Anemia crónica grave por Ancylostoma duodenale en Ecuador: diagnóstico por duodenoscopia / Chronic and severe anemia caused by Ancylostoma duodenale in Ecuador: diagnosis by duodenoscopy

Resumen Durante 11 años un varón de 38 años de edad, residente en una región subtropical de Ecuador, había sido diagnosticado de anemia crónica y tratado con transfusiones de sangre en un hospital de la provincia de Cotopaxi, Ecuador. Fue transferido a Quito por una anemia grave, con hemoglobina de 4 g/dL. Se realizó una duodenoscopia en que se observaron nemátodos adultos, identificados posteriormente como Ancylostoma duodenale. El paciente fue tratado exitosamente con albendazol durante cinco días consecutivos y transfusiones de sangre. En el seguimiento a los ocho meses, no se encontró anemia ni huevos de anquilostomas en el examen de heces.

For 11 years, a 38-year-old male residing in a subtropical region of Ecuador, was repeatedly diagnosed with chronic anemia, and treated with blood transfusions in a hospital of province of Cotopaxi, Ecuador. He was transferred to Quito for severe anemia, having hemoglobin of 4 g/dL. Duodenoscopy was performed and adult nematodes, identified later as Ancylostoma duodenale, were observed. The patient was successfully treated with albendazole for five consecutive days and given blood transfusions. In the control visit at eight months, without anemia and no hookworm ova in the stool examined were found.

Efeitos da infecção crônica por Toxoplasma gondii sobre a parede intestinal de gatos domésticos / The effects of the infection caused by Toxoplasma gondii on the cat duodenal wall

O objetivo deste trabalho foi analisar os efeitos da infecção causada pelo Toxoplasma gondii sobre a parede do duodeno de gatos. Foram utilizados seis gatos (Felis catus), com cerca de três meses de vida, distribuídos aleatoriamente em Grupo controle (G1; n = 3) e Grupo infectado (G2; n = 3). Os animais do G2 receberam, por via oral, 200 cistos teciduais da cepa ME49 (tipo II) do T. gondii. Após 40 dias, os animais foram submetidos à eutanásia, laparotomia e retirada do duodeno, que foi fixado em solução de Bouin e submetido à rotina histológica para obtenção de cortes transversais de 3 µm. Os cortes foram corados com Hematoxilina-Eosina (HE), Azan, Ácido Periódico de Schiff (PAS), Alcian-Blue e Tricrômio de Mallory. Realizou-se uma avaliação qualitativa da parede intestinal e medidas comparativas entre os dois grupos, com relação: à espessura da túnica mucosa, túnica muscular, parede total, altura dos vilos, profundidade das criptas e altura dos enterócitos e seus núcleos. As células caliciformes, os linfócitos intraepiteliais e as células de Paneth foram quantificados. Os resultados mostraram que a infecção levou à atrofia da túnica mucosa, túnica muscular e parede intestinal do duodeno de gatos do G2 (p < 0,05). A altura dos enterócitos apresentou um aumento significativo (p < 0,05) nos animais do G2. Na avaliação qualitativa, as fibras colágenas ocupavam visivelmente uma maior área dos estratos da parede intestinal, o que sugere que estejam aumentadas. Observou-se a redução da secreção de sulfomucinas e o aumento das células de Paneth nesses mesmos animais (p < 0,05).

This paper analyzes the effects of the infection caused by Toxoplasma gondii on the cat duodenal wall. Six cats (Felis catus) with 3-month-old were randomly divided into Control Group (G1; n = 3) and Infected Group (G2; n = 3). The animals from G2 received orarilly 200 T. gondii tissye cysts of ME49-strain (type II). After 40 days, the animals were submitted to euthanasia, laparotomy and had their duodenum removed, fixed in Bouin solution and submitted to histological routine obtaining 3 µm transverse cuts. The cuts were stained with Hematoxylin-Eosin (HE), Azan, Periodic acid - Schiff (PAS), Alcian-Blue, and Mallory trichrome. Qualitative assessment of the intestine wall as well as comparative measurements with respect to the thickness of mucosa, muscle tunic, total wall, the height of the villous, the depth of the crypts, and the height of the enterocytes and their nuclei were carried out. Calciform cells, the intraepithelial lymphocytes, and the Paneth cells were quantified. The results showed that the infection led to the atrophy of the mucosa, muscle tunic, and the intestinal wall of the duodenum of G2 cats (p < 0.05). The enterocytes height presented significant (p < 0.05) increase for G2 animals. According to the qualitative analysis, the collagen fibers were visibly taken a broader area on the intestinal wall layers, what suggests they have increased in size. Decrease in the sulphomucins secretion and the increase of Paneth cells were observed for these animals (p < 0.05).

A human infection of Echinostoma hortense in duodenal bulb diagnosed by endoscopy

As gastroduodenoscopy performed more frequently, case reports of human echinostomiasis are increasing in Korea. A Korean woman presented at a local clinic with complaints of abdominal pain and discomfort that had persisted for 2 weeks. Under gastroduodenoscopy, two motile flukes were found attached on the duodenal bulb, and retrieved with endoscopic forceps. She had history of eating raw frog meat. The two flukes were identified as Echinostoma hortense by egg morphology, 27 collar spines with 4 end-group spines, and surface ultrastructural characters. This report may prove frogs to be a source of human echinostome infections.

Strongyloidiasis in a patient with IgA deficiency.

With rising frequency of immuno suppression particularly due to use of various immuno suppressive agents and increasing incidence of human immuno deficiency virus infection, incidence of opportunistic infection due to various parasites are also on the rise. Persistent strongyloides stercoralis infection which normally also infects healthy individuals is documented in a case of hypogammaglobulinemia reported in the present paper emphasizing it to be another potential opportunistic infection which one may encounter in near future.