Gallbladder ascariasis in Kosovo - focus on ultrasound and conservative therapy: a case series.

BACKGROUND: Ascaris lumbricoides is one of the most common intestinal infections in developing countries, including Kosovo. In contrast to migration to the bile duct, migration of the worm to the gallbladder, due to the narrow and tortuous nature of the cystic duct, is rare. When it does occur, it incites acalculous cholecystitis. CASE PRESENTATIONS: This case series describes a 16-month-old Albanian girl, a 22-month-old Albanian girl, a 4-year-old Albanian girl, and a 10-year-old Albanian boy. Here we report our experience with gallbladder ascariasis including clinical manifestations, diagnostic procedures, and treatment. Fever, diarrhea and vomiting, dehydration, pale appearance, and weakness were the manifestations of the primary disease. In all patients, a physical examination revealed reduced turgor and elasticity of the skin. Abdomen was at the level of the chest, soft, with minimal palpatory pain. The liver and spleen were not palpable. A laboratory examination was not specific except for eosinophilia. There were no pathogenic bacteria in coproculture but Ascaris was found in all patients. At an ultrasound examination in all cases we found single, long, linear echogenic structure without acoustic shadowing containing a central, longitudinal anechoic tube with characteristic movement within the gallbladder. Edema of the gallbladder wall was suggestive of associated inflammation. There were no other findings on adjacent structures and organs. All patients received mebendazole 100 mg twice a day for 3 days. They also received symptomatic therapy for gastroenteritis. Because of elevated markers of inflammation all patients were treated with antibiotics, assuming acute cholecystitis, although ultrasound was able to confirm cholecystitis in only two of our four patients. Since the length of stay was dependent on the primary pathology it was 7 to 10 days. At control ultrasounds on 14th day, third and sixth month, all patients were free of ascariasis. CONCLUSIONS: Gallbladder ascariasis should be considered in all patients presenting with abdominal pain, distension, colic, nausea, anorexia, and intermittent diarrhea associated with jaundice, nausea, vomiting, fever, and severe radiating pain. Eosinophilia, ova, and parasites on stool examination as well as an anechogenic tube with characteristic movement within the bile duct found on abdominal ultrasound are conclusive for diagnosis. Mebendazole is an effective drug for the treatment. Surgical treatment is rarely needed.

Acute Acalculous Cholecystitis Caused by Giardia lamblia.

We report a case of a 70-year-old man with acute acalculous cholecystitis caused by Giardia lamblia. Contrast-enhanced computed tomography (CT) showed distention of the gallbladder due to a pericholecystic abscess without gallstones. Magnetic resonance cholangiopancreatography and drip infusion cholecystocholangiography-CT demonstrated a stricture of the hilar bile duct and cystic duct obstruction. We conducted transpapillary bile duct brush cytology and a biopsy of the hilar bile duct stricture; numerous active trophozoites of Giardia lamblia were observed without malignant findings. We considered this bile duct lesion to be biliary giardiasis. Biliary giardiasis should be taken into consideration when diagnosing acute acalculous cholecystitis.

Toxocarosis y colecistitis aguda alitiásica: ¿consecuencia o coincidencia? / Toxocarosis and acalculous acute cholecystitis: consequence or coincidence?

La toxocarosis humana es una parasitosis larvaria crónica catalogada dentro de las cinco enfermedades subestimadas más importantes por los CDC. Las larvas pueden diseminarse por vía sistémica y migrar a distintos tejidos (larva migrans visceral) incluyendo el hígado y vesícula biliar. La colecistitis aguda acalculosa (CAA) es una enfermedad rara en niños. El diagnóstico se basa en parámetros clínicos y criterios imagenológicos. Se ha asociado a sepsis, shock, trauma, quemaduras, enfermedades sistémicas graves, anomalías congénitas e infecciones, como también en niños sanos. Presentamos el caso de una toxocarosis infantil con síntomas clínicos y criterios imagenológicos compatibles con una CAA tratado médicamente, y discutir la relación entre ambos cuadros en base a la evidencia publicada.

Human toxocarosis is a chronic larval parasitosis listed as one of the five most important neglected diseases by the CDC. The larvae can spread systemically and migrate to different tissues including liver and gallbladder. Acalculous acute cholecystitis (AAC) is a rare disease in children. The diagnosis is based on clinical parameters and imaging criteria. It has been reported in relation to sepsis, shock, trauma, burns, severe systemic diseases, congenital anomalies, infections and also in healthy children. We report a pediatric case of toxocarosis, with clinical symptoms and imaging criteria compatible with AAC treated medically, and discuss the relationship between toxocarosis and AAC based on published evidence.

Cystoisosporiasis-related human acalculous cholecystitis: the need for increased awareness.

Cholecystitis is one of the common surgical indications affecting human beings in many countries. A variety of infectious agents can be associated with acute or chronic acalculous cholecystitis, especially in HIV/AIDS patients. In this investigation, the authors aim to describe two cases of histologically and molecularly documented cystoisosporiasis (syn. isosporiasis) as the cause of chronic acalculous cholecystitis in two immunodeficient patients. During microscopic examinations of more than 2500 diarrheic patients' samples, 11 cases of cystoisosporiasis-related recurrent persistent/chronic diarrhea were detected. A review of the medical records of Cystoisospora belli (syn. Isospora belli)-positive patients showed that two of them, i.e. a patient with prolonged corticosteroid therapy and an AIDS patient, several months prior to fecal examinations had undergone cholecystectomy due to acalculous cholecystitis. The study was continued by a review of the histopathological investigation of the recuts prepared from the excised gallbladder tissue sections and stained with hematoxylin and eosin in order to detect a possible specific clinical correlation with cystoisosporiasis. Light microscopic examination revealed the presence of various developmental stages of a coccidial parasite, namely Cystoisospora belli, in both patients' gallbladder tissue sections. To the best of our knowledge, C. bellii-associated cholecystitis has not been previously reported in a patient with prolonged corticosteroid therapy.

[Gastrointestinal giardiasis associated with Helicobacter pylori].

The study involved 160 patients with chronic cholecystitis associated with chronic gastroduodenitis. Obtaining biopsy specimens of gastric mucosa and bile samples allowed to compare the microbial picture and the morphological structure of gastric mucosa in the same patient, to identify patterns of colonization of the stomach, 12 duodenal ulcer and gall bladder various microorganisms. At cytological examination was detected in the gall bladder G. lamblia in 47.5 +/- 3.95% of cases in the stomach--in 29.09 +/- 6.12% of cases. The frequency of H. pylori detection in biopsy of gastric mucosa amounted to 98.18 +/- 1.8% of cases, in 12-duodenum--93.75 +/- 1.9%, in the gall bladder--to 54.38 +/- 3.94%, in the bile duct--in 54.38 +/- 3.94%. It was found strict association between the detection of H. pylori and G. lamblia in the stomach--100% of H. pylori-infection combined with giardiasis. Morphological changes of gastric mucosa in the form of lymphoid infiltration detected mainly in the mixed-infection H. pylori and G. lamblia.