Case report: Intestinal perforation and secondary peritonitis due to Acanthocephala infection in a black-bellied pangolin (Phataginus tetradactyla).

A case of Acanthocephala infection in a 5-year-old female rehabilitated and released black-bellied pangolin (Phataginus tetradactyla), which was part of a post-release monitoring program of a pangolin research operation in the Central African Republic, is described. This represents the first report of Acanthocephala infection in this species, which lead to intestinal perforation, secondary peritonitis and ultimately to the death of the animal concerned. It is of relevance to alert the pangolin conservation and research community to a so far unreported cause of death. A case history and necropsy findings, as well as preliminary parasite identification and genetic characterization which potentially revealed a new gigantorhynchid taxon are presented.

Biliary ascariasis and severe bacterial outcomes: Report of three cases from a paediatric hospital in Brazil.

INTRODUCTION: Biliary ascariasis, although uncommon, can lead to infectious complications and severe outcomes. This study reported three patients with biliary ascariasis and who were admitted to a paediatric hospital in Salvador, Brazil. CASE REPORTS: Case 1: A 1-year-old boy, with HIV, hospitalised with diarrhoea, fever, pain, and abdominal distension. He underwent an exploratory laparotomy, which showed peritonitis secondary to a perforation of the hepatic duct by ascaris. Case 2: A 3-year-old boy admitted with fever, abdominal pain and jaundice. Imaging examination was suggestive of ascaris in the intrahepatic biliary tract and a hepatic abscess. Case 3: A 7-year-old boy who was hospitalised with a history of abdominal colic, jaundice and fever, with a suggestive image of ascaris in the biliary tract and evolution to sepsis. DISCUSSION: Three cases of biliary ascariasis were reported with severe infectious complications involving peritonitis, hepatic abscess and sepsis. CONCLUSION: In endemic regions, biliary ascariasis should be considered in cases with jaundice, abdominal pain and fever, due to its morbidity and risk of complications.

Perforation of the Small Intestine with Acute Peritonitis Caused by Enterobius Vermicularis.

Perianal and perineal pruritus is often associated with Enterobius vermicularis in children. Although this roundworm is common in pediatric practice, most doctors are unaware that it can cause appendicular colic with/or appendicitis, severe urogenital complications, bowel perforation, and peritonitis. We report a case of a young male who presented with signs and symptoms of acute peritonitis. Dur-ing the operation, perforation of the jejunum with a purulent exudate under the transverse colon, a left lateral canal, a Douglas cavity were found as well as single enlarged mesenteric lymph nodes. Histological studies detected Enterobius vermicularis in the lumen of the appendix and jejunum, as well as in the purulent exudate in the intestinal wall and serosa. A mesenteric lymph node, histologically presented with chronic nonspecific lymphadenitis. In conclusion, infection with Enterobius vermicularis should be considered in peri-tonitis, appendicitis, and enlarged mesenteric lymph nodes, especially in young patients.

Schistosomal Peritonitis Presenting as Acute Abdomen: A Case Report.

BACKGROUND: Schistosomiasis is a trematode infestation causing a chronic granulomatous disease in various organs. Both S. mansoni & S. haematobium are endemic in Ethiopia. Most infected individuals are asymptomatic. Ectopic schistosomiasis can affect the lungs, genitalia, CNS, skin, peritoneum, Lymph nodes & other organs. Schistosomiasis as a cause of acute abdomen is seldom reported. CASE DETAIL: A 51 years-old male Ethiopian farmer presented with a two weeks history of abdominal pain with recent onset bilious vomiting and abdominal distention. Emergency laparotomy done & the finding was multiple tiny whitish nodule over the peritoneum & small bowel with multiple mesenteric lymphadenopathy. The diagnosis was confirmed with histopathology study. CONCLUSIONS: Schistosomal peritonitis is a very uncommon form of schistosomiasis. Physicians should be aware of such atypical presentation in patients from endemic areas of schistosomiasis. And biopsy should be considered in unsettled forms of peritonitis during laparotomy. The pathogenesis is not well known which warrants further study.

Acute mesenteric ischemia-like syndrome associated with suspected Spirocerca lupi aberrant migration in dogs.

OBJECTIVE: To describe acute mesenteric infarction due to suspected Spirocerca lupi aberrant migration in 5 dogs. CASE SERIES SUMMARY: All dogs were large breed, none of which exhibited typical clinical signs associated with spirocercosis. All dogs were eventually diagnosed with septic peritonitis. On exploratory laparotomy, thickening of the jejunal arteries, surrounding mesojejunum, and segmental necrosis were identified. Similar thickening and hematoma formation were found in other regions of the mesentery. In 4 of the cases, the necrotic segment was located in the distal jejunum. Histology revealed thrombotic mesenteric vessels with intralesional S. lupi nematode larvae. Resection and anastomosis of the necrosed section was performed and all but 1 dog survived and were discharged within 1-6 days. NEW OR UNIQUE INFORMATION PROVIDED: Spirocerca lupi is a potential cause of mesenteric infarction in endemic areas when no other obvious etiology is identified.

Toxocara related peritonitis: A case report and review of literature.

Toxocariasis is a clinical syndrome caused by the larvae of two ascarid nematodes, namely, Toxocara canis and T. cati that live in dogs and cats as definitive hosts. Humans acquire Toxocara infection by accidental consumption of eggs contaminated foods, soil, water or larvae encapsulated in the viscera or meats of various paratenic hosts e.g., chicken. After oral ingestion, the ova hatch and the free larvae penetrate the intestinal wall to migrate to distant tissues throughout the body. Larvae may also infiltrate the intestinal wall and cause enteritis and mass occupying lesions. Here, we present a T. canis related gastroenteritis and peritonitis case successfully treated with albendazole. We reviewed the literature and found seven previously published Toxocara related peritonitis cases. To our knowledge, this is the first review about non-disseminated toxocariasis that restricted to the intestine and presented as eosinophilic ascites due to peritoneal inflammation. The most common abdominal symptoms were abdominal pain and nausea, and the most common findings were eosinophilic infiltrations on endoscopic biopsy specimens and eosinophilia in the peripheric blood samples.

Mass Mortality Attributed to Acanthocephaliasis at a Gull-billed Tern (Gelochelidon nilotica) Colony in Coastal California, USA.

From 12 May 2013 to 29 May 2013, the Gull-billed Tern (Gelochelidon nilotica) colony at the San Diego Bay National Wildlife Refuge, California, US, experienced a mass die-off of at least 92 adults, representing 71-92% of the breeding population on the US west coast. Cause of death was determined to be peritonitis due to perforations of the intestine by a large quantity of acanthocephala (Profilicollis [=Polymorphus] altmani). This is a unique report of P. altmani infecting G. nilotica, and a report of a great impact to a tern population in southern California. Mole crabs (Emerita analoga), the intermediate host for P. altmani and a major component of the Gull-billed Tern diet in San Diego, were found in the stomachs of necropsied terns along with cystacanths, and are the presumed source of the parasite infection. The tern's dietary reliance upon mole crabs likely amplified parasite transmission and infection. We suggest additional research to determine factors that influence parasite infection of intermediate and definitive hosts, particularly mole crabs, given that they are a vital resource for migrating birds within the coastal zone.

Asymptomatic Effluent Protozoa Colonization in Peritoneal Dialysis Patients.

Currently, chronic kidney disease (CKD) is a global health problem. Considering the impaired immunity of CKD patients, the relevance of infection in peritoneal dialysis (PD), and the increased prevalence of parasites in CKD patients, protozoa colonization was evaluated in PD effluent from CKD patients undergoing PD. Overnight PD effluent was obtained from 49 asymptomatic stable PD patients. Protozoa analysis was performed microscopically by searching cysts and trophozoites in direct wet mount of PD effluent and after staining smears. Protozoa were found in PD effluent of 10.2% of evaluated PD patients, namely Blastocystis hominis, in 2 patients, and Entamoeba sp., Giardia sp., and Endolimax nana in the other 3 patients, respectively. None of these patients presented clinical signs or symptoms of peritonitis at the time of protozoa screening. Our results demonstrate that PD effluent may be susceptible to asymptomatic protozoa colonization. The clinical impact of this finding should be further investigated.

[Appendicitis schistosomiasis: unusual lesion about two cases in Senegal]. / Appendicite bilharzienne: une lésion rare à propos de deux cas au Sénégal.

Appendiceal schistosomiasis is a rare disease of only histopathological diagnosis. Appendectomy should be followed by treatment with praziquantel to avoid complications. We report two cases of appendiceal schistosomiasis while discussing the place of this infection in the pathogenesis of appendicitis. Finally we recommend a routine pathological examination of any part of appendectomy for better care for patients.

Perforation of small bowel caused by Schistosoma japonicum: a case report.

A 67-year-old man from Jingzhou was admitted to the First Hospital Affiliated to Yangtze University in July 2013 with sudden onset of abdominal pain with dizziness for 12 h. The patient had sign of peritoneal irritation. Ultrasonography of the abdomen and pelvis showed hepatic fibrosis due to schistosomiasis. Computed tomography showed free gas in the peritoneal cavity. Plain abdominal radiography showed bilateral subdiaphragmatic accumulation of gas, perforation of the viscus, and radio-opacity in the left renal area. The patient underwent emergency exploratory laparotomy. At laparotomy, a moderate amount of muddy yellow pus was found in the intra-abdominal cavity. At the junction of the jejunum and ileum, about 250 cm from Treitz's ligament, there was an about 10-cm length of inflamed small bowel with perforation (3 mm in diameter) along the mesenteric border at the middle of the lesion. The patient underwent resection of the affected intestinal segment, along with end-to-end intestinal anastomosis. Histopathological examination revealed mucosal necrosis and hemorrhage with a large number of infiltrating eosinophils and neutrophils, and acute submucosal inflammation with a large number of infiltrating eosinophils and neutrophils associated with Schistosoma japonicum (S. japonicum) eggs. No intravascular adult parasite was found. Postoperatively, the patient was treated with praziquantel (30 mg/kg daily) for 4 d. The patient progressed well. To the best of our knowledge, this is the first case of small bowel perforation associated with eggs of S. japonicum.

Molecular characterization of Acanthamoeba strains isolated from domestic dogs in Tenerife, Canary Islands, Spain.

The present study describes two cases of Acanthamoeba infections (keratitis and ascites/peritonitis) in small breed domestic dogs in Tenerife, Canary Islands, Spain. In both cases, amoebic trophozoites were observed under the inverted microscope and isolated from the infected tissues and/or fluids, without detecting the presence of other viral, fungal or bacterial pathogens. Amoebae were isolated using 2 % non-nutrient agar plates and axenified for further biochemical and molecular analyses. Osmotolerance and thermotolerance assays revealed that both isolates were able to grow up to 37 °C and 1 M of mannitol and were thus considered as potentially pathogenic. Moreover, the strains were classified as highly cytotoxic as they cause more than 75 % of toxicity when incubated with two eukaryotic cell lines. In order to classify the strains at the molecular level, the diagnostic fragment 3 (DF3) region of the 18S rDNA of Acanthamoeba was amplified and sequenced, revealing that both isolates belonged to genotype T4. In both cases, owners of the animals did not allow any further studies or follow-up and therefore the current status of these animals is unknown. Furthermore, the isolation of these pathogenic amoebae should raise awareness with the veterinary community locally and worldwide.

Acute blastocystis-associated appendicular peritonitis in a child, Casablanca, Morocco.

Despite increasing reports that Blastocystis infection is associated with digestive symptoms, its pathogenicity remains controversial. We report appendicular peritonitis in a 9-year-old girl returning to France from Morocco. Only Blastocystis parasites were detected in stools, appendix, peritoneal liquid, and recto-uterine pouch. Simultaneous gastroenteritis in 26 members of the child's family suggested an outbreak.

Fatal infection with Taenia martis metacestodes in a ring-tailed lemur (Lemur catta) living in an Italian zoological garden.

A case of fatal infection caused by larval forms of Taenia martis in a ring-tailed lemur (Lemur catta) living in the Rome zoological garden is described. The animal, living in a semi-natural pen with other 15 conspecific individuals and being fed with fresh fruit and vegetables, yoghurt and eggs, was transported to the Istituto Zooprofilattico of Rome for post-mortem examination. The anamnesis included, ten days before the death, apathy, lack of appetite, abdominal distension and diarrhoea. A severe exudative fibrinous-purulent peritonitis with numerous adhesions between the abdominal wall and the bowel loops was detected. After intestine removal, two free and viable, 4 cm long, whitish, leaf-like parasitic forms were pinpointed. Macroscopic examination of the two parasites allowed their identification as larval stages of cestodes, identified via molecular analysis as T. martis metacestodes. This report represents the first record of T. martis infection in the host species and in a zoological garden and for the pathological relevance of the infection.

A rare case of abdominal cocoon.

AIM: Abdominal cocoon is a rare cause of intestinal obstruction usually diagnosed incidentally at laparotomy. It manifests by forming a membrane that typically encases the small bowel loops, leading to mechanical obstruction. Preoperative diagnosis is difficult. The etiology of this condition is not well understood; however, it is a form of chronic irritation and inflammation. METHOD: A 33 years old male, from Bangladesh, presented to our emergency department complaining of abdominal pain, nausea, and vomiting. CT abdomen shows a picture of intestinal obstruction at the level of the small intestine. Intraoperative findings showed encapsulation of small bowel by a dense whitish membrane as a cocoon. Histological examination showed a granulomatous peritonitis and Ascaris Lumbricoides in the bowel resected. RESULTS AND CONCLUSIONS: The preoperative diagnosis of abdominal cocoon is difficult and hence, the diagnosis is usually confirmed by laparotomy. Surgery remains the cornerstone in the management of abdominal cocoon. The pathogenesis of abdominal cocoon remains elusive and has been associated with several conditions. The initial diagnosis of our patient was bowel obstruction from cocoon syndrome (CT and intraoperative findings) probably primitive, and only histologically proved granulomatous peritonitis associated with the presence of the parasite.

Cestode infection in 2 dogs: cytologic findings in liver and a mesenteric lymph node.

Mesocestoides cestode infections in dogs are well known for causing severe peritonitis with larvae or larval fragments (metacestodes, tetrathyridia, or calcareous corpuscles) frequently observed cytologically in peritoneal fluid samples. This case report describes the cytologic and clinical features of 2 dogs infected with cestode larvae, with one case confirmed and the other presumed to be Mesocestoides sp. In these 2 unusual cases, cestode larvae or larval fragments were found in fine-needle aspirates of the liver and a mesenteric lymph node, but no organisms were found in peritoneal fluid samples. The data presented in this report indicate that clinical pathologists should not rule out Mesocestoides sp cestodiasis based on the absence of larvae in peritoneal fluid samples from dogs.

Colonic perforation with peritonitis in amoebiasis: a tropical disease with high mortality.

BACKGROUND: Invasive colonic amoebiasis presents primarily with dysentery; colonic perforation occurs rarely. Cases of amoebic colonic perforations have been reported sporadically over the past 20 years. METHODS: A retrospective study was done in the surgical unit of a tertiary care hospital in North India. The case records of those patients were reviewed who underwent exploratory laparotomy from January 2011 to September 2012 and were diagnosed with amoebic colonic perforation on histopathological examination. Details concerning the clinical presentation, investigations, intraoperative findings, operative procedures, and postoperative outcomes were retrieved. RESULTS: Amongst, a total of 186 emergency exploratory laparotomies carried out during the study, 15 patients of amoebic colonic perforation were identified. The median age of the patients was 42 years (IQR 32.0-58.0) and the male to female ratio was 13:2. Previous history of colitis was present in only 1 patient. The preoperative diagnosis was perforation peritonitis in 12 patients; and intussusception, intestinal obstruction and ruptured liver abscess in 1 patient each. Ten patients had single perforation while 5 had multiple colonic perforations. All the patients except one had perforations in the right colon. Bowel resection was performed depending upon the site and extent of the colon involved-right hemicolectomy (8), limited ileocolic resection (6) and sigmoidectomy (1). Bowel continuity could be restored only in 2 of the 15 patients and a stoma was constructed in the remaining 13 patients. The overall mortality rate was found to be 40% (6/15). CONCLUSION: Amoebic colonic perforation is associated with unusually high mortality.

Pathology of enteric infections induced by the acanthocephalan Profilicollis chasmagnathi in Olrog's gull, Larus atlanticus, from Argentina.

Acanthocephalans can be pathogenic helminths of marine birds. Every year during the breeding season, there is variable mortality among prefledged chicks from the largest known Olrog's gull (Larus atlanticus) colony. Mortality has been associated with infection by the acanthocephalan Profilicollis chasmagnathi. Our aim was to study the role of chicks' size as a risk factor for intensity of infection and severe pathology, and to expand upon previous pathological findings reported in acanthocephalan-infected chicks. Size of the chick was associated with intensity of infection and number of intestinal perforations, which increased by 6.9% and 4.1%, respectively, for each millimetre increment in chick size. Infection was associated with inflammatory enteritis and granulomatous peritonitis. Complete intestinal perforations were observed in 85% and 97.3% of the studied chicks in 2005 and 2006, respectively, and they were observed very early during the post-hatching period. Our results show: (1) the presence of advanced pathology associated with acanthocephalan infections in chicks, beginning very early in the post-hatching period; and (2) significant increases in the intensity of infection and the associated pathology as a function of size of chicks, in dead chicks during this period.