Abdominal angiostrongyliasis, report of two cases and analysis of published reports from Colombia. / Abdominal angiostrongyliasis, report of two cases and analysis of published reports from Colombia

Abdominal angiostrongyliasis is a parasitic zoonosis, endemic in the American continent. Its etiological agent is Angiostrongylus costaricensis, a nematode whose definitive hosts are rats and other rodents and the intermediate hosts, slugs. Mammals acquire the infection by consuming vegetables contaminated with L3 larvae. The disease shows a heterogeneous clinical spectrum and given its low incidence its diagnosis is a great challenge. In Colombia, the first case was reported in 1979 and until 1998, only five additional cases have been reported. However, in the last two decades, no new cases were reported. Here we discuss two cases of children from Huila and Caquetá departments who developed the disease. Both cases required long in-patient care and multiple surgical interventions. The diagnosis was achieved by histopathological observation of parasitic elements inside the mesenteric arteries. One of the children died while the other fully recovered. We discuss the epidemiology, pathogenic cycle, clinical presentation, diagnosis, and prevention strategies of this disease paying particular attention to our patients' features and the Colombian context.

La angiostrongiloidiasis abdominal es una zoonosis parasitaria endémica en el continente americano. Su agente etiológico es el nematodo Angiostrongylus costaricensis, cuyos huéspedes definitivos son los roedores y, los intermediarios, los caracoles y las babosas, por lo que se adquiere al consumir vegetales contaminados con larvas en estadio 3. La presentación clínica es muy variada y, dada su rareza, su diagnóstico es un desafío. En Colombia el primer caso se reportó en 1979 y, desde entonces hasta 1998, se han informado cinco casos más, aunque en las últimas dos décadas no se había reportado ningún caso. Se describen aquí dos casos de angiostrongiloidiasis en niños provenientes de los departamentos de Huila y Caquetá que requirieron una larga hospitalización y múltiples intervenciones quirúrgicas. El diagnóstico se logró al observar en los especímenes quirúrgicos larvas and huevos cuya morfología sugería una infección por nematodos; uno de los pacientes murió y el otro se recuperó satisfactoriamente. Se discuten la epidemiología, la patogenia, la presentación clínica, el diagnóstico y las estrategias de prevención de esta parasitosis, con énfasis en las características particulares de los casos descritos y en el contexto colombiano.

Changes in the severity of gastric mucosal inflammation associated with Helicobacter pylori in humans coinfected with intestinal helminths.

BACKGROUND: Though a few studies in animal models suggest that intestinal helminths (IH) favorably affect evolution of gastritis associated with Helicobacter pylori (H. pylori) the studies supporting this concept in humans are only a few and are based on serological data. METHODS: To evaluate the possible influence of IH on the human gastric mucosa, three groups of Venezuelan adults with gastropathy (endoscopically diagnosed) were studied: H. pylori-/IH- (n = 17), H. pylori+/IH- (n = 18), and H. pylori+/IH+ (n = 11). Histological analysis (hematoxylin-eosin) and immunohistochemical staining (peroxidase) for cytokines interleukin-1beta (IL-1ß), tumor necrosis factor alpha (TNF-α), gamma interferon (IFN-γ), and interleukin 4 (IL-4) were undertaken in gastric antral biopsies. RESULTS: Expression of the four cytokines was detected in all individuals in varying degrees, but proinflammatory cytokines were expressed in a higher degree in the H. pylori+/IH- group, mainly IL-1ß (Th1-dominant immune response), associated with a higher degree of both histological inflammation and gastric cancer risk index (GCRI), as compared to the H. pylori-/IH- group. In contrast, an increased expression of IL-4 and a reduced expression of proinflammatory cytokines (Th2-dominant response), plus the tendency to a lower degree of mononuclear infiltration, mucosal atrophy in gastric corpus, and GCRI, were evidenced in the coinfected group. CONCLUSIONS: The findings of the present study is perhaps the first histological evidence of a possible modulatory effect of IH on the gastric mucosal inflammatory response due to H. pylori infection in humans.

Infections and pathology of free-roaming backyard chickens on St. Kitts, West Indies.

Free-roaming chickens on Caribbean islands are important sentinels for local avian diseases and those introduced by birds migrating through the Americas. We studied 81 apparently healthy unvaccinated free-roaming chickens from 9 parishes on St. Kitts, an eastern Caribbean island. Using commercial ELISAs, no chickens had antibodies against avian influenza virus, West Nile virus, or Salmonella Enteritidis, although seropositivity was high to infectious bursal disease virus (86%), infectious bronchitis virus (84%), Mycoplasma (37%), and avian avulavirus 1 (Newcastle disease virus, 31%). Examination of small and large intestinal contents revealed cestodes in 79% and nematodes in 75% of the chickens. Although ectoparasites and endoparasites were common (74% and 79%, respectively), only a few chickens had lesions at postmortem examination, mainly intestinal serosal nodules (12%) and feather loss (6%). Histologic examination of 18 organs from each bird revealed lesions in high percentages of organs, mainly the liver (86%), lung (75%), spleen (60%), small intestine (56%), skin (42%), and kidney (40%). Lesions included degenerative, reactive, inflammatory, and neoplastic, and were not correlated with the serologic status of the chickens except in one case of infectious bursal disease. Microscopically, Paratanaisia bragai was seen in the kidneys of 3 chickens and intestinal coccidiasis in 1 chicken. Pulmonary silicate aggregates were common, were present in intestinal serosal nodules, and were suggestive of environmental exposure.

Cholinergic signaling plasticity maintains viscerosensory responses during Aspiculuris tetraptera infection in mice small intestine.

Intestinal parasites alter gastrointestinal (GI) functions like the cholinergic function. Aspiculuris tetraptera is a pinworm frequently observed in laboratory facilities, which infests the mice cecum and proximal colon. However, little is known about the impact of this infection on the GI sensitivity. Here, we investigated possible changes in spontaneous mesenteric nerve activity and on the mechanosensitivity function of worm-free regions of naturally infected mice with A. tetraptera. Infection increased the basal firing of mesenteric afferent nerves in jejunum. Our findings indicate that nicotinic but not muscarinic receptors, similarly affect spontaneous nerve firing in control and infected animals; these axons are mainly vagal. No difference between groups was observed on spontaneous activity after nicotinic receptor inhibition. However, and contrary to the control group, during infection, the muscarinic signaling was shown to be elevated during mechanosensory experiments. In conclusion, we showed for the first time that alterations induced by infection of the basal afferent activity were independent of the cholinergic function but changes in mechanosensitivity were mediated by muscarinic, but not nicotinic, receptors and specifically by high threshold nerve fibers (activated above 20mmHg), known to play a role in nociception. These plastic changes within the muscarinic signaling would function as a compensatory mechanism to maintain a full mechanosensory response and the excitability of nociceptors during infection. These changes indicate that pinworm colonic infection can target other tissues away from the colon.

Morphological and histochemical changes associated with massive infection by Neoechinorhynchus buttnerae (Acanthocephala: Neoechinorhynchidae) in the farmed freshwater fish Colossoma macropomum Cuvier, 1818 from the Amazon State, Brazil.

The study describes the morphological changes associated with parasitism by the intestinal acanthocephalan Neoechinorhynchus buttnerae in tambaqui juveniles Colossoma macropomum farmed in an excavated nursery, in Manaus (Amazon) in September 2013. After fish biometrics, analysis of macroscopic changes in morphology and counting of parasites, bowel fragments were fixed and submitted to histological and histochemical processing. All fish analyzed had acanthocephalans in the intestine; intestinal loops were milky white in color, with the presence of nodules with heavy parasitism. The changes in tissues that form the intestine varied according to the arrangement of the parasites: either free in the intestinal lumen or fixed by the proboscis on the organ wall. In the first case, the changes found were flaking, abrasion, compression, hypertrophy of goblet cells and disappearance of the villi on the mucosa, leukocytic cell infiltration in the submucosa, and muscle layer thickening. In the second case, in addition to these, other changes were observed as metaplasia in muscle tissue with its replacement by a loose connective tissue with severe leukocytic infiltration, edema in blood vessels, and necrotic foci. The histochemical analysis revealed that positive Alcian Blue mucosal cells (pH 2.5) were more expressive in parasitized intestines than in intestines not parasitized by N. buttnerae.

Correlation study and histopathological description of intestinal alterations in dogs infected with Leishmania infantum.

The aim of this work was a correlation study and histopathological description of alterations associated with the presence of Leishmania infantumamastigote in the intestinal wall of dogs infected with canine visceral leishmaniasis (CVL). Three groups were used: G1 (n = 8), comprising naturally infected dogs with CVL with amastigotes of L. infantum in the small and large intestines; G2 (n = 9), infected dogs with CVL, without intestinal amastigotes; and G3 (n = 3), uninfected dogs. Histochemistry and immunohistochemistry methods were used for histopathology and amastigotes identification. 47.1% (8/17) of dogs from G1 group had amastigotes in the mucosa, submucosa and muscle layers of the small and large intestines and it was observed a prominent inflammatory reaction characterized by chronic infiltration of mononuclear cells: macrophages, lymphocytes and plasma cells. Comparison between the groups showed only a significant difference in relation to mucosal microscopic structural alterations in dogs from G1 in relation to G2 and G3. Parasite burden showed significant correlations with the microscopic alterations and clinical status of dogs in G1. By the conclusion, the inflammatory reactions caused by the parasites in the intestines might have contributed towards alterations in digestive processes, worsening the dogs' clinical status of CVL.

Correlation study and histopathological description of intestinal alterations in dogs infected with Leishmania infantum / Estudo de correlação e descrição histopatológica das lesões intestinais de cães infectados com Leishmania infantum

Abstract The aim of this work was a correlation study and histopathological description of alterations associated with the presence of Leishmania infantumamastigote in the intestinal wall of dogs infected with canine visceral leishmaniasis (CVL). Three groups were used: G1 (n = 8), comprising naturally infected dogs with CVL with amastigotes of L. infantum in the small and large intestines; G2 (n = 9), infected dogs with CVL, without intestinal amastigotes; and G3 (n = 3), uninfected dogs. Histochemistry and immunohistochemistry methods were used for histopathology and amastigotes identification. 47.1% (8/17) of dogs from G1 group had amastigotes in the mucosa, submucosa and muscle layers of the small and large intestines and it was observed a prominent inflammatory reaction characterized by chronic infiltration of mononuclear cells: macrophages, lymphocytes and plasma cells. Comparison between the groups showed only a significant difference in relation to mucosal microscopic structural alterations in dogs from G1 in relation to G2 and G3. Parasite burden showed significant correlations with the microscopic alterations and clinical status of dogs in G1. By the conclusion, the inflammatory reactions caused by the parasites in the intestines might have contributed towards alterations in digestive processes, worsening the dogs’ clinical status of CVL.

Resumo O objetivo foi realizar um estudo de correlação e descrição histopatológica das lesões associadas à presença de amastigotas de Leishmania infantum na parede intestinal de cães infectados com leishmaniose visceral canina (LVC). Os cães foram subdivididos em três grupos: G1 (n = 8) cães naturalmente infectados com LVC e com amastigotas de L. infantum no intestino; G2 (n = 9) com LVC, mas sem o parasitismo intestinal; e G3 (n = 3) cães não infectados. Métodos histoquímicos e imunoistoquímicos foram utilizados para a histopatologia e a identificação das amastigotas, respectivamente. 47,1% (8/17) dos cães infectados (grupo G1) apresentavam formas amastigotas na mucosa, submucosa e camada muscular do intestino delgado e grosso, destacando-se uma reação inflamatória caracterizada por infiltrado crônico de células mononucleares; macrófagos, linfócitos e plasmócitos. Observou-se uma diferença significativa somente com relação às alterações estruturais microscópicas intestinais nos cães do G1 quando comparadas com G2 e G3. A intensidade parasitária intestinal teve correlação significativa com as alterações microscópicas e os sinais clínicos dos cães do G1. Concluiu-se que as amastigotas de L. infantum por causarem reações inflamatórias na parede intestinal dos cães podem ter contribuído para as alterações dos processos digestórios, agravando ainda mais o quadro clínico dos animais.

Pathological and parasitological characterization of infection by trematodes (Paramphistomatidae) in the large intestine of capybaras.

Gross and histological lesions caused by an intestinal parasite were described in three capybaras. The parasites presented a mean length of 14 mm and width of 7 mm, were round to oval or piriform, reddish and pedunculated, and adhered strongly to the mucosa of the large intestine. The intestinal mucosa at the parasite attachment site presented loss of surface epithelium and most glands, with replacement by fibrovascular proliferation that protruded from the mucosa and was involuted by the ventral sucker of the parasite. The lamina propria presented cellular debris, eosinophils, macrophages and plasma cells. The morphological characteristics, observed using serial histological sections, made it possible to classify the parasite as a trematode (Paramphistomatidae), compatible with Taxorchis schistocotyle. One capybara also harbored many ciliated protozoa in the large intestine (at the site of attachment of the parasite) and inside the caeca of the trematodes. In conclusion, this study described a multifocal necrotizing colitis associated with T. schistocotyle parasitism in capybaras.

Pathological and parasitological characterization of infection by trematodes (Paramphistomatidae) in the large intestine of capybaras / Caracterização patológica e parasitológica da infecção por trematódeos (Paramphistomatidae) no intestino grosso de capivaras

Gross and histological lesions caused by an intestinal parasite were described in three capybaras. The parasites presented a mean length of 14 mm and width of 7 mm, were round to oval or piriform, reddish and pedunculated, and adhered strongly to the mucosa of the large intestine. The intestinal mucosa at the parasite attachment site presented loss of surface epithelium and most glands, with replacement by fibrovascular proliferation that protruded from the mucosa and was involuted by the ventral sucker of the parasite. The lamina propria presented cellular debris, eosinophils, macrophages and plasma cells. The morphological characteristics, observed using serial histological sections, made it possible to classify the parasite as a trematode (Paramphistomatidae), compatible with Taxorchis schistocotyle. One capybara also harbored many ciliated protozoa in the large intestine (at the site of attachment of the parasite) and inside the caeca of the trematodes. In conclusion, this study described a multifocal necrotizing colitis associated with T. schistocotyle parasitism in capybaras.

Lesões macroscópicas e histológicas causadas por um parasita intestinal foram descritas em três capivaras. Os parasitas apresentaram média de 14 mm de comprimento e 7 mm de largura, eram de circulares a ovais ou piriformes, avermelhados, pedunculados e estavam fortemente aderidos à mucosa do intestino grosso. A mucosa intestinal, em que os parasitas estavam aderidos, apresentou perda do epitélio e da maioria das glândulas, sendo substituídos por proliferação fibrovascular que se projetava a partir da mucosa e era envolvida pela ventosa ventral do parasita. A lâmina própria apresentou restos celulares, eosinófilos, macrófagos e plasmócitos. As características morfológicas, utilizando cortes histológicos seriados, proporcionaram a classificação do parasita como um trematoda Paramphistomatidae, compatível com Taxorchis schistocotyle. Uma capivara continha também numerosos protozoários ciliados no intestino grosso (no local de fixação do parasita) e no lúmen do ceco desses parasitos. Em síntese, este estudo demonstrou a ocorrência de colite necrótica associada ao parasitismo por T. schistocotyle em capivaras.

Conocimientos sobre parasitismo intestinal en personal médico / Knowledge about intestinal parasites among the medical personnel

OBJETIVO: evaluar los conocimientos básicos sobre parasitismo intestinal de médicos que prestan servicios en la atención primaria de salud. MÉTODOS: se realizó una encuesta que incluyó cuatro preguntas que evaluaban conocimientos generales acerca del parasitismo intestinal y una pregunta sobre Giardia lamblia, protozoo patógeno de elevada incidencia y prevalencia en nuestro medio. Se aplicó entre los meses de enero y marzo de 2011, con carácter anónimo, a un grupo de médicos de la atención primaria de salud. RESULTADOS: todos los médicos que fueron encuestados tuvieron errores al responder el cuestionario. A pesar de que en los temas evaluados las respuestas correctas superaron el 50 %, el promedio de respuestas correctas de los 26 incisos que conformaban las cinco preguntas del cuestionario fue 20,73 %. CONCLUSIONES: los médicos que prestan servicio en diferentes unidades de la atención primaria de salud, mostraron insuficiente conocimiento sobre el parasitismo intestinal, por lo que se impone el desarrollo de un programa educativo en aras de atenuar estas dificultades.

OBJECTIVE: evaluate the level of basic knowledge about intestinal parasites among primary health care doctors. METHODS: an anonymous survey was conducted made up of four questions evaluating general knowledge about intestinal parasites and one question about Giardia lamblia, a pathogenic protozoan of high incidence and prevalence in our country. The survey was applied to a group of primary health care doctors between January and March 2011. RESULTS: all the doctors surveyed had errors in their answers to the questionnaire. Despite the fact that correct answers about the topics evaluated exceeded 50 %, the average of correct answers for the 26 items included in the five questions was 20.73 %. CONCLUSIONS: primary health care doctors showed insufficient knowledge about intestinal parasites. Hence the need to develop an education program to attenuate those difficulties.

Schistosoma mansoni granuloma in late evolutive phase, in a case of tumoral form in man.

INTRODUCTION: Authors describe human schistosomal granuloma in late chronic phase, from the morphological and evolutionary viewpoints. METHODS: The study was based on a histological analysis of two fragments obtained from a surgical biopsy of peritoneum and large intestine of a 42-year-old patient, with a pseudotumoral form mimicking a peritoneal carcinomatosis associated to the schistosomiasis hepatointestinal form. RESULTS: Two hundred and three granulomas were identified in the pseudotumor and 27 in the intestinal biopsy, with similar morphological features, most in the late chronic phase, in fibrotic healing. A new structural classification was suggested for granulomas: zone 1 (internal), 2 (intermediate) and 3 (external). CONCLUSIONS: Regarding granuloma as a whole, we may conclude that fibrosis is likely to be controlled by different and independent mechanisms in the three zones of the granuloma. Lamellar fibrosis in zone 3 seems to be controlled by matrix mesenchymal cells (fibroblasts and myoepithelial cells) and by inflammatory exudate cells (lymphocytes, plasmocytes, neutrophils, eosinophils). Annular fibrosis in zone 2, comprising a dense fibrous connective tissue, with few cells in the advanced phase, would be controlled by epithelioid cells involving zone 1 in recent granulomas. In zone 1, replacing periovular necrosis, an initialy loose and tracery connective neoformation, housing stellate cells or with fusiform nuclei, a dense paucicellular nodular connective tissue emerges, probably induced by fibroblasts. In several granulomas, one of the zones is missing and granuloma is represented by two of them: Z3 and Z2, Z3 and Z1 or Z2 and Z1 and, ultimately, by a scar.

Schistosoma mansoni granuloma in late evolutive phase, in a case of tumoral form in man / Granuloma equistossomótico em fase evolutiva tardia, em um caso de forma tumoral no homem

INTRODUCTION: Authors describe human schistosomal granuloma in late chronic phase, from the morphological and evolutionary viewpoints. METHODS: The study was based on a histological analysis of two fragments obtained from a surgical biopsy of peritoneum and large intestine of a 42-year-old patient, with a pseudotumoral form mimicking a peritoneal carcinomatosis associated to the schistosomiasis hepatointestinal form. RESULTS: Two hundred and three granulomas were identified in the pseudotumor and 27 in the intestinal biopsy, with similar morphological features, most in the late chronic phase, in fibrotic healing. A new structural classification was suggested for granulomas: zone 1 (internal), 2 (intermediate) and 3 (external). CONCLUSIONS: Regarding granuloma as a whole, we may conclude that fibrosis is likely to be controlled by different and independent mechanisms in the three zones of the granuloma. Lamellar fibrosis in zone 3 seems to be controlled by matrix mesenchymal cells (fibroblasts and myoepithelial cells) and by inflammatory exudate cells (lymphocytes, plasmocytes, neutrophils, eosinophils). Annular fibrosis in zone 2, comprising a dense fibrous connective tissue, with few cells in the advanced phase, would be controlled by epithelioid cells involving zone 1 in recent granulomas. In zone 1, replacing periovular necrosis, an initialy loose and tracery connective neoformation, housing stellate cells or with fusiform nuclei, a dense paucicellular nodular connctive tissue emerges, probably induced by fibroblasts. In several granulomas, one of the zones is missing and granuloma is represented by two of them: Z3 and Z2, Z3 and Z1 or Z2 and Z1 and, ultimately, by a scar.

INTRODUÇÃO: Os autores descrevem o granuloma esquistossomótico no homem, na fase crônica tardia, do ponto de vista morfológico e evolutivo. MÉTODOS: O estudo baseou-se na análise histológica de dois fragmentos obtidos de biópsia cirúrgica do peritônio e do intestino grosso de um paciente de 42 anos de idade, com a forma pseudotumoral mimetizando carcinomatose peritoneal associada à forma hepatointestinal da esquistossomose. RESULTADOS: Foram identificados 203 granulomas no pseudotumor e 27 na biópsia intestinal, com aspectos morfológicos semelhantes, a maioria na fase crônica tardia, em cura por fibrose. Foi sugerida nova classificação estrutural para os granulomas: zona 1 (interna), zona 2 (intermediária) e zona 3 (externa). CONCLUSÕES: Considerando o granuloma como um todo, concluímos que, provavelmente, a fibrose é comandada por mecanismos diferentes e independentes nas três zonas do granuloma. A fibrose lamelar na zona 3 parece ser comandada pelas células mesenquimais da matriz (fibroblastos e células mioepiteliais) e pelas células do exsudato inflamatório (linfócitos, plasmócitos, neutrófilos, eosinófilos). A fibrose anular na zona 2, composta por conjuntivo fibroso denso, pouco celular na fase avançada, seria comandada pelas células epitelioides que envolvem a zona 1 nos granulomas recentes. Na zona 1, substituindo a necrose periovular, a neoformação conjuntiva inicialmente frouxa, rendilhada, albergando células estreladas ou com núcleos fusiformes, surge um conjuntivo denso, paucicelular, nodular, provavelmente induzido pelos fibroblastos. Em muitos granulomas falta uma das zonas descritas e o granuloma é representado apenas por duas delas: Z3 e Z2, Z3 e Z1 ou Z2 e Z1 e, no final, por uma cicatriz.

Experimental infection with Cryptosporidium parvum IIaA21G1R1 subtype in immunosuppressed mice.

Cryptosporidium parvum subtype IIaA21G1R1 oocysts were used to infect dexamethasone immunosuppressed N: NIH Swiss mice. This is the first Cryptosporidium mouse model in which the relationship between infection and apoptosis has been histologically studied at each portion of the gut in order to observe this dynamic in chronic cryptosporidiosis. Histology showed developmental stages in the duodenum, proximal and distal jejunum, ileum, cecum and colon, with the small intestine remaining infected until day 35 post infection. At proximal jejunum an inverse correlation between infection and apoptosis was observed at days 28 and 35 p.i. Data suggests that jejunum could be an interesting place to carry out further studies on the dynamics of Cryptosporidium infection and apoptosis. Based on these findings, this mouse model was useful to evaluate clinical, parasitological and histological aspects of C. parvum subtype IIaA21G1R1 infection, and it will be an appropriate tool to investigate different aspects of Cryptosporidium infection.

Enteroparasitosis en niños desnutridos graves de un hospital de la ciudad de Maracaibo, Venezuela / Intestinal parasitosis in severely malnourished children at a hospital in the city of Maracaibo, Venezuela

Para comparar la prevalencia de enteroparásitos en niños con desnutrición severa de la Unidad de Recuperación Nutricional del Hospital Chiquinquirá de Maracaibo, Estado Zulia, con niños eutróficos que asisten a la consulta de niños sanos del mismo hospital; se realizó un examen coproparasitológico a 50 niños desnutridos graves y 50 niños eutróficos, mediante examen directo; técnica de concentración (Ritchie) y coloración de Ziehl Neelsen. Entre los protozoarios, Cryptosporidium sp. ocupó el primer lugar con un 14% en el grupo de los desnutridos graves y Giardia lamblia en los eutróficos con un 20%. De los helmintos identificados, Trichuruis trichiura prevaleció con 12% en los desnutridos, mientras Ascaris lumbricoides en los eutróficos ocupó el primer lugar con un 8%. No se encontró diferencia estadísticamente significativa entre la prevalencia de parásitos en general con la edad, el sexo o la desnutrición, ni entre poliparasitismo versus monoparasitismo. La medida en que se relacionan la desnutrición y las parasitosis intestinales es difícil de esclarecer, al ser la desnutrición una condición multifactorial ya que depende de la especie parasitaria presente, la intensidad de la parasitosis, las características inmunológicas y genéticas del hospedero, del medio socioeconómico en el que se desenvuelva el individuo, entre otros factores.

To compare the prevalence of intestinal parasites in children with severe malnutrition in the Nutritional Recovery Unit at the Chiquinquirá Hospital of Maracaibo, State of Zulia, with eutrophic children attending consult for healthy children at the same hospital, stool examinations were performed for 50 seriously malnourished children and 50 eutrophic children by direct examination, using the concentration technique (Ritchie) and Ziehl Neelsen. Among the protozoa, Cryptosporidium sp. ranked first, with 14% in the group of severely malnourished and Giardia lamblia in 20% of the eutrophic children. Of the identified helminths, Trichuris trichiura prevailed, with 12% in the malnourished group, while Ascaris lumbricoides took first place with 8% in the eutrophic group. No statistically significant difference was found between the prevalence of parasites in general with age, sex or malnutrition, or between polyparasitism versus monoparasitism. The extent to which malnutrition and intestinal parasites relate is difficult to clarify, since malnutrition is a multifactorial condition that depends on the parasite species present, intensity of the parasitosis, immunologic and genetic characteristics of the host, the socio economic environment in which the individual develops and other factors.

Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy.

CONTEXT: Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. OBJECTIVE: To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. METHODS: Recorded biopsies archive at "Complexo Hospitalar Professor Edgar Santos" , a general teaching Hospital in the state of Bahia, Northeast Brazil, from January 1995 to January 2009, were reviewed. One thousand ten duodenal biopsy reports were found. Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected. RESULTS: Eleven biopsies showed parasites, including cases of Cryptosporidium sp. and Strongyloides stercoralis. Vomiting (91%), abdominal pain (78%), diarrhea (78%) and weight loss (78%) were usual symptoms. Seventy-five percent had duodenal mucosa changes on endoscopy, while 25% have no changes. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed. Villus atrophy and reactive epithelium were usual in Strongyloides cases. CONCLUSIONS: No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.

Salmonella spp. en manipuladores de alimentos en los comedores de una universidad venezolana / Salmonella spp. among food handlers in the dining room at a venezuelan university

La relación existente entre una inadecuada manipulación de los alimentos y la producción de infecciones gastrointestinales a través de éstos, ha sido ampliamente demostrada y una gran variedad de microorganismos entre ellos Salmonella spp. está asociada a esta transmisión. El propósito de esta investigación fue detectar la prevalencia de Salmonella a partir de muestras de heces en manipuladores de alimentos que laboran en dos comedores universitarios del estado Zulia. Entre los meses abril y julio del año 2009, se cultivaron 40 muestras de heces de individuos asintomáticos de ambos sexos y diferentes edades. El aislamiento e identificación bioquímica y serológica se realizó siguiendo la metodología convencional. Las pruebas de susceptibilidad a los agentes antimicrobianos se efectuaron según el método de difusión del disco siguiendo los criterios establecidos por el CLSI. Del total de muestras procesadas 4 de ellas (10%) resultaron positivas para el género Salmonella, 3 (75%) correspondientes al serogrupo B y 1 (25%) resultó ser al serogrupo E1. El 50% de las cepas mostró resistencia a ampicilina. La presencia de Salmonella en las heces de los manipuladores constituye un grave problema de salud pública, que no debe pasar desapercibido debido a su elevada infectividad y a su asociación a brotes importantes

The relationship between inadequate food handling and the production of gastrointestinal infections has been amply demonstrated, and a variety of organisms, including Salmonella, are associated with this transmission. The purpose of this research was to detect the prevalence of Salmonella in stool samples from food handlers who work in two dining rooms at the Zulia state university. Between April and July of 2009, 40 samples were cultured from stools of asymptomatic individuals of both sexes and different ages. Isolation, biochemical and serological identification were performed using conventional methodology. Tests for susceptibility to antimicrobial agents were done using the disk diffusion method, following criteria established by the CLSI. Of the total samples processed, four of them (10%) were positive for Salmonella 3, (75%) for serogroup B and 1 (25%) for serogroup E1. 50% of the strains were ampicillin resistant. The presence of Salmonella in the stools of food handlers is a major public health problem that should not go unnoticed due to its high infectivity and association with major outbreaks

Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy / Perfil clínico, endoscópico e histopatológico de casos de duodenite parasitária diagnosticados por endoscopia digestiva alta

CONTEXT: Intestinal parasites induce detectable histopathological changes, which have been studied in groups with known diagnosis of parasitic disease. There is no available study with a larger base without previous diagnosis. OBJECTIVE: To describe clinical and histopathological findings of parasitosis diagnosed by endoscopic biopsy in patients submitted to upper digestive endoscopy. METHODS: Recorded biopsies archive at "Complexo Hospitalar Professor Edgar Santos" , a general teaching Hospital in the state of Bahia, Northeast Brazil, from January 1995 to January 2009, were reviewed. One thousand ten duodenal biopsy reports were found. Reports positive for parasites had their specimens reviewed and photographed. All blocks of biopsy selected as case were retrieved and reviewed by an experienced pathologist. Clinical, laboratorial and endoscopic data were collected. RESULTS: Eleven biopsies showed parasites, including cases of Cryptosporidium sp. and Strongyloides stercoralis. Vomiting (91 percent), abdominal pain (78 percent), diarrhea (78 percent) and weight loss (78 percent) were usual symptoms. Seventy-five percent had duodenal mucosa changes on endoscopy, while 25 percent have no changes. Anemia and low serum albumin were important laboratorial data. HIV infection association was observed. Villus atrophy and reactive epithelium were usual in Strongyloides cases. CONCLUSIONS: No endoscopic or histopathologic finding was pathognomonic. One percent of duodenal endoscopic biopsies showed parasites.

CONTEXTO: Parasitas intestinais podem induzir alterações histopatológicas, que têm sido estudadas em subgrupos com diagnóstico firmado de parasitose. Não há estudo disponível com base mais ampla, sem diagnóstico prévio. OBJETIVO: Descrever os achados clínicos e histopatológicos de parasitoses diagnosticadas por biopsia em pacientes submetidos a endoscopia digestiva alta. MÉTODO: Laudos de biopsias realizadas de janeiro de 1995 a janeiro de 2009, no Complexo Hospitalar Professor Edgar Santos, hospital geral universitário localizado no nordeste brasileiro, foram revisados. Mil e dez laudos de biopsia duodenal foram revistos. Biopsias positivas para parasitas tiveram suas lâminas revisadas e fotografadas. Todos os blocos de biopsia selecionados como casos foram recuperados e revisados por experiente patologista. Dados clínicos, laboratoriais e endoscópicos foram coletados. RESULTADOS: Onze biopsias mostraram parasitas, incluindo casos de Cryptosporidium sp. e Strongyloides stercoralis. Vômitos (91 por cento), dor abdominal (78 por cento), diarreia (78 por cento) e perda ponderal (78 por cento) foram sintomas comuns. Setenta e cinco por cento apresentaram alterações na mucosa duodenal à endoscopia, enquanto 25 por cento não apresentaram modificações. Anemia e hipoalbuminemia foram importantes dados laboratoriais. Foi observada associação com infecção pelo HIV. Atrofia de vilosidades e epitélio reativo foram comuns nos casos de S. stercoralis. CONCLUSÕES: Nenhum achado endoscópico ou histopatológico foi patognomônico. Um por cento das biopsias duodenais por via endoscópica mostraram parasitas.