Detection and molecular characteristics of Rhytidodoides sp. (Digenea: Rhytidodidae) from the gall bladder of green sea turtles (Chelonia mydas) in the Ogasawara Islands, Japan.

Trematodes of the genus Rhytidodoides are parasitic in marine turtles. Of the already known species, Rhytidodoides similis Price, 1939, occurs especially in the gall bladder. In this study, we surveyed 73 green sea turtles (Chelonia mydas) in the Ogasawara Islands, Japan, and detected Rhytidodoides sp. from the gall bladders of 18 turtles. A detailed morphological analysis revealed that the forebody of Rhytidodoides sp. differed slightly in shape from that of R. similis. There has been no information on DNA sequences of the family Rhytidodidae. A molecular phylogeny based on 28S rDNA sequences of Rhytidodoides sp. and related taxa suggested that the Rhytidodidae is sister to the other families of Echinostomatoidea. The intraspecific diversity of Rhytidodoides sp. was examined by using DNA sequences of mitochondrial cytochrome c oxidase subunit 1 gene (COI). The population genetic features of the COI haplotypes demonstrated that Rhytidodoides sp. is highly diverse in the Ogasawara Islands. The DNA sequences determined in this study will contribute to the species identification of congeners and the taxonomic reconsideration of the Echinostomatoidea.

Gallbladder schistosomiasis: rare but possible, a case report and review of the literature.

After Malaria, schistosomiasis remains the most important tropical disease in large parts of the world. It affects mainly the colon and the urinary tract. The hepatic involvement is significantly frequent, particularly by the mansoni species. Still one of the extremely rare locations is the gallbladder. Our case is about a 51 year old woman from Tunisia, which is no longer considered an endemic country, with no particular medical history, underwent surgery for symptomatic cholelithiasis. She had a laparoscopic cholecystectomy. Post operative period was uneventful. Histology of the gallbladder showed fibrosis in the mucosa and schistosomal ova in the wall. As a conclusion we can see that due to the lack of specific clinical and radiological signs, the diagnosis of gallbladder schistosomiasis is established only after the histological examination.

Unexpectedly High Prevalence of Cystoisospora belli Infection in Acalculous Gallbladders of Immunocompetent Patients.

Objectives: Indications for cholecystectomy have changed dramatically over the past three decades. Cystoisospora belli has been reported in cholecystectomy specimens of immunocompetent patients. The present study was designed to determine the prevalence and clinical association of C belli in the gallbladder. Methods: The study included retrospective review of cholecystectomy specimens (n = 401) removed for various indications, and a prospective cohort of cholecystectomy specimens (n = 22) entirely submitted for histologic evaluation. Correlations of presence of C belli with age, sex, clinical indication, and abnormalities of preoperative laboratory values were assessed by Fisher exact test. Results: C belli was identified in 39/401 (9.7%) of the retrospective cohort, and 6/22 (27.3%) of the entirely submitted specimens. The presence of C belli showed no correlation with age, sex, clinical indication, or laboratory abnormalities. Conclusions: C belli resides in a latent state in the gallbladder and may be best considered a commensal organism.

Differential diagnosis of gallbladder ascariasis debris: the added value of contrast enhanced ultrasound with high frequency transducer.

Ascariasis debris of the gallbladder is a very rare incidental or symptomatic presentation. Ascaris debris has a pseudotumorous appearance and may be confused with neoplasia. The aim of the current retrospective study is to investigate the value of contrast enhanced ultrasound (CEUS) for the differential diagnosis of ascariasis debris and neoplasia of the gallbladder. MATERIAL AND METHODS: Conventional B-mode ultrasound (BMUS) and CEUS were performed for solitary echo-rich gallbladder lesions. Analysis of the CEUS enhancement pattern of the lesions was conducted according to the current EFSUMB guidelines. Two radiologists assessed the CEUS enhancement patterns in consensus. The final gold standard was surgery with histological examination or imaging follow-up. RESULTS: A total of 9 patients with final diagnoses of gallbladder ascariasis debris were included. As a control group 26 solitary hyperechoic gallbladder lesions without shadowing were included as a control group. The typical zigzag morphology with multiple echogenic parallel lines without shadow were detected inside the lumen of the gallbladder in 6 patients. After injection of 2.4 ml ultrasound contrast agents, all hyperechoic gallbladder ascariasis debris lesions showed no enhancement. All patients in the control group with similar BMUS morphology showed contrast enhancement. CONCLUSIONS: Real time visualization of contrast enhancement without radiation exposure is one of the main advantages of CEUS over other diagnostic modalities to differentiate ascariasis debris in the gallbladder from enhancing neoplasia. Thus, surgery and other interventions and their complications could be avoided.

Epithelial Inclusions in Gallbladder Specimens Mimic Parasite Infection: Histologic and Molecular Examination of Reported Cystoisospora belli Infection in Gallbladders of Immunocompetent Patients.

Recent publications have described epithelial cytoplasmic vacuoles and inclusions incidentally noted within gallbladder epithelium and concluded that they represent coccidian parasite infection, in particular, Cystoisospora belli. We identified 8 gallbladder specimens from our institution in the past 3 years in which this diagnosis was suggested or in which similar epithelial alterations were prominent. Molecular analysis was performed on the 8 gallbladder specimens and on 3 positive control specimens: small bowel biopsies from acquired immunodeficiency syndrome patients with diarrhea. Polymerase chain reaction using primers designed to amplify an internal transcribed spacer (ITS2) in the C. belli ribosomal gene cluster was performed on the DNA samples. All 8 gallbladder specimens were negative for amplification, while a product consistent with C. belli was amplified from all 3 positive controls. Histologically, the gallbladder cytoplasmic inclusions stained diffusely positive for Grocott-Gomori's methenamine silver and Periodic acid-Schiff with diastase. In contrast, sections from a positive control small bowel biopsy demonstrated organisms that were negative for Grocott-Gomori's methenamine silver and showed a distinct capsular and punctate internal staining on Periodic acid-Schiff with diastase in various parasite forms. Together, the lack of molecular evidence of C. belli and the distinct morphologic and special staining patterns in these gallbladders compared with positive control small bowel suggest that these epithelial changes do not represent true C. belli infection. Our results suggest that gallbladders of immunocompetent patients may occasionally show epithelial changes that can morphologically mimic C. belli infection. Pathologists should be aware of this histologic variant to minimize unnecessary treatment, testing, and patient anxiety.

Biliary ascariasis presenting with gangrenous perforation of the gall bladder: report of a case and brief review of literature.

The most common cause of gallbladder perforation is calculous cholecystitis. Rarer causes include trauma, iatrogenic injuries, biliary stasis and gall bladder ischemia. We report a case of gall bladder gangrene with perforation, secondary to extensive ascariasis. A 45-year-old woman presented with acute intestinal obstruction and jaundice. She had abdominal distension and right hypochondrial tenderness. Abdominal radiography showed dilated bowel loops and ultrasonogram showed worms in the small intestine and biliary tree. On exploration, a bolus of worms 2 feet proximal to the ileocaecal junction was found causing obstruction. Worms were also present in the bile duct and gallbladder causing gangrene and perforation. She underwent cholecystectomy, bile-duct exploration and enterotomy. However, she died on the third postoperative day of overwhelming sepsis. Enteric complications of ascaris leading to bowel obstruction are well-known. Hepatobiliary complications such as cholangitis and obstructive jaundice are rare. However, such an extreme degree of infestation leading to gangrene and perforation of the gall bladder is extremely rare.

Amazonian waters harbour an ancient freshwater Ceratomyxa lineage (Cnidaria: Myxosporea).

A new species of Ceratomyxa parasitizing the gall bladder of Cichla monoculus, an endemic cichlid fish from the Amazon basin in Brazil, is described using morphological and molecular data. In the bile, both immature and mature myxospores were found floating freely or inside elongated plasmodia: length 304 (196-402) µm and width 35.7 (18.3-55.1) µm. Mature spores were elongated and only slightly crescent-shaped in frontal view with a prominent sutural line between two valve cells, which had rounded ends. Measurements of formalin-fixed myxospores: length 6.3±0.6 (5.1-7.5) µm, thickness 41.2±2.9 (37.1-47.6) µm, posterior angle 147°. Lateral projections slightly asymmetric, with lengths 19.3±1.4µm and 20.5±1.3µm. Two ovoid, equal size polar capsules, length 2.6±0.3 (2-3.3) µm, width 2.5±0.4 (1.8-3.7) µm, located adjacent to the suture and containing polar filaments with 3-4 turns. The small subunit ribosomal DNA sequence of 1605 nt was no more than 97% similar to any other sequence in GenBank, and together with the host, locality and morphometric data, supports diagnosis of the parasite as a new species, Ceratomyxa brasiliensis n. sp. Maximum parsimony and maximum likelihood analyses showed that C. brasiliensis n. sp. clustered within the marine Ceratomyxa clade, but was in a basally divergent lineage with two other freshwater species from the Amazon basin. Our results are consistent with previous studies that show Ceratomyxa species can cluster according to both geography and host ecotype, and that the few known freshwater species diverged from marine cousins relatively early in evolution of the genus, possibly driven by marine incursions into riverine environments.

Prevalence of Platynosomum fastosum infection in free roaming cats in northeastern Brazil: Fluke burden and grading of lesions.

The objective of this paper was to investigate prevalence and parasite load of the trematode Platynosomum fastosum infection and the risk of developing cholangitis/cholangiohepatitis among infected domestic cats in a city of northeastern Brazil, and to characterize the influence of fluke burden in the formation of lesions in liver and gallbladder. A total of 141 cats was necropsied and examined for the presence of P. fastosum. The observed prevalence was 42.6% (60/141, 95% CI=34.2-50.9). Parasite load varied from 1 to 219 flukes per animal. Adult cats were more frequently infected than kittens (p<0.01). Risk of cholangitis was about three times higher in infected animals (RR=3.23, 95% CI=2.01-5.07, p<0.01). Centrolobular congestion, portal cholangitis and cholestasis was significantly more common in infected as compared to non-infected cats (p<0.01). Similarly, fibrosis, cholangitis and mucous gland hyperplasia were significantly more prevalent in the bile duct of infected animals (p<0.01). Mild fibrosis and cholecystitis were observed principally in infected cats. Hyperplastic precursor lesions of cholangiocarcinoma were observed, but no solid tumor was diagnosed. These results reveal high prevalence of P. fastosum in free roaming cats in northeastern Brazil, with increased risk of liver disease.

Cystoisospora belli Infection of the Gallbladder in Immunocompetent Patients: A Clinicopathologic Review of 18 Cases.

Cystoisospora belli, previously known as Isospora belli, is an obligate intracellular coccidian parasite that is most often associated with gastrointestinal disease in immunocompromised patients. In this study, we detail the clinicopathologic features of 18 cases of Cystoisospora infection affecting the gallbladder in immunocompetent individuals and compare them with a control group. Each case was reviewed for cholecystitis (none, acute, chronic), epithelial disarray, presence of intraepithelial lymphocytes (none, rare [≤5 per 20 epithelial cells], present [>5 per 20 epithelial cells]), architectural distortion, intramucosal eosinophilia, and mural thickening/serositis. The mean age of patients with Cystoisospora infection was 33 years and the male to female ratio 1:4.3. Cholecystectomy was performed for biliary dyskinesia (n=7), abdominal pain (n=7), suspected cholelithiasis (n=5), and cholecystitis (n=3). In 2 cases, Cystoisospora was found in donor gallbladders resected at the time of liver transplantation. Each case was characterized by eosinophilic, oval or banana-shaped intraepithelial parasites within perinuclear parasitophorous vacuoles. Most cases showed epithelial disarray and minimal intraepithelial lymphocytosis. Of the 11 cases with an average follow-up of 15 months, none had evidence of disease related to Cystoisospora infection within the biliary tract or elsewhere in the gastrointestinal tract. We present the largest series of gallbladder cystoisosporiasis in immunocompetent patients to date. Cystoisospora infection is underrecognized in the gallbladders of immunocompetent patients, in part due to the subtle findings in routine cholecystectomy specimens. On the basis of the clinical follow-up, gallbladder cystoisosporiasis in immunocompetent individuals appears to be a self-limited infection.

[ULTRASOUND DIAGNOSIS OF PARASITIC INVASION OF THE GALLBLADDER].

Migration of ascaris from the lumen of the small intestine to the biliary system was previously thought to be very rare pathology and the diagnosis had not be without specific examination methods. At the present time widespread active ultrasonic technologies in the emergency surgical service can became more accessible to show worm in a gall bladder and ducts. The paper presents two cases of gallbladder ascariasis, identified by ultrasound.

Morphological and ultrastructural redescription of Chloromyxum leydigi Mingazzini, 1890 (Myxozoa: Myxosporea), type species of the genus, infecting the gall bladder of the marine cartilaginous fish Torpedo marmorata Risso (Chondrichthyes: Torpedinidae), from the Portuguese Atlantic Coast.

Chloromyxum leydigi Mingazzini, 1890, the type species of Chloromyxum Mingazzini, 1890, is redescribed based on material found in the gall bladder of the cartilaginous fish Torpedo marmorata Risso collected from the Portuguese Atlantic coast and its sporogonic development is described. Plasmodia and mature spores were floating free in the bile. Plasmodia are polysporic and highly polymorphic in shape and organization. Mature spores are spherical to subspherical with a pointed anterior end, measuring 12.3 +/- 0.5 microm in length and 9.0 +/- 0.5 microm in width. The spore wall is composed of two asymmetric shell valves, each bearing 4-5 elevated surface ridges. A bundle of 40-50 tapering caudal filaments extends from the basal portion of the shell valves. Four pyriform equal-sized polar capsules, measuring about 5.3 x 3.2 microm, are observed at the same level in the anterior pole of the spores, each containing a polar filament coiled in 8-9 (rarely 10) turns. Spore morphology, tissue tropism, host species and sequences of the SSU rRNA gene supported species identification. Since its discovery, this species has been dubiously reported from several cartilaginous hosts, namely due to the poor description of its features.

Ascariasis of gallbladder: a rare case report and a review of the literature.

Ascariasis of the gallbladder is a very rare presentation. We report a case of a 15-year-old boy who presented with complaints of pain in the abdomen, vomiting, pruritus, and fever on-and-off for 10 days. On radiological examination, an ultrasonography of the abdomen showed a dilated gallbladder with multiple linear echogenic, tubular, parallel lines inside the lumen of the gallbladder, common bile duct and intrahepatic biliary radicles. The zigzag and coiling movement of a worm was noted in the lumen of the gallbladder on real time B-mode ultrasonography. The patient was successfully treated with an anthelminthic drug. On follow up no evidence of the worm was noted in the gallbladder or common bile duct lumen.

Live worm in gallbladder: a case report.

Ascariasis, the most common helminthic infection is caused by ascaris lumbricoides. Usually the adult worm lives in the small intestine. Rarely it migrates through the papilla of vater and may enter the common bile duct. We are reporting a case of live worm in gall bladder. Presence of Ascaris lumbricoides in gallbladder is rare entity as it is difficult to reach there due to narrow and tortuous cystic duct.

Interaction of two myxozoan parasites from naked goby Gobiosoma bosc, in Lake Pontchartrain, Louisiana.

During a parasitological survey of naked gobies ( Gobiosoma bosc ) in Lake Pontchartrain, Louisiana, U.S.A., 2 myxozoan parasites were found infecting the gall bladders of 84 of 90 fish. Parasite plasmodia of each were morphologically distinct; plasmodia bearing Ellipsomyxa-like spores were elongate and fusiform (1,126 by 403 µm), and those bearing Sphaeromyxa-like spores were large and discoid (1,400 µm diameter). Neither parasite conformed to any described species of myxozoan, and both are described here. Sphaeromyxa kenti n. sp. bears boomerang-shaped spores ranging 17.5-19.8 µm long by 3.8-5.2 µm wide. Two unequal sized polar capsules contain ribbon-like polar filaments characteristic of this genus. Ellipsomyxa adlardi n. sp. bears ovoid spores 11.3-14.4 by 7.1-8.8 µm, with 2 rounded polar capsules oriented in opposite directions relative to the longitudinal plane of the spore. Phylogenetically both species cluster with sequenced members of their respective genera. Plasmodia of E. adlardi n. sp. were encountered in 72.2% of gobies examined, and S. kenti n. sp. in 25.6%. Overall, 6.7% of animals were uninfected, and only 4.4% of the 90 fish examined were infected with both species. The observed co-occurrence was lower than expected by chance, strongly suggestive of an interaction between these species.

Ascariasis vesicular: reporte de un caso / Gallbladder ascariasis: case report

We report a case of a young patient who was admitted for study and management of severe hypocalcemia. During evolution of the condition the patient presents abdominal pain (biliary colic) related to the presence of Ascaris lumbricoides in the gallbladder, responding to conservative medical therapy.

Reportamos un caso de un paciente joven que ingresó para estudio y manejo de una hipocalcemia grave. Durante su evolución el paciente presentó dolor abdominal (cólico vesicular) relacionado con la presencia de un ejemplar de Ascaris lumbricoides en la vesícula biliar, que respondió a terapia médica conservadora.

Gallbladder ascariasis with uneventful worm migration back to the duodenum: A case report.

Ascariasis, a worldwide parasitic disease, is regarded by some authorities as the most common parasitic infection in humans. The causative organism is Ascaris lumbricoides, which normally lives in the lumen of the small intestine. From the intestine, the worm can invade the bile duct or pancreatic duct, but invasion into the gallbladder is quite rare because of the anatomical features of the cystic duct, which is narrow and tortuous. Once it enters the gallbladder, it is exceedingly rare for the worm to migrate back to the intestine. We report a case of gallbladder ascariasis with worm migration back into the intestine, in view of its rare presentation.

A new species of Opisthioglyphe (Trematoda: Telorchiidae) from gall bladder of turtles in Malaysia.

Opisthioglyphe sharmai n. sp. is described from the gall bladder of the Malayan box turtle, Cuora amboinensis, and the black marsh turtle, Siebenrockiella crassicollis, in Malaysia. The new species is morphologically similar to Opisthioglyphe ranae and some other members of the genus parasitic in amphibians and reptiles. Opisthioglyphe sharmai n. sp. is easily differentiated from all other members of the genus by the cirrus sac extending posterior to the ventral sucker, while in all previously known species the cirrus sac is entirely or mostly preacetabular with the base of the structure not reaching beyond mid-line of the ventral sucker. Despite the overall stable morphology, O. sharmai n. sp. is characterized by highly variable arrangement of testes, from tandem to opposite. It is only the second representative of the genus described from turtles and the first species of Opisthioglyphe parasitic in gall bladder, while all previously described members of the genus are parasitic in the intestine of their hosts.