Neurocysticercosis in Children.

Neurocysticercosis is one of the most common parasitic infections in the central nervous system in children. The usual clinical manifestation is new-onset focal seizure. However, there are other multiple clinical manifestations, such as increased intracranial pressure, meningoencephalitis, spinal cord syndrome, and blindness. The diagnosis needs high index of suspicion with clinical history, physical examination, neuroimaging, and immunologic studies. Recent advances in neuroimaging and serology facilitate the accurate diagnosis. Management of neurocysticercosis should focus on critical symptoms first, such as the use of antiepileptic drugs and medical or surgical therapy for increased intracranial pressure.

Central nervous signs, blindness and cerebral vermicosis in free-ranging peregrine falcons (Falco peregrinus) associated with aberrant larval migrations.

Four free-ranging peregrine falcons (Falco peregrinus) were submitted with a history of unilateral or bilateral blindness and central nervous signs to a veterinary clinic in Germany. There were no indications of trauma or ocular disease. Likewise, other differential diagnoses for CNS signs were ruled out within the diagnostic process. The clinical diagnostic panel in live falcons included general examination, radiography, endoscopy, hematology, ophthalmoscopy and parasitological examination of the feces, blood gas analysis and blood chemistry as well as computed tomography, and magnetic resonance imaging (MRI). A complete pathological and histopathological examination was performed post-mortem. The only common finding in all birds was an infection with the nematode parasite Serratospiculum tendo. The parasite was confirmed morphologically and via PCR. In two falcons intracerebral vermicoses was suspected in MRI and confirmed in subsequent histopathology, but molecular biological identification of the parasite species failed from brain tissue. Until today, S. tendo had been reported to affect the respiratory system, the liver and different parts of the gastrointestinal tract and to cause cachexia, inappetence, regurgitation, dyspnea and general signs of illness such as lethargy, poor plumage, and reduced reproduction. Our findings indicate that aberrant migration should be considered as cause for CNS signs in falcons. As S. tendo might be a possible cause for this, CNS signs might be included in the list of clinical signs of serratospiculiasis in falcons.

The surgery of intra-orbital hydatid cyst: a case report and literature review.

Intra-orbital hydatid cyst is a very rare pathological entity that affects children and the young adults; it is secondary to the development in the orbit of the echinococcus granulosis tapeworm. Its frequency does not exceed 1% of all cases of hydatid disease. Clinical presentation of intra-orbital hydatid cyst is dominated by proptosis and a decrease in visual acuity, complete surgical excision is difficult, evolution is generally better when the treatment is early before the installation of irreversible optic atrophy. We report one case of a 3 years old girl operated for right intra-orbital hydatid cyst who presented with proptosis and blindness. Complete removal was difficult and puncture of the cyst was performed followed by excision of its membrane with good post-operative results. We also discuss the different epidemiological, clinical, radiological and therapeutic aspects of intra-orbital hydatid cyst and a review of literature of this rare pathology.

Diffuse unilateral subacute neuroretinitis in a healthy Korean male: the first case report in Korea.

A 52-yr-old male was referred for progressive visual loss in the left eye. The decimal best-corrected visual acuity (BCVA) was 0.01. Fundus examination revealed diffuse retinal pigment epithelial degeneration, focal yellow-white, infiltrative subretinal lesion with fuzzy border and a live nematode within the retina. Diffuse unilateral subacute neuroretinitis (DUSN) was diagnosed and the direct laser photocoagulation was performed to destroy the live nematode. During eight months after treatment, BCVA gradually improved to 0.2 along with the gradual restoration of outer retinal layers on SD-OCT. We report on the first case of DUSN in Korea. DUSN should be included in the differential diagnosis of unexplained unilateral visual loss in otherwise healthy subjects.

Ocular cysticercosis with intermittent blindness.

We report this peculiar case of ocular cysticercosis with intermittent blindness which is never reported to our knowledge. This case highlights use of Ultrasound for examination of the posterior segment of eye globe. In limited facilities Ultrasound is the main modality to reach the diagnosis. We also wish to enforce the point that in endemic regions and in young population primary cysticercosis and its complications must be kept in differentials of cystic mass or calcified mass, as in this case, we have seen both the stages of cysticercosis progression.

Failure of chemotherapy in the first reported cases of Acanthamoeba keratitis in Pakistan.

Acanthamoeba keratitis is a painful and progressive infection of the cornea that can result in loss of vision. Here, for the first time in Pakistan, we report two cases of Acanthamoeba keratitis. The first patient was a 37-year-old female who presented with severe itching, redness, pain, along with loss of vision. The patient was a regular soft contact lens wearer. The second patient was a 25-year-old female who had been using soft contact lenses for the past two years. She presented with a burning sensation and extreme pain, along with loss of vision. Both patients were treated for a possible microbial keratitis with topical moxifloxacin hydrochloride drops, vancomycin drops, propamidine isethionate ointment, amphotericin B drops, and amikacin drops. However, the response was inadequate and both patients were referred for corneal transplant. Acanthamoeba castellanii was isolated by placing contact lenses and contact lens cases on non-nutrient agar plates containing a lawn of non-invasive Escherichia coli K-12 HB101 bacteria. The polymerase chain reaction (PCR) using genus-specific probes confirmed the identity of Acanthamoeba spp., whereas the morphological characteristics of trophozoites and cysts were suggestive of A. castellanii in both cases. With growing use of contact lenses for vision correction/cosmetic use coupled with sub-standard lens care in this region and the possibility of non-contact lens-associated Acanthamoeba keratitis, a need for increased awareness of this sight-threatening infection is discussed further.

Lymphatic filariasis and onchocerciasis.

Lymphatic filariasis and onchocerciasis are parasitic helminth diseases that constitute a serious public health issue in tropical regions. The filarial nematodes that cause these diseases are transmitted by blood-feeding insects and produce chronic and long-term infection through suppression of host immunity. Disease pathogenesis is linked to host inflammation invoked by the death of the parasite, causing hydrocoele, lymphoedema, and elephantiasis in lymphatic filariasis, and skin disease and blindness in onchocerciasis. Most filarial species that infect people co-exist in mutualistic symbiosis with Wolbachia bacteria, which are essential for growth, development, and survival of their nematode hosts. These endosymbionts contribute to inflammatory disease pathogenesis and are a target for doxycycline therapy, which delivers macrofilaricidal activity, improves pathological outcomes, and is effective as monotherapy. Drugs to treat filariasis include diethylcarbamazine, ivermectin, and albendazole, which are used mostly in combination to reduce microfilariae in blood (lymphatic filariasis) and skin (onchocerciasis). Global programmes for control and elimination have been developed to provide sustained delivery of drugs to affected communities to interrupt transmission of disease and ultimately eliminate this burden on public health.

Geomapping of trematode-induced granulomatous anterior uveitis - a newly identified cause of blindness among children in the Pudukkottai district of the Tamil Nadu State, India.

There is evidence that a specific type of allergic conjunctive-uveal granuloma reported from South India could be due to infection by a trematode parasite. In these patients, the histopathological examination of the eye reveals a zonal granulomatous inflammation with purulent material including structures with a distinct double-layer tegument, typical for a trematode worm. To investigate this further, medical records describing such cases in the Pudukkottai district, Tamil Nadu State, India, covering the period 2001-2005, were collected. Since trematodes require a snail intermediate host for completing the life cycle, ponds frequently used for bathing in the area were inspected to identify a possible culprit. The hypothesis that ponds with snail habitats could be the source of infection was supported by the finding of a positive correlation between the geographical distribution of patients' residencies and the location of such ponds. Geographic information systems were used to study the spatial distribution of ponds and patients, while satellite- based remote sensing was applied to attempt finding a parameter characteristic for ponds with snail habitats that could facilitate risk-identification over larger areas. It was found that ponds carrying risk could be differentiated from others through analysis of their spectral surface properties. This pond classification approach, confirmed by field visits, could thus become a useful tool for the location of snail habitats constituting risk as predicted.

Ocular parasitosis: a rare cause of hypertensive uveitis.

A middle-aged Asian gentleman presented with four weeks' history of recurrent redness, pain and deterioration of vision in his right eye. He was diagnosed with chronic, unilateral, granulomatous hypertensive uveitis. During one of the serial examinations a single, off-white, extremely motile, thread-like worm about 15 mm long was noted in the anterior chamber. Surgical retrieval of the worm was unsuccessful. The worm disappeared in the eye and was never seen again. Patient suffered from chronic waxing and waning granulomatous inflammation with uncontrolled high intraocular pressure despite treatment. The vision dropped down to no perception of light. Therapeutic success in such patients depends upon early and complete surgical removal of the worm, which could be a real challenge as worms are highly motile and only visible sporadically, as in this case. Ocular parasitosis should be kept in mind as a differential diagnosis in treating non-responsive chronic hypertensive granulomatous inflammation, especially if the patient is of Southeast Asian origin or has recently visited the region.

[Ophthalmic complications in the course of opportunistic infections--part I]. / Zmiany chorobowe aparatu wzrokowego w przebiegu zakazen oportunistycznych--Czesc I.

One of the most important problem of contemporary medicine appears to be constantly increasing number of patients with opportunistic infections. The situation is mainly due to world epidemic of AIDS. The progress in transplantology, huge number of immunocompromised patients during oncological and hematological treatment as well as prolongation of life time in children with congenital immunodeficiencies are successive conditions for the development of opportunistic infection. Pathogens infecting immunocompromised individuals have very low virulence, but in these persons disease is often very severe and potentially lethal. Main agents responsible for opportunistic infections are: Toxoplasma gondii, Cytomegalovirus hominis, Herpes simplex virus, Varicella-zoster virus and fungi. In the paper we describe clinical symptoms, diagnostic methods and therapies of ocular toxoplasmosis and viral infections. Knowledge of diagnosing methods and treatment of opportunistic infections which, when untreated, may quickly lead to vision loss, is necessary in contemporary ophthalmological practice.

Halicephalobus gingivalis (Nematoda) infection in a Grevy's zebra (Equus grevyi).

A 6-yr-old female Grevy's zebra (Equus grevyi) with a disseminated rhabditiform nematode infection is described. Antemortem clinical signs were limited to blindness and abnormal behavior believed to be caused by a recurrent nematode-induced uveitis. Histologic examination of the kidneys, heart, eyes, uterus, and lymph nodes revealed granulomas containing multiple sections of rhabditiform nematodes. Most of the recovered nematodes were larval stages with only a few adult females noted. The adults measured 243-297 microm x 11-16 microm (x = 269 x 14 microm). The distinctive rhabditiform esophagi had corpus:isthmus:bulb proportions of 19:11:5. On the basis of adult morphology, the nematode was identified as Halicephalobus gingivalis. This is the first report of this parasite in a zebra and indicates that this parasitic granulomatous disease should be considered in zebras with neurologic disease.

Trauma ocular por Himenópteros: aspectos clínicos e histopatológicos / Ocular trauma by Himenopteros: clinical and hystopathological aspects

Säo apresentados 3 casos clínicos de trauma ocular por insetos da ordem dos Himenópteros. Tais acidentes säo pouco frequentes em grandes cidades. Os insetos inoculam nos tecidos oculares misturas de substâncias altamente tóxicas, como aminas, peptídeos, enzimas. Todos os casos apresentavam alteraçöes anatômicas e funcionais graves do segmento anterior do olho e foram submetidos a tratamento cirúrgico, tendo o exame anátomo-patológico revelado intensa destruiçäo tecidual da córnea e cristalino. Discutem-se ainda as açöes dos componentes do veneno sobre os tecidos humanos, concluindo-se que o trauma ocular por insetos Himenópteros pode determinar uma baixa acentuada de acuidade visual ou mesmo cegueira definitiva