Residual gastritis associated with Strongyloides stercoralis infection: A case report.

RATIONALE: Strongyloides stercoralis, a rare human intestinal parasite, poses a significant health risk, capable of causing lifelong infection and even mortality due to its atypical manifestation of symptoms. In this case report, we reported a case of a patient diagnosed with S. stercoralis infection of the residual stomach and meticulously detail its treatment process, offering valuable insights and a reference point for clinicians. PATIENT CONCERNS: we report a case of infection caused by S. stercoralis after subtotal gastrectomy (Billroth type II) in a 47-year-old middle-aged man. It presents with recurrent nausea and vomiting, accompanied by intermittent food residue vomiting and constipation. DIAGNOSES: Upon endoscopic examination, we observed mucosal swelling and erosion in the anastomosis and output ring of stomach, while pathological analysis confirmed the presence of Strongyloides stercoralis eggs. Subsequently, the administration of albendazole for anti-infection treatment proved to be effective, thereby reinforcing the diagnosis of S. stercoralis infection. INTERVENSIONS: The patient underwent aggressive management including fasting, fluid replacement, anti-infection therapy, albumin supplementation, and albendazole treatment at a dose of 300 mg/kg/day for 3 days to eliminate the parasite. OUTCOMES: After treatment, the patient's symptoms of nausea, vomiting, and constipation were alleviated and returned to normal upon discharge. Over the subsequent 3 years, the patient reported no instances of vomiting and experienced a recovery of digestive function compared to their discharge status. LESSONS: S. stercoralis infection is relatively rare in the remnant stomach, endoscopic and pathological examination may be one of the important methods to diagnose S. stercoralis infection, and it is effective to treat albendazole according to the course of treatment.

Nodular and sclerosing gastritis caused by Cylicospirura felineus in a puma (Puma concolor).

An adult male puma (Puma concolor), hit by a car in an urban area, died three days later despite the therapeutic support provided. At necropsy, multiple firm nodules were identified in the gastric mucosa. The nodules were coated by an intact mucosa with a central opening from which reddish and cylindrical nematodes protruded into the lumen. Twenty-seven nematodes were retrieved for morphological and morphometric evaluations. During histopathological examination of the gastric tissue, the adult nematodes appear in longitudinal and transverse sections, surrounded by thick bands of collagen, interspersed with mixed inflammatory infiltrates. The nematodes had an eosinophilic cuticle with caudal serrated projections (bulbar type), coelomyarian musculature, pseudocoelom, and females with uterus containing numerous larvated eggs, characteristics consistent with the Cylicospirura genus. Morphologically, female nematodes had six large tricuspid teeth in the oral cavity and the vulva had an opening anterior to the esophagus-intestinal junction. Male nematodes had five pairs of small papillae near the tip of the tail. These findings were consistent with Cylicospirura felineus. This parasite should be included in the differential diagnosis of nodular gastric wall lesions in wild felids.

Nodular and sclerosing gastritis caused by Cylicospirura felineus in a puma (Puma concolor) / Gastrite nodular esclerosante causada por Cylicospirura felineus em onça parda (Puma concolor)

Abstract An adult male puma (Puma concolor), hit by a car in an urban area, died three days later despite the therapeutic support provided. At necropsy, multiple firm nodules were identified in the gastric mucosa. The nodules were coated by an intact mucosa with a central opening from which reddish and cylindrical nematodes protruded into the lumen. Twenty-seven nematodes were retrieved for morphological and morphometric evaluations. During histopathological examination of the gastric tissue, the adult nematodes appear in longitudinal and transverse sections, surrounded by thick bands of collagen, interspersed with mixed inflammatory infiltrates. The nematodes had an eosinophilic cuticle with caudal serrated projections (bulbar type), coelomyarian musculature, pseudocoelom, and females with uterus containing numerous larvated eggs, characteristics consistent with the Cylicospirura genus. Morphologically, female nematodes had six large tricuspid teeth in the oral cavity and the vulva had an opening anterior to the esophagus-intestinal junction. Male nematodes had five pairs of small papillae near the tip of the tail. These findings were consistent with Cylicospirura felineus. This parasite should be included in the differential diagnosis of nodular gastric wall lesions in wild felids.

Resumo Uma onça parda (Puma concolor) foi encontrada em uma área urbana após atropelamento e, apesar do suporte terapêutico fornecido, o animal morreu três dias depois. No exame post-mortem, múltiplos nódulos firmes foram identificados na mucosa gástrica. Os nódulos eram revestidos por mucosa intacta com um orifício central, do qual se insinuavam nematódeos cilíndricos e avermelhados. Vinte e sete nematódeos foram recuperados para avaliação morfológica e morfométrica. Na avaliação histopatológica do tecido gástrico, os nematódeos adultos apareceram em cortes longitudinais e transversais, circundados por bandas espessas de colágeno, intercaladas por infiltrado inflamatório misto. Os nematódeos eram constituídos por cutícula eosinofílica, com projeções serrilhadas voltadas caudalmente (do tipo bulbar), musculatura celomiariana, pseudoceloma e, nas fêmeas, útero com numerosos ovos larvados cujos achados foram sugestivos do gênero Cylicospirura. Morfologicamente, a cavidade bucal continha seis grandes dentes trífidos, na fêmea, a abertura da vulva era anterior à junção esôfago intestinal; e os machos tinham cinco pares de pequenas papilas próximas à ponta da cauda. Esses achados foram consistentes com Cylicospirura felineus. Este parasita deve ser incluído no diagnóstico diferencial de lesões nodulares da parede gástrica em felinos selvagens.

Concomitant Infection of S. mansoni and H. pylori Promotes Promiscuity of Antigen-Experienced Cells and Primes the Liver for a Lower Fibrotic Response.

Helicobacter pylori chronically colonizes the stomach and is strongly associated with gastric cancer. Its concomitant occurrence with helminths such as schistosomes has been linked to reduced cancer incidence, presumably due to suppression of H. pylori-associated pro-inflammatory responses. However, experimental evidence in support of such a causal link or the mutual interaction of both pathogens is lacking. We investigated the effects of co-infection during the different immune phases of S. mansoni infection. Surprisingly, co-infected mice had increased H. pylori gastric colonization during the interferon gamma (IFNγ) phase of schistosome infection but reduced infiltration of T cells in the stomach due to misdirection of antigen-experienced CXCR3+ T cells to the liver. Unexpectedly, H. pylori co-infection resulted in partial protection from schistosome-induced liver damage. Here, we demonstrate that an increase in fibrosis-protective IL-13Ra2 is associated with H. pylori infection. Thus, our study strongly points to an immunological interaction of anatomically isolated pathogens, eventually resulting in altered disease pathology.

Eosinophilic esophagitis, gastroenteritis, and colitis in a patient with prior parasite exposure.

Eosinophilic gastrointestinal disorders (EGID) comprise a spectrum of inflammatory diseases that can affect any segment of the gastrointestinal tract. The pathogenesis of these conditions is complex; differentiating between primary and secondary forms of these disorders can be clinically challenging. We report a case of primary EGID in a patient with remote parasite exposure, whose symptoms were initially attributed to irritable bowel syndrome. Endoscopy revealed the rare finding of EGID involving the entire gastrointestinal tract; symptoms improved with an elimination diet. This case raises the possibility of a link between prior parasite exposure and development of EGID, and underscores the necessity of exploring alternative diagnoses in patients with presumed IBS who present with severe symptoms.

Epidemiology of Sulcascaris sulcata (Nematoda: Anisakidae) ulcerous gastritis in the Mediterranean loggerhead sea turtle (Caretta caretta).

Sulcascaris sulcata Rudolphi 1819 is a gastric nematode parasite of sea turtles. Here, we report the occurrence and describe for the first time the pathological changes caused by S. sulcata in the Mediterranean loggerhead sea turtle (Caretta caretta) stranded along the Tyrrhenian coast and northern Adriatic coast of Italy. Prevalence of infection was significantly higher in loggerhead sea turtles from the Adriatic Sea. Both prevalence and abundance of infection showed an increasing trend along with host age classes from both geographical localities. Nevertheless, while many small loggerhead sea turtles were found infected from the Adriatic Sea, only bigger individuals were infected from the Tyrrhenian Sea. The most common gross pathological change was a mucous gastritis with focal to multifocal raised ulcerous lesions roundish to irregular in shape ranging from 1 to over 20 cm in length, and cream-yellowish to greenish in color. The severity grade of gastritis increased with higher number of S. sulcata individuals. Microscopic pathological changes ranged from atrophic gastritis with heterophilic infiltration in the lamina propria to the destruction of the mucosal and sub-mucosal surfaces and necrosis. Results here obtained demonstrate that S. sulcata may cause ulcerous gastritis in both samples of loggerhead sea turtles studied from the Mediterranean Sea. Observed differences in S. sulcata infection among the different host age classes and between the two studied basins are likely linked to the differences of regional habitat and intermediate prey host availability.

Hypereosinophilia and epigastralgia after visiting Tunisia: a rare differential diagnosis of helminthiases.

Causes of hypereosinophilia among travelers returning from North Africa are dominated by helminth infections, especially when associated with gastrointestinal signs. Non-infectious causes must nonetheless be investigated after negative microbiological assessment and failure of a broad empiric antiparasite treatment. We report the case of a young man with epigastralgia and major weight loss since a stay in Tunisia. Empiric treatment with albendazole was not successful. Eosinophilic gastroenteritis was diagnosed and resolved under corticosteroid treatment.

ULCERATIVE AND NECROTIZING GASTRITIS IN A CAPTIVE SLOTH (BRADYPUS VARIEGATUS, XENARTHRA, BRADYPODIDAE) DUE TO SEVERE PARASITISM WITH PARALEIURIS LOCCHII (NEMATODA, SPIROCERCIDAE).

This is the first reported case of lethal gastric parasitism by the nematode Paraleiuris locchii in a captive sloth ( Bradypus variegatus ). There were more than 600 parasites in the stomach of the sloth, associated with extensive areas of ulceration and necrosis. The animal developed emaciation, dehydration, and anemia that progressed to death.

Parasitic Ulcerous Caseous Gastroesophagitis Associated with Rameshwarotrema uterocrescens Rao, 1975 (Digenea: Pronocephalidae) in a Juvenile Green Turtle ( Chelonia mydas , Linnaeus 1758 [Testudines: Cheloniidae]): A Case Report.

Here we report a case of ulcerative caseous gastroesophagitis associated with Rameshwarotrema uterocrescens, Rao, 1975 (Digenea: Pronocephalidae), in a juvenile green turtle ( Chelonia mydas ) from southern Brazil. Similar pathologies have been reported only in adult green turtles from Costa Rica. This paper presents the second report of parasitic esophagitis due to R. uterocrescens and the first occurrence in juvenile green turtles along coastal Brazil.

A Case of Ancylostoma ceylanicum Infection Occurring in an Australian Soldier Returned from Solomon Islands.

A 26-year-old male member of the Australian Defense Force presented with a history of central abdominal pain of 4 weeks duration and peripheral eosinophilia consistent with eosinophilic enteritis. Acute hookworm disease was diagnosed as the cause. Adult worms recovered from feces after therapy with albendazole were morphologically consistent with Ancylostoma ceylanicum. As the patient had been deployed with the Regional Assistance Mission to Solomon Islands for 6 months prior to this presentation, it is very likely that the A. ceylanicum was acquired in Solomon Islands. Until now, it has been assumed that any Ancylostoma spp. recovered from humans in Solomon Islands is A. duodenale. However, this case demonstrates that human hookworm infection acquired in the Solomon Islands could be caused by A. ceylanicum.

Anisakidosis: a fortuitous mimicker of gastrointestinal malignancy.

A 51-year-old woman presented with epigastric pain, vomiting and diarrhoea. Her sister was recently diagnosed with duodenal adenocarcinoma, manifesting similar symptoms. Imaging revealed thickened gastric antrum with enlarged local lymph nodes. Endoscopy illustrated 3 worms embedded in the antral wall, identified as Anisakis simplex larvae. Larvae removal and a 2-week albendazole regimen treated the symptoms. With globalisation of cultural culinary practices, physicians must be vigilant of anisakidosis. Its ability to mimic peptic ulcer disease, chronic gastritis and malignancy necessitates broader differential diagnoses and lower thresholds for endoscopy.

Eosinophilic Enteritis in Horses with Motor Neuron Disease.

BACKGROUND: Equine motor neuron disease (EMND) is a neuromuscular disorder that affects adult horses. Although EMND has been linked to vitamin E deficiency, its etiopathogenesis is poorly understood. OBJECTIVES: To describe clinical features, laboratory results, and postmortem findings in a series of young horses with motor neuron disease (MND). ANIMALS: A herd of 15 young Andalusian horses with weakness, weight loss, muscle atrophy, and muscle fasciculations related to restricted intake of green forage. METHODS: A case series is presented in which horses were subjected to a clinical examination and plasma vitamin E measurement. Five severely affected horses were euthanized for detailed postmortem examination. Muscle specimens were taken from the M. sacrocaudalis dorsalis medialis and the M. gluteus medius for histopathologic and morphometric evaluation. RESULTS: MND was diagnosed in 5 horses based on clinical signs, low serum levels of vitamin E (0.11 ± 0.05 mg/dL; normal range,: 0.3-1.5 mg/dL), changes in muscle histopathology (neurogenic atrophy), and spinal cord lesions (neuronal chromatolysis in ventral horns). An unexpected postmortem finding was the presence of intestinal inflammation (catarrhal enteritis, edema, and eosinophilic infiltrate) associated with the presence of giant ciliated protozoa in all of the horses. CONCLUSIONS: Although a mechanistic link could not be established, it is hypothesized that intestinal inflammation may have been involved in the decreased absorption of vitamin E, thus favoring the development of MND.

First ultrastructural observations on gastritis caused by Physaloptera clausa (Spirurida: Physalopteridae) in hedgehogs (Erinaceus europeaus).

Ultrastructural changes of gastritis due to infection with Physaloptera clausa in 12 fresh carcasses of euthanized European hedgehogs (Erinaceus europaeus) collected from different part of Urmia, Iran, in which they were highly populated with this animal, six females and six males were subjected to detail necropsy with special reference to the stomach. Macroscopic changes of stomach were recorded and some of the worms collected. Based on number of parasites present in the stomach, they were divided into light infection, mild infection, and severe infection. Parasites were collected, and worms identification of the species was confirmed on the basis of light microscope examination with reference to keys. Tissues fixed in 3% glutaraldehyde, post-fixed in 1% osmium tetroxide and processed and plastic embedded; ultrathin sections of 60-70 nm were cut and stained with uranyl acetate and lead citrate; electron microscopic observations showed that, in light infection some changes were observed in gastric cells such as dilatation and vesiculation of the endoplasmic reticulum, large numbers of lipid granules, mitochondrial swelling, nuclear chromatin margination, and some nucleus showed washed out appearance. Other cells showed some alterations in mitochondria, dilatation of smooth endoplasmic reticulum, loss of both free and bound ribosomes, vesiculation in cytoplasm, and increase Golgi apparatus and secretory vesicles. The inflammatory cells including lymphocytes, macrophages, mast cells, and predominantly eosinophils were identified. In moderate infection, the cellular pattern of gastric mucosa replaced with inflammatory cells. The marked increase of macrophages and other inflammatory cell was observed. A particular finding in our study was the presence of globule leukocyte in the moderate stage. Moreover, scant formation and distribution of collagen fibers as well as fibroblasts were also noted. In severe infection, the most obvious observation was marked distribution of collagen fibers around the mucosal cells. The fibroblastic cells with elongated nucleus and extensive indentation were noticed. In conclusion, the result of our study revealed P. clausa could be a cause of gastritis and according to cellular pattern of inflammatory reaction, with the increase of worm burden and development of infection, chronic gastritis was stabilized. Present investigation documented the ultrastructural changes during verminous gastritis in hedgehogs.

Gastritis, Enteritis, and Colitis in Horses.

The gastrointestinal system of horses is affected by a large variety of inflammatory infectious and noninfectious conditions. The most prevalent form of gastritis is associated with ulceration of the pars esophagea. Although the diagnostic techniques for alimentary diseases of horses have improved significantly over the past few years, difficulties still exist in establishing the causes of a significant number of enteric diseases in this species. This problem is compounded by several agents of enteric disease also being found in the intestine of clinically normal horses, which questions the validity of the mere detection of these agents in the intestine.

A rat model of intragastric infection with Anisakis spp. live larvae: histopathological study.

Anisakiasis is a fish-borne parasitic disease caused by consumption of raw or undercooked fish or cephalopods parasited by Anisakis spp. third stage larvae. The pathological effects of the infection are the combined result of the mechanical action of the larva during tissue invasion, the direct tissue effects of the excretory/secretory products released by the parasite, and the complex interaction between the host immune system and the Anisakis antigens. The aim of this study was to develop an experimental model of infection with Anisakis spp. live larvae in rats, useful to study the acute and chronic histopathological effects of the Anisakis infection. Sprague-Dawley rats were subjected to esophageal catheterization to place larvae directly into the stomach. Reinfections at different intervals after the first infection were preformed. Live larvae were found anchored to the mucosa and passing through the wall of the stomach and showed a strong resistance being able to stay alive at different sites and at the different pH. Migration of larvae from the stomach to other organs out of the gastrointestinal tract was also observed. The histopathological study showed the acute inflammatory reaction, with predominance of polymorphonuclear eosinophils and a mild fibrotic reaction. The model of infection described is valid to study the behavior of the larvae inside the host body, the histopathological changes at the invasion site, and the effects of the repeated infections by ingestion of live larvae.

Dual infection with Pythium insidiosum and Blastomyces dermatitidis in a dog.

A 4-year-old male neutered Labrador Retriever with severe gastrointestinal signs, but no respiratory signs, was diagnosed with multifocal pyogranulomatous gastritis, enteritis, and lymphadenitis with intralesional hyphae and multifocal pyogranulomatous pneumonia with intralesional yeast. Based on cytologic evaluation, histologic examination with special stains, and immunohistochemical analysis of tissues collected antemortem or at necropsy, dual infections with Pythium insidiosum and Blastomyces dermatitidis were detected and are reported for the first time.

Gastric infection by Strongyloides stercoralis: a case report.

Strongyloides stercoralis is an intestinal nematode with a complex life cycle that involves colonizing and reproducing in the upper small intestinal mucosa. In a healthy host, the parasite usually does not cause any symptoms. We report a gastric infection case of S. stercoralis. A 72-year-old Turkish man was admitted to the Department of General Surgery with complaints of epigastric pain, nausea and vomiting for five days. Upper gastrointestinal endoscopy evidenced a diffuse infiltrate in the stomach, causing decreased distensibility. Microscopically, superficial chronic inflammation with hyperplastic reactive changes and damaged surface was observed. Histopathological examination of the gastric mucosa showed numerous cross-sections of adult worms, eggs and rhabditiform larvae of S. stercoralis developing in the gastric crypts.