Microbiota in non-IgE-mediated food allergy.

PURPOSE OF REVIEW: To perform a nonsystematic review of the literature on the microbiota in the different types of non-IgE-mediated food allergy. RECENT FINDINGS: The commonest non-IgE-mediated disorders managed by allergists include: eosinophilic esophagitis, food protein-induced enteropathy, food protein-induced enterocolitis syndrome, and food protein-induced allergic proctocolitis. The review of the literature describes how at phylum level we observe an increase of Proteobacteria in eosinophilic esophagitis esophageal microbiota and in food protein-induced enterocolitis syndrome, and food protein-induced allergic proctocolitis gut microbiota, while we observe an increase of Bacteroidetes in healthy controls. Several studies endorse the concept that a bloom of Proteobacteria in the gut reflects dysbiosis or an unstable gut microbial community structure. In several studies, the type of diet, the use of probiotics and in a single experience the use of fecal microbiota transplantation has produced significant variations of the microbiota. SUMMARY: Genetic factors alone cannot account for the rapid rise in food allergy prevalence and the microbiome might be contributing to allergy risk. Our review showed that common features of the pathological microbiota among different types of non-IgE-mediated food allergy can be identified. These evidences suggest a possible role of the microbiota in the pathogenesis and non-IgE-mediated food allergies and the need to understand the effects of its modulation on the disorders themselves.

[Proctocolitis by cryptococcus in an immunocompetent patient: first report in Peru]. / Proctocolitis por criptococo en inmunocompetente: primer reporte de caso en Per ú.

Cryptococcosis is a typical opportunistic fungal infection in immunocompromised patients especially those with HIV (human immunodeficiency virus). We report a case of primary intestinal criptococosis in a 57 year old women HIV negative with one year of abdominal pain and hematochezia. Colonoscopy reveals nodular and friable mucosa from rectum to distal descending colon. We report the first case of gastrointestinal criptococosis in Peru in an immunocompetent patient.

Sexual Transmission of Intestinal Parasites and Other Enteric Pathogens among Men Who Have Sex with Men Presenting Gastrointestinal Symptoms in an STI Unit in Barcelona, Spain: A Cross-Sectional Study.

Sexually transmitted infections (STIs) are a major problem worldwide. In addition, the spectrum of STIs is now expanding, including parasitic, bacterial, and viral infections. The study retrospectively describes the presence of enteric pathogens among 73 patients with gastrointestinal symptoms of enteritis and proctocolitis attending to an STI unit in Barcelona, Spain, between 2015 and 2016. Only patients investigated for intestinal parasitic infections were included in the study. Different diagnostic procedures were established for the detection of parasites, bacterial enteropathogens, and other STI agents. Entamoeba histolytica was the most prevalent pathogen in our cohort (20.5%), especially among individuals with proctocolitis. Contrarily, Giardia intestinalis was detected in 11.0% of patients, only associated with enteritis cases. Polymicrobial infections were common in our study (45.2%). Of note, 55.6% of shigellosis cases were coinfected with E. histolytica. The investigation highlights the importance of including parasites as differential gastrointestinal diagnosis, disregarding travel history, particularly among risk populations.

First pediatric case of Chromobacterium haemolyticum causing proctocolitis.

Bloody diarrhea in children is usually due to either infectious or inflammatory etiology, but infection is far more common than inflammatory bowel disease in children worldwide. If, however, the patient has unfavorable response to antibiotics and a definite infectious agent has yet to be identified; colonoscopy should be performed. The current patient presented with acute onset of mucous bloody diarrhea. Stool culture was initially identified as Vibrio mimicus and later identified as Aeromonas schubertii but the biochemistry did not fit well with either organism. After a prolonged course of hematochezia despite i.v. antibiotics, colonoscopy was performed that showed inflammation in the rectosigmoid area. Meanwhile, the final biochemistry tests and 16s rRNA sequencing of the organism confirmed Chromobacterium haemolyticum infection. Twelve weeks after the initial colonoscopy, repeat colonoscopy showed post-infectious colitis. Herein we report on the first pediatric case of C. haemolyticum infection causing proctocolitis.

Sex, lies, and gastrointestinal tract biopsies: a review of selected sexually transmitted proctocolitides.

There are many insults that result in gastrointestinal tract inflammation. Infections can be particularly challenging because (1) only a limited number of organisms provoke a specific endoscopic and/or histologic appearance; and (2) although some organisms may be present on biopsies, the findings may be so subtle or organisms so few that they are easily missed if the reviewer is not performing a specific search for the offender. Sexually transmitted infections (STI) are rarely a consideration at the time of GI biopsy examination and clinicians rarely inquire about sexual behavior at the time of initial patient interview. Although establishing a definitive STI diagnosis is not possible on histology alone, these infections are associated with inflammatory patterns that may help raise this diagnostic possibility. Becoming familiar with these patterns is necessary as worldwide outbreaks of these infections are being reported. This review aims to provide the pathologist with histologic clues associated with the most frequently encountered bacterial pathogens in the setting of STI proctitis, namely, Chlamydia trachomatis, Neisseria gonorrhoeae, and Treponema pallidum.

Lymphogranuloma venereum proctosigmoiditis is a mimicker of inflammatory bowel disease.

There has been an increasing prevalence of lymphogranuloma venereum (LGV) or Chlamydia trachomatis (C. trachomatis) cases among the men who have sex with men (MSM) population, particularly in Europe and North America. These cases may present with an incomplete or undisclosed history and proctosigmoiditis without characteristic adenopathy syndrome. During the initial evaluation and colonoscopy, there is a strong clinical and endoscopic suspicion of inflammatory bowel disease (IBD) by virtue of presentation and endoscopic and histological findings. The diagnosis of IBD is subsequently modified to LGV proctosigmoiditis when one or more of the following transpire: (1) there is failure of response to IBD therapy; (2) additional components of history (MSM/travel) may be identified; (3) return of initially performed Chlamydia antibody test is positive; and (4) response to antibiotics effective against Chlamydia. We describe three such cases initially suspected to be an inflammatory bowel disease and subsequently identified as C. trachomatis proctosigmoiditis.

Intestinal microbiota and secretory immunoglobulin A in feces of exclusively breast-fed infants with blood-streaked stools.

Episodes of blood-streaked stools are not uncommon in exclusively breast-fed infants under 6 months of age. Such bleeding is thought to be associated with food protein-induced proctocolitis, however the pathomechanism remains unclear. The aim of this study was to investigate intestinal microbiota and secretory immunoglobulin A in the feces of exclusively breast-fed infants with blood-streaked stools. Fecal specimens from 15 full-term infants with blood-streaked stools and 15 breast-fed healthy infants were studied and the results compared. All infants had been delivered vaginally and exclusively breast-fed. The fecal microbiota were investigated by phylogenetic analysis combined with culture methods for some bacterial species, and feces were assessed for the presence of fecal secretory immunoglobulin A by enzyme-linked immunosorbent assay. Phylogenetic cluster analysis revealed four major clusters of fecal bacteria, cluster A being found only in healthy infants. The Bacteroides fragilis group was observed more frequently in controls than in patients (P < 0.05). In the controls, the predominant species belonging to the Enterobacteriaceae group was Escherichia coli, whereas in the patients it was Klebsiella (P < 0.05). Concentrations of secretory immunoglobulin A were high in one third of the healthy controls. In conclusion, the pathomechanism of rectal bleeding in exclusively breast-fed infants may be related to differences in the composition of their intestinal flora.

[Lymphogranuloma venereum proctocolitis in men with HIV-1 infection]. / Respuesta completa al tratamiento con doxiciclina en pacientes con infección por VIH-1 con proctitis por linfogranuloma venéreo.

INTRODUCTION: We present a series of 15 cases with lymphogranuloma venereum (LGV) with the aim of evaluating the response to a 21-day oral course of doxycycline (100mg twice daily). PATIENTS AND METHODS: It is an observational study where we describe a series of cases with LGV diagnosed in the Hospital Germans Trias i Pujol's HIV Unit between March 2008 and April 2009. RESULTS: All our patients were HIV infected men who had sex with men with proctitis in 80% of the cases. In all of them Chlamydia trachomatis was determined by PCR on rectal swab specimens, with a negative result after 21 days of treatment with doxycycline. Serovar L2 was confirmed in all the specimens with the reverse hybridization technique. DISCUSSION: A high index of clinical suspicion is the mainstay to the early diagnosis of LGV since the clinical presentation remains unspecific. The treatment with doxycycline eradicates C. trachomatis in HIV patients with LGV.

Lymphogranuloma venereum proctocolitis: a silent endemic disease in men who have sex with men in industrialised countries.

Lymphogranuloma venereum (LGV) is a sexually transmitted disease (STD) caused by serovars L1-L3 of Chlamydia trachomatis. Rare in the western world prior to 2003, different outbreaks or clusters of LGV have been reported in Europe, North America and Australia among men who have sex with men (MSM) over the past few years. The majority were HIV infected MSM with high-risk sexual behaviour and a high rate of concomitant STD, including hepatitis C. Most of them presented with a proctitis syndrome and only a few with the classical bubonic form. A previously non-described serovar, L2b, has been identified as the main causative agent of the epidemic. A delay in diagnosis has been the rule because of the misleading symptomatology of LGV proctitis, the unfamiliarity of the disease to physicians, and the lack of a routine diagnostic test for LGV serovars. It is crucial to increase the awareness of the disease among physicians for prompt diagnosis and treatment, to avoid complications, and to stop ongoing transmission. It has additional public health implications since LGV may facilitate the transmission and acquisition of HIV and other STD.

Intestinal microbiota in exclusively breast-fed infants with blood-streaked stools.

Intestinal microbiota in exclusively breast-fed infants with blood-streaked stools and in healthy exclusively breast-fed babies was compared. Total anaerobes, bifidobacteria, lactobacilli, coliform bacteria, enterococci and clostridia were quantified by cultivation methods in feces of 17 full-term exclusively breastfed patients (aged 16.3 +/- 7.4 weeks) with blood-streaked stools and in the control group of 22 healthy fullterm exclusively breast-fed infants (13.7 +/- 6.4 weeks). Specific fluorescence in situ hybridization kits for Bifidobacterium spp. were used for the quantitative detection of bifidobacteria in samples. Control samples had significantly (p < 0.05) higher counts of total anaerobes. Bifidobacteria were not detected in patients' samples in 65 % and in controls in 36 % (p < 0.01). Bifidobacteria counts were also significantly higher in the control group (p < 0.01). Furthermore, clostridia strains were detected only in feces from bifidobacteria-negative infants reaching counts >8 log CFU/g. Lactobacilli were not detected in 65 % patients and in 45 % control samples. However, this difference was not significant as well as the difference in lactobacilli counts. Eosinophilia was observed in 35 % of patients, low IgA concentration in 71 % and also low IgG concentration in 71 %. pANCA positivity was found in 53 % of patients. In conclusion a significant low proportion of bifidobacterial microbiota in patients with blood-streaked stools was shown in comparison with controls.

Balanitis y proctitis por estreptococo del grupo A / Balanitis and proctitis caused by group A streptococcus

Se presenta un caso de enfermedad perianal estreptocócica asociada a balanopostitis (AU)