Intestinal parasites including Cryptosporidium, Cyclospora, Giardia, and Microsporidia, Entamoeba histolytica, Strongyloides, Schistosomiasis, and Echinococcus: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice.

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of intestinal parasites in the pre- and post-transplant period. Intestinal parasites are prevalent in the developing regions of the world. With increasing travel to and from endemic regions, changing immigration patterns, and the expansion of transplant medicine in developing countries, they are increasingly recognized as a source of morbidity and mortality in solid-organ transplant recipients. Parasitic infections may be acquired from the donor allograft, from reactivation, or from de novo acquisition post-transplantation. Gastrointestinal multiplex assays have been developed; some of the panels include testing for Cryptosporidium, Cyclospora, Entamoeba histolytica, and Giardia, and the performance is comparable to conventional methods. A polymerase chain reaction test, not yet widely available, has also been developed to detect Strongyloides in stool samples. New recommendations have been developed to minimize the risk of Strongyloides donor-derived events. Deceased donors with epidemiological risk factors should be screened for Strongyloides and recipients treated if positive as soon as the results are available. New therapeutic agents and studies addressing the optimal treatment regimen for solid-organ transplant recipients are unmet needs.

Up-regulation of Interleukin-21 Contributes to Liver Pathology of Schistosomiasis by Driving GC Immune Responses and Activating HSCs in Mice.

The pathology of schistosome egg-induced liver granuloma, fibrosis and eventually liver scarring is complicated. CD4+ helper T (Th) cells play critical roles in both host humoral immunity and cellular immunity against parasitic infection and immunopathology in schistosomiasis. Follicular helper T (Tfh) cells are another specialized subset of Th cells and involved in infectious diseases. However, the immune regulatory mechanism of Tfh cells in severe liver pathology of schistosomiasis is still poorly understood. In this study, using a S. japonicum-infected mouse model, we studied the dynamics and effects of Tfh cells in vivo and demonstrated that Tfh phenotype molecules ICOS, PD-1 and functional factor IL-21 were positively correlated with disease development by flow cytometry. Meanwhile, our results also showed that Tfh cells enriched in splenic germinal center (GC) and promoted B cells producing IgM with the progress of hepatic immunopathology by B-T co-culture experiments. More importantly, our data indicated that IL-21 contributed to the formation and development of hepatic egg granuloma and subsequent fibrosis by driving GC responses and activating HSCs by immunohistochemical detection and blocking assay in vitro. Our findings contribute to the better understanding of the immunopathogenesis of schistosomiasis and have implications for therapeutic intervention of hepatic fibrotic diseases.

Recombinant adeno-associated virus-mediated inhibition of microRNA-21 protects mice against the lethal schistosome infection by repressing both IL-13 and transforming growth factor beta 1 pathways.

UNLABELLED: Schistosomiasis is a serious parasitic disease in humans, which can lead to liver fibrosis and death. Accumulating evidence indicated that targeting the deregulated microRNAs (miRNAs) could mitigate disease outcomes. Here, we showed that progressive hepatic schistosomiasis caused elevation of miR-21 and efficient and sustained inhibition of miR-21 by using highly hepatic tropic adeno-associated virus serotype 8 (rAAV8), which protected mice against lethal schistosome infection through attenuation of hepatic fibrosis (HF). We demonstrated an additive role of interleukin (IL)-13 and transforming growth factor beta 1 (TGF-ß1) in up-regulating miR-21 expression in hepatic stellate cells (HSCs) by activation of mothers against decapentaplegic (SMAD) proteins. Furthermore, down-regulation of miR-21 in HSCs reversed HF by enhancing SMAD7 expression, thus repressing TGF-ß1/Smad and IL-13/Smad pathways. CONCLUSION: This study suggests the mechanism of IL-13-mediated schistosomiasis HF by up-regulation of miR-21 and highlights the potential of rAAV8-mediated miR-21 inhibition as a therapeutic intervention for hepatic fibrotic diseases, such as schistosomiasis.

Schistosomiasis combined with colorectal carcinoma diagnosed based on endoscopic findings and clinicopathological characteristics: a report on 32 cases.

AIMS AND BACKGROUND: To improve understanding of the relationship between schistosome-related enteropathy and colorectal carcinoma with particular focus on endoscopic findings and clinicopathological characteristics of colonic schistosomiasis. MATERIALS AND METHODS: All cases of intestinal schistosomiasis diagnosed at West China Hospital, Chengdu, China, between October 2006 and October 2012 were included in this study. A total of 179 cases of colonic schistosomiasis diagnosed through colonoscopy and pathological examinations were collected for analysis and the demographics, symptoms, endoscopic findings and clinicopathological characteristics were retrospectively evaluated. RESULTS: Of the 179 colonic schistosomiasis patients, 32 combined with colorectal cancer (CRC) were found, between the ages of 44 and 85 years (24 males, 75%). These 32 lesions were classified as 12 endophytic/ulcerative (37.5%), 10 exophytic/fungating (31.2%), 4 annular (12.5%), 3 giant polypus (9.4%), and 3 IIc (superficial depressed type) (9.4%). The segments of rectum and sigmoid colon were involved in 19 patients (59.4%) and 6 patients (18.8%), respectively. The histopathologic types were classified as follows: 30 well- differentiated adenocarcinomas, one mucinous adenocarcinoma and one poorly differentiated adenocarcinoma. The pathological findings suggest colorectal malignancy with deposited schistosome ova. CONCLUSIONS: Chronic schistosomal infestation has a probable etiological role in promoting genesis of colorectal neoplasms.

[Progress in researches of molecular mechanism of schistosome cercariae infection].

Schistosome cercariae must penetrate skin as an initial step to successfully infect the final host. Proteolytic enzymes secreted from the acetabular glands of cercariae contribute significantly to the invasion process. Nowadays, the researches of molecular mechanism of schistosome infection mainly focus on the cercarial secretions including serine protease and cysteine protease. Previous researches already showed that Schistosoma mansoni penetrates the skin mainly depend on cercarial elastease secreted by cercariae while Schistosoma japonicum penetrates the skin chiefly by cathepsin B2. The illustration of molecular mechanism of schistosome cecariae infection will accelerate the identification of novel vaccines and drug targets.

Cerebral Schistosomiasis: case report and review of literature

Schistosomiasis is an infection caused by trematodes (flatworms from the phylum Platyhelminthes), which are acquired transcutaneously by swimming in contaminated waters. The central nervous system (CNS) schistosomiasis is a rare presentation of the disease. Brain infection to S. Mansoni has been rarely reported, in anedoctal fashion. It should be recognized early, since it disposes a specific treatment, and this treatment may prevent neurological deterioration. A high index of suspicion is necessary, mainly in patients coming from endemic areas, with brain or spinal cord lesions associated with eosinophilia and inflammatory CSF. Finding eggs from schistosoma into excrements or CNS biopsy confirms the diagnosis. We describe a 35-year old Brazilian man, harboring an isolated brain infection to S. mansoni.

Schistosomiasis among recreational users of Upper Nile River, Uganda, 2007.

After recreational exposure to river water in Uganda, 12 (17%) of 69 persons had evidence of schistosome infection. Eighteen percent self-medicated with praziquantel prophylaxis immediately after exposure, which was not appropriate. Travelers to schistosomiasis-endemic areas should consult a travel medicine physician.

Esquistossomose: quebrando o ciclo / Schistosomiasis: breaking the Cycle

O combate à esquistossomose esbarra nas dificuldades geradas pelas condições sanitárias a que muitas pessoas estão expostas, especialmente na região nordeste, devido à desigualdade social que ainda persiste no Brasil. Gravado na região metropolitana de Recife e Cabo de Santo Agostinho/PE, os principais objetivos deste vídeo são: oferecer aos profissionais do Sistema Único de Saúde (SUS) uma visão ampliada sobre a doença; contribuir para o conhecimento do seu ciclo; e orientar quanto ao reconhecimento do agente etiológico, bem como os fatores que mantêm a transmissão da doença.

Trombose venosa mesentérica após desconexão ázigo-portal para o tratamento de varizes esofágicas hemorrágicas na esquistossomose mansônica / Mesenteric venous thrombosis following porta-azygous disconnection for the treatment of bleeding esophageal varices in mansonian schistosomiasis

A trombose venose mesentérica é definida pela presença de trombo no sistema venoso mesentérico com infarto intestinal, independentemente do grau de severidade. Pode ser primária ou secundária aos fatores de risco como procedimeto cirúrgico abdominal...(aU)

Background - Mesenteric venous thrombosis following surgical treatment for portal hypertensionis a splenectomy. Case report - A male patient with schistosomiasis presenting with previous history of upper digestive bleeding underwent porta-azygous disconnecction...

Undiagnosed and potentially lethal parasite infections among immigrants and refugees in Australia.

Intestinal parasite infections are a major cause of ill health in many resource-poor countries. This study compares the types and rates of these infections and their risk factors in recently arrived and long-term immigrants in Australia. Cross-sectional surveys of 127 East African and 234 Cambodian immigrants and refugees were undertaken in 2000 and 2002, respectively, to assess the burden of intestinal parasites and collect demographic information. Serum samples were assessed for eosinophilia and Strongyloides stercoralis and Schistosoma antibodies, and feces examined for ova, cysts, and parasites. Intestinal parasites were identified in 77/117 fecal samples from East African and in 25/204 samples collected from Cambodian participants. Eleven percent (14/124) of East Africans and 42% (97/230) of Cambodians had positive or equivocal serology for S stercoralis. Schistosoma serology was positive or equivocal in 15% (19/124) of East African participants. Potentially serious intestinal parasite infections are common among recent and longer term immigrants despite multiple visits to health care providers. Immigrants and refugees from high-risk countries would benefit from comprehensive health checks soon after resettlement.

Localized papular cutaneous schistosomiasis: two cases in travellers.

Schistosomiasis is endemic in many parts of the tropics and subtropics with an estimated 200 million people, at least, infected worldwide. The symptoms and signs of vesical and gastrointestinal forms are readily recognized but ectopic forms are rare even in endemic areas and present a greater diagnostic challenge, particularly when they are encountered in nontropical climes. We now report two cases of cutaneous schistosomiasis presenting in Edinburgh with subtle, but remarkably similar, skin lesions.

Infecciones tropicales en viajeros a Latinoamérica: parte II / Tropical diseases in travelers to Latin America: part II

Las infecciones permanecen como una de las más importantes causas de morbilidad entre los viajeros. Los países de América Latina son uno de los puntos de destino más importantes. Las dos enfermedades de mayor frecuencia son malaria y diarrea del viajero; sin embargo, Latinoamérica es aún un importante lugar de transmisión de fiebre amarilla, dengue, leishmaniasis, hepatitis por virus A, hepatitis por virus B y enfermedades de transmisión sexual. Alrededor del 7 por ciento de los casos de malaria en el viajero en todo el mundo, se adquirieron en Sudamérica y 40 a 60 por ciento de ellos son causados por Plasmodium falciparum. Se deben suministrar a los viajeros recomendaciones adecuadas de vacunación, quimioprofilaxis y medidas de protección individual, orientadas a sus lugares de destino. Un problema interesante de discutir es la enfermedad en el viajero que retorna a casa

Encephalopathy after distal splenorenal shunt in schistosomiasis: surgical treatment by ligation of collateral circulation

A anastomose esplenorenal distal e a melhor alternativa para a prevençäo da hemorragia em esquistossomoticos que sangram devido hipertensäo portal. Baseado na experiência anastomose esplenorenal distal de que apenas pequeno grupo destes pacientes desenvolve encefalopatia portosistemica no pós-operatorio da anastomose esplenorenal distal...

Schistosomiasis as a predisposing factor to veno-occlusive disease of the liver following allogeneic bone marrow transplantation.

Among 89 allogeneic bone marrow transplant recipients, veno-occlusive disease of the liver (VOD) was diagnosed in 10 patients (11.2%). All cases (n = 5) with schistosomal hepatic periportal fibrosis detected by pretransplant ultrasonography, developed severe fatal VOD in spite of normal initial liver functions and absence of portal hypertension. The incidence of VOD among patients without previous schistosomal contact was 5.95% (5/84). The relative risk to develop VOD was calculated to be 16.8-fold higher in patients with previous schistosomiasis. Schistosomal hepatic periportal fibrosis may thus be added to the known risk factors predisposing to the development of VOD in allogeneic transplant recipients.

Schistosomiasis and nutritional myopathy in a Brazilian tapir (Tapirus terrestris).

Gross lesions suggestive of severe hepatoenteropathy and myopathy were noted in a 4.5-yr-old Brazilian tapir (Tapirus terrestris) from a zoo in Michigan (USA). The major microscopic lesions were granulomatous hepatitis and hemorrhagic enteritis associated with non-operculated eggs compatible with those of the Schistosomatidae (Digenea). Skeletal muscle and tongue contained foci of severe acute myodegeneration and necrosis. The hepatic vitamin E value of 1.3 ppm dry weight was considered critically low.

Fluxo sanguíneo da veia ázigos na esquistossomose hepatesplênica: ação do propranol / Blood flow azygos vein blood flow in hepatosplenic schistosomiasis: action propranol

Estudaram-se catorze pacientes com esquistossomose hepatesplênica, que haviam apresentado, pelo menos, um episódio de hemorragia digestiva associada á ruptura de varizes de esôfago. Todos os casos permaneceram em regime de internação hospitalar durante o periodo de estudo. Estavam em boas condições gerais e hemodinamicamente estáveis. O bloqueio beta-adrenérgico foi obtido com a administração de propranolol por via oral com doses que variaram de 120 a 1320 mg/dia. e valor médio de 571.43 mg. O beta-bloqueio foi definido pela redução da freqliência cardiaca em repouso no leito (deitado), entre 20 e 25%, ou pela hipotensão postural maior que 5 mm.Hg na pressão diastolica. Observou-se que, além da variação dos parâmetros que definiram o bloqueio, ocorreu, também, redução significativa da pressão arterial sistólica com o paciente deitado (7.80%), bem como em posição deppé (9.54%), depois da obtenção do bloqueio beta-adrenérgico. Notou-se, ainda, redução significativa da freqüência cardiaca em posiçâo em pé (22.77%) . Ao contrário, não se constatou variação significativa da pressão arterial diastolica. A dose da droga necessária para a obtenção do bloqueio foi designada como "dose de bloqueio". Em seguida a caracterizaçào desta, realizou-se a curva de decaimento sérico do propranolol, sendo que as dosagens foram realizadas por método fluorimétrico. Determinou-se, portanto, o nível sérico máximo do medicamento e, conseqüentemente, o intervalo de tempo entre a 90 administração e o nivel de pico. O propranolol foi 5suspenso por um intervalo de tempo mínimo de 48 horas, e o paciente encaminhado para uma avaliação hemodinâmico-angiográfica. Nesta avaliação, determinou-se o fluxo sangüineo da veia ázigos verificando-se valor médio basal de 374.76+124.31 ml/min. Observou-se reduçâo média deste fluxo...