[Strongyloides stercoralis as uncommon cause of ascitic fluid infection in cirrhosis]. / Strongyloides stercoralis como causa infrecuente de infección de líquido ascítico en cirrosis.

Male patient, with a history of alcoholic cirrhosis frequent user of anti-inflammatory drugs including corticosteroids. He consulted for digestive bleeding secondary to a bulbar ulcer. During the admission, he had fever and antibiotic treatment with ceftriaxone is started, for a urinary infection. Fever persisted for 48 hours, so a diagnostic paracentesis was made: Strongyloides stercoralis larvae were seen in the direct microscopic exam. The patient started antiparasitic treatment with ivermectin. He was discharged and did not returned for follow up. Although infection with S. stercoralis is relatively common in patients with alcoholic liver cirrhosis, ascites infected with Strongyloides corresponds to an infrequent form of presentation. This case shows the importance of diagnostic paracentesis in every cirrhotic patient. It is important to consider atypical presentation of Strongyloides infection in the immunocompromised host, considering it could be fatal without treatment.

Strongyloides stercoralis como causa infrecuente de infección de líquido ascítico en cirrosis / Strongyloides stercoralis as uncommon cause of ascitic fluid infection in cirrhosis

Resumen Se comunica el caso clínico de un varón, con antecedentes de una cirrosis hepática alcohólica y gota, usuario crónico de antiinflamatorios, incluyendo corticoesteroides. Consultó por una melena secundaria a una úlcera bulbar. Durante su internación presentó fiebre, tratándose con ceftriaxona por un probable foco urinario. Por persistir febril, se realizó una paracentesis diagnóstica. En la muestra de líquido ascítico se observaron larvas de Strongyloides stercoralis. Recibió tratamiento antiparasitario con ivermectina, con buena respuesta clínica. Aunque la infección por S. stercoralis es relativamente frecuente en pacientes con cirrosis hepática alcohólica, la ascitis infectada por Strongyloides corresponde a una forma de presentación infrecuente. Este caso muestra la importancia de la paracentesis diagnóstica en todo paciente con ascitis secundaria a una cirrosis. Es importante considerar la presentación atípica de la infestación por Strongyloides en el contexto del paciente inmunocomprometido, ya que sin tratamiento puede tener una alta mortalidad.

Abstract Male patient, with a history of alcoholic cirrhosis frequent user of anti-inflammatory drugs including corticosteroids. He consulted for digestive bleeding secondary to a bulbar ulcer. During the admission, he had fever and antibiotic treatment with ceftriaxone is started, for a urinary infection. Fever persisted for 48 hours, so a diagnostic paracentesis was made: Strongyloides stercoralis larvae were seen in the direct microscopic exam. The patient started antiparasitic treatment with ivermectin. He was discharged and did not returned for follow up. Although infection with S. stercoralis is relatively common in patients with alcoholic liver cirrhosis, ascites infected with Strongyloides corresponds to an infrequent form of presentation. This case shows the importance of diagnostic paracentesis in every cirrhotic patient. It is important to consider atypical presentation of Strongyloides infection in the immunocompromised host, considering it could be fatal without treatment.

Microfilaria and Strongyloides larva diagnosed in cerebrospinal fluid and ascitic fluid, respectively: Approach to their morphology on cytology.

Filariasis and Strongyloidiasis are two endemic parasitic infections seen in any tropical country. Filariasis, commonly caused by Wuchereria bancrofti, Brugia malayi, and Brugia timori is seen often in peripheral blood and lymphoid tissue. But it can be isolated from wide variety of soft tissue sites in the body like soft tissue lumps, breast, thyroid, body fluids. Strongyloides stercoralis, a helminthic infection, usually affects the respiratory and gastrointestinal (GI) tract, and frequently picked up in GI biopsies. However, in cases of hyper infection and patients with altered immunity, it can be isolated from other rare sites like body fluid samples. Accurate morphological Identification and confirmation are important for specific management. We report a case of microfilaria isolated from cerebrospinal fluid and a case of Strongyloides larva isolated from ascitic fluid in clinically unsuspected cases of these two parasitic infestations. We have also added a brief discussion on morphological differences between the two larval forms.

[Study on effect of clinical pathway implementation in advanced schistosomiasis with ascites].

OBJECTIVE: To evaluate the effect of clinical pathway (CP) on the implementation of advanced schistosomiasis patients with ascites. METHODS: Totally 1 129 cases of advanced schistosomiasis patients with ascites but without other complications were selected randomly from the Performance Evaluation and Management System for Medical Treatment of Advanced Schistosomiasis Patients in Hubei Province from year 2011 to 2013. Among the patients, 754 cases were treated by CP (CP group), and 375 cases were treated with traditional methods (NCP group), and the hospitalization days, hospitalization expenses, medicine proportions, treatment outcomes and degrees of satisfaction and health knowledge rates of the two groups were compared. Meanwhile, the variation of CP was calculated. RESULTS: The average length of hospital days of the CP group and NCP group were (13.85 ± 5.60) d and (17.92 ± 5.80) d, respectively, and the average hospitalization costs of the two groups were (4 699.14 ± 1 520.59) Yuan and (5 692.01 ± 1 616.66) Yuan, respectively, both the differences were statistically significant (both P ＜ 0.05). Also the hospitalization cost structures of the two groups were remarkably different, the composition ratios of the inspection fee and accommodation fee in the CP group were lower than those in the NCP group, but the constituent ratios of the examination fee, diagnosis and treatment fee, drug charges and other expenses were higher than those in the NCP group (all P < 0.05). The awareness rate of health knowledge in the CP group was higher than that in the NCP group (P < 0.05), but there were no statistically significant differences in the treatment outcome and the degree of satisfaction between the two groups (both P > 0.05). The variation rate of CP was 9.02% (68/754). CONCLUSIONS: The implementation of CP can decrease the days of hospital stay and medical expenses, improve the awareness rate on health knowledge of the patients. The CP treatment with low variation rate is applicable to advanced schistosomiasis patients with ascites but without complications.

[Clinical characteristics of 16 newly discovered advanced schistosomiasis patients in Dongpo District, Meishan City, Sichuan Province].

OBJECTIVE: To understand the clinical characteristics of newly discovered advanced schistosomiasis patients in Dongpo District, Meishan City, Sichuan Province, so as to provide the reference for enhancing the clinicians' awareness for diagnosis and treatment of this disease and improving the therapeutic effect. METHODS: The data of medical records and schedule of case survey of 16 newly discovered advanced schistosomiasis patients in Dongpo District, Meishan City, Sichuan Province were collected and analyzed. RESULTS: The mean age of the 16 newly discovered advanced schistosomiasis patients was 63 years, and there were 10 cases at ages of over 60 years. The 16 cases included 8 men and 8 women, and 10 cases were detected in the historical hyper-endemic areas. There were 11 cases with an ascitic type of advanced schistosomiasis, 4 cases with a megalosplenia type, and one case with a colon proliferation type. The primary initial symptoms mainly included ascites, splenomegaly, hypersplenism and portal hypertension. Following inpatient treatments, 15 cases achieved clinical improvments. CONCLUSIONS: It is necessary to enhance the prevention and control of advanced schistosomiasis. If the patients with portal hypertension, hepatosplenomegaly, upper gastrointestinal hemorrhage visit a doctor, the clinicians should pay much attention to advanced schistosomiasis and they need to comprehensively analyze the clinical data in combination with the epidemiological information, clinical features and laboratory examinations, and make a correct diagnosis and give treatments timely.

Morbidity of mansoni schistosomiasis in Pernambuco-Brazil: Analysis on the temporal evolution of deaths, hospital admissions and severe clinical forms (1999-2014).

BACKGROUND: Current scientific information reported that due to successive treatments of schistosomiasis cases in endemic areas of Brazil in the last 30 years, there has been a decrease in severe clinical form (hepatosplenic) and mortality from upper gastrointestinal bleeding due to this disease. Against this information, literature data show that the state of Pernambuco presents significant percentage of deaths and hospitalizations due to schistosomiasis, and occurrence of severe clinical forms as schistosomiasis myeloradiculopathy and persistence of localities with high parasite loads. This scenario justified this research which seeking to update the morbidity and mortality of schistosomiasis in Pernambuco. OBJECTIVE: To conduct a temporal analysis on the evolution of deaths, hospital admissions and severe forms of Manson's schistosomiasis over the last 16 years in Pernambuco, Brazil. METHODS: It was performed a gathering secondary data on schistosomiasis, from healthcare information systems and from the records of Hospital das Clínicas, Federal University of Pernambuco (HC-UFPE), covering the period from 1999 to 2014. RESULTS: From 1999 to 2013 were registred 2578 deaths due to schistosomiasis and between 2008 and 2014 were recorded 473 hospitalizations for this disease. Among 1999-2014 were identified 1943 cases of schistosomiasis treated at the Hospital das Clínicas of Pernambuco. Among these cases, 72.6% (n. 1411) of the individuals presented the hepatosplenic clinical form (HE), 60.8% (n. 858) were at the age group 30-59 years (adults) and 58% were female. Among the HE cases, 4.6% (n. 58) had ascites, 43.2% (n. 556) had upper gastrointestinal bleeding and 39.1% (n. 489) had collateral circulation. The pattern of fibrosis in the liver E/EC (advanced fibrosis) and F/FC (very advanced fibrosis) occurred in 65.5% (n. 793) of cases. Between 1999-2014 the evolution curve of severe clinical forms of schistosomiasis remained stable, showing a tendency to decline from 2012. CONCLUSION: When compared to other states of Brazil, Pernambuco shows high numbers of deaths and hospital admissions due to schistosomiasis. The actions of the Schistosomiasis Control Program (PCE) have been developed in a disintegrated, disjointed and discontinuous way, which may explain the magnitude of deaths, hospitalizations and severe forms of the disease in Pernambuco, showing a lack of control and the maintenance of severe frame morbidity of schistosomiasis in this state.

[Culture and characterization of spontaneous ascites cells isolated from Microtus fortis].

OBJECTIVE: To isolate and culture the spontaneous ascites cells from Microtus fortis under artificial conditions, so as to investigate the molecular mechanism at the cell level. METHODS: The cells were isolated from spontaneous ascites of M. fortis artificially bred for 90 d, and were cultured and observed under a microscope. The differences of ascites cells among normal, spontaneous ascites and schistosomiasis infected samples of M. fortis were compared. The lesion of tissue was observed simultaneously. RESULTS: There were no obvious organ tissue lesions in M. fortis with spontaneous ascites, and the number and types of cells in peritoneal fluid were irregular and significantly changed. With the extension of culture time, the colonies appeared and there were a large number of vacuole-like cells in the cultured medium and sequentially presenting proliferation, deformation, disintegration and the fiber-like changes and could be passaged 3-4 d only. CONCLUSIONS: The cells from M. fortis with spontaneous ascites are similar to its abdominal cavity cells after infection of Schistosoma japonica.

Strongyloides stercoralis hyperinfection causing eosinophilic ascites.

Strongyloidiasis is associated with Strongyloides stercoralis, an intestinal nematode with greater prevalence in tropical and subtropical regions. Hyperinfection syndrome with dissemination may occur in immunosuppressed individuals. However, invasion of peritoneal cavity with peritoneal effusion is rarely reported in the literature. We report a case of S. stercoralis hyperinfection in a young alcoholic patient with Diabetes mellitus, liver disease and ascites. Diagnostic paracentesis showed numerous filariform larvae of S. stercoralis against a background of eosinophils.

Molecular characterization of Acanthamoeba strains isolated from domestic dogs in Tenerife, Canary Islands, Spain.

The present study describes two cases of Acanthamoeba infections (keratitis and ascites/peritonitis) in small breed domestic dogs in Tenerife, Canary Islands, Spain. In both cases, amoebic trophozoites were observed under the inverted microscope and isolated from the infected tissues and/or fluids, without detecting the presence of other viral, fungal or bacterial pathogens. Amoebae were isolated using 2 % non-nutrient agar plates and axenified for further biochemical and molecular analyses. Osmotolerance and thermotolerance assays revealed that both isolates were able to grow up to 37 °C and 1 M of mannitol and were thus considered as potentially pathogenic. Moreover, the strains were classified as highly cytotoxic as they cause more than 75 % of toxicity when incubated with two eukaryotic cell lines. In order to classify the strains at the molecular level, the diagnostic fragment 3 (DF3) region of the 18S rDNA of Acanthamoeba was amplified and sequenced, revealing that both isolates belonged to genotype T4. In both cases, owners of the animals did not allow any further studies or follow-up and therefore the current status of these animals is unknown. Furthermore, the isolation of these pathogenic amoebae should raise awareness with the veterinary community locally and worldwide.

Ascites as an initial presentation of spontaneously ruptured hydatid cyst.

We describe the diagnosis of a 77-year-old woman admitted to our outpatient department with a 3-month history of abdominal bloating and distension. Abdominal computed tomography revealed a large cystic lesion in the posterior segment of the right hepatic lobe, with a separated germinal layer and widespread ascites with dense internal echoes and septal appearance. The result of a serum Echinococcus indirect haemagglutination test was positive and findings were indicative of the spontaneous rupture of a hydatid cyst into the peritoneal cavity without trauma. Ascites is rarely seen in the course of hydatid disease, but can result from cyst rupture into the peritoneal cavity. This should be considered in the differential diagnosis of ascites, especially in areas such as Turkey, where hydatid disease in endemic.

Loiasis with pleural and peritoneal involvement.

We describe a case of atypical loiasis presenting with a chronic pleuroperitoneal effusion in a 50-year-old woman from the Democratic Republic of Congo. Effusions disappeared with conventional treatment and no recurrence was detected after 4 months of follow-up. Such cases of loiasis involving visceral sites have been unusually reported in the literature.

[Case report: Budd-Chiari syndrome and esophageal variceal bleeding due to alveolar echinococcosis]. / Olgu sunumu: alveoler ekinokoka bagli budd-chiari sendromu ve özofagus varis kanamasi

Alveolar echinococcosis of the liver is a rare larval cestode disease which is due to the intrahepatic growth of the tapeworm Echinococcus multilocularis. This cestode naturally evolves as a larval stage within cysts in the body of carnivores. Humans are accidental intermediate hosts and become infected, either by eating food contaminated with carnivore-originated eggs or by touching foxes. It behaves as malignant liver tumour and rarely causes Budd-Chiari syndrome and variceal bleeding. Budd-Chiari syndrome is a hepatic venous outflow tract obstruction and may be present abdominal pain, hepatomegaly and ascites. Parasitic cysts may cause compression and thrombosis of the hepatic venous outflow tract. It may present as portal hypertension and variceal upper gastrointestinal bleeding. We here in report a 47-year-old woman without a prior history of liver disease presented with Budd-Chiari syndrome and variceal bleeding due to Alveolar echinococcosis. The course of this rare disease is demonstrated by means of the most important laboratory, serologic and radiologic parameters.

Mycobacterium cosmeticum as an unusual cause of ascites.

Despite an increase in the prevalence of non-tuberculous mycobacterium (NTM), the diagnosis remains difficult and its treatment controversial. Prolonged duration of treatment is frequently needed and eradication is often unlikely.