Blastocystis and urticaria: Examination of subtypes and morphotypes in an unusual clinical manifestation.

Blastocystis is a human common enteric protist that may colonize a large variety of non-human hosts linked to symptoms and diseases such as abdominal pain, constipation, diarrhea, urticaria, flatulence and irritable bowel syndrome (IBS). Blastocystis exhibits remarkable genetic diversity and multiple subtypes (STs) within the genus with no absolute associations with clinical symptomatology. Here we analyzed fecal samples from Argentinean patients (n=270) belonging to symptomatic (urticaria and non-specific gastrointestinal symptoms, n=39) and asymptomatic control (n=28). Those patients infected with Blastocystis (n=67) were submitted for morphological analysis, DNA extraction, 18S PCR, sequencing and STs identification according to DNA barcoding. Blastocystis vacuolar forms were the predominant morphotype (75%), ameboid-like forms were evidenced in 1.5% of samples. Blastocystis ST3 was detected in 71.6% (n=48), of which 71.4%, (n=35) and 28.6% (n=14) belonged to symptomatic and asymptomatic respectively. Other subtypes identified were ST1 (14.9%), ST6 (7.5%) and ST2 (5.9%). Blastocystis 18S barcoding evidenced in non-urticaria symptomatic patients and asymptomatic control group the presence of allele 134 (ST3) (p<0.0001), while allele 34 (ST3) was detected in 85.7% (18/21) of symptomatic uricaria as compared with control group (1/21) (p<0.0001). The presence of a particular allele (a34) significantly associated with urticaria patients was detected and the clinical implications of these findings are herein discussed.

Reduced population of interstitial cells of Cajal in Chagasic megacolon.

BACKGROUND/AIMS: In Chagasic megacolon, there is a reduction in the population of interstitial cells of Cajal. It was aimed to evaluate density of Cajal cells in the resected colon of Chagasic patients compared to control patients and to verify possible association between preoperative and postoperative bowel function of megacolon patients and cell count. METHODOLOGY: Sixteen megacolon patients (12 female; mean age 54.4 (31-73)) were operated on. Pre- and postoperative evaluation using Cleveland clinic constipation score was undertaken. Resected colons were examined. Cajal cells were identified by immunohistochemistry (anti-CD117). The mean cell number was compared to resected colons from 16 patients (7 female; mean age 62.8 (23-84)) with non-obstructive sigmoid cancer. Association between pre- and postoperative constipation scores and cell count for megacolon patients was evaluated using the Pearson test (r). RESULTS: A reduced number of Cajal cells (per field: 2.84 (0-6.6) vs. 9.68 (4.3-13); p<0.001) were observed in the bowel of megacolon patients compared to cancer patients. No correlation between constipation score before (r=- 0.205; p=0.45) or after surgery (r=0.291; p=0.28) and cell count in megacolon was observed. CONCLUSIONS: Patients with megacolon display marked reduction of interstitial cells of Cajal. An association of constipation severity and Cajal cells depopulation was not demonstrated.

Gastrointestinal helminthiasis presenting with acute diarrhoea and constipation: report of two cases with a second pathology.

Gastrointestinal helminthiasis in developing countries contributes to malnutrition and anemia. Diagnosis and treatment of helminthiasis, especially with low worm load is an unmet public health need in such settings. The infection may sometimes become manifest when a second pathology leads to purgation of the gastrointestinal tract. Two cases of helminthiasis are presented in which the infections only became amenable to diagnosis due to acute diarrhoea caused by giardiasis and lactulose administration. In the first case, acute giardiasis revealed Ascaris lumbricoides infestation, and in the second case primary helminthiasis (strongyloidiasis) was revealed by lactulose, and also led to Vibrio cholera bacteremia. These cases highlight the need to diagnose helminth infestations especially with low worm burdens by means of public health surveillance programmes. These cases highlight the need to diagnose helminth infestations especially with low worm burdens by means of public health surveillance programmes.

Severity of Giardia infection associated with post-infectious fatigue and abdominal symptoms two years after.

BACKGROUND: A high rate of post-infectious fatigue and abdominal symptoms two years after a waterborne outbreak of giardiasis in Bergen, Norway in 2004 has previously been reported. The aim of this report was to identify risk factors associated with such manifestations. METHODS: All laboratory confirmed cases of giardiasis (n = 1262) during the outbreak in Bergen in 2004 received a postal questionnaire two years after. Degree of post-infectious abdominal symptoms and fatigue, as well as previous abdominal problems, was recorded. In the statistical analyses number of treatment courses, treatment refractory infection, delayed education and sick leave were used as indices of protracted and severe Giardia infection. Age, gender, previous abdominal problems and symptoms during infection were also analysed as possible risk factors. Simple and multiple ordinal logistic regression models were used for the analyses. RESULTS: The response rate was 81% (1017/1262), 64% were women and median age was 31 years (range 3-93), compared to 61% women and 30 years (range 2-93) among all 1262 cases. Factors in multiple regression analysis significantly associated with abdominal symptoms two years after infection were: More than one treatment course, treatment refractory infection, delayed education, bloating and female gender. Abdominal problems prior to Giardia infection were not associated with post-infectious abdominal symptoms. More than one treatment course, delayed education, sick leave more than 2 weeks, and malaise at the time of infection, were significantly associated with fatigue in the multiple regression analysis, as were increasing age and previous abdominal problems. CONCLUSION: Protracted and severe giardiasis seemed to be a risk factor for post-infectious fatigue and abdominal symptoms two years after clearing the Giardia infection.

[Epidemiologic and laboratory assessments of etiologic implications of Blastocystis hominis in gastrointestinal diseases]. / Evaluari epidemiologice si de laborator privind implicarea etiologica în afectiuni gastrointestinale a Blastocystis hominis.

Authors present the first laboratory and epidemiological results which reveal the circulation in a population of protozoan Blastocystis hominis and its implication in the determinations of some gastrointestinal troubles, with fever, diarrhea and constipation, intense intestinal meteorism, associated with abdominal pain and cramps. Out of the 3106 investigated patients, 9.7% presented B. hominis as a unique etiologic agent, with an increased prevalence in adults (74.3%) and women (65.3%). Blastocystis infection with clinical manifestations or its asymptomatic form is included among emergent diseases.

Clinics in diagnostic imaging (52). Spinal cord schistosomiasis.

A 2-year-old Brazilian boy presented with bilateral leg weakness and constipation, followed by development of progressive paraparesis and bladder dysfunction. Neurological examination revealed flaccid paraparesis. Blood tests and CSF analysis showed eosinophilia. The MR examination revealed a spinal cord mass extending from T9 to L1 levels, with a heterogeneously-enhancing solid component and a cystic component. Stool tests for Schistosoma mansoni eggs were positive. The patient underwent surgery, the intramedullary mass was partially resected, and the diagnosis of spinal cord infection by Schistosoma mansoni was confirmed. After surgery, the patient was treated with praziquantel and oxamniquine. He was discharged with partial improvement of the lower extremity weakness and bowel/bladder function. The clinical and imaging features of spinal cord schistosomiasis are reviewed.

Spontaneous intraperitoneal expulsion of an unruptured hydatid cyst.

We report a 43-year-old man with a 20 x 20 cm hydatid cyst, spontaneously extruded out from the left lobe of the liver. This complication of hydatid cyst has not been recorded earlier, and makes the case unique in itself and worth reporting. The patient presented with a rare complication of biliary peritonitis of hydatid disease.

Intestinal obstruction due to ascariasis.

BACKGROUND: Intestinal obstruction due to ascariasis results from heavy worm infestation. This study is a review of 92 patients with intestinal obstruction from Ascaris lumbricoides. METHODS: Sixty-eight patients without peritonism were treated conservatively with resuscitation, antibiotics and anthelminthics. The remaining 24 patients presented with abdominal signs suggesting strangulation. Plain abdominal radiography was done in all patients. Abdominal ultrasonography was performed in the last 22 patients. RESULTS: There were no deaths in the first group and duration of hospital stay ranged from 4 to 7 days. Five of 24 patients in the second group died during resuscitation. After successful resuscitation, 19 had a laparotomy. Six patients needed resection of gangrenous bowel with primary anastomosis, in 11 an enterotomy was used to remove obstructing worms and in two it was possible to milk obstructing worms into the colon. Seven patients died after operation, giving an overall mortality rate of 12 of 24 patients in the second group. The characteristic sonographic features of 'railway track' sign and 'bull's eye' appearance helped make the diagnosis of ascariasis, and ultrasonographic signs were also typical for strangulation in five patients. CONCLUSION: Early clinical diagnosis supported by ultrasonography, together with prompt surgery when necessary, might reduce the mortality rate in what is still a potentially dangerous condition.