Case Report: Profound Anemia in a 2-Year-Old Boy Associated with a Leech in the Oropharynx.

A 2-year-old boy presented to Kapsowar Mission Hospital in Kenya with a history of general tiredness associated with mild, unilateral epistaxis and one episode of hematemesis. On admission, he had a hemoglobin value of 3.5 g/dL, with a white cell count of 20.6 × 109/L. The child was examined by the physician on call, with no source of bleeding found. Later that day, after a local physician noted that the presentation could be due to an unrecognized leech infestation, a deep examination of the oropharynx was performed with a laryngoscope and revealed a leech attached deep in the oropharynx. The anesthetist visualized the leech with a laryngoscope and removed it with Magill forceps. After the procedure and blood transfusion, the child's hemoglobin level improved to 10.4 g/dL, and on the following day, the child was much improved in energy and was playing outside. He was discharged home on iron supplements and made a full recovery.

Identification of the intermediate host of Gongylonema sp., the etiological agent of the necrotic oropharyngeal disease of the Scops owl (Otus scops).

Since 1997, fledgling Scops owls (Chordata: Strigidae) have been brought to the Brinzal Owl Rescue Centre (Madrid, Spain) with severe lesions in their oral cavities. Lesions consist of the presence of proliferative necrotic material in the oral cavity resulting in white plaques, which can lead to death by starvation. This disease has been detected in owls only within the limits of the city of Madrid. The etiologic agent has been identified as Gongylonema sp. (Nematoda: Spirurida), a nematode genus that includes a coprophagous arthropod as intermediate host in its cycle. The aim of this study was to identify the intermediate host of the parasite. Our work was structured in four component phases: i) Diet study of newborn chicks; ii) trapping arthropods that could be intermediate hosts; iii) molecular detection of the parasite in the selected arthropods: and iv) molecular characterization of the detected parasites by amplifying the cox1 gene. Four male owls were radio-tagged in order to locate their nests and a camera trap was placed to identify the prey brought to the owlets. Secondly, the arthropods present in the hunting areas of the owls were sampled, identified and analyzed by real time PCR (rtPCR). Only oriental cockroaches, B. orientalis (Arthropoda: Blattodea), were positive by rtPCR detection of Gongylonema sp. (66.7%). The nematodes obtained from cockroaches had a 99.8% identity of the cox1 gene with the Gongylonema sp. isolated for the first time in a Scops owl. Furthermore, these sequences only showed an <89% identity with all the other Gongylonema sequences available in the GenBank database. We conclude that the oriental cockroach should be considered as an intermediate host of the etiologic agent of NOD.

Case Report: Unusual Presentation of Pharyngeal Mucosal Leishmaniasis due to Leishmania (Viannia) braziliensis.

Mucosal leishmaniasis (ML) affects predominantly the nose and occurs usually weeks or months after the cure of the primary cutaneous lesion. The pathology of ML is characterized by an exaggerated inflammatory reaction with infiltration of lymphocytes, macrophages, and plasma cells. There is also a paucity of parasites and a strong delayed-type hypersensitivity reaction. Herein, we report a case of a young man who had a large ulcer in his left leg and complained of dysphagia. In nasofibrolaryngoscopy, there were nodular lesions in the oropharynx and rhinopharynx. The skin lesion biopsy showed a chronic inflammation with amastigotes inside macrophages, and DNA of Leishmania braziliensis confirmed the diagnosis of ML in tissue biopsied from the pharynx. The leishmaniasis skin test was negative. Cytokine evaluation showed lack of production of interferon (IFN)-γ, interleukin (IL)-1ß, and IL-17 with enhancement of these cytokine levels after cure.

A Rare Cause of Hemoptysis: Oropharyngeal Leech

We report the case of a 33-year-old patient who presented with dyspnea and hemoptysis due to an oropharyngeal leech infestation. The patient was a shepherd and his detailed history revealed that he had been drinking water from natural springs. In the examination, a vivid dark green colored foreign body moving towards the nasopharynx and hypopharynx was detected in the oropharynx. The leech was removed under local anesthesia by gently grasping with the help of a long clamp. It should be noted that leeches are common in rural water sources and they can cause severe morbidity and even mortalities due to serious complications such as severe anemia and airway obstructions. A thorough oral and oropharyngeal examination will be sufficient to identify such cases, indicating the importance of physical examination in patients that present with otherwise unexplained airway obstruction and hemoptysis.

Detection, prevalence, and transmission of avian hematozoa in waterfowl at the Arctic/sub-Arctic interface: co-infections, viral interactions, and sources of variation.

BACKGROUND: The epidemiology of avian hematozoa at high latitudes is still not well understood, particularly in sub-Arctic and Arctic habitats, where information is limited regarding seasonality and range of transmission, co-infection dynamics with parasitic and viral agents, and possible fitness consequences of infection. Such information is important as climate warming may lead to northward expansion of hematozoa with unknown consequences to northern-breeding avian taxa, particularly populations that may be previously unexposed to blood parasites. METHODS: We used molecular methods to screen blood samples and cloacal/oropharyngeal swabs collected from 1347 ducks of five species during May-August 2010, in interior Alaska, for the presence of hematozoa, Influenza A Virus (IAV), and IAV antibodies. Using models to account for imperfect detection of parasites, we estimated seasonal variation in prevalence of three parasite genera (Haemoproteus, Plasmodium, Leucocytozoon) and investigated how co-infection with parasites and viruses were related to the probability of infection. RESULTS: We detected parasites from each hematozoan genus in adult and juvenile ducks of all species sampled. Seasonal patterns in detection and prevalence varied by parasite genus and species, age, and sex of duck hosts. The probabilities of infection for Haemoproteus and Leucocytozoon parasites were strongly positively correlated, but hematozoa infection was not correlated with IAV infection or serostatus. The probability of Haemoproteus infection was negatively related to body condition in juvenile ducks; relationships between Leucocytozoon infection and body condition varied among host species. CONCLUSIONS: We present prevalence estimates for Haemoproteus, Leucocytozoon, and Plasmodium infections in waterfowl at the interface of the sub-Arctic and Arctic and provide evidence for local transmission of all three parasite genera. Variation in prevalence and molecular detection of hematozoa parasites in wild ducks is influenced by seasonal timing and a number of host traits. A positive correlation in co-infection of Leucocytozoon and Haemoproteus suggests that infection probability by parasites in one or both genera is enhanced by infection with the other, or that encounter rates of hosts and genus-specific vectors are correlated. Using size-adjusted mass as an index of host condition, we did not find evidence for strong deleterious consequences of hematozoa infection in wild ducks.

Human Cutaneous Myiasis by the Australian Sheep Blowfly, Lucilia cuprina (Diptera: Calliphoridae), in Oklahoma.

This case report describes an incident of myiasis in Oklahoma City, Oklahoma. Paramedics treated a 53-year-old man in the field when he suffered cardiac arrest. He was intubated by the paramedics and transported to an emergency room, where he received two stents and a balloon pump. He was found to have a GCS of three and remained in the hospital for 7 days before passing away. After his death, the breathing tube was removed, revealing the presence of several maggots. On closer inspection, the dipteran larvae were found in both the oral and nasal cavities. Four of these larvae were reared to adulthood and identified as Lucilia cuprina (Weidemann) (Diptera: Calliphoridae), commonly known as the Australian sheep blowfly, by the Biology Department of the University of Oklahoma. Based on the fly's life cycle and rate of development, the infestation is suspected to be hospital acquired.

[Leeches of the upper aerodigestive tract]. / Sangsues des voies aérodigestives supérieures.

INTRODUCTION: The leech is an aquatic worm living in fresh water, especially in tropical areas. It may be found exceptionally in the upper aerodigestive tract (UADT) after consumption of spring water or water from natural wells, after swimming in still waters (lakes and dams). The author's objective was to study epidemiological, clinical, therapeutic, and evolutive aspects of this infestation. PATIENT AND METHODS: This prospective 2-year study was carried out from January 1, 2007 to December 31, 2008. We included all patients consulting at the emergency unit presenting with leeches in the UADT. RESULTS: Twenty patients living in rural settings were included: 16 children, mostly boys (sex ratio 3:1). All cases were recorded during the summer season, with 14 cases due to consumption of fresh water and six due to swimming in still waters. The delay between infestation and onset of symptoms ranged from 2 to 15 days. Leeches were found in the oropharynx (six cases), the nasopharynx (five cases), the hypopharynx (six cases), and the glottis (three cases). An anemia syndrome was noted in four patients. All parasites were removed. All patients were given local antiseptics and analgesics. Patients with anemia were given iron supplementation. The outcome was favorable for all patients. DISCUSSION: UADT leeches are not uncommon in Morocco. The infestation is usually observed in the summer. Symptoms vary according to UADT localization. The diagnosis should be made rapidly to prevent complications. Whatever the localization, removing the parasite is difficult. In laryngeal localizations induction general anesthesia is recommended, without intubation. Evolution after treatment is rapidly favorable, with complete disappearance of symptoms.

Oropharyngeal leech infestation and therapeutic options.

This is a case report about a rare oropharyngeal foreign body causing oropharyngeal symptoms such as sore throat, dysphagia and hemoptysis. We reported a 7 year-old boy who had ingested a leech from a bottle which had been filled with water and it had attached to the palate within 4 days. The leech was identified as approximately 3 cm in length. Leech was removed under premedication by using monopolar cauterization. Although child infestation by a leech in the upper respiratory tract is very rare, it should be investigated when contaminated liquids are ingested. Electro cauterization should be borne in mind as a therapeutic option in the treatment of leech infestations in the upper respiratory tract under pre-medication in pediatric patients.

[An entomological case report during the winter months: estimation of the post-mortem interval considering the influence of cold temperatures on the development of the forensically important blowfly Calliphora vomitoria]. / Eine insektenkundliche Fallbetrachtung in den Wintermonaten: Leichenliegezeitbestimmung unter Berücksichtigung des Einflusses niedriger Temperaturen auf die Entwicklung der forensisch wichtigen Schmeissfliege Calliphora vomitoria.

The authors describe a case report with entomological estimation of the post-mortem interval in the winter months. In early December 2007, the body of a suicide was discovered not far from a lake near Bonn in North Rhine-Westphalia four weeks after the man had disappeared from a hospital. The corpse was very well preserved and did not show any signs of advanced putrefaction. The stage of decomposition did not allow a correct estimation of the time since death. Infestation of insect larvae of the species Calliphora vomitoria was detected in the oral cavity as well as in the self-inflicted deep cut to the throat responsible for death. The age of the larvae was determined by considering the specific minimum threshold of the species (minimum temperature necessary for development). To estimate the time until the blowflies detect the body and start to oviposit, the authors ran an experiment with a pig in a comparable environment with similar temperatures. Altogether, these investigations suggested that the man had committed suicide shortly after disappearing from the hospital. Without the entomological evaluation it would have been very difficult to narrow down the post-mortem interval correctly.

Infestación por Hirudo medicinalis (sanguijuela) / Hirudo medicinalis (leech) infestation

Las sanguijuelas son anélidos hermafroditas de los que existen más de 700 especies, siendo Hirudo medicinalis la más conocida por su empleo durante más de 2000 años en Medicina. Sin embargo, con el advenimiento de la Medicina científica cayeron en desuso siendo hoy día poco conocidas. Presentamos el caso de un varón de 71 años que consultó en el Servicio de Urgencias por el hallazgo de restos hemáticos en la saliva y sensación de cuerpo extraño en la orofaringe, descubriéndose como causa de los síntomas una infestación accidental por este gusano. Se comenta la rareza de este hallazgo y se describe el empleo actual de la sanguijuela en técnicas de microcirugía reconstructiva, así como los últimos estudios publicados por la producción de sustancias anticoagulantes (AU)

Leeches are hermaphroditic annelides, and over 700 species have been described. Hirudo medicinalis is the best-known one, because of its medicinal use over the last 2,000 years or more. However, the advent of scientific Medicine has led to their being proressively forgotten, and leeches are at present almost unknown to the physician. We report the case of a 71-year-old male who was seen at the Emergency Outpatient Clinic because of bloody residues in his saliva and a sensation of oropharyngeal foreign body. The cause of these symptoms was found to be an accidental infestation by these blood-sucking worms. The rarity of this findings is discussed, as well as the present use of leeches in reconstructive surgery techniques and procedures, and the latest published studies of their use in the production of anticoagulant agents (AU)

Hallazgo simultáneo de microsporidios en secreciones respiratorias y heces de niños de corta edad / Simultaneous detection of microsporian spores in respiratory secretions and in stool specimens of toddlers

Se efectuó un estudio prospectivo de 70 niños de 1 a 24 meses de edad, con baja probabilidad de infección por HIV, 35 con patologías respiratorias infecciosas y 35 sin ellas. Estuvo dirigido a detectar ocurrencia contemporánea de esporas de microsporidios en secreciones respiratorias (SR) y heces (H), empleando métodos desarrollados para microscopía óptica (coloraciones de Weber modificado por Kokoskin y de Ziehl-Neelsen Acid-Fast modificado por los autores). En el primer grupo fueron positivos en SR 11/35 niños (31,4 por ciento), de los cuales 7/11 (63,6 por ciento) también mostraron esporas en H. En el segundo grupo fueron positivos en SR 8/35 (22,9 por ciento), de los cuales 5/8 (62,5 por ciento) lo fueron en H. En ambos grupos la prevalencia de microsporidios en SR fue importante, sin diferencia estadística significativa entre ellos, y fue destacada la simultaneidad de hallazgos en SR y H en ambos grupos. Conclusiones: 1) una de las especies de microsporidios, o quizás más, probablemente son parásitos naturales y habituales del aparato respiratorio de seres humanos inmunológicamente sanos, como acontece para el aparato digestivo y 2) cuando está presente una infección respiratoria por microsporidios en éstos sujetos, sería un hecho común que simultáneamente se detecten esporas de éstos organismos en sus heces (AU)

Lagochilascaris minor in a patient from the Colombian amazon: a case report.

A chronic infection (10 years) by Lagochilascaris minor is described in a woman from the amazon region of Colombia. This is the third case of infection by this parasite that has been described so far in Colombia, and only the first one in a person coming from the Colombian Amazon region.

Laryngeal involvement during post kala-azar dermal leishmaniasis in India.

Post kala-azar dermal leishmaniasis (PKDL) involving the mucus membranes is relatively rare on the Indian sub-continent. We describe 3 cases of PKDL presenting with hoarseness of voice. In one case the skin, nasal, oral, oropharyngeal and laryngeal mucosa had nodular and nodulo-ulcerative lesions; in the 2 other cases, genitalia and anorectal mucosa were also affected. Laryngoscopic examination revealed nodular lesions on the vocal cords. Biopsy smear and culture confirmed their leishmanial origin.

[Histopathology of mucocutaneous leishmaniasis caused by Leishmania (Vianna) braziliensis]. / Histopathologie de la leishmaniose cutanéo-muqueuse à Leishmania (Viannia) braziliensis.

A histopathological study of mucocutaneous leishmaniasis due to Leishmania (Viannia) braziliensis was carried out on 28 cutaneous and 114 mucosal biopsies, taken from Bolivian and Peruvian patients. This study showed similar histopathological findings in cutaneous and mucosal lesions. The cutaneous biopsies showed a strong epidermal hyperplasia occasionnally budding in the dermis. In the ulcerative area, the epidermis was totally necrosed and replaced by a fibrino-leucocytic edge. In the dermis, histio-lympho-plasmocytic infiltration was constantly found. The histiocytes often gathered in follicles sometimes with diffuse fibrosis. The parasites were encountered in 28.6 p. 100 of the biopsies. Whatever the mucosa concerned (i.e. nasal, palatal or lingual), the mucosal lesion was not different from the cutaneous lesion. The malpighian epithelium is either absent or the seat of a pseudo-epitheliomatous hyperplasia. Major histio-lympho-plasmocytic infiltration was found and extended through the depth of the lamina propria. Suppurative and fibrinoid necroses coexisted superficially and sometimes penetrated in depth. The parasites were found in about 30 p. 100 of the cases.

Tails of the unexpectorated: experiences with leech infestation in childhood.

Two potentially lethal cases of leech infestation of the upper airways in childhood are described and a safe and effective way of dealing with the problem is suggested.