by endoscopy. We discuss endoscopy as diagnostic modality, and the effectiveness and safety that endoscopic treatment may provide in view of the potential risk for neurocysticercosis.

Taenia: An Uninvited Guest.

BACKGROUND: Taenia saginata and Taenia solium species are worldwide in distribution, causing bovine and porcine cysticercosis, and taeniasis in humans having the greatest economic and medical importance. CASE REPORT: A 55-year-old woman living in a village around Rasht (northern Iran) was referred to our hospital with a history of chronic abdominal pain and recent dyspepsia and epigastric fullness. According to her clinical history, she was a candidate for an upper gastrointestinal endoscopy. A large tape worm was seen in the stomach. Our efforts at extracting it from the stomach were unsuccessful. The endoscope was withdrawn and therapy with niclosamide was initiated. At the next visit, her symptoms were alleviated and she was relieved from the chronic pain. CONCLUSIONS: We believe that the retrograde migration of the tapeworm into the stomach may be due to low gastric acidity as a result of atrophic gastritis and chronic proton pump inhibitor use.

[Teniasis in a child with finding of Taenia saginata proglottids in the school environment: a case report]. / Un caso pediatrico di teniasi con reperimento di proglottidi di Taenia saginata in ambiente scolastico.

We describe a case of teniasis in a child, associated to the finding of Taenia proglottids in a classroom of a primary school in the area of Cuneo (Local Health Unit Cn-1, Piedmont Region, Italy). Several proglottids had been repeatedly found by cleaners on the bookbox of several schooldesks in the same classroom. Laboratory investigation was able to identify Taenia saginata proglottids and cooperation of the local Public Health Unit with the school management allowed to identify and treat the affected child. Laboratory investigation was crucial to exclude a Taenia solium infection, which should have had important public health implications. In fact, infection among humans can follow the ingestion of Taenia solium eggs and in this case larval forms in several tissues can occur (cysticercosis). Moreover the disease can be particularly severe when cysticerci invade the brain, causing seizures and hydrocephalia.

Unusual colonoscopy finding: Taenia saginata proglottid.

Infection with tapeworms is a major problem in many parts of the world. Patients may be asymptomatic or have a significant morbidity depending on the species. Infection with Taenia species is sometimes found by expulsion of eggs or proglottids in stool. Species specific diagnosis of Taenia is difficult, but possible. We present a case of Taenia saginata incidentally discovered, and risk factors for transmission, diagnosis, symptoms, and treatment.

Subcutaneous Taenia crassiceps infection in a patient with non-Hodgkin's lymphoma.

Infections with larvae of Taenia crassiceps are rare in humans and have mostly affected patients with acquired immunodeficiency syndrome. We report the first case of a patient with malignancy (non-Hodgkin's lymphoma) and infection of the subcutis and muscles of the hand and forearm. Surgery and antiparasitic chemotherapy led to a complete cure.