Hepatobiliary Ascariasis in a Piglet.

PURPOSE: Ascariasis caused by the helminth Ascaris suum is the most common parasitosis of swine worldwide and it may involve all age categories of pigs. The present study reports an unusual localization of A. suum worms in the biliary system of a piglet slaughtered for human consumption. METHODS: The liver was subjected to ultrasound scan and pathological examination. The isolated worms were morphologically examined and the DNA was extracted for the molecular identification of the species involved. RESULTS: A total of 43 preadult nematodes were found within the gallbladder and the bile ducts. Parasites were morphologically identified as belonging to the genus Ascaris and molecularly as A. suum. At gross examination, the liver was moderately enlarged, with the bile ducts severely dilated. A chronic inflammatory infiltrate was noted, often centered around ectatic bile ducts (up to 5 mm in diameter), lined by hyperplastic epithelium and filled with sections of nematodes. The worm sections showed smooth cuticle, coelomyarian musculature, and an intestinal tract lined by columnar, uninucleated cells within a pseudocoelom. The ex vivo ultrasonographic examination of the liver allowed the visualization of several nematodes in the bile duct lumen and could be suggested for in vivo diagnosis. Unfortunately, the absence of the intestine did not allow to define the pathogenesis of the infection. CONCLUSION: Although, given the unusual nature of this finding, it is difficult to identify predisposing factors for this A. suum localization, it suggests that ascariasis should be considered in the differential diagnosis of pigs with hepatobiliary disease.

Capillaria hepatica (syn. Calodium hepaticum) as a Cause of Asymptomatic Liver Mass.

Capillaria hepatica (syn. Calodium hepaticum) is a parasitic nematode of rodents, rarely infecting humans. An asymptomatic Israeli adult male with extensive travel history was diagnosed with a liver mass on routine post-thymectomy follow-up. Imaging and computer tomography (CT) guided biopsy were inconclusive. Surgical excision revealed an eosinophilic granuloma with fragments of a nematode suspected to be C. hepatica. Molecular methods verified the diagnosis, and the patient was treated empirically. This is the first case of hepatic capillariasis described in Israel, and the first to be diagnosed using molecular methods.

Diagnosis and clinical management of hepatosplenic schistosomiasis: A scoping review of the literature.

BACKGROUND: Hepatosplenic schistosomiasis (HSS) is a disease caused by chronic infection with Schistosma spp. parasites residing in the mesenteric plexus; portal hypertension causing gastrointestinal bleeding is the most dangerous complication of this condition. HSS requires complex clinical management, but no specific guidelines exist. We aimed to provide a comprehensive picture of consolidated findings and knowledge gaps on the diagnosis and treatment of HSS. METHODOLOGY/PRINCIPAL FINDINGS: We reviewed relevant original publications including patients with HSS with no coinfections, published in the past 40 years, identified through MEDLINE and EMBASE databases. Treatment with praziquantel and HSS-associated pulmonary hypertension were not investigated. Of the included 60 publications, 13 focused on diagnostic aspects, 45 on therapeutic aspects, and 2 on both aspects. Results were summarized using effect direction plots. The most common diagnostic approaches to stratify patients based on the risk of variceal bleeding included the use of ultrasonography and platelet counts; on the contrary, evaluation and use of noninvasive tools to guide the choice of therapeutic interventions are lacking. Publications on therapeutic aspects included treatment with beta-blockers, local management of esophageal varices, surgical procedures, and transjugular intrahepatic portosystemic shunt. Overall, treatment approaches and measured outcomes were heterogeneous, and data on interventions for primary prevention of gastrointestinal bleeding and on the long-term follow-up after interventions were lacking. CONCLUSIONS: Most interventions have been developed on the basis of individual groups' experiences and almost never rigorously compared; furthermore, there is a lack of data regarding which parameters can guide the choice of intervention. These results highlight a dramatic need for the implementation of rigorous prospective studies with long-term follow-up in different settings to fill such fundamental gaps, still present for a disease affecting millions of patients worldwide.

Parasites of the liver - epidemiology, diagnosis and clinical management in the European context.

Parasites in the liver cause significant global morbidity and mortality, as they can lead to recurrent cholangitis, cirrhosis, liver failure and cancer. Due to climate change and globalisation, their incidence is increasing, especially in Europe. The correct diagnosis of a hepatic parasite is often delayed because clinicians are unfamiliar with respective entities. Therefore, in this review, we aim to provide clinicians with a comprehensive clinical picture of hepatic parasites and to bring these neglected parasitic liver diseases to the wider attention of hepatology stakeholders in Europe and around the world.

The visceral larva migrans caused by Toxocara canis: a case report.

Hepatic toxocarosis is caused by the dog´s roundworm, Toxocara canis. Responsible for an eosinophilic inflammatory syndrome causing liver damage that can be detected on ultrasound, computed tomography and sometimes magnetic resonance imaging. We report the case of a nine-year-old child, living in countryside, with a notion of cohabitation with canids. He presented a digestive symptomatology revealed by abdominal pain, with a hemeosinophilia in the hemogram. The etiological assessment of hyper eosinophilia objectified a positive Toxocara canisserology. The imaging assessment in search of digestive visceral lesions, found multiple heterogeneous hypoechogenic areas, poorly defined, scattered in the liver. On the abdominal CT scan, its areas appear of unenhanced density and low density and better visible after injection of contrast product. This observation reveals that imagery, although not very specific, helps in the assessment of liver damage from digestive toxocarosis.

Genetic algorithms identify individuals with high risk of severe liver disease caused by schistosomes.

Schistosomes induce severe hepatic disease, which is fatal in 2-10% of cases, mortality being higher in cases of co-infection with HBV or HCV. Hepatic disease occurs as a consequence of the chronic inflammation caused by schistosome eggs trapped in liver sinusoids. In certain individuals, the repair process leads to a massive accumulation of fibrosis in the periportal spaces. We and others have shown that genetic variants play a crucial role in disease progression from mild to severe fibrosis and explain why hepatic fibrosis progresses rapidly in certain subjects only. We will review here published findings concerning the strategies that have been used in the analysis of hepatic fibrosis in schistosome-infected individuals, the genetic variants that have associated with fibrosis, and variants in new pathways crucial for fibrosis progression. Together, these studies show that the development of fibrosis is under the tight genetic control of various common variants with moderate effects. This polygenic control has made it possible to develop models that identify schistosome-infected individual at risk of severe hepatic disease. We discuss the performances and limitations of these models.

Infection by Platynosomum illiciens (= P. fastosum) in domestic cats of Araguaína, Tocantins, northern Brazil / Infecção por Platynosomum illiciens (= P. fastosum) em gatos domésticos de Araguaína, Tocantins, Norte do Brasil

Abstract Platynosomiasis is a hepatopathy caused by Platynosomum illiciens(= P. fastosum) (Trematoda: Dicrocoelidae), which occurs mainly in domestic and wild cats in tropical and subtropical areas. The objective of this study was to verify the occurrence of P. illiciens infection in domestic cats in the city of Araguaína, Tocantins, Brazil, using necropsy and coproparasitological tests. Additionally, we aimed to evaluate the use of two different techniques to diagnose P. illiciens infection in domestic cats and verify whether this parasitism was associated with individual feline characteristics. For this, 54 cats of different ages were analyzed. The percentage of infection was 33.3% (CI = 21.1-47.5%), parasite load was 9-509, mean intensity was 151.7, and mean abundance was 50.5 trematodes per animal. The risk of infection was higher for females than for males (OR = 5.00; P = 0.017). The spontaneous sedimentation coproparasitological test demonstrated the greatest sensitivity and specificity in diagnosing P. illiciens. This study is the first to report the occurrence of P. illiciens in cats in the state of Tocantins, northern Brazil.

Resumo A platinosomose é uma hepatopatia causada por Platynosomum illiciens(= P. fastosum) (Trematoda: Dicrocoelidae), que ocorre principalmente em felinos domésticos e selvagens de áreas tropicais e subtropicais. O objetivo deste trabalho foi verificar a ocorrência de P. illiciens em gatos domésticos do município de Araguaína, Tocantins, Brasil, por meio de necrópsia e exames coproparasitológicos, bem como avaliar o uso de diferentes técnicas no diagnóstico de P. illiciens em gatos domésticos e verificar a associação da parasitose com características individuais dos felinos. O estudo foi realizado em 54 gatos com diferentes idades, machos e fêmeas. O percentual de infecção foi de 33,3% (IC= 21,1% - 47,5%), a carga parasitária observada foi de 09-509, a intensidade média de 151,7 e a abundância média de 50,5 trematódeos por animal. As fêmeas apresentaram maior chance de infecção do que os machos (OR=5,00; P=0,017). O teste coproparasitológico que demonstrou maior sensibilidade e especificidade foi o de sedimentação espontânea. O presente estudo faz o primeiro relato da ocorrência de P. illiciens em gatos no estado do Tocantins, região Norte do Brasil.

Infection by Platynosomum illiciens (= P. fastosum) in domestic cats of Araguaína, Tocantins, northern Brazil.

Platynosomiasis is a hepatopathy caused by Platynosomum illiciens(= P. fastosum) (Trematoda: Dicrocoelidae), which occurs mainly in domestic and wild cats in tropical and subtropical areas. The objective of this study was to verify the occurrence of P. illiciens infection in domestic cats in the city of Araguaína, Tocantins, Brazil, using necropsy and coproparasitological tests. Additionally, we aimed to evaluate the use of two different techniques to diagnose P. illiciens infection in domestic cats and verify whether this parasitism was associated with individual feline characteristics. For this, 54 cats of different ages were analyzed. The percentage of infection was 33.3% (CI = 21.1-47.5%), parasite load was 9-509, mean intensity was 151.7, and mean abundance was 50.5 trematodes per animal. The risk of infection was higher for females than for males (OR = 5.00; P = 0.017). The spontaneous sedimentation coproparasitological test demonstrated the greatest sensitivity and specificity in diagnosing P. illiciens. This study is the first to report the occurrence of P. illiciens in cats in the state of Tocantins, northern Brazil.

Clinical and laboratory characterizations of hepatic capillariasis.

Hepatic capillariasis is a rare and neglected parasitic disease caused by infection with Capillaria hepatica in human liver. The disease is not well described and the information for the disease's clinical manifestation, laboratory findings and disease management strategy is not well reported. The limited information for this neglected infection often results in the delay of diagnosis or misdiagnosed to other diseases, therefore the real prevalence or severity of the infection may be underestimated. More case report with systemic analysis and features summary of this disease is needed to better understand the serious zoonotic disease. This study included systemic analysis of 16 patients infected with hepatic capillariasis in China between 2011-2017, including clinical manifestations, laboratory/radiative image findings and treatment results. Clinical manifestation included sustained fever (56.25%), respiratory disorder (37.5%), abdominal pain (37.5%), diarrhea (25%), leukocytosis (93.75%) and eosinophilia (100%). No egg was detected in feces of all patients. Over 60% patients showed elevated level of hepatic enzymes and proteins related to liver fibrosis in sera. Ultrasound and MRI examinations displayed scattered parasitic granuloma leisure in affected liver. Liver biopsy revealed parasite eggs, necrotized parasitic granulomas and septal fibrosis. Treatment with albendazole combined with corticoids for several treatment courses cured all patients with capillariasis. The difficulty of diagnosis, apparent damage of liver functions and potential fibrosis make the disease's prevalence and severity underestimated.

First Human Case of Metacestode Infection Caused by Versteria sp. in a Kidney Transplant Recipient.

Cestodes are emerging agents of severe opportunistic infections among immunocompromised patients. We describe the first case of human infection, with the recently-proposed genus Versteria causing an invasive, tumor-like hepatic infection with regional and distant extension in a 53-year-old female kidney transplant recipient from Atlantic Canada.

A case of hepatic anisakiasis caused by Pseudoterranova decipiens mimicking metastatic liver cancer.

BACKGROUND: Anisakid nematodes (Anisakis spp. or Pseudoterranova spp.) usually infect gastric or intestinal walls, while they rarely infect in extra-gastrointestinal sites of human body. Generally, Anisakis spp. larvae are highly infected in fish intermediate hosts, whereas Pseudoterranova spp. larvae are very rarely infected. To the best of our knowledge, there have been no reports which have documented cases of hepatic anisakiasis caused by Pseudoterranova spp. This report describes the first documented case of hepatic anisakiasis due to infection with Pseudoterranova decipiens and clinical features of the hepatic anisakiasis through literature review. CASE PRESENTATION: The case was a 28-year-old man with prior history of malignancy who was found to have a hepatic mass mimicking metastatic liver tumor. A new low density area of 20 mm in diameter in liver segment 7 was found on follow-up CT. With suspicious diagnosis of metastatic liver cancer, laparoscopic partial hepatectomy was performed. A pathological examination revealed no evidence of malignancy, but showed necrotic granuloma with eosinophil infiltration and the presence of a larva with Y-shaped lateral cords, which are specific to anisakid larvae. The type of larva was identified as Pseudoterranova decipiens sensu lato using PCR of DNA purified from a fixed granuloma embedded in paraffin. CONCLUSION: The present report is the first to discuss the case of a patient with hepatic anisakiasis caused by Pseudoterranova decipiens. Hepatic anisakiasis is a potential differential diagnosis for hepatic tumors and genetic identification with the PCR method was reliable for obtaining final diagnosis even when the larvae body in the resected specimen collapses with time.

[Hepatic Parasitosis: Atypical presentation] / Parasitosis Hepática: Presentación atípica.

Benign solid liver tumors are composed by a heterogeneous group of lesions. Hepatic parasitosis is an infrequent etiological cause of benign solid liver tumors. Objective. To present the case of a patient with benign solid liver tumors treated with right portal vein embolization and, later, with hepatectomy. Clinical case. 60-year-old, male patient diagnosed with multiple solid liver tumors, due to a generalized case of jaundice. The decision to perform surgery was made on the basis of the clinical symptoms and the impossibility of discarding malignancy through complementary tests. Before surgery, hepatic volumetry and right portal vein embolization were done to increase future hepatic remnant. Right hepatectomy and hepatic resection of segment IVa were performed. The patient evolved positively from jaundice and the anatomopathological results showed a lesion related to hepatic parasitosis. Conclusion. In the presence of a solid liver tumor, it is necessary to rule out the malignant etiology of the lesion. If this is not possible, or if the patient continues with the symptomatology, surgical resection is prescribed, taking into account the volume of the hepatic gland and future hepatic remnant.

Los tumores hepáticos sólidos benignos están formados por un grupo heterogéneo de lesiones. Las parasitosis hepáticas conforman una causa etiológica poco frecuente de tumores hepáticos sólidos benignos. Objetivo. Reportar el caso de un paciente con tumores hepáticos solidos benignos tratado con embolización portal derecha y posteriormente hepatectomía. Caso clínico. Paciente de 60 años, sexo masculino, al cual se le diagnostican múltiples tumores hepáticos sólidos, debido a cuadro de ictericia generalizada. Debido al cuadro sintomático, y al no poder descartar malignidad con las pruebas complementarias, se decide realizar cirugía. Previamente se realiza volumetría de la glándula hepática y embolización portal derecha para aumentar el remanente hepático futuro. Se realiza hepatectomía derecha y segmentectomía hepática IVa. Evoluciona con mejoría del cuadro ictérico y el resultado anatomopatológico informa lesión vinculable a parasitosis hepática. Conclusión. Ante la presencia de un tumor hepático sólido, es necesario descartar etiología maligna de la lesión. Si no es posible descartar esto, o si el paciente persiste con sintomatología, la resección quirúrgica está indicada, teniendo en cuenta el volumen de la glándula hepática y del remanente hepático futuro.

Hepatic schistosomiasis with massive splenomegaly: a case report and literature review.

Schistosomiasis is a parasitic disease caused by Schistosoma species. Intestinal and hepatic schistosomiases are the most common forms of chronic disease. We describe a case of a 26-year old patient from Eritrea who was referred to our hospital with abdominal pain and diarrhea. The diagnosis of hepatosplenic schistosomiasis was made by liver biopsy and the patient was treated with praziquantel. Hepatic schistosomiasis is characterised by deposition of schistosomal eggs in the liver which results in a host cell immune response and leads to granuloma formation and neoangiogenesis. This is hallmarked by different grades of periportal fibrosis with portal hypertension leading to splenomegaly. Normal liver architecture is preserved and periportal fibrosis can be reversible if treated adequately and timely. With a recent native schistosomiasis cluster report from France and the expected influx to Europe of persons from regions endemic for schistosomiasis, increased awareness of this disease in healthcare practitioners is needed. We review the epidemiology, pathogenesis, clinical presentation and treatment of schistosomiasis.

Nonspecific CD8+ T Cells and Dendritic Cells/Macrophages Participate in Formation of CD8+ T Cell-Mediated Clusters against Malaria Liver-Stage Infection.

CD8+ T cells are the major effector cells that protect against malaria liver-stage infection, forming clusters around Plasmodium-infected hepatocytes and eliminating parasites after a prolonged interaction with these hepatocytes. We aimed to investigate the roles of specific and nonspecific CD8+ T cells in cluster formation and protective immunity. To this end, we used Plasmodium berghei ANKA expressing ovalbumin as well as CD8+ T cells from transgenic mice expressing a T cell receptor specific for ovalbumin (OT-I) and CD8+ T cells specific for an unrelated antigen, respectively. While antigen-specific CD8+ T cells were essential for cluster formation, both antigen-specific and nonspecific CD8+ T cells joined the clusters. However, nonspecific CD8+ T cells did not significantly contribute to protective immunity. In the livers of infected mice, specific CD8+ T cells expressed high levels of CD25, compatible with a local, activated effector phenotype. In vivo imaging of the liver revealed that specific CD8+ T cells interact with CD11c+ cells around infected hepatocytes. The depletion of CD11c+ cells virtually eliminated the clusters in the liver, leading to a significant decrease in protection. These experiments reveal an essential role of hepatic CD11c+ dendritic cells and presumably macrophages in the formation of CD8+ T cell clusters around Plasmodium-infected hepatocytes. Once cluster formation is triggered by parasite-specific CD8+ T cells, specific and unrelated activated CD8+ T cells join the clusters in a chemokine- and dendritic cell-dependent manner. Nonspecific CD8+ T cells seem to play a limited role in protective immunity against Plasmodium parasites.

Hepatic paragonimiasis in a 15-month-old girl: a case report.

BACKGROUND: Paragonimiasis, particularly hepatic paragonimiasis (HP), is a type of zoonotic parasitic disease rarely encountered in infants. There have been only a few reports of HP, and no case of HP has been reported in an infant. CASE PRESENTATION: A 15-month-old girl presented with persistent mild fever with a duration of 1 month, hepatomegaly, and low-density lesions in the right hepatic lobe on abdominal ultrasound and computer tomography. Pathological examination and serum antibody detection were performed to verify HP. The diagnosis of HP was established based on findings of Charcot-Leyden crystals on liver lesion biopsy and antibodies against paragonimus westermani detected by enzyme-linked immunosorbent assay. After initiation of praziquantel (75 mg/kg/day for 3 days), all clinical findings promptly improved and the patient was discharged. CONCLUSION: It is very important to consider paragonimiasis in the clinical examination of infants from an area with paragonimiasis epidemic presenting with fever, hepatomegaly, low-density lesions in the liver.

A leishmaniose visceral ainda deve ser lembrada no diagnóstico diferencial de hepatoesplenomegalia febril? Revisão bibliográfica e relato de caso / Should visceral leishmaniasis still be remembered in the differential diagnosis of febrile hepatosplenomegaly? Literature review and case report

Apesar de não haver caso autóctone na Região Sudeste, a leishmaniose visceral é encontrada em pacientes que migram de regiões endêmicas. Como é uma doença que, se não reconhecida e conduzida adequadamente, apresenta alta mortalidade, realizamos uma revisão bibliográfica e destacamos, com o relato deste caso, a importância de a incluirmos no diagnóstico diferencial de hepatoesplenomegalia febril ainda na avaliação clínica inicial, pois o retardo no diagnóstico piora o prognóstico e a sobrevida do paciente, sendo sumária a introdução de terapêutica apropriada o mais breve possível.(AU)

Although there is no autochthonous case finding in the Southeast Region, visceral leishmaniasis is found in patients migrating from endemic areas. Because it is a disease that, if not properly recognized and treated, presents high mortality, we performed a bibliographic review and highlight, with the report of this case, the importance of including it in the differential diagnosis of febrile hepatosplenomegaly in the initial clinical evaluation. The late diagnosis worsens the patient's prognosis and survival, and the introduction of appropriate therapeutics should be made as soon as possible.(AU)

Thrombocytopenia as a marker of liver steatosis in a low-endemic area for schistosomiasis mansoni.

INTRODUCTION:: Thrombocytopenia is commonly found in patients living in highly endemic areas for Schistosoma mansoni. Recently, different degrees of liver steatosis have also been associated with low platelet counts worldwide. We investigated the association of platelet counts with hepatosplenic schistosomiasis and with liver steatosis in an area of low prevalence of schistosomiasis in Brazil. METHOD:: Pains, a city in the state of Minas Gerais, Brazil, had a population of 8,307 inhabitants and a schistosomiasis prevalence of 8%. Four micro-areas comprising 1,045 inhabitants were selected for this study. Blood sample was collected and a complete blood count (CBC) was performed. Eighty-seven (87) patients had low platelet counts (group 1 - 8.3%) and 94 volunteers presenting normal CBC were randomized (group 2 - 8.9%). They underwent clinical and ultrasound examinations. Liver steatosis was determined as either present or absent using abdominal ultrasound. A spleen > 12 cm in length, measured by ultrasound (US), was considered to be increased. Data collected were analyzed using SPSS software version 19.0. RESULTS:: Twenty-two patients (22/25.3%) in group 1 had liver steatosis compared with 11 volunteers (11.7%) in group 2 (p=0.02). Hepatosplenic schistosomiasis was diagnosed in two patients (p>0.05). CONCLUSION:: Thrombocytopenia was not a good marker of hepatosplenic schistosomiasis mansoni in a low prevalence area in Brazil. Liver steatosis was associated with thrombocytopenia in our study.

Hepatosplenic schistosomiasis: playing hide-and-seek with an elusive parasite.

A 27-year-old man of Eritrean origin presented with persistent left-sided abdominal pain. Initial investigation showed signs of liver fibrosis, portal hypertension and splenomegaly. A diagnosis of hepatosplenic schistosomiasis was suspected on grounds of elevated total IgE, grey area antischistosomiasis antibodies and the high endemic status of his native country. However, repeated microscopy of faecal and urine samples, as well as rectal biopsies, failed to demonstrate schistosomal eggs. Finally, the diagnosis of hepatosplenic schistosomiasis was established through demonstration of a Schistosoma mansoni egg in a liver biopsy taken in an attempt to clarify the cause of the above findings. The patient had recently been treated for uncomplicated malaria. Lowered schistosomiasis worm/egg burden and hence reduced sensitivity of classic microscopy-based schistosomiasis testing was attributed to the antischistosomal activity of the antimalarial chemotherapy.