Chyluria with massive proteinuria: Do not reach for the biopsy gun!

We report on a patient presenting with persistent chyluria due to filariasis, whose clinical course was complicated by massive proteinuria and severe hypoalbuminemia. Treatment with dietary manipulation, antifilarials, and sclerotherapy resulted in successful reversal of the above abnormalities. It has been reported that chyluria is not associated with massive proteinuria, or that even in cases of massive proteinuria, hypoalbuminemia is not seen and implies a glomerular pathology. We argue that chyluria is always associated with proteinuria, which may be massive, and does not warrant a kidney biopsy unless proteinuria persists despite resolution of chyluria.

Systemic oxidative stress in Suffolk and Santa Ines sheep experimentally infected with Haemonchus contortus.

The mechanisms responsible for the imbalance between oxidants and antioxidants in sheep infected with Haemonchus contortus are not well established. This study aimed to prove the hypothesis that oxidative stress occurring during infection by H. contortus varies according to breed, and that the parasite burden correlates with hypoalbuminaemia and anaemia. Thus, after deworming and confirming the absence of infection, two different sheep breeds, Suffolk (n = 15) and Santa Ines (n = 22), were orally inoculated with a single dose of 5,000 L3 of H. contortus. The egg counts per gram of faeces (EPG), packed cell volume (PCV) and concentrations of several plasma markers of oxidative stress (lipid peroxidation, albumin, uric acid, total bilirubin, total antioxidant capacity [TAC], total oxidant concentration [TOC] and the oxidative stress index [OSI]) were quantified before (control group) and during the experimental infection (28, 34 and 42 days post-inoculation). In both breeds, TOC increased at 28 days and TAC increased at 42 days. In Suffolk sheep, there was a positive correlation of EPG with oxidant components (28 days) and a negative correlation of EPG with PCV (42 days). In Santa Ines sheep, there was a positive correlation of EPG with bilirubin (r = 0.492; p = 0.020). H. contortus infection caused oxidative stress, which varied according to the breed. Parasite burden was not associated with hypoalbuminaemia, whereas there was a negative correlation with PCV. This research provides the first evidence that the antioxidant status contributes more to the resilience to H. contortus in Santa Ines sheep compared to Suffolk sheep.

Spectrum of complications associated with Plasmodium vivax infection in a tertiary hospital in South-Western India.

OBJECTIVE: To determine the range and incidence of complications associated with Plasmodium vivax (P. vivax) malaria. METHODS: A retrospective analysis was performed of all patients of P. vivax malaria admitted in Kasturba Medical College, Manipal between January and December, 2010. Patients with mixed malarial infection were excluded by appropriate tests. Clinical presentation and laboratory parameters were studied. RESULTS: Medical records of 213 individuals who satisfied the inclusion criteria were reviewed. Anaemia was seen in 65 (30.5%), leucopenia in 38 (17.8%) and thrombocytopenia in 184 (86.4%) patients. Aspartate and alanine aminotransferases were elevated in 86 (40.4%), and 89 (41.9%) patients respectively. Hypoalbuminemia was observed in 157 (73.6%) cases. Elevated serum creatinine was noted in in 59 (27.5%) patients. Creatine kinase was elevated in 30 out of 59 patients (50.8%). Overall, 107 (50.2%) patients fulfilled WHO criteria for severe malaria. None of the patients succumbed to the disease. CONCLUSIONS: P. vivax malaria is a potentially severe disease, and the term "benign" tertian malaria is a misnomer. Despite significant morbidity, with timely and appropriate treatment P. vivax malaria has an excellent outcome.

Age patterns in undernutrition and helminth infection in a rural area of Brazil: associations with ascariasis and hookworm.

OBJECTIVE: To investigate the nutritional status of individuals from a rural area of Brazil, and associations with helminth infections in an age-stratified sample. METHOD: A total of 1113 individuals aged from 6 months to 83 years from the rural community of Americaninhas in Minas Gerais were investigated. Assessments comprised anthropometric measurements of weight, height and body composition, examining faecal samples for helminth eggs, and peripheral blood assays for albumin, haemoglobin and ferritin concentrations. RESULTS: Ten percent of the participants were underweight, 12.8% were overweight and 28.3% of the children and adolescents were stunted. 11.6% had low lean body mass and 28.8% had low fat body mass. Hypoalbuminaemia was seen in 5.5%, anaemia in 12.5% and iron deficiency in 13.1%, although the prevalence of these two indices increased with age. Multivariate analysis showed that, after controlling for age, sex and socio-economic status, stunting was significantly associated with Ascaris lumbricoides infection among children and adolescents, whereas low body mass was significantly associated with hookworm infection among adults and the elderly. CONCLUSIONS: Helminth infections are associated with undernutrition in endemic populations, with important differences between the effects of hookworm and A. lumbricoides on age-related nutritional status.

Larval cyathostominosis in horses in Ontario: an emerging disease?

From 1991 to 2003, 24 cases of larval cyathostominosis were diagnosed at postmortem in equids, 15 (63%) from 2001 to 2003. Cases occurred from September to May, the majority from October to December. Median age was 12 mo. Diarrhea, colic, and weight loss were common clinical signs. Hypoalbuminemia and microcytosis were consistent findings.

Clinical and serological aspects of visceral leishmaniasis in northeast Brazilian dogs naturally infected with Leishmania chagasi.

Human visceral leishmaniasis is endemic in the northeast of Brazil, where the domestic dog is an important parasite reservoir in the infectious cycle of Leishmania chagasi. In this study, we evaluated the clinical signs of canine visceral leishmaniasis (CVL), serum protein profile and the antileishmanial IgG antibody production in 86 dogs living in northeast endemic areas of leishmaniasis. Thirty dogs from a leishmaniasis-free area were used as a control group. The major clinical signs of CVL seen were emaciation and skin ulcers (80%), followed by onychogryphosis and conjunctivitis (73%). Depilation was observed in 60% of animals while lymphadenomegaly, splenomegaly, liver enlargement or kidney involvement was less frequent (< or =20%). VL seropositive dogs presented with serum hyperproteinemia, hypoalbuminemia, hypergammaglobulinemia and decreased albumin/globulin ratio. A lower sensitivity and higher specificity was observed for promastigote indirect fluorescent antibody test (IFAT) (83 and 100%, respectively) compared with enzyme-linked immunosorbent assay (ELISA) (94 and 90%), which uses a crude extract of Leishmania. There was a positive correlation between IFAT and ELISA titers of antileishmanial IgG antibodies (Spearman test, P < 0.05), which was augmented in CVL dogs. This study found that the determination of serum protein, A/G ratio and the use of two different leishmanial serological tests like IFAT and ELISA are essential in CVL screening.