[Ascariasis in the intrahepatic biliary duct: about a case in pediatrics]. / Ascaridiosis en la vía biliar intrahepática: a propósito de un caso pediátrico.

Twenty five percent of the world population is affected by Ascaris lumbricoides. Hepatobiliary ascariasis occurs in areas with high endemicity and great amount of parasitic load, generating intense inflammation to fibrosis. We report a twoyear- old patient that consults about abdominal distension and cough of one month of evolution associated with 72 hours of fever. Abdominal ultrasound is performed, which shows bile duct, stomach, small intestine with ascaris and chest x-ray with interstitial inflammatory infiltrate, associated with hyperleukocytosis with hypereosinophilia and elevated gamma-glutamyl transpeptidase. Antibiotic, anthelminthic treatment is administered, without achieving the elimination of the bile duct parasites, requiring their removal by percutaneous cholangiography.

El 25 % de la población mundial se encuentra infectada por Ascaris lumbricoides. La ascaridiosis hepatobiliar ocurre en zonas con alta endemicidad y gran carga parasitaria, y genera desde intensa inflamación hasta fibrosis. Se presenta a un paciente de 2 años, que consultó por distensión abdominal y tos de 1 mes de evolución asociada a fiebre en las últimas 72 h. Se realizó una ecografía abdominal que evidenció áscaris en la vía biliar, en el estómago y en el intestino delgado, y una radiografía de tórax con infiltrado inflamatorio intersticial, asociado a hiperleucocitosis con hipereosinofilia y gammaglutamiltranspeptidasa elevada. Se administró un tratamiento antibiótico, antihelmíntico, sin lograr la eliminación de los parásitos de la vía biliar, por lo que se requirió su extracción mediante colangiografía percutánea.

Bovine fasciolisis in São Paulo state, Brazil.

Fasciolosis is a zoonotic disease with a worldwide distribution caused by Fasciola hepatica, which leads to severe economic losses in cattle such as reducing meat and milk production, livers condemnation, growth retardation and increase in mortality. From October 2008 to April 2011, condemned bovine livers in slaughterhouses of different municipalities from São Paulo state, Brazil were evaluated for the presence of Fasciola hepatica. Out of 20,635 analyzed livers, 1422 were infected with F. hepatica. These cattle came from 33 municipalities, out of which 16 showed infected animals and where 7 municipalities did not show statistical difference between each month throughout the year: Tuiuti - 276/1408 (19,6%), Atibaia - 44/257 (17,1%), Joanópolis - 116/738 (15,7%), Bragança Paulista - 318/2316 (13,3%), Piracaia - 182/1442 (12,6%), Santo Antonio de Posse - 118/1005 (11,7%), Amparo 131/2003 (6,5%). The other nine municipalities, Monte Alegre do Sul, Descalvado, Campinas, Morungaba, Pedreira, Socorro, Munhoz, Jaguariúna and Itatiba showed a positive percentage varying from 5.08% to 1.46%. Our results demonstrated the presence of F. hepatica in this region was higher than official data, bringing the need for control measures. There is also an apparent increase in fasciolosis two to three months after low to medium precipitation, however high precipitation causes a decrease in fasciolosis prevalence.

Platynosomum fastosum-induced cholangiocarcinomas in cats.

Platynosomum fastosum is a feline biliary tract trematode that generally causes asymptomatic infections. In the early 1980s in Brazil, P. fastosum was associated with cholangiocarcinomas, but this finding was not confirmed in the various publications on the parasite during the last 30 years. This study aims to report three cases of cholangiocarcinomas in cats associated with the presence of P. fastosum. From 2000 to 2011, in the Veterinary Hospital of the Federal University of Campina Grande in northeast Brazil, 348 cats were necropsied, 11 of which (3.16%) were parasitized by P. fastosum. Three cases that resulted in death were associated with cholangiocarcinomas that were found to be associated with P. fastosum. Histologically, the tumors consisted of acini composed of cells with pleomorphic nuclei, loose chromatin, evident nucleoli and lightly eosinophilic cytoplasm. Metastases were observed in two cases. The first case involved metastases to the lungs, kidneys, ovary and peritoneum, and in the second case, the lymph nodes, kidneys, heart and encephalon were involved. The other 8 cats died from other causes, and the parasite was an incidental finding. In those cases, the histologic lesions were nonsuppurative cholangiohepatitis and periductal fibrosis with P. fastosum present. Six animals also showed pre-neoplastic changes (hyperplasia and dysplasia) of the biliary duct epithelium. The study concluded that, as observed in other human biliary tract trematodes, P. fastosum causes cholangiocarcinomas in the liver of cats.

Ascariasis hepatobiliar con abscesos: a propósito de un caso en Honduras / Hepatobiliary ascariasis with abcesses: A case report from Honduras

Introducción: De las complicaciones menos frecuentes de la infección parasitaria por helminto intestinal Ascaris Lumbricoides, la ascaris hepática en niños es rara. Más rara aun es la ascaris hepatobiliar con abscesos. Caso clínico: se presenta el caso de una niña de 6 años de edad con sindrome de down, desnutrición proteico-calórica crónica grado II y nivel socieconómico bajo, que se presento con história de fiebre diaria no cuantificada, tos seca, dolor abdominal y hepatomegalia dolorosa de dos semanas de evolución. se realizó ultrasonido abdominal donde se encontraron múltiples abscesos hepáticos con A. lumbricoides en hígado y via biliar. la paciente desarrolló un bloque séptico sin respuesta al tratamiento instaurado y falleció a los 30 días intrahospitalarios. Conclusiones: La ascariasis hepatobiliar, aunque rara, tiene una alta morbi-mortalidad si no se diagnostica y se instaura el manejo adecuado tempranamente. Es imperativo que los médicos hondureños sospechen y diagnostiquen esta parasitosis para que con adecuado manejo contribuyan a disminuir la mortalidad, principalmente infantil, por esa causa. Es necesario implementar medidas de prevención y control eficaces para la geohelmintiasis en Honduras...(AU)

Ascariasis hepatobiliar con abscesos: a propósito de un caso en Honduras / Hepatobiliary ascariasis with abcesses: a case report from Honduras

Introducción: De las complicaciones menos frecuentes de la infección parasitaria por helminto intestinal Ascaris Lumbricoides, la ascaris hepática en niños es rara. Más rara aun es la ascaris hepatobiliar con abscesos. Caso clínico: se presenta el caso de una niña de 6 años de edad con sindrome de down, desnutrición proteico-calórica crónica grado II y nivel socieconómico bajo, que se presento con história de fiebre diaria no cuantificada, tos seca, dolor abdominal y hepatomegalia dolorosa de dos semanas de evolución. se realizó ultrasonido abdominal donde se encontraron múltiples abscesos hepáticos con A. lumbricoides en hígado y via biliar. la paciente desarrolló un bloque séptico sin respuesta al tratamiento instaurado y falleció a los 30 días intrahospitalarios. Conclusiones: La ascariasis hepatobiliar, aunque rara, tiene una alta morbi-mortalidad si no se diagnostica y se instaura el manejo adecuado tempranamente. Es imperativo que los médicos hondureños sospechen y diagnostiquen esta parasitosis para que con adecuado manejo contribuyan a disminuir la mortalidad, principalmente infantil, por esa causa. Es necesario implementar medidas de prevención y control eficaces para la geohelmintiasis en Honduras...

A new species of myxosporean (Sphaeromyxidae), a parasite of lined seahorses, Hippocampus erectus, from the Gulf of Mexico.

Sphaeromyxa cannolii sp. n. is described from the bile ducts of aquaria-maintained lined seahorses (Hippocampus erectus) from the Gulf of Mexico. Spores of the new species are linear, 17-18 µm long and 5-6 µm wide, with flattened tips; polar capsules measure 4 × 3 µm. Routine necropsies of H. erectus following planned death revealed liver inflammation, bile duct obstruction, bile accumulation, and myxozoan parasites in the bile ducts of 11 of 40 animals sampled (27.5%). The presence of S. cannolii in an aquaculture setting should prompt keepers to carefully quarantine new animals and exclude annelid fauna, a potential intermediate host of myxozoans.

Significance of bile-duct changes in schistosomiasis.

Lesions involving the intra-hepatic biliary ducts in schistosomiasis have been reported in the literature, both in mice and man, but there are no data concerning their quantitative, evolutionary or post curative chemotherapeutic aspects on record. In order to obtain such data an investigation on this subject was attempted. Mice infected with 50 Schistosoma mansoni cercariae were submitted to a liver biopsy at the 9th week post-infection, and treated with 400 mg/bw praziquantel immediately afterwards. Infected and non-infected controls were submitted to the same procedures. By 19 weeks from cercarial exposure all surviving animals were sacrificed. The biliary ducts were counted on histological sections and the results were expressed as biliary ducts/portal spaces. This quantitative evaluation was compared with that from normal controls and revealed hyperplasia as the main biliary duct change (p<0.007) in schistosomiasis. Hyperplastic changes underwent only mild partial and not statistically significant regression after specific chemotherapy (p>0.05). Infected and untreated animals presented ductal changes that did not differ from those of the treated group. Measurements of serum bilirubin (total and direct), and gamma-glutamyl-transpeptidase (gamma-GT) did not reveal significant differences when animals from the several groups were compared. Thus, bile ducts exhibit a proliferative response in relation to neighboring S. mansoni injury to portal areas, but although these lesions are histopathologically impressive, they lack a functional or prognostic significance.

CT identification of ascaris in the biliary tract.

Ascariasis is one of the most common helminthic diseases worldwide. The presence of this worm in the biliary tree causes biliary colic, recurrent pyogenic cholangitis, pancreatitis, hepatic abscesses, and septicemia. The diagnosis of biliary ascariasis is usually made by ultrasound (US). We report the computerized-tomography (CT) aspects that allowed the identification of ascaris in the biliary tract in two patients.

Liver morphology with emphasis on bile ducts changes and survival analysis in mice submitted to multiple Schistosoma mansoni infections and chemotherapy.

In an attempt to be as close as possible to the infected and treated patients of the endemic areas of schistosomiasis (S. mansoni) and in order to achieve a long period of follow-up, mice were repeatedly infected with a low number of cercariae. Survival data and histological variables such as schistosomal granuloma, portal changes, hepatocellular necrosis, hepatocellular regeneration, schistosomotic pigment, periductal fibrosis and chiefly bile ducts changes were analysed in the infected treated and non treated mice. Oxamniquine chemotherapy in repeatedly infected mice prolonged survival significantly when compared to non-treated animals (chi-square 9.24, p = 0.0024), thus confirming previous results with a similar experimental model but with a shorter term follow-up. Furthermore, mortality decreased rapidly after treatment suggesting an abrupt reduction in the severity of hepatic lesions. A morphological and immunohistochemical study of the liver was carried out. Portal fibrosis, with a pattern resembling human Symmers fibrosis was present at a late phase in the infected animals. Bile duct lesions were quite close to those described in human Mansonian schistosomiasis. Schistosomal antigen was observed in one isolated altered bile duct cell. The pathogenesis of the bile duct changes and its relation to the parasite infection and/or their antigens are discussed.

Hepatobiliary alterations in massive biliary ascariasis: histopathological aspects of an autopsy case

Os autores apresentam os aspectos histopatologicos encontrados no figado de um caso de autopsia de ascaridiase biliar macica. A intensa colangite foi o aspecto predominante, mas outras lesoes tambem foram encontradas, tais como metaplasia pilorica e intestinal, hiperplasia epitelial com papilomas intraductais, e por vezes padrao adenomatoso. Restos do helminto foram encontrados fortemente aderidos ao epitelio, sendo intensa a positividade de mucopolissacarides, principalmente acidos, na borda luminal do epitelio ductal e em glandulas proliferadas ao redor dos ductos. Os autores discutem a semelhanca da ascaridiase biliar com a colangio hepatite oriental, e sugerem que o processo inflamatorio e a presenca de restos do verme sao responsaveis pelas alteracoes hiperplasicas e metaplasicas, analogamente ao que ocorre na clonorquiase, fascioliase e esquistossomose

Hepatobiliary alterations in massive biliary ascariasis. Histopathological aspects of an autopsy case.

Hepatobiliary alterations found in an autopsy case of massive Biliary Ascariasis, are reported on histological grounds. Severe cholangitis was the main finding, but other changes were also detected, such as pyloric and intestinal metaplasia, hyperplasia of the epithelial lining, with intraductal papillomas and adenomatous proliferation. Remnants of the worm were observed tightly adhered to the epithelium, forming microscopic intrahepatic calculi. Mucopolysaccharides, especially acid, showed to be strongly positive on the luminal border, and in proliferated glands around the ducts. The authors discuss the similarity between such findings and Oriental Cholangio-hepatitis, and suggest that inflammation and the presence of the parasitic remnants are responsible for the hyperplastic and metaplastic changes, similarly with what occurs in chlonorchiasis, fascioliasis and schistosomiasis.