[Acute abdomen by anisakiasis and globalization]. / Addome acuto da anisakiasi e globalizzazione.

OBJECTIVES: The AA report a case of a patient with acute abdomen caused by intestinal Anisakiasis, a fish-transmitted infection that results from ingestion of raw or improperly cooked fish contaminated by live larvae of Anisakis Simplex, a round worm from the order of Ascaridida. MATERIAL AND METHODS: A 33-year-old man, presented to the emergency room with severe upper abdominal pain, nausea and vomiting, without fever. The patient revealed that he had eaten pickled anchovies a few days before. RESULTS: On the exploratory laparotomy an edematous and stenotic tract of 15 cm of jejunum was found, and a segmental resection was performed. Histologically, the resected jejunum showed a conspicuous and diffuse inflammatory infiltration, predominantly made up of eosinophil granulocytes, numerous mucosal erosions and the presence in the submucosa of sections of parasites which were identified as Anisakis Simplex larvae. DISCUSSION: The ingestion of fish contaminated by Anisakis larva is often followed by the appearance of systemic or gastrointestinal symptoms due respectively to the direct larva localization and the allergic reaction to some parasite components. Diagnosis is made frequently difficult by clinical manifestations that could mimic symptoms of other diseases more common in Italy. CONCLUSIONS: Globalization has made Anisakiasis a more and more frequent disease worldwide, as increased mixture of different cultures and international travelling has allowed the spreading of risky feeding habits. That's why Anisakiasis should be considered in differential diagnosis of intestinal obstruction in patients with positive anamnesis for suspiciously cooked or conserved seafood eating.

Suppression of extraintestinal and intestinal Nippostrongylus brasiliensis-induced eosinophilia by Eimeria nieschulzi.

Eosinophil responses in extraintestinal and intestinal tissues were examined in August and Sprague-Dawley rats infected with Nippostrongylus brasiliensis or Eimeria nieschulzi (or both), and in uninfected controls to test the hypothesis that E. nieschulzi suppresses the systemic N. brasiliensis-induced eosinophil response. Caudal vein blood, femoral bone marrow, bronchoalveolar lavage fluid, peritoneal lavage fluid, and duodenal and jejunal samples were collected on day 8 postinfection (PI) with E. nieschulzi, on day 16 PI of the N. brasiliensis infection, when these days coincided in the concurrently infected rats, and from uninfected controls. Differential white blood cell counts were made from blood smears and cytocentrifuged preparations, and duodenal and jejunal eosinophils per villus crypt unit were quantified. Eimeria nieschulzi significantly reduced N. brasiliensis-induced eosinophil levels in peripheral blood, lavage fluids, and duodenal and jejunal tissues in both rat strains. August and Sprague-Dawley rats monospecifically infected with N. brasiliensis and concurrently with both parasites demonstrated elevated eosinopoiesis compared with uninfected controls and rats infected with only E. nieschulzi; however, despite this, concurrently infected rats had a significantly greater level of eosinopoiesis than those infected with only the nematode. In addition, E. nieschulzi induced elevated neutrophil levels in both monospecifically and concurrently infected rats in all extraintestinal tissues examined in both rat strains, whereas lymphocyte counts decreased concomitantly. This study suggests that the intestinal coccidian E. nieschulzi has the ability to modulate the systemic inflammatory response to N. brasiliensis and that this is not a rat strain-specific phenomenon.

PEDRo: a database for storing, searching and disseminating experimental proteomics data.

BACKGROUND: Proteomics is rapidly evolving into a high-throughput technology, in which substantial and systematic studies are conducted on samples from a wide range of physiological, developmental, or pathological conditions. Reference maps from 2D gels are widely circulated. However, there is, as yet, no formally accepted standard representation to support the sharing of proteomics data, and little systematic dissemination of comprehensive proteomic data sets. RESULTS: This paper describes the design, implementation and use of a Proteome Experimental Data Repository (PEDRo), which makes comprehensive proteomics data sets available for browsing, searching and downloading. It is also serves to extend the debate on the level of detail at which proteomics data should be captured, the sorts of facilities that should be provided by proteome data management systems, and the techniques by which such facilities can be made available. CONCLUSIONS: The PEDRo database provides access to a collection of comprehensive descriptions of experimental data sets in proteomics. Not only are these data sets interesting in and of themselves, they also provide a useful early validation of the PEDRo data model, which has served as a starting point for the ongoing standardisation activity through the Proteome Standards Initiative of the Human Proteome Organisation.

A microsporidian previously undescribed in humans, infecting enterocytes and macrophages, and associated with diarrhea in an acquired immunodeficiency syndrome patient.

To date, the only microsporidian that has been associated with diarrhea and weight loss in acquired immunodeficiency syndrome patients is the newly identified Enterocytozoon bieneusi. A second species is now described that was associated with intestinal symptoms in a 32-year-old, human immunodeficiency virus- seropositive, Native American male homosexual. Stool studies and routine light microscopy of multiple small intestinal biopsies that showed atrophy with acute and chronic inflammation were without apparent pathogens. Light microscopy of semi-thin plastic sections, cytochemical stains of paraffin sections, and ultrastructural studies revealed extensive microsporidial infection of enterocytes and submucosal macrophages. No other pathogens were identified. Unlike E bieneusi, this microsporidian appeared to develop within septated parasitophorous vacuoles, and lacked polar disks and clear clefts. It most closely resembled, but was distinguishable from, members of the genus Encephalitozoon. Awareness of the microsporidia as potential opportunists in acquired immunodeficiency syndrome patients is increasing the incidence of identification of these organisms.

Intestinal immune cells in Strongyloides stercoralis infection.

BACKGROUND: Strongyloides stercoralis can cause a wide spectrum of disease in man, ranging from a chronic asymptomatic infection to a hyperinfective, often fatal syndrome. In rodents, spontaneous expulsion of Strongyloides spp occurs after experimental infection. Mast cells, goblet cells, and eosinophils have been identified as possible effectors of this expulsion. AIMS: To investigate intestinal histopathology and mucosal immunity in immunocompetent patients with chronic S stercoralis infection. METHODS: Jejunal biopsies were performed in 19 immunocompetent patients with a positive stool examination for S stercoralis and few or no symptoms, and in seven healthy controls. Specimens were processed for histopathological analysis and stained by the immunoperoxidase technique, using the following monoclonal antibodies: CD2, CD3, CD4, CD8, anti-T cell receptor (TcR) gamma/delta, RFD1 and RFD7 (two different macrophage markers), Ki67+ (proliferating) cells, antihuman leucocyte antigen (HLA)-DR, and anticollagen IV. In addition, CD25+ cells, mast cells, IgE expressing cells, calprotectin containing cells, and neutrophil elastase positive cells were stained by the alkaline phosphatase method. RESULTS: Jejunal morphology and the numbers of different T cell subsets, mast cells, IgE expressing cells, eosinophils, and goblet cells were unaffected by S stercoralis infection. Conversely, the numbers of mature macrophages and dividing enterocytes in the crypts were reduced significantly. Crypt enterocytes did not express HLA-DR in both groups. The expression of HLA-DR by villus enterocytes was also comparable in patients and controls. There were no activated (CD25+) cells in the mucosa of either patients or controls. CONCLUSIONS: Compared with seven healthy uninfected volunteers, a group of 19 Brazilians with clinically mild strongyloides infection showed no abnormality of mucosal structure and no increase in non-specific inflammatory cells. Likewise, there was no increase in mucosal T cells or macrophages.

Jejunal perforation caused by abdominal angiostrongyliasis.

The authors describe a case of abdominal angiostrongyliasis in an adult patient presenting acute abdominal pain caused by jejunal perforation. The case was unusual, as this affliction habitually involves the terminal ileum, appendix, cecum or ascending colon. The disease is caused by the nematode Angiostrongylus costaricensis, whose definitive hosts are forest rodents while snails and slugs are its intermediate hosts. Infection in humans is accidental and occurs via the ingestion of snail or slug mucoid secretions found on vegetables, or by direct contact with the mucus. Abdominal angiostrongyliasis is clinically characterized by prolonged fever, anorexia, abdominal pain in the right-lower quadrant, and peripheral blood eosinophilia. Although usually of a benign nature, its course may evolve to more complicated forms such as intestinal obstruction or perforation likely to require a surgical approach. Currently, no efficient medication for the treatment of abdominal angiostrongyliasis is known to be available. In this study, the authors provide a review on the subject, considering its etiopathogeny, clinical picture, diagnosis and treatment.

The endoscopic diagnosis of intestinal capillariasis in a child: a case report.

A 13-year-old boy was diagnosed as having intestinal capillariasis by gastroduodenoscopy. He presented with a 10-month history of chronic abdominal pain and diarrhea. The boy had stayed in central Thailand and had eaten uncooked fish and raw shellfish. Gastroduodenoscopy showed normal jejunal mucosa although histology revealed flattened villi, crypt proliferation, acute inflammation, and eosinophilic granulomata. An egg of Capillaria philippinensis was also seen. The child was treated with mebendazole for 30 days. He had gained six kilograms by the time of his last follow-up.

Hyperinfection with Strongyloides stercoralis.

Strongyloidiasis is caused by Strongyloides stercoralis, which commonly produces gastrointestinal problems. If immune systems are compromised, the nematode larvae may spread and produce Strongyloides hyperinfection. Diagnosis of strongyloidiasis is based on the observation of larvae in coproparasitological studies. We present a case of a 49-year-oldman, VIH, who developed Strongyloides hyperinfection, diagnosed postmortem. Our patient reached the dissemination stage, which resulted in severe damage to the stomach and intestine, perforation of the intestinal wall, as well as sepsis due to the dissemination of bacteria. The diagnosis is difficult because of the low larvae excretion in stools. It is usually performed by the microscopic examination of fresh and fixed enriched stool samples. Serology was reported to be useful for screening and follow-up after treatment. This case reaffirms that HIV immunosuppression favours the dissemination of S stercoralis larvae. Thus, a search for intestinal parasites should be considered in similar cases.

Overt gastrointestinal bleeding because of hookworm infection.

Hookworm infection is a relatively common cause of anemia in endemic areas. The most common hookworm species are Ancylostoma duodenale and Necator americanus. In this report we present a case of overt gastrointestinal bleeding because of hookworm infection. Capsule endoscopy revealed many hookworms in the lumen of proximal jejunum where active bleeding was seen. The patient was successfully treated with Albendazole.