Toward automating the diagnosis of gastrointestinal parasites in cats and dogs.

Diagnosing gastrointestinal parasites by microscopy slide examination often leads to human interpretation errors, which may occur due to fatigue, lack of training and infrastructure, presence of artifacts (e.g., various types of cells, algae, yeasts), and other reasons. We have investigated the stages in automating the process to cope with the interpretation errors. This work presents advances in two stages focused on gastrointestinal parasites of cats and dogs: a new parasitological processing technique, named TF-Test VetPet, and a microscopy image analysis pipeline based on deep learning methods. TF-Test VetPet improves image quality by reducing cluttering (i.e., eliminating artifacts), which favors automated image analysis. The proposed pipeline can identify three species of parasites in cats and five in dogs, distinguishing them from fecal impurities with an average accuracy of 98,6%. We also make available the two datasets with images of parasites of dogs and cats, which were obtained by processing fecal smears with temporary staining using TF-Test VetPet.

Ultrasonography for early diagnosis of Toxocara canis infection in puppies.

Toxocara canis is one of the most common intestinal parasites in dogs and represents a highly infectious zoonotic parasite worldwide. Adult worms live in the bowel of dogs, and infections in puppies are commonly acquired transplacentally. The biology of the parasite and the commonly used diagnostic method, based on faecal examination, often prevent an early diagnosis of toxocariasis in puppies. Ultrasonographic diagnosis of intestinal ascariasis could be a feasible alternative method to diagnose T. canis infection in puppies during the prepatent period. The present study evaluated the diagnostic accuracy of ultrasonography for the diagnosis of intestinal toxocariasis in new-born puppies during the prepatent period. Fifty-four new-born puppies were prospectively recruited in the study. Each dog underwent intestinal ultrasonography and copro-microscopic examination every 5 days, starting from the 10th day post-birth. Intestinal ultrasonography visualized adult T. canis nematodes in the puppies' small intestine from the 10th day post-birth. On the 15th day after birth, ultrasonography showed 100% specificity and 85.4% sensitivity in diagnosing T. canis infection, despite negative results deriving from the copro-microscopic examination performed at the same time point. Our results showed that ultrasonography can be used as test for early diagnosis of T. canis infection in new-born puppies during the prepatent period. Early ultrasonographic diagnosis of T. canis infection in puppies could help control the disease in dogs and reduce the zoonotic risk for the human population.

Parasitosis intestinales. La endoscopía y el estudio anatomopatológico como herramientas auxiliares diagnosticas en Strongyloidiasis Stercolaris / Intestinal parasitosis. endoscopy and anatomopathological study as auxiliary tools diagnostic in Strongyloidiasis Stercolaris

Introducción: La Strongyloidiasis es una parasitosis intestinal producida por un nematodo de distribución mundial, es endémica en zonas tropicales. Los métodos convencionales de diagnósticos suelen no ser lo suficientemente sensibles ni específicos. La endoscopia ha aumentado la sensibilidad de realizar mejores diagnósticos. Así es como la biopsia gástrica y/o duodenal juegan un rol importantísimo y se considera que los hallazgos endoscópicos son útiles como marcadores de severidad de la infección y obtención del agente etiológico. Objetivos: Realizar una revisión bibliográfica sobre la fisiopatogénesis y signo sintomatología del Strongyloides Stercoralis. Demostrar la utilidad de la endoscopía para evaluar inmenidad o daño de la mucosa duodenal como signo directo de organicidad y como método de obtención de muestras con el fin de realizar la observación directa del agente patógeno causal. Material y Método: Estudio observacional. Transversal. Retrospectivo. Se tuvieron en cuenta las endoscopías realizadas en el Servicio de Endoscopía del Hospital Español de Buenos Aires desde junio de 2016 a junio 2018. Resultados: Se realizaron 5286 estudios endoscópicos que constituyeron el 100% de la muestra. El 0,0189% (1 una endoscopía) de las endoscopías realizadas correspondieron a duodenitis inespecífica asociada a estudio anatomopatológico que confirma parasitosis intestinal por Strongiloidesis stercolaris. Discusión: Los principales síntomas clínicos de presentación de este nematodosis son náuseas, vómitos, anorexia, diarrea, pérdida de peso, y dolor abdominal, que frecuentemente confunden la etiología e imitan los síntomas de otras enfermedades, como en el caso de nuestro paciente. Tener en cuenta signosintomatologia atípica como refiere la World Gastroenterology Organization en su Practice Guidelines aumenta la sospecha diagnóstica Conclusión: La endoscopia digestiva alta es una herramienta diagnostica muy útil cuando la signo sintomatología no es muy clara. Una de las principales claves para hacer el diagnostico es tener un indicio de sospecha.

ntroduction: Strongyloidiasis is an intestinal parasitosis produced by a nematode of worldwide distribution, endemic in tropical areas., The conventional methods of diagnosis are usually not sensitive or specific enough. Endoscopy has increased the sensibility of making better diagnoses, as well as gastric and / or duodenal biopsy; plays a very important role and it is considered that the endoscopic findings are useful as markers of infection severity and in obtaining the etiological agent. Objectives: Carrying out a bibliographic review on the pathogenesis and signosyntomathology of Strongyloides Stercorali symptomatology. To demonstrate the usefulness of endoscopy to evaluate indemnity or damage of the duodenal mucosa as a direct sign of organicity and as a simple obtaining method in order to perform direct observation of the causative pathogen. Materials and Methods: Observational study. Cross. Retrospective. Endoscopies performed at the Endoscopy Service of the Hospital Español de Buenos Aires from June 2016 to June 2018 were taken into account. Results: There were 5286 endoscopic studies that constituted 100% of the sample. The 0.0189% (1 endoscopy) of the endoscopies performed corresponded to nonspecific duodenitis associated with an anatomopathological study that confirmed intestinal parasites by Strongiloidesis stercolaris. Discussion: The main clinical symptoms of this nematode are nausea, vomiting, anorexia, diarrhea, weight loss, and abdominal pain that frequently confuse the etiology and mimic the symptoms of other diseases, as in the case of our patient. Taking into account atypical signs and symptoms as the World Gastroenterology Organization refers in its Practice Guidelines increases diagnostic suspicion Conclusion: Upper digestive endoscopy is a very useful diagnostic tool when the signs and symptoms are not very clear. One of the main keys to make the diagnosis is to have an indication of diagnostic suspicion

Economic Analysis of the Impact of Overseas and Domestic Treatment and Screening Options for Intestinal Helminth Infection among US-Bound Refugees from Asia.

BACKGROUND: Many U.S.-bound refugees travel from countries where intestinal parasites (hookworm, Trichuris trichuria, Ascaris lumbricoides, and Strongyloides stercoralis) are endemic. These infections are rare in the United States and may be underdiagnosed or misdiagnosed, leading to potentially serious consequences. This evaluation examined the costs and benefits of combinations of overseas presumptive treatment of parasitic diseases vs. domestic screening/treating vs. no program. METHODS: An economic decision tree model terminating in Markov processes was developed to estimate the cost and health impacts of four interventions on an annual cohort of 27,700 U.S.-bound Asian refugees: 1) "No Program," 2) U.S. "Domestic Screening and Treatment," 3) "Overseas Albendazole and Ivermectin" presumptive treatment, and 4) "Overseas Albendazole and Domestic Screening for Strongyloides". Markov transition state models were used to estimate long-term effects of parasitic infections. Health outcome measures (four parasites) included outpatient cases, hospitalizations, deaths, life years, and quality-adjusted life years (QALYs). RESULTS: The "No Program" option is the least expensive ($165,923 per cohort) and least effective option (145 outpatient cases, 4.0 hospitalizations, and 0.67 deaths discounted over a 60-year period for a one-year cohort). The "Overseas Albendazole and Ivermectin" option ($418,824) is less expensive than "Domestic Screening and Treatment" ($3,832,572) or "Overseas Albendazole and Domestic Screening for Strongyloides" ($2,182,483). According to the model outcomes, the most effective treatment option is "Overseas Albendazole and Ivermectin," which reduces outpatient cases, deaths and hospitalization by around 80% at an estimated net cost of $458,718 per death averted, or $2,219/$24,036 per QALY/life year gained relative to "No Program". DISCUSSION: Overseas presumptive treatment for U.S.-bound refugees is a cost-effective intervention that is less expensive and at least as effective as domestic screening and treatment programs. The addition of ivermectin to albendazole reduces the prevalence of chronic strongyloidiasis and the probability of rare, but potentially fatal, disseminated strongyloidiasis.

An ultrasonographic scoring method for transabdominal monitoring of ascarid burdens in foals.

REASONS FOR PERFORMING STUDY: Parascaris spp. infections can lead to life-threatening small intestinal impactions in foals. Currently available diagnostic techniques cannot estimate the magnitude of an ascarid burden, and hence identify foals potentially at risk of developing impactions. OBJECTIVES: To describe and evaluate an ultrasonographic transabdominal scoring technique for monitoring of ascarid burdens in foals and to perform a cost-benefit analysis of the application of this technique. STUDY DESIGN: A transabdominal ultrasonographic technique was validated against ascarid worm counts from 10 foals aged 162-294 days. In a treatment trial, 15 foals were randomly allocated to 3 treatment groups: ivermectin, oxibendazole and no treatment. Blinded ultrasound examinations were performed daily for 5 consecutive days following treatment. Foals were examined ultrasonographically twice by the same investigator, and by different investigators for intra- and interobserver agreement evaluation. Cost-benefit analyses identified threshold values for the probability of ascarid impactions above which the screening method becomes cost-effective. METHODS: The ultrasound technique used 3 locations along the ventral midline. An ascarid scoring system was established that assessed the magnitude of ascarid burden ranging from 1-4. The method was validated against worm burdens of 10 worms and above with calculation of diagnostic specificity, sensitivity, and predictive values. Treatment trial data were evaluated statistically using mixed model analysis. Kappa values were generated for intra- and interobserver agreement. RESULTS: Two consecutive examinations were found to detect worm burdens >10 ascarids reliably. Ascarid scores declined in response to both anthelmintic treatments, although differences were not statistically significant. Kappa values indicated fair to moderate intra- and interobserver agreements. The majority of cost-benefit analyses indicated that ultrasound examinations are cost effective when the probability of ascarid impactions is above a range of 0.0001-0.0082 (i.e. 1 in 10,000 to 8 in 1000 foals). CONCLUSIONS: The ultrasonographic screening techniques can be a useful tool for monitoring ascarid burdens in foals.

Anisakiasis presenting to the ED: clinical manifestations, time course, hematologic tests, computed tomographic findings, and treatment.

BACKGROUND: The prevalence of anisakiasis is rare in the United States and Europe compared with that in Japan, with few reports of its presentation in the emergency department (ED). This study describes the clinical, hematologic, computed tomographic (CT) characteristics, and treatment in gastric and small intestinal anisakiasis patients in the ED. METHODS: We retrospectively reviewed the data of 83 consecutive anisakiasis presentations in our ED between 2003 and 2012. Gastric anisakiasis was endoscopically diagnosed with the Anisakis polypide. Small intestinal anisakiasis was diagnosed based on both hematologic (Anisakis antibody) and CT findings. RESULTS: Of the 83 cases, 39 had gastric anisakiasis and 44 had small intestinal anisakiasis based on our diagnostic criteria. Although all patients had abdominal pain, the gastric anisakiasis group developed symptoms significantly earlier (peaking within 6 hours) than the small intestinal anisakiasis group (peaking within 48 hours), and fewer patients with gastric anisakiasis needed admission therapy (5% vs 57%, P<.01). All patients in the gastric and 40 (91%) in the small intestinal anisakiasis group had a history of raw seafood ingestion. Computed tomographic findings revealed edematous wall thickening in all patients, and ascites and phlegmon of the mesenteric fat were more frequently observed in the small intestinal anisakiasis group. CONCLUSIONS: In the ED, early and accurate diagnosis of anisakiasis is important to treat and explain to the patient, and diagnosis can be facilitated by a history of raw seafood ingestion, evaluation of the time-to-symptom development, and classic CT findings.

Capillaria philippinensis in Upper Egypt: has it become endemic?

The goal of this study was to present an overview of human infections with Capillaria philippinensis, a new emerging parasite in Upper Egypt. The study included 21 inpatients who had been admitted to the Assiut University Hospital. Patients suffered from intermittent abdominal pain, borborygmi, chronic diarrhea lasting for several weeks, and marked weight loss. Hypoalbuminemia and low serum levels of potassium, calcium, and sodium were detected in most patients. A stool examination was performed using direct smears and the formalin-ether concentration method. Intact adult worms and/or eggs were evaluated using a light microscope and processed for scanning electron microscopy. The examination by light microscopy illustrated the general morphology of different stages. Using scanning electron microscopy, intestinal villi were found partially covering the cuticle of the adult worms, which provided evidence for the invasion of adult worms into the jejunal mucosa. Two distinct types of eggs, thick-shelled and thin-shelled, were identified and measured.

Ascaris lumbricoides-induced acute pancreatitis: diagnosis during EUS for a suspected small pancreatic tumor.

CONTEXT: Ascaris lumbricoides is the second most common intestinal parasite world-wide and, although the infection can be asymptomatic, in some cases it can present with complications, such as acute pancreatitis. CASE REPORT: We describe the case of a 37-year-old man, with a history of travelling in Eastern countries who presented with Ascaris lumbricoides-induced acute pancreatitis mimicking a small pancreatic cancer, diagnosed during an upper EUS. The endoscopy revealeda roundworm floating in the duodenum; its endoultrasonographic appearance showed a diffuse inhomogeneous pattern, with hypoechoic echotexture, such as in acute pancreatitis. Microbiological examination of the worm revealed a 20 cm long Ascaris lumbricoides. CONCLUSION: In non endemic countries, acute pancreatitis induced by Ascaris lumbricoides is an unusual diagnosis, and should be suspected especially in patients with history of traveling in endemic areas.