Human pulmonary dirofilariasis with secondary myocarditis

Abstract Dirofilariasis is a little-known zoonosis, with dogs and cats as definitive hosts. It is caused by nematodes and transmitted by mosquito bites. We report the case of a 67-year-old man with a consumptive syndrome with two subpleural pulmonary opacities. A transthoracic lung biopsy revealed a Dirofilaria worm. Myocardial nuclear magnetic resonance (NMR) demonstrated dilated cardiomyopathy after myocarditis related to dirofilariasis. Human infection is rare and occurs accidentally. The most common radiological alteration is a mainly subpleural coin lesion. Dirofilariasis is a neglected emergent disease and knowledge about it is important for differential diagnoses from neoplastic pulmonary nodules.

Infección pulmonar por Lophomonas sp en una paciente con leucemia mieloide aguda / Lung infection by lophomonas spp. in a female patient with acute myeloid leukemia

RESUMEN Las infecciones por protozoos son prevalentes a nivel mundial, en particular en pacientes inmunosuprimidos. Comunicamos el caso de una paciente procedente de la ciudad de Viña del Mar, Chile, portadora de leucemia mieloide aguda en quiense confirmó una infección por Lophomonas sp. en lavado bronquioalveolar. Se manejó con antibióticos, pero falleció decomplicaciones de su enfermedad de base. Existe poca literatura disponible respecto a este microorganismo. Concluimos que debe considerarse a Lophomonas sp. como posibilidad diagnóstica si se encuentran protozoos en lavados bronquioalveolares de pacientes inmunosuprimidos.

ABSTRACT Protozoic infections are prevalent worldwide, particularly in immunosuppressed patients. We reported the case of a patient from the city of Viña del Mar, Chile, a carrier of acute myeloid leukemia in whom an infection by Lophomonas sp. was confirmed by bronchoalveolar lavage. She was treated with antibiotics but died of complications of the underlying disease. There is little literature available on this microorganism. We conclude that Lophomonas sp. should be considered as a diagnostic possibility if protozoa are found in bronchoalveolar lavage of immunosuppressed patients.

Gastrointestinal and pulmonary nematodes in calves naturally infected in the cities of Botucatu and Manduri, in the Brazilian state of São Paulo / Nematódeos gastrintestinais e pulmonares em bezerros naturalmente infectados nos municípios de Botucatu e Manduri, estado de São Paulo

This study aimed to determine the occurrence of gastrointestinal and pulmonary parasites in calves and to evaluate seasonal and age patterns in parasitism. For this, we used 140 clinically healthy crossbreed calves (two to 12 months old) that belonged to two private farms in the municipalities of Botucatu (n=53) and Manduri (n=87), São Paulo state, Brazil. The calves were monitored for 12 months (from September 2014 to August 2015). Fecal samples were collected directly from the rectum every three months. Fecal egg counts were determined using the modified McMaster technique with a sensitivity of 50 eggs per gram of feces (EPG). Coproculture was performed on pooled samples to identify Strongylida infective larvae. First-stage larvae of Dictyocaulus viviparus were extracted by a modified Baermann method. The data showed non-normal distribution (Shapiro-Wilk) and the nonparametric Kruskall-Wallis test was employed to evaluate the EPG data by seasons and age groups. Dunn's post-test was used for multiple comparisons (P<0.05). The calves from Manduri farm showed significantly higher fecal egg counts (P<0.0001) in the winter when compared to other seasons. At Botucatu farm, young calves (2-3 months old) showed significantly higher EPG than old calves (8-12 months) (P=0.01). The prevalence and overall mean of animals positive for Strongylida type-eggs were 81.1% and 340 in Botucatu, respectively, versus 83.9% and 854 in Manduri, respectively. Furthermore, we found Strongyloides spp., Moniezia spp., and Trichuris spp. eggs and Eimeria spp. oocysts. The prevalent genera in all coprocultures in decreasing order were: Cooperia spp., Haemonchus spp., Oesophagostomum spp., and Trichostrongylus spp. First-stage larvae of Dictyocaulus viviparus were found only in Botucatu farm samples throughout the year, except in spring.(AU)

O objetivo deste estudo foi investigar os parasitas gastrintestinais e pulmonares que acometem bezerros bem como a possível influência de fatores climáticos e da idade no parasitismo. Para isso, durante um período de 12 meses (setembro de 2014 a agosto de 2015), amostras de fezes foram coletadas a cada três meses diretamente da ampola retal de 140 bezerros mestiços (dois a 12 meses de idade), clinicamente saudáveis, pertencentes a duas propriedades leiteiras localizadas nos municípios de Botucatu (n=53) e Manduri (n=87), estado de São Paulo. Realizou-se a contagem de ovos por grama de fezes pela técnica de McMaster modificada com sensibilidade de 50 ovos por grama de fezes (OPG). Coproculturas foram realizadas em pool de amostras para a obtenção das larvas infectantes (L3). Larvas de primeiro estágio de Dictyocaulus viviparus foram recuperadas pela modificação da técnica de Baermann. Os dados não se apresentaram normalmente distribuídos (Shapiro-Wilk), e o teste não paramétrico de Kruskal-Wallis foi utilizado para avaliar os dados de OPG em relação às estações do ano e faixa etária. Para comparações múltiplas, empregou-se o pós-teste de Dunn. Foi verificado que em Manduri, no inverno, houve um aumento significativo (P<0,0001) na contagem de OPG em comparação as demais estações do ano. Em Botucatu, os animais com dois a três meses de idade apresentaram maiores contagens de OPG quando comparados aos animais de oito a 12 meses de idade (P=0,01). A prevalência e a média global de animais positivos para ovos do tipo Strongylida, em Botucatu, foi de 81,1% e 340, respectivamente, e em Manduri foi de 83,9% e 854, respectivamente. Em adição, de maneira geral, foram encontrados ovos de Strongyloides spp., Moniezia spp., Trichuris spp. e oocistos de Eimeria spp. Foram recuperadas, em ordem de prevalência, larvas infectantes de Cooperia spp., Haemonchus spp., Oesophagostomum spp. e Trichostrongylus spp. Larvas de D. viviparus foram recuperadas somente na propriedade de Botucatu durante todo o ano, com exceção da primavera.(AU)

Estrongiloidosis pulmonar / Pulmonary strongyloidiasis

Strongyloidiasis is an infection caused by the parasite Strongyloides stercoralis, which can be asymptomatic and means a high morbidity and mortality in immunocompromised hosts, severe malnutrition and coinfection with HTLV-1 virus. The parasite has the potential to produce and multiply internal autoinfection in humans, thus an hyperinfection can be developed. A case of pulmonary infection by this parasite is presented in this study, infection which advanced into a respiratory failure and required mechanical ventilation and hemodynamic support in an intensive care unit. The standard treatment combined with ivermectin and albendazole was provided, achieving an appropriate response.

La estrongiloidosis es una infección causada por el parásito Strongyloides stercoralis, la cual puede cursar con una alta morbi-mortalidad en pacientes inmunocomprometidos, con desnutrición grave y coinfección con el virus HTLV-1. Se puede desarrollar una hiperinfección, dado que el parásito tiene el potencial de producir una autoinfección interna. Se presenta un caso de infección pulmonar por S. stercoralis que progresó a una falla respiratoria y requirió soporte ventilatorio y hemodinámico en una unidad de cuidados intensivos, suministrándole el tratamiento estándar combinado de ivermectina y albendazol con una respuesta satisfactoria.

Pleural fluid characteristics of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis

BACKGROUND/AIMS: Pleuropulmonary paragonimiasis produces no specific symptoms or radiologic findings, allowing for the possibility of misdiagnosis. We evaluated the specific clinical and pleural fluid features of pleuropulmonary paragonimiasis masquerading as pleural tuberculosis. METHODS: We retrospectively analyzed the clinical and radiologic characteristics of 20 patients diagnosed with pleuropulmonary paragonimiasis between 2001 and 2011. RESULTS: In total, 17 patients presented with respiratory symptoms, including dyspnea (30%), hemoptysis (20%), cough (20%), and pleuritic chest pain (15%). Chest radiographs revealed intrapulmonary parenchymal lesions, including air-space consolidation (30%), nodular opacities (20%), cystic lesions (15%), ground-glass opacities (10%), and pneumothorax (5%). A pleural f luid examination revealed eosinophilia, low glucose levels, and high lactate dehydrogenase (LDH) levels in 87%, 76%, and 88% of the patients, respectively. These traits helped to distinguish pleuropulmonary paragonimiasis from other pleural diseases such as parapneumonic effusion, malignancy, and pleural tuberculosis. CONCLUSIONS: Pleuropulmonary paragonimiasis is often initially misdiagnosed as other pleural diseases. Therefore, it is important to establish the correct diagnosis. In patients with unexplained pleural effusion living in paragonimiasis-endemic areas, pleural fluid obtained by thoracentesis should be examined to distinguish pleuropulmonary paragonimiasis. When marked eosinophilia, high LDH levels, and low glucose levels are identified in pleural fluid, physicians could consider a diagnosis of pleuropulmonary paragonimiasis.

Current status of Paragonimus and paragonimiasis in Ecuador

A review of national and international publications on paragonimiasis in Ecuador, epidemiological records from the Ministry of Public Health and unpublished research data was conducted to summarise the current status of the parasite/disease. The purpose of the review is to educate physicians, policy-makers and health providers on the status of the disease and to stimulate scientific investigators to conduct further research. Paragonimiasis was first diagnosed in Ecuador 94 years ago and it is endemic to both tropical and subtropical regions in 19 of 24 provinces in the Pacific Coast and Amazon regions. Paragonimus mexicanus is the only known species in the country, with the mollusc Aroapyrgus colombiensis and the crabs Moreirocarcinus emarginatus, Hypolobocera chilensis and Hypolobocera aequatorialis being the primary and secondary intermediate hosts, respectively. Recent studies found P. mexicanus metacercariae in Trichodactylus faxoni crabs of the northern Amazon. Chronic pulmonary paragonimiasis is commonly misdiagnosed and treated as tuberculosis and although studies have demonstrated the efficacy of praziquantel and triclabendazole for the treatment of human infections, neither drug is available in Ecuador. Official data recorded from 1978-2007 indicate an annual incidence of 85.5 cases throughout the 19 provinces, with an estimated 17.2% of the population at risk of infection. There are no current data on the incidence/prevalence of infection, nor is there a national control programme.

Pulmonary Toxocariasis Mimicking Invasive Aspergillosis in a Patient with Ulcerative Colitis

A 45-year-old-male who had underlying ulcerative colitis and presented with fever and dry cough. Initially, the patient was considered to have invasive aspergillosis due to a positive galactomannan assay. He was treated with amphotericin B followed by voriconazole. Nevertheless, the patient deteriorated clinically and radiographically. The lung biopsy revealed eosinophilic pneumonia, and ELISA for Toxocara antigen was positive, leading to a diagnosis of pulmonary toxocariasis. After a 10-day treatment course with albendazole and adjunctive steroids, the patient recovered completely without any sequelae. Pulmonary toxocariasis may be considered in patients with subacute or chronic pneumonia unresponsive to antibiotic agents, particularly in cases with eosinophilia.

Bronchopulmonary Infection of Lophomonas blattarum: A Case and Literature Review

Human infections with Lophomonas blattarum are rare. However, the majority of the infections occurred in China, 94.4% (136 cases) of all cases in the world. This infection is difficult to differentiate from other pulmonary infections with similar symptoms. Here we reported a case of L. blattarum infection confirmed by bronchoalveolar lavage fluid smear on the microscopic observations. The patient was a 21-year-old female college student. The previous case which occurred in Chongqing was 20 years ago. We briefly reviewed on this infection reported in the world during the recent 20 years. The epidemiological characteristics, possible diagnostic basis, and treatment of this disease is discussed in order to provide a better understanding of recognition, diagnosis, and treatment of L. blattarum infection.

A Case of Human Pulmonary Dirofilariasis in a 48-Year-Old Korean Man

Dirofilariasis is a rare disease in humans. We report here a case of a 48-year-old male who was diagnosed with pulmonary dirofilariasis in Korea. On chest radiographs, a coin lesion of 1 cm in diameter was shown. Although it looked like a benign inflammatory nodule, malignancy could not be excluded. So, the nodule was resected by video-assisted thoracic surgery. Pathologically, chronic granulomatous inflammation composed of coagulation necrosis with rim of fibrous tissues and granulations was seen. In the center of the necrotic nodules, a degenerating parasitic organism was found. The parasite had prominent internal cuticular ridges and thick cuticle, a well-developed muscle layer, an intestinal tube, and uterine tubules. The parasite was diagnosed as an immature female worm of Dirofilaria immitis. This is the second reported case of human pulmonary dirofilariasis in Korea.

Two cases of pulmonary and pleural sparganosis confirmed by tissue biopsy and immunoserology

Sparganosis in humans is an incidental infection and is known to be associated with eating insufficiently cooked meat of frogs and snakes or drinking unboiled stream water. Although it can involve various internal organs, pulmonary and pleural involvement due to sparganum is rare. Because we recently experienced two cases involving lung parenchyma and pleura that were misdiagnosed as bacterial pneumonia and lung cancer, we herein intend to present them in detail.

A Pulmonary Paragonimiasis Case Mimicking Metastatic Pulmonary Tumor

Pulmonary paragonimiasis is a relatively rare cause of lung disease revealing a wide variety of radiologic findings, such as air-space consolidation, nodules, and cysts. We describe here a case of pulmonary paragonimiasis in a 27-year-old woman who presented with a 2-month history of cough and sputum. Based on chest computed tomography (CT) scans and fluorodeoxyglucose positron emission tomography (FDG-PET) findings, the patient was suspected to have a metastatic lung tumor. However, she was diagnosed as having Paragonimus westermani infection by an immunoserological examination using ELISA. Follow-up chest X-ray and CT scans after chemotherapy with praziquantel showed an obvious improvement. There have been several reported cases of pulmonary paragonimiasis mimicking lung tumors on FDG-PET. However, all of them were suspected as primary lung tumors. To our knowledge, this patient represents the first case of paragonimiasis mimicking metastatic lung disease on FDG-PET CT imaging.

A Case of Pulmonary Paragonimiasis with Involvement of the Abdominal Muscle in a 9-Year-Old Girl

In Korea, many people enjoy eating raw or underkooked freshwater crayfish and crabs which unfortunately may cause paragonimiasis. Here, we describe a case of pulmonary and abdominal paragonimiasis in a 9-year-old girl, who presented with a 1-month history of abdominal pain, especially in the right flank and the right inguinal area, with anorexia. A chest radiograph revealed pleural effusion in both lungs, and her abdominal sonography indicated an inflammatory lesion in the right psoas muscle. Peripheral blood analysis of the patient showed hypereosinophilia (66.0%) and an elevated total serum IgE level (>2,500 IU/ml). The pleural effusion tested by ELISA were also positive for antibodies against paragonimiasis. Her dietary history stated that she had ingested raw freshwater crab, 4 months previously. The diagnosis was pulmonary paragonimiasis accompanied by abdominal muscle involvement. She was improved after 5 cycles of praziquantel treatment and 2 times of pleural effusion drainage. In conclusion, herein, we report a case of pulmonary and abdominal paragonimiasis in a girl who presented with abdominal pain and tenderness in the inguinal area.

Hepato-pulmonary amebiasis: a case report

Infections with Entamoeba histolytica are seen worldwide and are more prevalent in the tropics. About 90 percent of infections are asymptomatic, and the remaining 10 percent produce a spectrum of clinical syndromes, ranging from dysentery to abscesses of the liver or other organs. Extra-intestinal infection by E. histolytica most often involves liver. Pleuro-pulmonary involvement, seen as the second most common extra-intestinal pattern of infection, is frequently associated with amebic liver abscess. Pulmonary amebiasis occurs in about 2-3 percent of patients with invasive amebiasis. We report herein the case of a 45-year-old male presenting with hepato-pulmonary amebiasis. The diagnosis was established from direct examination of sputum, in which trophozoites of E. histolytica were detected, and by serology. Following treatment with metronidazole and chloroquine, the clinical evolution improved significantly. On regular follow-up visits, the patient was asymptomatic. This case report reiterates the need for collaboration between clinicians and microbiologists for timely diagnosis of such infections.

Three Cases of Paragonimiasis in a Family

Paragonimiasis typically results from the consumption of raw or improperly cooked crustacea, especially crabs and crayfish. Although previously endemic in Korea, the prevalence of this disease decreased in the early 1970s because of educational campaigns and fewer intermediate hosts as a result of ecological changes. Recently, we were presented with a family where all members were infected with Paragonimus after ingestion of Kejang (= drunken crab). The mother was hospitalized for general myalgia and weakness first, followed by the father, who was hospitalized for dyspnea 2 month later. After the parents were diagnosed with paragonimiasis, we recommended their daughter to visit our hospital for a checkup, because they all had eaten freshwater crabs soaked in soybean sauce. She complained of generalized myalgia, fever, and pleuritic pain, and was also diagnosed with paragonimiasis. Peripheral blood of the 3 patients revealed hypereosinophilia, and computed tomography (CT) scans of their chests showed pleural effusion. The results of antibody tests by ELISA were positive for paragonimiasis. We report here the case series of familial paragonimiasis in a modern urban city, rather than in a typical endemic area.

Pulmonary, microbiological and hematological changes in Crotalus durissus terrificus (Serpentes, Viperidae) parasitized by nematodes of the genus Rhabdias (Nematoda, Rhabdiasidae) / Alterações Pulmonares, microbiológicas e hematológicas em Crotalus durissus terrificus (Serpentes, Viperidae) parasitadas pelos nematódeos do gênero Rhabdias (Nematoda, Rhabdiasidae)

This study reported the pulmonary, microbiological, and hematological alterations in Crotalus durissus terrificus parasitized by nematodes of the genus Rhabdias. Histological, microbiological, and hematological analysis were performed on parasitized (n=6) and non-parasitized (n=6) snakes. Granulocytic and mononuclear cell infiltrates in the pulmonary parenchyma and epithelium were also observed during the histological analysis of parasitized snakes. Microbiological analysis of parasitized animals revealed the following Gram-negative bacteria: Citrobacter divergens, Burkholderia cepacia, Stenotrophomonas maltophilia, Proteus vulgaris, Enterobacter sakazakii, Enterobacter ammnigenus, Pseudomonas aeruginosa, Pantoea sp. and Providencia rettgeri. In non-parasitized snakes, the following species were identified: B. cepacia, Pseudomonas fluorescens, and Acinetobacter baumanii. Increased levels of plasmatic protein, decreased lymphocyte counts, and normal red blood cell values were observed in parasitized animals.

Este trabalho relata as alterações pulmonares, microbiológicas e hematológicas em Crotalus durissus terrificus parasitadas pelo nematódeo do gênero Rhabdias. As análises histológicas, microbiológicas e hematológicas foram realizadas em serpentes parasitadas (n=6) e não parasitadas (n=6). Foram observados infiltrados de células granulocíticas e mononucleares no parênquima pulmonar durante a análise histopatológica das serpentes parasitadas. A análise microbiológica revelou as seguintes bactérias Gram-negativas; Citrobacter divergens, Burkholderia cepacia, Stenotrophomonas maltophilia, Proteus vulgaris, Enterobacter sakazakii, Enterobacter ammnigenus, Pseudomonas aeruginosa, Pantoea sp. e Providencia rettgeri. Nas serpentes não parasitadas foram identificadas: B. cepacia, Pseudomonas fluorescens e Acinetobacter baumanii. Nos animais parasitados observaram-se: aumento da concentração de proteína plasmática, diminuição da contagem de linfócitos, e valores normais de hematimetria.