Hyperinfection with Strongyloides stercoralis presenting as acute abdomen in a patient on corticosteroid therapy: A case report.

Infection with Strongyloides stercoralis, a human pathogenic roundworm, is common in tropical countries like India. Owing to its variable clinical presentation and irregular larval output in stool, it often remains neglected and underdiagnosed. Signs and symptoms are largely dependent on the immune status of the infected individual. Alteration in the host immunity due to chronic use of steroids can surge the number of parasites and cause hyperinfection syndrome. This can be catastrophic with a fatal outcome. Focus on early detection and treatment of the parasite in at-risk patients is imperative to reduce mortality. We summarize here an interesting case of hyper infection syndrome of strongyloidiasis with gangrenous bowel changes later progressing to burst abdomen.

Schistosomal Peritonitis Presenting as Acute Abdomen: A Case Report.

BACKGROUND: Schistosomiasis is a trematode infestation causing a chronic granulomatous disease in various organs. Both S. mansoni & S. haematobium are endemic in Ethiopia. Most infected individuals are asymptomatic. Ectopic schistosomiasis can affect the lungs, genitalia, CNS, skin, peritoneum, Lymph nodes & other organs. Schistosomiasis as a cause of acute abdomen is seldom reported. CASE DETAIL: A 51 years-old male Ethiopian farmer presented with a two weeks history of abdominal pain with recent onset bilious vomiting and abdominal distention. Emergency laparotomy done & the finding was multiple tiny whitish nodule over the peritoneum & small bowel with multiple mesenteric lymphadenopathy. The diagnosis was confirmed with histopathology study. CONCLUSIONS: Schistosomal peritonitis is a very uncommon form of schistosomiasis. Physicians should be aware of such atypical presentation in patients from endemic areas of schistosomiasis. And biopsy should be considered in unsettled forms of peritonitis during laparotomy. The pathogenesis is not well known which warrants further study.

Acute invasive small-bowel Anisakiasis: clinical and CT findings in 19 patients.

PURPOSE: To evaluate the clinical and CT findings in patients with small-bowel Anisakiasis. MATERIALS AND METHODS: Nineteen patients with small-bowel Anisakiasis and who underwent abdominal CT between 2005 and 2012 were enrolled in our study. All of these patients were diagnosed using either a serologic test for Anisakiasis (n = 18) or by pathology (n = 1). Their medical records were reviewed in order to determine the clinical findings. CT images were retrospectively reviewed by two radiologists to evaluate the characteristics of the involved bowel wall and the ancillary findings. RESULTS: All patients had presented with the acute onset of severe abdominal pain as well as a history of having recently eaten raw fish. The mean time interval from eating the fish to the onset of abdominal pain was 1.7 days. Eighteen patients were treated conservatively and experienced resolution of their symptoms within seven days of hospitalization. One patient underwent surgical exploration for presumed small-bowel ischemia. The sites of involvement included the ileum (16/19, 84%) and jejunum (3/19, 16%). All patients had circumferential bowel-wall thickening (mean, 0.8 cm) with an intermediate length of involved bowel (mean, 7.9 cm). Small-bowel obstruction occurred in 16 patients (84%). The target sign was present in 17 patients (89%), ascites, particularly in the perilesional area, in 16 patients (84%), and mesenteric edema in 15 patients (79%). CONCLUSION: Small-bowel Anisakiasis should be considered in the differential diagnosis of acute abdomen in order to avoid unnecessary surgery when patients present with abdominal pain after having recently eaten raw fish, concentric bowel-wall thickening with the target sign in the ileum, perilesional ascites, as well as bowel obstruction seen on CT.

Acute intestinal anisakiasis: CT findings.

Small bowel anisakiasis is a relatively uncommon disease that results from consumption of raw or insufficiently pickled, salted, smoked, or cooked wild marine fish infected with Anisakis larvae. We report a case of intestinal anisakiasis in a 63-year-old woman presenting with acute onset of abdominal complaints one day after ingestion of raw wild-caught herring from the Northsea. Computed tomography (CT) scanning demonstrated thickening of the distal small bowel wall, mucosa with hyperenhancement, mural stratification, fluid accumulation within dilated small-bowel loops and hyperemia of mesenteric vessels. In patients with a recent history of eating raw marine fish presenting with acute onset of abdominal complaints and CT features of acute small bowel inflammation the possibility of anisakiasis should be considered in the differential diagnosis of acute abdominal syndromes.

Porocephalosis due to encysted Armillifer nymph presenting as an acute abdominal emergency: case report and review of literature.

A rare case of porocephalosis infection presenting with an acute abdominal emergency in a 60 year old Nigerian is presented. The characteristic radiologic appearance of Armillifer nymph is described, and clinical findings which may be caused by this parasite are reviewed. A brief review of the epidemiology of porocephalosis is also included.

A case of ectopic intraabdominal fascioliasis presented with acute abdomen.

Human fascioliasis with Fasciola species occurs worldwide and is most common among rural people who tend sheep and eat uncooked water vegetables, particularly watercress. The natural history of the acute phase begins with ingestion of metacercariae encysted on various kinds of aquatic vegetation such as watercress. Fascioliasis primarily involves the liver, bile ducts, gallbladder, and occasionally ectopic sites. We describe herein a case of ectopic fascioliasis. This uncommon form of disease was peritonitis; both visceral and parietal peritoneal layers were affected with the formation of multiple nodules and ascites.

Imaging features of pediatric pentastomiasis infection: a case report.

We report here a case of pentastomiasis infection in a 3-year-old girl who had high fever, abdominal pain, abdominal tension and anemia. Ultrasound scanning of the abdomen revealed disseminated hyperechoic nodules in the liver and a small amount of ascites. Abdominal MRI showed marked hepatomegaly with disseminated miliary nodules of high signal intensity throughout the hepatic parenchyma on T2-weighted images; retroperitoneal lymphadenopathy and disseminated miliary nodules on the peritoneum were also noted. Chest CT showed scattered small hyperdense nodules on both sides of the lungs. The laparoscopy demonstrated diffuse white nodules on the liver surface and the peritoneum. After the small intestinal wall and peritoneal biopsy, histological examination revealed parenchymal tubercles containing several larvae of pentastomids and a large amount of inflammatory cell infiltration around them. The pathological diagnosis was parasitic granuloma from pentastomiasis infection.

Unusual presentations of malaria in children: an experience from a tertiary care center in North East India.

OBJECTIVE: To identify cases of malaria with unusual presentations. METHODS: The medical record of all the cases of malaria admitted to PICU and pediatric general ward from Oct 2006 to Sep 2009, were reviewed and cases with unusual presentations were identified. The study design was retrospective descriptive study. RESULTS: Sixteen (10%) out of 162 malaria cases had unusual presentations - three had hemiplegia, two each with viral hepatitis-like presentation, acute abdomen, gastrointestinal bleed, generalized edema and hyperglycemia and one each with ptosis, severe headache and subacute intestinal obstruction-like presentation. Eleven cases had mixed parasitemia and two each with P. vivax and P. falciparum. One case was diagnosed on clinical grounds. CONCLUSION: Malaria is a common disease, but both typical and atypical presentations deserve attention for early diagnosis and management.

Imaging Features of Pediatric Pentastomiasis Infection: a Case Report

We report here a case of pentastomiasis infection in a 3-year-old girl who had high fever, abdominal pain, abdominal tension and anemia. Ultrasound scanning of the abdomen revealed disseminated hyperechoic nodules in the liver and a small amount of ascites. Abdominal MRI showed marked hepatomegaly with disseminated miliary nodules of high signal intensity throughout the hepatic parenchyma on T2-weighted images; retroperitoneal lymphadenopathy and disseminated miliary nodules on the peritoneum were also noted. Chest CT showed scattered small hyperdense nodules on both sides of the lungs. The laparoscopy demonstrated diffuse white nodules on the liver surface and the peritoneum. After the small intestinal wall and peritoneal biopsy, histological examination revealed parenchymal tubercles containing several larvae of pentastomids and a large amount of inflammatory cell infiltration around them. The pathological diagnosis was parasitic granuloma from pentastomiasis infection.

[Acute abdomen by anisakiasis and globalization]. / Addome acuto da anisakiasi e globalizzazione.

OBJECTIVES: The AA report a case of a patient with acute abdomen caused by intestinal Anisakiasis, a fish-transmitted infection that results from ingestion of raw or improperly cooked fish contaminated by live larvae of Anisakis Simplex, a round worm from the order of Ascaridida. MATERIAL AND METHODS: A 33-year-old man, presented to the emergency room with severe upper abdominal pain, nausea and vomiting, without fever. The patient revealed that he had eaten pickled anchovies a few days before. RESULTS: On the exploratory laparotomy an edematous and stenotic tract of 15 cm of jejunum was found, and a segmental resection was performed. Histologically, the resected jejunum showed a conspicuous and diffuse inflammatory infiltration, predominantly made up of eosinophil granulocytes, numerous mucosal erosions and the presence in the submucosa of sections of parasites which were identified as Anisakis Simplex larvae. DISCUSSION: The ingestion of fish contaminated by Anisakis larva is often followed by the appearance of systemic or gastrointestinal symptoms due respectively to the direct larva localization and the allergic reaction to some parasite components. Diagnosis is made frequently difficult by clinical manifestations that could mimic symptoms of other diseases more common in Italy. CONCLUSIONS: Globalization has made Anisakiasis a more and more frequent disease worldwide, as increased mixture of different cultures and international travelling has allowed the spreading of risky feeding habits. That's why Anisakiasis should be considered in differential diagnosis of intestinal obstruction in patients with positive anamnesis for suspiciously cooked or conserved seafood eating.

Schistosomal peritonitis: a rare cause of acute abdomen.

Schistosomiasis is a major parasitic infection of tropical areas. We present a 26-year-old male immigrant from Egypt with acute abdomen due to schistosomial infection, mimicking symptoms of acute appendicitis, with histopathological detection and representation of schistosomial eggs in the unusual area of the greater omentum. This is a rare case with findings of intra-peritoneal schistosoma ova. We review the pertinent literature and indicate the need for a new approach to infectious diseases with unusual clinical presentation, due to pathogens coming from distal geographical regions, in which surgeons must keep a high index of suspicion.

Acute abdomen caused by primary torsion of the omentum in hydatid disease.

Hydatid disease is a considerable social health problem because of its endemic distribution in many countries. Although hydatid disease is usually seen in the liver or lung, it may present anywhere in the body. Here, we present a patient with a primary torsion of a hydatid cyst attached to the greater omentum with a peduncle that caused acute abdomen. This is the first report of a primary torsion of the omentum in hydatid disease. Clinicians are urged to be cognizant of the different and rare locations of hydatid disease, especially in endemic countries.

[Use of anamnesis and immunological techniques in the diagnosis of anisakidosis in patients with acute abdomen]. / Utilidad de la anamnesis y de las técnicas inmunológicas en el diagnóstico de la anisakidosis en pacientes con abdomen agudo.

INTRODUCTION: Anisakis simplex can be a cause of digestive symptoms. Our aim was to evaluate the epidemiological antecedents and immunological data available for a differentiation between patients with anisakidosis and those with other acute abdominal problems. PATIENTS AND METHODS: this is a prospective cohort study involving 134 patients with acute abdominal problems: 52 patients were diagnosed with anisakidosis by means of surgical and pathological findings and/or specific IgE seroconversion against Anisakis simplex (group A), and in 82 patients anisakidosis had been ruled out (group NA: non-anisakidosis). We evaluated the antecedent of raw fish ingestion, the skin prick test, and IgE immunoblotting as diagnostic tools. RESULTS: patients in groups A and NA differ in terms of prior raw fish ingestion (p < 0.0001) and positive SPT (p < 0.0001), with their respective negative predictive values (NPV) being 98.39% (95%CI: 90.17-99.92) and 95.56% (95%CI: 83.64-99.23). Regarding immunoblotting, in 86.2% of patients in group A a band of 60 kDa was detected, which was also detected in 19.2% of patients in group NA. CONCLUSIONS: a negative answer to the question about raw or undercooked fish ingestion has very high sensitivity and NPV (98.39%), and is thus reasonably reliable to rule out anisakidosis. The absence of cutaneous sensitization to crude A. simplex extract gives a high probability (95.56%) that the illness is absent. The presence of a band of about 60 kDa in immunoblotting would be useful for diagnosis.

[Acute abdomen due to massive intestinal ascaridiasis: a case report]. / Un caso di addome acuto da infestazione massiva da ascaridi.

Ascaridiasis is a geohelminthiasis with a worldwide distribution, especially occurring in countries with hot-humid climates. The infection occurs most frequently in children between three and nine years of age. We report a case of ascaridiasis regarding a ten-year-old girl born in Bangladesh who arrived in Italy about one year before. During laparotomy for suspected acute appendicitis, a large number of ascaridia nematodes were seen in the small intestine.

Utilidad de la anamnesis y de las técnicas inmunológicas en el diagnóstico de la anisakidosis en pacientes con abdomen agudo / No disponible

Introducción: Anisakis simplex puede producir síntomas digestivosy alérgicos. En este trabajo se evalúan los antecedentesepidemiológicos y los resultados inmunológicos para diferenciarentre pacientes con anisakidosis y aquellos con otras patologíasdigestivas que cursan con dolor abdominal.Pacientes y método: estudio de cohortes realizado con 134pacientes: 52 fueron diagnosticados de anisakidosis por los hallazgosquirúrgicos y anatomopatológicos y/o seroconversión específicafrente a A. simplex (grupo A) y en 82 pacientes la anisakidosisfue excluida como diagnóstico (grupo NA: no-anisakidosis). Sehan evaluado el antecedente de ingesta de pescado crudo, laprueba cutánea en prick (PC) y el inmunoblot IgE como elementosde diagnóstico.Resultados: los pacientes de los grupos A y NA mostraron resultadosdiferentes respecto a la de ingesta de pescado crudo (p <0,0001) y la PC (p < 0,0001), con valores predictivos negativos(VPN) del 98,39 y 95,56% y positivos (VPP) del 70,83 y 87,50%,respectivamente. En el inmunoblot, se halló una banda de aproximadamente60 kDa en el 86,2 y 19,2% de los pacientes del grupoA y NA, respectivamente (VPP: 62,50%; VPN: 94,03%).Conclusiones: en pacientes con dolor abdominal, la ingesta depescado crudo o poco cocinado tiene elevada sensibilidad y VPN(98,39%) pero menor VPP (70,83%), por lo que nos ayuda principalmentea descartar la anisakidosis. La ausencia de sensibilizacióncutánea al extracto crudo de A. simplex apoya la ausencia de anisakidosiscon una probabilidad alta (95,56%). La presencia de una bandade 60 kDa en el inmunoblot podría ser útil para su diagnóstico

Introduction: Anisakis simplex can be a cause of digestivesymptoms. Our aim was to evaluate the epidemiological antecedentsand immunological data available for a differentiationbetween patients with anisakidosis and those with other acute abdominalproblems.Patients and methods: this is a prospective cohort study involving134 patients with acute abdominal problems: 52 patientswere diagnosed with anisakidosis by means of surgical and pathologicalfindings and/or specific IgE seroconversion againstAnisakis simplex (group A), and in 82 patients anisakidosis hadbeen ruled out (group NA: non-anisakidosis). We evaluated theantecedent of raw fish ingestion, the skin prick test, and IgE immunoblottingas diagnostic tools.Results: patients in groups A and NA differ in terms of priorraw fish ingestion (p < 0.0001) and positive SPT (p < 0.0001),with their respective negative predictive values (NPV) being98.39% (95%CI: 90.17-99.92) and 95.56% (95%CI: 83.64-99.23). Regarding immunoblotting, in 86.2% of patients in groupA a band of 60 kDa was detected, which was also detected in19.2% of patients in group NA.Conclusions: a negative answer to the question about raw orundercooked fish ingestion has very high sensitivity and NPV(98.39%), and is thus reasonably reliable to rule out anisakidosis.The absence of cutaneous sensitization to crude A. simplex extractgives a high probability (95.56%) that the illness is absent.The presence of a band of about 60 kDa in immunoblotting would be useful for diagnosis (AU)