Pleuropulmonary Paragonimiasis with Multiple Nodules in the Pleura.

An asymptomatic 47-year-old woman was admitted with pleural effusion and pulmonary infiltrates 1 month after ingesting raw wild boar and deer meat. Both her blood and pleural fluid were eosinophilic. Thoracoscopy revealed multiple nodules of the pleura, and biopsy samples of the nodules showed necrosis with epithelioid cell granulomas. An enzyme-linked immunosorbent assay was positive for antibodies against Paragonimus westermani, and the patient was successfully treated with praziquantel. This is the first reported case of pulmonary or pleuropulmonary paragonimiasis where several pleural nodules were observed. The detection of pleural nodules on thoracoscopy can contribute to the prompt and accurate diagnosis of paragonimiasis.

[Combined left hemihepatectomy for multiple organ alveococcosis]. / Kombinirovannaya levaya gemigepatektomiya v lechenii mul'tiorgannogo al'veokokkoza.

Advanced multiple organ parasitic invasion is reported in the article. A thorough assessment of pathological process, surgical anatomy and preoperative examination resulted radical surgery despite multiple organ disease. Surgical procedure included extended left-sided hemihepatectomy, atypical resection of S6liver segment and pancreas, removal of themediastinal parasite with partial excision of parietal pleura and pericardium.

Observación de Ascaris lumbricoides a través de una aguja de biopsia pleural. Un caso raro de ascariasis intrapleural / Ascaris lumbricoides through pleural biopsy needle. A rare case of intrapleural ascariasis

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Parasitic diseases of the pleura.

Parasitic infections are prevalent in certain parts of the world and may cause pleural involvement, which often goes unrecognized. Common parasites involving the pleura include Entamoeba histolytica, Echinococcus granulosus and Paragonimus westermani. Amebiasis can cause empyema with "anchovy sauce" pus, reactive pleural effusions and bronchopleural fistula with hydropneumothorax. Echinococcosis may result in pleural thickening, pneumothorax, secondary pleural hydatidosis and pleural effusions. Paragonimiasis may cause chylous and cholesterol pleural effusions, pleural thickening and pneumothorax. Less commonly, pulmonary eosinophilia, or Loeffler's syndrome, caused by Ascaris lumbricoides, Ancylostoma duodenale and Necator americanus and tropical pulmonary eosinophilia caused by Wuchereria bancrofti and Brugia malayi may involve the pleura. This article provides a comprehensive review of parasitic infections involving the pleura. A high index of suspicion in the appropriate clinical setting is required to facilitate prompt diagnosis and treatment of these diseases.

Molecular diagnosis of sparganosis associated with pneumothorax in a dog.

Pneumothorax was diagnosed in a dog presenting with progressive exercise intolerance and tachypnoea. Needle thoracocentesis failed to resolve the pneumothorax, and an exploratomy thoracotomy was performed. Upon inspection of the thoracic cavity, numerous white nodules (2 to 4mm) were present throughout the mediastinum, parietal pleura and the lung lobes. The owners of the dog elected intra-operative euthanasia, and a post mortem examination was performed. At necropsy, structures consistent with the plerocercoid (larval) stage of a tapeworm were identified in association with inflammation of the pleural cavity. Molecular methods were used to identify the parasite as Spirometra erinacei. Molecular diagnosis, along with the clinical presentation and pathological findings, allowed the diagnosis of proliferative sparganosis.

Omental and pleural milky spots: different reactivity patterns in mice infected with Schistosoma mansoni reveals coelomic compartmentalisation.

In vertebrate animals, pleural and peritoneal cavities are repositories of milky spots (MS), which constitute an organised coelom-associated lymphomyeloid tissue that is intensively activated by Schistosoma mansoni infection. This study compared the reactive patterns of peritoneal MS to pleural MS and concluded from histological analysis that they represent independent responsive compartments. Whole omentum, lungs and the entire mediastinum of 54 S. mansoni-infected mice were studied morphologically. The omental MS of infected animals were highly activated, modulating from myeloid-lymphocytic (60 days of infection) to lymphomyeloid (90 days of infection) and lymphocytic or lymphoplasmacytic (160 days of infection) types. The non-lymphoid component predominated in the acute phase of infection and was expressed by monocytopoietic, eosinopoietic and neutropoietic foci, with isolated megakaryocytes and small foci of late normoblasts and mast cells. Nevertheless, pleural or thoracic MS of infected mice were monotonous, consisting of small and medium lymphocytes with few mast and plasma cells and no myeloid component. Our data indicate that compartmentalisation of the MS response is dependent on the lymphatic vascularisation of each coelomic cavity, limiting the effects or consequences of any stimulating or aggressive agents, as is the case with S. mansoni infection.

Pulmonary dirofilariasis: computed tomography findings and correlation with pathologic features.

OBJECTIVE: The purpose of this study was to describe the computed tomography (CT) and pathologic features of 5 nodules of pulmonary dirofilariasis in 4 patients. METHODS: Four patients with 5 nodules of pathologically confirmed pulmonary dirofilariasis who under went CT were enrolled, and the imaging interpretations were retrospectively compared with the histopathologic characteristics. RESULTS: Three of the 4 patients had a solitary nodule, and the remaining patient had 2 nodules. All the nodules were distributed in the right lower lobe and were attached to the pleura. They were all round or oval in shape and ranged in size from 11 to 22 mm in largest diameter (mean=17 mm). On thinner section CT, the nodules had a well-defined smooth margin with or without a shallow notch; they were connected to the arterial branch and, occasionally, to the venous branch. On contrast-enhanced CT, all the nodules contained a homogeneous low-attenuation area, which corresponded to areas of coagulative necrosis on histopathologic examination. CONCLUSION: Although the CT findings of a pulmonary dirofilariasis nodule are nonspecific, awareness of the findings on contrast-enhanced CT and the pathologic appearance of this rare benign condition may facilitate its differentiation from a malignant nodule.

Bovine neosporosis: immunoblot improves foetal serology.

The purpose of the study is the comparative evaluation of the immunofluorescent antibody test (IFAT) and an immunoblot (IB) test for the examination of foetal fluids for specific antibodies against Neospora caninum. Peritoneal and pleural fluids as well as abomasal contents were analysed. The results of the serological examinations were compared to those obtained by histological, immunohistochemical, and PCR analysis of foetal tissues as well as to the results of maternal serological examinations. Fluids were used undiluted in the IB and reactions against six immunodominant antigens were recorded. When the recognition of at least two immunodominant antigens was regarded as positive, the agreement of the IB with other diagnostic methods was good to moderate as characterised by kappa-values of 0.76 (histology/immunohistochemistry), 0.69 (maternal serology) and 0.54 (PCR on foetal tissues). The IB results agreed better with the results of the other diagnostic methods than those of the IFAT. The higher relative sensitivity of the IB was regarded as the main reason for the better agreement. However, also the specificity of the IB was superior to that of the IFAT in relation to histology/immunohistochemistry, maternal serology and PCR.

Enterocytozoon bieneusi as a cause of proliferative serositis in simian immunodeficiency virus-infected immunodeficient macaques (Macaca mulatta).

CONTEXT: Enterocytozoon bieneusi is the most frequent microsporidian parasite of human patients with acquired immunodeficiency syndrome and is a significant cause of diarrhea and wasting. Recently, this organism has also been recognized as a spontaneous infection of several species of captive macaques. As in humans, E bieneusi frequently causes enteropathy and cholangiohepatitis in immunodeficient simian immunodeficiency virus (SIV)-infected macaques. OBJECTIVE: To examine E bieneusi as an etiologic agent of nonsuppurative proliferative serositis in immunodeficient rhesus macaques (Macaca mulatta). DESIGN: Retrospective analysis of necropsy material obtained from immunodeficient SIV-infected rhesus macaques. RESULTS: Examination of SIV-infected rhesus macaques (n = 225) revealed E bieneusi proliferative serositis in 7 of 16 cases of peritonitis of unknown origin. The organism could be identified by in situ hybridization and polymerase chain reaction in sections of pleura and peritoneum obtained at necropsy. Serositis was always accompanied by moderate-to-severe infection of the alimentary tract, and morphologic evidence suggested dissemination through efferent lymphatics. Colabeling experiments revealed most infected cells to be cytokeratin positive and less frequently positive for the macrophage marker CD68. Sequencing of a 607-base pair segment of the small subunit ribosomal gene revealed 100% identity to sequences obtained from rhesus macaques (Genbank accession AF023245) and human patients (Genbank accession AF024657 and L16868). CONCLUSIONS: These findings indicate that E bieneusi disseminates in immunodeficient macaques and may be a cause of peritonitis in the immunocompromised host.

Drastic reduction of a filarial infection in eosinophilic interleukin-5 transgenic mice.

In order to establish the role of eosinophils in destroying parasites, transgenic mice have been used in experimental helminthiases but not in filariasis. Litomosoides sigmodontis offers a good opportunity for this study because it is the only filarial species that completes its life cycle in mice. Its development was compared in transgenic CBA/Ca mice overexpressing interleukin-5 (IL-5) and in wild-type mice following subcutaneous inoculation of 40 infective larvae. An acceleration of larval growth was observed in the IL-5 transgenic mice. However, the recovery rate of adult worms was considerably reduced in these mice, as evidenced 2 months postinoculation (p.i.). The reduction occurs between days 10 and 30 p.i. in the coelomic cavities. As early as day 10, spherical aggregates of eosinophils and macrophages are seen attached on live developing larvae (always similarly localized on the worm) in both wild-type and transgenic mice. However, on day 60 p.i., granulomas were found in the transgenic mice only, probably because of the higher density of eosinophils. Furthermore, on day 30 p.i., young filariae are seen trapped in granulomas, some of them surrounded by Splendore-Hoeppli deposits, which illustrates the release of the major basic protein by eosinophils. The high protection rate obtained (65%) is similar to that observed previously in BALB/c mice following vaccination with irradiated larvae. Both protocols have a common factor, the high production of IL-5 and eosinophilia. However, protection occurs later in primary infected transgenic mice because specific antibodies are not yet present at the time of challenge.

Litomosoides sigmodontis: dynamics of the survival of microfilariae in resistant and susceptible strains of mice.

Litomosoides sigmodontis in the BALB/c mouse is the only model of filariasis which allows the observation of the complete development in an immunocompetent mouse. In this study, we injected microfilariae (mf) intravenously, as well as into the pleural cavity, the site of natural release of mf from adult female worms, and followed the kinetics of elimination within the host. In susceptible BALB/c mice, mf circulated at high levels in the blood. In contrast, in C57BL/6 mice, which are refractory to full development, mf were eliminated rapidly from the peripheral blood. However, 6 days after intrapleural injection, viable larvae could be found in the pleural cavity and lung capillaries of both susceptible and resistant strains. The numbers of mf in the pleural cavity and lung capillaries in individual mice were significantly correlated, but not dependent on strain or peripheral microfilaraemia. Thus, although C57BL/6 mice showed enhanced production of nitric oxide by pleural exudate cells and a faster change in the numbers of circulating leukocytes after injection, rapid killing of mf by cell or nitric oxide-mediated mechanisms were not the reason for the different outcome. Furthermore, 3 h after iv injection, only a small percentage of mf could be recovered from the peripheral circulation, indicating the presence of a reservoir for mf containment. In conclusion, injected mf showed disparate dynamics of persistence within susceptible and resistant hosts, which is similar to the disparate outcome of natural infections with L. sigmodontis. This difference became obvious within 1 day after injection. The lung capillary system plays obviously a crucial part in regulation of microfilaremia. Our model also provides a possible means to explain frequent cases of occult infections in human filariasis.

Tissue migration of Elaphostrongylus spp. in guinea pigs (Cavia porcellus).

Third-stage larvae of Elaphostrongylus cervi, originating from red deer (Cervus elaphus), first reached the central nervous system (CNS) of guinea pigs (Cavia porcellus) 11 days postinfection (DPI). Neurologic signs were seen between 11 and 62 DPI in 4 of a total of 18 infected guinea pigs killed up to 112 DPI. Animals showing signs had 3 or more larvae in the CNS. Only 1, of a total of 1,114 larvae recovered, had developed to the fourth stage at 40 DPI. A direct tissue migration by third-stage larvae to the CNS was revealed by pressing and digesting almost all body tissues and by histological examination. Larvae penetrated through the stomach wall into the peritoneal cavity and then through the diaphragm into the pleural cavity. Many became encapsulated by inflammatory cells in the omentum, abdominal mesentery, mediastinum, and just beneath the liver capsule and lung pleura. A total of 44 larvae succeeded in reaching the CNS, apparently by migrating from the body cavities into muscles of the lateral body wall and entering the vertebral canal, likely along spinal nerves. Data were not consistent with a hematogenous migratory route that has been proposed previously. Few third-stage larvae of E. alces, originating from moose (Alces alces), were able to penetrate the gut of guinea pigs and none reached the CNS.

[Experimental studies on development of Paragonimus heterotremus in rats].

AIM: To study the polymorphism of the development of Paragonimus heterotremus in rats and to ascertain the host nature of the rat. METHODS: SD and Wistar rats were each infected orally with 100 metacercariae of P. heterotremus. The distribution and development of the worms recovered from rats 14-156 days after infection were observed. RESULTS: Thirty days after infection, reproductive organs appeared in the worms recovered from the body cavities. Seventy days after infection, worm-cysts were found in the lungs, livers and pleural wall, the worms in the cysts matured but the worms detected in the muscles were still stunted on the 156 th day after infection. CONCLUSION: Rat is the definitive host and paratenic host of P. heterotremus. The development of P. heterotremus is polymorphic.

Human pulmonary dirofilariasis: analysis of 24 cases from São Paulo, Brazil.

STUDY OBJECTIVE: To present the clinical, radiologic, and pathologic aspects of 24 cases of human pulmonary dirofilariasis (HPD) from São Paulo, Brazil. DESIGN: Retrospective study of 24 patients with a confirmed diagnosis of HPD over a 14-year period (from February 1982 to June 1996). SETTING: Thoracic Surgery and Pulmonary Division, University of São Paulo and Hospital Albert Einstein, São Paulo, Brazil. RESULTS: Seventeen patients were male (70.1%) and seven were female (29.9%). Their mean age was 51.4 years. Fifty-four percent of the patients were asymptomatic and 75% had a well-circumscribed noncalcified peripheral subpleural pulmonary nodule on the chest radiograph and thoracic CT scan, located preferentially in the lower lobes. The diagnosis was made after thoracotomy and wedge resections in 16 patients, by videothoracoscopy in six, after a pleural biopsy in one, and after necropsy in one. The pathologic examination of all the nodules revealed a central zone of necrosis, surrounded by a narrow granulomatous zone and peripherally by fibrous tissue. Pulmonary vessels exhibit varying degrees of endarteritis. In all cases, a dead worm, usually necrotic and fragmented, was found. CONCLUSIONS: A subpleural, noncalcified pulmonary nodule in the appropriate clinical and epidemiologic setting should alert the clinician, radiologist, or pathologist to the possibility of Dirofilaria. HPD should be considered in the differential diagnosis of pulmonary nodules.

Respiratory cryptosporidiosis: case series and review of the literature.

Five case of intestinal cryptosporidiosis with pulmonary involvement in patients with AIDS are reported. The diagnosis was based on the recognition of acid-fast oocysts in sputum or aspirated bronchial material and stool specimens. Coughing and excess secretions were present in all cases. Four patients had other associated pulmonary pathogens: two Mycobacterium tuberculosis, one Mycobacterium fortuitum and one Cytomegalovirus + Pneumocystis carinii; all of them had a previous (three cases) or simultaneous (one case) diagnosis of intestinal cryptosporidiosis, presenting with diarrhoea and vomiting. In the fifth patient Cryptosporidium was the only pulmonary pathogen found in a bronchial aspirate, and the onset of diarrhoea was 1 month after respiratory detection. Fifty-seven cases of respiratory cryptosporidiosis have been reported since 1980. In 17 of them, no other pathogen was found. Diarrhoea was present in 77% of the patients, cough in 77%, dyspnea in 58%, expectoration in 54%, fever in 45%, thoracic pain in 33%.

Pleural effusions in human immunodeficiency virus-infected patients. Correlation with concomitant pulmonary diseases.

The objective of our study was to evaluate the prevalence of pleural effusions in patients with the acquired immunodeficiency syndrome, to correlate these effusions with any concomitant pulmonary diseases and to evaluate the role of cytologic examination in the diagnosis of the effusions. Twenty-eight of 389 (7.2%) human immunodeficiency virus-infected patients had pleural effusions and 27 of the 28 were suffering from concomitant pulmonary diseases. Those diseases were bacterial pneumonia (9), mycobacterial infection (7), non-Hodgkin's lymphoma (4) and Kaposi's sarcoma (2). Pneumocystis carinii pneumonia was diagnosed in two patients, and cytomegalovirus pneumonitis and pulmonary aspergillosis and small cell carcinoma in one patient each. Cytologic examination of pleural effusions provided conclusive diagnoses of mycobacterial infection in 2 of the 7 patients, of non-Hodgkin's lymphoma in 4 and of P carinii infection in 2.

Pleural Mesocestoides and cardiac shock in an obese vervet monkey (Cercopithecus aethiops).

Only one case of infection by tetrathyridia larvae of the tapeworm genus Mesocestoides was detected in 416 necropsies of captive vervet monkeys (Cercopithecus aethiops). Two hundred nine larvae were distributed between both pleural cavities. Mass and size ranges of larvae were determined. A plasma cell reaction indicated a humoral immune response to parasite antigens, which may have contributed to acute, lethal cardiac shock. Coagulative myocytolysis was confirmed. The history of this case and associated circumstantial evidence and reports in the literature suggest that infection of primates by tetrathyridia probably occurs after capture rather than before.

Experimental transfer of Paragonimus westermani from rodents to rodents following subcutaneous and intraperitoneal routes.

In order to investigate the experimental transfer of Paragonimus westermani from rodents to rodents following subcutaneous and intraperitoneal routes, 13 rats and 23 mice were inoculated with a total of 115 (1 mature and 114 immature) worms of P. westermani subcutaneously and intraperitoneally. The age of worms before transfer was 25-193 days. The transfer was performed immediately after worm collection from rodents which were killed at various intervals from 4 to 144 days after infection. The location, development and size of worms were recorded. An infection rate of 58% (or 21/36) was demonstrated in rodents after experimental transfer of P. westermani by intraperitoneal and subcutaneous routes. Twenty-seven worms were recovered, giving a worm recovery rate of 23.5%. The rate was significantly higher by the subcutaneous route (34.8%) than by the intraperitoneal route (20.7%) but no difference was found between mice (23.9%) and rats (23.0%). The sizes of worms in the abdominal cavity, pleural cavity and thoracic muscles of mice, and in the leg muscles of rats were much less than in the pleural cavity and lung cysts of rats. A mature worm (7 x 5 mm) and numerous eggs were found in the uterus and pleural cavity of one rat. It is evidence that these rodents are unfavourable definitive hosts of P. westermani, because the worm size, infectivity, maturation and egg production are usually very low. However, the worms are usually widely distributed in their rodent hosts and remain small in size for a long period. Therefore, these rodents are good paratenic hosts for P. westermani and can play an important role in infecting cats and dogs with P. westermani in the laboratory.