Case Report: Disseminated Cysticercosis due to Intentional Ingestion of Parasitic Worm Eggs for Weight Loss.

A 20-year-old female resident of Beijing intended to consume the eggs of the parasitic worm, Taenia saginata, for weight loss; however, she apparently inadvertently ingested Taenia solium (pork tapeworm) eggs, which resulted in disseminated cysticercosis. Cysticerci developed in the brain, tongue, muscles, liver, peritoneum, and subcutaneous tissues. She was administered oral albendazole and praziquantel. After four 10-day courses of treatment, most of the cysts disappeared and she recovered. After 3 years, the patient remains in good health.

Immune signatures of pathogenesis in the peritoneal compartment during early infection of sheep with Fasciola hepatica.

Immune signatures of sheep acutely-infected with Fasciola hepatica, an important pathogen of livestock and humans were analysed within the peritoneal compartment to investigate early infection. Within the peritoneum, F. hepatica antibodies coincided with an intense innate and adaptive cellular immune response, with infiltrating leukocytes and a marked eosinophilia (49%). However, while cytokine qPCR analysis revealed IL-10, IL-12, IL-13, IL-23 and TGFß were elevated, these were not statistically different at 18 days post-infection compared to uninfected animals indicating that the immune response is muted and not yet skewed to a Th2 type response that is associated with chronic disease. Proteomic analysis of the peritoneal fluid identified infection-related proteins, including several structural proteins derived from the liver extracellular matrix, connective tissue and epithelium, and proteins related to the immune system. Periostin and vascular cell adhesion protein 1 (VCAM-1), molecules that mediate leukocyte infiltration and are associated with inflammatory disorders involving marked eosinophilia (e.g. asthma), were particularly elevated in the peritoneum. Immuno-histochemical studies indicated that the source of periostin and VCAM-1 was the inflamed sheep liver tissue. This study has revealed previously unknown aspects of the immunology and pathogenesis associated with acute fascioliasis in the peritoneum and liver.

First molecular evidence of the simultaneous human infection with two species of Echinococcus granulosus sensu lato: Echinococcus granulosus sensu stricto and Echinococcus canadensis.

Cystic echinococcosis is a widespread zoonotic parasitic disease especially in Tunisia which is one of the most endemic countries in the Mediterranean area. The etiological agent, Echinococcus granulosus sensu lato, implies dogs and other canids as definitive hosts and different herbivore species as intermediate hosts. Human contamination occurs during the consumption of parasite eggs passed in the environment through canid feces. Hydatid cysts coming from a child operated for multiple echinococcosis were collected and analyzed in order to genotype and to obtain some epidemiological molecular information. Three targets, ribosomal DNA ITS1 fragment, NADH dehydrogenase subunit 1 (nad1), and mitochondrial cytochrome c oxydase subunit 1 (CO1) genes, were amplified and analyzed by RFLP and sequencing approach. This study presents the first worldwide report in human of a simultaneous infection with Echinococcus granulosus sensu stricto (genotype G1) and Echinococcus canadensis (genotype G6) species. This is also the first report of the presence of E. canadensis in the Tunisian population which argues in favor of a greater importance of this species in human infestation in Tunisia than previously believed.

Extraintestinal oxyuriasis - report of three cases and review of literature.

Extraintestinal oxyuriasis, in our experience with three affected women of fertile age, presented itself as a solitary fibrotic nodular lesion, with a varying location. The sites of location were: parietal peritoneum, serous surface of the uterus and wall of the uterine tube. The size of the nodules was 5 to 10 mm. Histologically, the lesions were hypocellular fibrotic nodules with a variable amount of neutrophils and amorphous eosinophilic material in the center, harbouring eggs of the parasite and remnants of pinworm cuticle. All three lesions were asymptomatic, only being discovered incidentally during the operations for unrelated conditions. Their peroperative recovery by a surgeon did not alter the course of surgery. These findings document the ability of pinworms to migrate into the abdominal cavity via the female genital tract.

Case report: First confirmed case of canine peritoneal larval cestodiasis caused by Mesocestoides vogae (syn. M. corti) in Japan.

Canine peritoneal larval cestodiasis (CPLC) is an unusual parasitic disease in dogs that is caused by asexual proliferation of larval Mesocestoides. A 12 year-old spayed Shetland sheepdog with abdominal distension was referred to the Animal Medical Center at Nihon University, Japan. The presence of ascites was confirmed by abdominal ultrasonography and X-ray imaging. In addition, a number of parasites were observed in the ascitic fluid collected by abdominal paracentesis. Each of the whitish colored parasites was less than 1mm in size. The parasites were morphologically identified as Mesocestoides sp. tetrathyridia. The parasites had four suckers and calcareous corpuscles, but no hooks or rostellum. Mitochondrial (mt) 12S rDNA and mt cytochrome c oxidase subunit 1 DNA amplified from the tetrathyridia were used for molecular identification to species level. DNA sequence analysis showed that the tetrathyridia shared more than 99% identity with M. vogae (syn. M. corti) for each gene. The patient was treated with a standard dose (5mg/kg) of praziquantel, which was administered subcutaneously twice at an interval of 14 days. This resulted in successful deworming. This is the first case that CPLC was diagnosed in a dog that had never been taken outside of Japan, indicating that M. vogae is distributed in this country.

Peritoneal manifestations of fascioliasis on CT images: a new observation.

PURPOSE: To describe peritoneal manifestations of fascioliasis on CT. MATERIALS AND METHODS: We reviewed CT images in 31 patients with fascioliasis confirmed by enzyme-linked immunosorbent assay (ELISA) (n = 24) or surgery (n = 7). Image analyses were performed to identify hepatic, biliary, and peritoneal abnormalities. RESULTS: Hepatic abnormalities were seen in 28 (90.3 %) of the 31 patients. The most common finding was caves sign, which was present in 25 (80.1 %) patients. Three patients (9.7 %) presented with biliary abnormalities exhibiting dilatation and enhancing wall thickening of the bile duct, wall thickening of the gallbladder, and elongated structures in the bile duct or gallbladder. Peritoneal abnormalities were seen in 14 (45.2 %) of the 31 patients. The most common peritoneal abnormality was mesenteric or omental infiltration, which was seen in 9 (29.0 %) patients. Other peritoneal findings included lymph node enlargement (n = 7), ascites (n = 7), thickening of ligamentum teres (n = 2), and peritoneal mass (n = 2). CONCLUSION: Peritoneal manifestations of fascioliasis are relatively common, and CT findings include mesenteric or omental infiltration, lymph node enlargement, ascites, thickening of the ligamentum teres, and peritoneal masses.

Parasitic infection improves survival from septic peritonitis by enhancing mast cell responses to bacteria in mice.

Mammals are serially infected with a variety of microorganisms, including bacteria and parasites. Each infection reprograms the immune system's responses to re-exposure and potentially alters responses to first-time infection by different microorganisms. To examine whether infection with a metazoan parasite modulates host responses to subsequent bacterial infection, mice were infected with the hookworm-like intestinal nematode Nippostrongylus brasiliensis, followed in 2-4 weeks by peritoneal injection of the pathogenic bacterium Klebsiella pneumoniae. Survival from Klebsiella peritonitis two weeks after parasite infection was better in Nippostrongylus-infected animals than in unparasitized mice, with Nippostrongylus-infected mice having fewer peritoneal bacteria, more neutrophils, and higher levels of protective interleukin 6. The improved survival of Nippostrongylus-infected mice depends on IL-4 because the survival benefit is lost in mice lacking IL-4. Because mast cells protect mice from Klebsiella peritonitis, we examined responses in mast cell-deficient Kit(W-sh)/Kit(W-sh) mice, in which parasitosis failed to improve survival from Klebsiella peritonitis. However, adoptive transfer of cultured mast cells to Kit(W-sh)/Kit(W-sh) mice restored survival benefits of parasitosis. These results show that recent infection with Nippostrongylus brasiliensis protects mice from Klebsiella peritonitis by modulating mast cell contributions to host defense, and suggest more generally that parasitosis can yield survival advantages to a bacterially infected host.

Production of experimental hydatid cyst in the eye, peritoneum and liver of BALB/c mice.

As the main treatment for this infection is surgery, the surgery team personnel are at the risk of the protoscoleces released from the hydatid cysts (HC) of patients. The first goal of this study was to determine the probability of the production of ocular HC in mice due to the fluid of the aspirated protoscoleces from the sheep liver with HC. The second goal of this study was to produce HC in the peritoneum and liver, in order to gather more information for future studies on hepatic and peritoneal HC treatment procedures. For the first goal of this study, different concentrations of protoscoleces were prepared and injected into the eyes of 60 mice. After 20 weeks, 10 of the 60 mice of this group died. The remaining 50 mice were examined by a surgeon under the anesthesia. There weren't any symptoms of HC in the eyes and around it. For the second goal, 39 new mice were separated into three sub groups and 0.5 ml of protoscolex solution was injected intraperitoneally. After 20 weeks, they were anesthetized and their peritoneum, intestines and liver were examined. HC was seen in the peritoneum and liver of 6 mice.

New data on Henneguya pellis (Myxozoa: Myxobolidae), a parasite of blue catfish Ictalurus furcatus.

The original description of Henneguya pellis, a myxozoan parasitizing blue catfish Ictalurus furcatus, is supplemented with new data on histopathology, spore morphology, and 18S small subunit (SSU) ribosomal DNA (rDNA) sequence. Plasmodia presented as both internal and external, raised, cyst-like lesions on the body wall of the peritoneal cavity and on the skin. The cysts contained numerous elongate, lanceolate myxospores, flattened parallel to the suture line. The spore body was 14.8 ± 1.1 µm (range 13.0-17.1) long and 4.8 ± 0.8 µm (range 4.0-7.4) wide in frontal view. The caudal appendages were 77.7 ± 8.8 (range 57.4-96.4) in length. There were 2 pyriform polar capsules, unequal in length, with the longer capsule measuring 7.2 ± 0.6 µm (range 6.2-8.4) in length and the shorter capsule measuring 6.5 ± 0.5 µm (range 5.5-8.0). The polar capsules were not significantly different in width, measuring 1.7 ± 0.2 µm (range 1.4-1.9). There were 8 turns in the polar filament coil. The total length of the spore was 92.5 ± 9.2 µm (range 73.3-113.5). Spore morphology and site of development are similar to that of Henneguya sutherlandi from channel catfish; however, 18S rDNA sequence data support previous findings that identify H. pellis and H. sutherlandi as 2 distinct species.

[The first case of human alveolar Echinococcosis in Hungary]. / A humán Echinococcus multilocularis infectio elso hazai esete.

Infection caused by Echinococcus multilocularis is a rare helminthiasis, human cases have not been diagnosed in Hungary until now. The endemic region is Central Europe; the occurrence of this infection has been reported from most of the neighbouring countries; however, E. multilocularis has been found in the red fox population in Hungary. Summarizing the recent knowledge concerning epidemiological, clinical patterns and therapeutic options, the authors describe the first Hungarian case of alveolar echinococcosis. In the presence of appropriate clinical findings, the possibility of this rare infection has to be considered in the differential diagnosis of infiltrative hepatic lesions.

Peritoneal manifestations of parasitic infection.

The purpose of this study was to describe of peritoneal manifestations of parasitic infection at CT. A broad spectrum of CT findings can be seen in the peritoneal cavity, including a varying degree of omental or mesenteric infiltration, single or multiple peritoneal mass or nodule, and peritoneal thickening or stranding. Recognition of these findings are crucial for establish an early diagnosis and helps avoid unnecessary surgery.

Hydatid hepatic cysts rupture into the biliary tract, the peritoneal cavity, the thoracic cavity and the hepatic subcapsular space: specific computed tomography findings.

BACKGROUND: This study attempts to demonstrate the role of computed tomography in the diagnosis of hepatic hydatid cyst rupture based on specific imaging findings and to propose combinations of the imaging findings diagnostic for specific types of rupture. METHODS: Eleven patients were studied with computed tomography of the abdomen, with 4-8 mm slice thickness, after the oral administration of contrast material and intravenous contrast material in 6 cases. RESULTS: Based on a combination of imaging findings the types of hepatic hydatid cyst rupture were: intrabiliary rupture in 7 patients, intraperitoneal rupture in 1 patient, intrathoracic rupture in 1 patient, hepatic subcapsular rupture in 2 patients. Structural deformity of the cyst was present in all cases, combined with: dilatation of the intrahepatic bile ducts (intrabiliary rupture); intraperitoneal fluid collections with diffuse haziness and stranding of the mesenteric fat (intraperitoneal rupture); an inhomogeneous lesion in the thorax with ipsilateral pleural effusion (intrathoracic rupture); a hydatid cyst located peripherally, with discontinuity of its adjacent to the hepatic capsule wall and subcapsular fluid collection (subcapsular rupture). The imaging findings were surgically and pathologically confirmed. CONCLUSIONS: Using combinations of specific imaging findings we correctly diagnosed the type of hepatic hydatid cyst rupture in all cases.

Acute but not chronic macrophage recruitment in filarial infections in mice is dependent on C-C chemokine ligand 2.

Macrophages play an important role in the formation of granulomas and the clearance of Brugia pahangi infections in mice. However, the factors responsible for the recruitment of these cells to the site of infection are not known. In this study we examined the role of the C-C chemokine ligand 2 (CCL2; also known as macrophage chemotactic factor - MCP1) in macrophage recruitment in intraperitoneal infections with B. pahangi. We observed that CCL2 was expressed by peritoneal exudate cells and was present in the sera of wild-type mice. Serum levels of CCL2 peaked twice during the immune response, once during the early, acute phase and again during the late, chronic phase. To further elucidate the role of this chemokine in the anti-filarial immune response, we compared CCL2 deficient (CCL2(-/-)) mice to wild-type mice. We observed that macrophage recruitment was impaired only during the acute phase in the former. While macrophage recruitment was unaffected during the chronic phase, increased accumulation of B and T lymphocytes was seen in these mice. We further report that larval clearance and the in vitro adhesion of PECs to larvae were unimpaired in these mice.

Critical roles for excretory-secretory cysteine proteases during tissue invasion of Paragonimus westermani newly excysted metacercariae.

Paragonimus westermani is a trematode parasite, which causes pulmonary and/or extrapulmonary granulomatous disease in humans. Successful invasion of the host tissue is critical for the survival of this tissue-invasive parasite. The enzymatic hydrolysis of host proteins is clearly a prerequisite of this process. In this study, we have investigated the functional roles of the excretory-secretory cysteine proteases of P. westermani newly excysted metacercariae (PwNEM) in tissue invasion. The 27 and 28 kDa enzymes (PwMc27 and PwMc28) purified from PwNEM excretory-secretory products (ESP), preferentially degraded fibrillar proteins, but not globular proteins. PwMc28 significantly facilitated the invasion of PwNEM into mouse peritoneum, whereas a diffusible cysteine protease inhibitor, trans-epoxysuccinyl-L-leuciloamido-(4-guanidino) butane (E-64) inhibited this process dose-dependently. Two distinct isoforms of PwMc28 (PwMc28a and PwMc28b), which exhibited two amino acid differences in their mature domains, were identified by tandem mass spectrometry and sequence analysis. Both enzymes were localized at the tegument on the anterior border and on the oral sucker, which suggests excretion-secretion via exocytosis or via the excretory canal network. The mRNA transcripts of PwMc28a and b were expressed abundantly during the active invasion/migration through the host's tissues, suggesting their relevant function to tissue invasion/migration in the definitive host.

A rare complication of the hepatic hydatid cyst: intraperitoneal perforation without anaphylaxis.

The hepatic hydatid cyst can lead to serious complications as a perforation into the biliary system or into the respiratory tract. The perforation into the peritoneal cavity can become dramatic, characterized by acute abdomen, usually with anaphylaxis. We recently treated a patient with a liver hydatid cyst perforated into the abdominal cavity. Computed tomography was a useful diagnostic tool, and the patient underwent emergency surgery. At laparotomy, 8 liters of hydatid liquid with floating daughter cysts and purulent material was found. The peritoneal cavity was washed with hypertonic solution, the hepatic cyst with daughter cysts. was removed, and a subtotal pericystectomy was performed. The critical clinical picture did not allow a cholecystectomy or a probe of the common hepatic duct to verify a biliary leakage. A biliary fistula appeared after 4 days and was successfully treated by endoscopic sphincterotomy. No anaphylactic phenomena were seen, probably because the great quantity of purulent material caused inactivity of the allergic component.

Accidental drainage of a cerebral hydatid cyst into the peritoneal cavity.

Intracranial hydatidosis is more common in children than in adults. The most severe complication is anaphylactic response after direct rupture into the subarachnoid spaces. We report a case of brain hydatid cyst that was accidentally drained into the peritoneal cavity and was not complicated by an anaphylactic response or dissemination.

Remote sensing of intraperitoneal parasitism by the host's brain: regional changes of c-fos gene expression in the brain of feminized cysticercotic male mice.

Experimental intraperitoneal Taenia crassiceps cysticercosis in mice exhibits distinct genetical, immunological and endocrinological features possibly resulting from the complex interactive network of their physiological systems. Very notable is the tendency of parasites to grow faster in hosts of the female sex. It is also remarkable in the feminization process that the infection induces in chronically infected male mice, characterized by their estrogenization, deandrogenization and loss of sexual and aggressive patterns of behaviour. The proto-oncogene c-fos is a sex steroid-regulated transcription factor gene, expressed basally and upon stimulation by many organisms. In the CNS of rodents, c-fos is found expressed in association to sexual stimulation and to various immunological and stressful events. Hence, we suspected that changes in c-fos expression in the brain could be involved in the feminization of the infected male mice. Indeed, it was found that c-fos expression increased at different times during infection in the hypothalamus, hippocampus, less so in the preoptic area and cortex, and not in several other organs. The significant and distinctive regional changes of c-fos in the CNS of infected mice indicate that the brain of the host senses intraperitoneal cysticercosis and may also announce its active participation in the regulation of the host-parasite relationship. Possibly, the host's CNS activity is involved in the network that regulates the estrogenization and deandrogenization observed in the chronically infected male mice, as well as in the behavioural and immunological peculiarities observed in this parasitic infection.

Experimental conversion of virulent RH Toxoplasma gondii tachyzoites in vitro.

We aimed to induce conversion of RH-stain tachyzoites to bradyzoites by changing the pH of the culture medium. Alkalization of the medium to pH 8 induced morphological changes in the cultured tachyzoites. The majority of the organism increased in size and changed from a regular crescent shape to a rounded or ovoid shape. Cyst-like structures were formed. Using a computerized image analyser, significant differences in the size of the whole organisms and in their nuclei were observed compared to the control group. The converted organisms also showed significant differences from the control group by quantitative DNA analysis, and did not infect mice.