Antihelminthic Therapy Research Articles

Ascaris in infected pancreatic necrosis: A case report of an intraoperative surprise

Introduction and Importance: Ascariasis lumbricoides is a common gastrointestinal tract helminthic disease in developing countries and is also a cause of hepatobiliary and pancreatic disease in endemic areas of the world. Involvement of the pancreatic duct by worms and associated pancreatitis is less common than the hepatic and biliary involvement. Case Presentation: A 38-year-old patient was admitted with a diagnosis of alcohol-induced acute pancreatitis and managed conservatively. However, the patient’s condition worsened after two weeks, and a CT scan revealed an acute necrotic collection with gas foci. After failed percutaneous pigtail catheter drainage, laparotomy was performed, revealing a necrotic collection in the right paracolic gutter, with the entire area frozen, and a worm observed in the necrosum. The colon and small bowel were intact without perforation. The suspicion arose that the worm might have either migrated from a duodenal perforation, which had possibly sealed after the acute phase, or migrated from the major pancreatic duct. Debridement of easily accessible necrotic tissues was performed, and the patient was admitted to the intensive care unit (ICU). Unfortunately, the patient tested positive for COVID-19, and a few days later, blood was observed in the drain. Re-exploration revealed diffuse blood oozing, and the abdomen was closed with packing. Conclusion: The route of ascaris migration to necrosum or its association with severe acute pancreatitis needs to be ensured in endemic areas. Cautious use of antihelminthic therapy in endemic areas could prevent fatal pancreatobiliary complications and its associated mortality.

Schistosomal appendicitis: a case report

BackgroundSchistosomiasis is one of the endemic parasitic diseases in many developing countries. Despite this, appendicitis secondary to schistosomiasis is an uncommon condition even in some endemic areas. Schistosomal appendicitis, an incidentally discovered appendicitis associated with schistosomiasis histological findings, affects young males predominantly. Timely diagnosis and treatment, including appendectomy and anti-helminthic therapy, are crucial.Case reportA 24-year-old Sudanese male patient presented with abdominal pain. Diagnosed with acute appendicitis, he underwent appendectomy, revealing appendix inflammation with Schistosoma ova in histopathology. Abdominal ultrasound detected no complications. Weakly positive Schistosoma serology was noted, but stool and urine analysis showed no infection evidence. Prescribed praziquantel, patient had 3-year post-op follow-up without complications.ConclusionsThis case report underscores the significance of including schistosomiasis in the differential diagnosis of appendicitis, particularly in regions where the disease is endemic. It underscores the necessity of histopathological evaluations for accurate diagnosis, emphasizing the potential implications for clinical practice in similar settings.

Pleuro-spinal Hydatid Cyst Masquerading as Spinal Tuberculosis: A Rare Case Report

Introduction: Primary hydatid cyst of the spinal cord is exceedingly rare. Diagnosis at the early stages is difficult as they may be asymptomatic or have mild vague pain. Patients typically present when there are features of cord/root compression. Magnetic resonance imaging (MRI) stands as the primary investigative modality, but even then, preoperative diagnosis might not always be possible as it may resemble other pathological conditions. Methods: This was a case report of a single case with evidence-based discussion. Informed consent was obtained. Case Report: We present a 62-year-old female patient with progressive paraparesis and numbness of bilateral lower limbs. MRI was suggestive of a tubercular pleurospinal lesion at the D9-D10 level. However, intraoperatively, it was identified to be a rare case of primary pleurospinal (thoracic) hydatid cyst. The patient was managed with complete surgical removal of all the cysts and antihelminthic drug therapy with no evidence of recurrence at the 2-year follow-up. Conclusion: Radiological diagnosis might not be accurate and hydatidosis must be kept in mind to avoid intraoperative confusion. Timely diagnosis, appropriate surgical planning, and comprehensive follow-up are crucial for achieving optimal outcomes.

Efficiency of the use of symbiotics Enteronormin in the complex antihelminth therapy of dogs for trichuriasis

Efficiency of the use of symbiotics Enteronormin in the complex antihelminth therapy of dogs for trichuriasis

An Update on Gastrointestinal Parasitic Infection in Captive Wild Animals in Bangladesh.

Gastrointestinal parasites cause health problems and even death in captive animals. These animals are more susceptible to parasitic infestations because of confinement and stress. The aim of the study is to describe parasitic causal agents in captive wild animals at the Bangladesh National Zoo, Chittagong Zoo, and Tilagarh Eco Park, in Sylhet. A total of 54 fecal samples were collected from the Bangladesh Zoo, Chittagong Zoo, and Tilagarh Eco Park from April 2022 to November 2022. Samples were collected from animals of the groups Aves (16), Reptiles (4), Artiodactyla (23), Perissodactyla (8), and Proboscidea (3). All samples were examined using a modified formalin ether sedimentation technique. Fecal examination consoled an overall occurrence of 61.1%. Out of 54 samples, 33 were positive for parasitic infection. The parasites observed were as follows: Ascarididae eggs (57.58%), Capillaria spp. (18.18%), Strongyloides spp. (9.09%), Trichuris spp. (6.06%), and mixed infection (9.09%). The order Reptiles had a 100% infection rate, while Aves had the lowest infection rate (50%). Only nematodes were detected in this study. Without showing evident, clinical signs and symptoms of disease, the prevalence of gastrointestinal parasites is high. This indicates a subclinical infection. This study shows that more epidemiological research and sanitation management programs, including regular antihelminthic therapy for controlling parasitic infection, should be adopted in zoos and ecoparks.

Enterobius vermicularis (Pinworm) Appendicitis: The Real Vermiform Appendix.

Enterobius vermicularis is the most common helminthic infection in the United States, infecting an estimated 40 million persons. A rare complication of E. vermicularis infestation is appendicitis. The diagnosis must be considered during pathologic examination to ensure appropriate treatment with anti-helminthic therapy.

Repetitive schistosoma exposure causes perivascular lung fibrosis and persistent pulmonary hypertension.

Pulmonary hypertension (PH) can occur as a complication of schistosomiasis. In humans, schistosomiasis-PH persists despite antihelminthic therapy and parasite eradication. We hypothesized that persistent disease arises as a consequence of exposure repetition. Following intraperitoneal sensitization, mice were experimentally exposed to Schistosoma eggs by intravenous injection, either once or three times repeatedly. The phenotype was characterized by right heart catheterization and tissue analysis. Following intraperitoneal sensitization, a single intravenous Schistosoma egg exposure resulted in a PH phenotype that peaked at 7-14 days, followed by spontaneous resolution. Three sequential exposures resulted in a persistent PH phenotype. Inflammatory cytokines were not significantly different between mice exposed to one or three egg doses, but there was an increase in perivascular fibrosis in those who received three egg doses. Significant perivascular fibrosis was also observed in autopsy specimens from patients who died of this condition. Repeatedly exposing mice to schistosomiasis causes a persistent PH phenotype, accompanied by perivascular fibrosis. Perivascular fibrosis may contribute to the persistent schistosomiasis-PH observed in humans with this disease.

Intraretinal granuloma in neurocysticercosis

A 7-year-old female with neurocysticercosis treated with systemic antihelminthic therapy approximately 1 year prior to presentation presented with visual distortion in the left eye. She was off antihelminthic therapy and was slowly tapering a long oral steroid course. Visual acuity was 20/25 in the left eye. A 2 mm consolidated intraretinal white lesion at 1 o'clock (A, B) was seen on ultra-wide-field imaging. The lesion was hyper-reflective on spectral-domain optical coherence tomography (SD-OCT) with vitreous cells in the posterior cortical vitreous (C, D).

Vertebral Hydatid Cyst: A Case Report

BACKGROUND: Hydatid disease is caused by the larval form of Echinococcus granulosus. The reported occurrence of bony hydatidosis is 0.5–3% of all the cases and 50% of them affect the spine. Nevertheless, lumbar vertebral involvement is extremely rare. The most common occurrence is the dorsal level. CASE REPORT: We present the case of a 32-year-old-military dog handler, who presented in 2018 to the urology department with an abdominal retroperitoneal mass. The MRI showed multilocular cystic lesions. The patient underwent surgery, and all of the cysts were removed. The anatomopathological evaluation concluded to hydatic cysts. He was briefly relieved from his symptoms. He was addressed to our department in 2020 suffering from lumbar-radicular pain and functional impotence of both lower limbs. MRI was performed showing multiple big cysts with inhomogeneous contents. CT scan showed destruction of the l5 vertebra. The patient underwent surgery. Initially, we performed through a posterior approach, an L4 to S1 laminectomy, posterior stabilization, and then total L5 corpectomy, anterior l4-s1 fusion through a xipho-pubic laparotomy after 2 months. Antihelminthic therapy was administrated. The patient’s symptoms completely disappeared. No signs of reoccurrence were noted at the 2-year follow-up. CONCLUSION: The primary extrahepatic cystic echinococcosis of bone is an extremely rare disease. Diagnosis can be long and difficult. It can lead to serious complications and should be highly considered in case of a cystic vertebral lesion in an endemic region. Spinal involvement is extremely rare but potentially curable with surgery and anthelmintic drug therapy.

Hydatid disease of the brain and spine.

Hydatiddisease of thecentral nervous systemis relatively rare and comprises about 2-3% of all the hydatid cyst cases reported in the world. Spinal hydatid disease is an even rarer entity. It is endemic in sheep and cattle-raising regions, seen mainly in Mediterranean countries including Turkey and Syria. Pediatric neurosurgeons in non-endemic countries face a challenge when they encounter children with hydatid cysts of the central nervous system, mostly due to lack of awareness and the ensuing diagnostic dilemmas. It is also a significant socioeconomic problem in developing countries, due to improper hygiene and lack of dedicated veterinary practice. The clinical features are largely nonspecific and very according to location and severity of disease. However, with the advent of advances in MR imaging, the diagnostic accuracy of hydatic disease involving the brain and spine has increased. Intact removal of the cyst/s, without causing any spillage, and appropriate antihelminthic therapy is the goal and key to cure and prevention of recurrence. In this manuscript, the current literature on hydatid cyst of the brain and spine is reviewed to better understand the epidemiology, pathophysiology, diagnostic accuracy, and advances in therapeutic options. A heightened clinical suspicion, awareness of MR imaging features, improved surgical strategies, and options for prevention are discussed.

Assessing the efficacy of parenteral iron therapy in treating pregnancy anemia of mild to moderate severity

Background: Anemia is a clinical condition characterized by the decreased number of red blood cells or their capacity to carry oxygen needed for physiological functions. Hemoglobin (Hb) value less than 2 standard deviations, less than the median value for healthy subjects matched for pregnancy status, smoking, altitude, gender, and age. Anemia is commonly seen in pregnancy where intravenous iron has proven to be highly effective as a treatment even in cases where oral iron seems ineffective. Aim: The present study was conducted to assess the efficacy of parenteral iron therapy in treating pregnancy anemia of mild to moderate severity. Materials and methods: The present study included 120 pregnant females having confirmed diagnoses of iron deficiency anemia. All the included subjects were given 100mg Mebendazole in a dose twice daily as an anti-helminthic therapy for 3 days duration. Also, during the therapy, folic acid was given to all the subjects. Stool examination for cyst and ova, urine culture, microscopy, and routine urine examination, Renal function test (RFT) was done for all the subjects. Results: The results of the present study showed that significant changes were seen in various hematologic parameters from baseline to follow-up.

Assessing the efficacy of parenteral iron therapy in treating pregnancy anemia of mild to moderate severity

Background: Anemia is a clinical condition characterized by the decreased number of red blood cells or their capacity to carry oxygen needed for physiological functions. Hemoglobin (Hb) value less than 2 standard deviations, less than the median value for healthy subjects matched for pregnancy status, smoking, altitude, gender, and age. Anemia is commonly seen in pregnancy where intravenous iron has proven to be highly effective as a treatment even in cases where oral iron seems ineffective. Aim: The present study was conducted to assess the efficacy of parenteral iron therapy in treating pregnancy anemia of mild to moderate severity. Materials and methods: The present study included 120 pregnant females having confirmed diagnoses of iron deficiency anemia. All the included subjects were given 100mg Mebendazole in a dose twice daily as an anti-helminthic therapy for 3 days duration. Also, during the therapy, folic acid was given to all the subjects. Stool examination for cyst and ova, urine culture, microscopy, and routine urine examination, Renal function test (RFT) was done for all the subjects. Results: The results of the present study showed that significant changes were seen in various hematologic parameters from baseline to follow-up.

Enterobius vermicularis-associated appendicitis: A 22-year case series and comprehensive review of the literature

IntroductionEnterobius vermicularis is known to be associated with appendicitis, however a causal relationship between Enterobius and appendicitis has not been established. The aim of this study was to explore the relationship between appendiceal Enterobius and histologic appendicitis. MethodsA retrospective review was performed of all pediatric appendectomies between 1997 and 2019. Patients with diagnosed with Enterobius were included for analysis. Patient demographics, operative findings, and pathologic reports were queried. Data were entered into an encrypted database and subsequently analyzed. A comprehensive review of the literature was also conducted. ResultsThirty-eight cases of Enterobius-associated appendicitis were identified out of 3541 (1.07%). Grossly normal appendices at operation were seen in 27% of patients. Inflammatory infiltrate was noted on histopathology in 78.3%, and Enterobius was considered to be the cause of that inflammation in 68.4%. The comprehensive literature review revealed 19 articles (1.87% incidence) that noted 35% of patients with appendiceal Enterobius had appendicitis on either histopathology or gross evaluation. ConclusionThe high rate of inflammation on pathology found among our patients with pinworm appendicitis suggests an association with presentation as acute appendicitis. Our comprehensive review revealed a higher proportion of Enterobius appendicitis. Treatment with antihelminthic therapy is recommended. Level of evidence (LOE)Level IV(4)-case series and comprehensive review.

Eosinophilic Myocarditis: When Allergies Attack the Heart!

Eosinophilic myocarditis is a clinical condition whereby myocardial injury is mediated by eosinophilic infiltration. A number of underlying causes, including reactive, clonal, or idiopathic hypereosinophilic syndrome, may trigger eosinophilia. Disease presentation may vary from mild subclinical variants to fulminant myocarditis with thromboembolic complications, and in some cases, endomyocardial and valvular fibrosis may be seen. A detailed examination coupled with the use of multimodality imaging, and endomyocardial biopsy may help establish diagnosis. Treatment is aimed at symptomatic management and treating the underlying cause of eosinophilia, such as withdrawal of implicated drugs, antihelminthic therapy for infection, immunosuppression for autoimmune conditions, and targeted therapy with tyrosine kinase inhibitors in cases with clonal myeloid disorders.

Pericardial Hydatidosis in a Young Boy

Persistent chest pain is an uncommon entity in adolescent population, with majority of cases having no discernible cardiac etiology. We report a young boy presenting with chest discomfort due to underlying large pericardial hydatid cyst. Initial diagnostic confirmation was based on classic echocardiographic features, including presence of sonographic water lily sign. Patient subsequently underwent successful surgical excision of cyst under cardiopulmonary bypass, along with perioperative antihelminthic and anti-inflammatory drug therapy. Patient continues to remain symptom free on follow-up, with no recurrence in cyst formation. This case highlights the high index of suspicion needed in diagnosing such atypical cardiac cysts, especially in patients from endemic zones.

A Case of Gastroduodenal Strongyloidiasis Causing Protein Losing Enteropathy

Strongylodiasis is an intestinal parasitic infection which can cause cataclysmic hyper infection syndrome in immunocompromised. Here we report an interesting and rare case of gastroduodenal strongyloidiasis presenting as protein losing enteropathy which was promptly diagnosed and dramatically reversed with antihelminthic therapy. J Microbiol Infect Dis 2020; 10(4): 237-239.

1406. Steroid-Sparing Agents to Control Inflammation in Complicated Neurocysticercosis: Three Cases

BackgroundClinical manifestations of neurocysticercosis (NCC) are primarily due to the inflammatory response against degenerating cysts of the Taenia solium tapeworm. Inflammation can occur when cysts lose their ability to evade the host immune response during their natural life cycle or result from antihelminthic therapy. A subset can develop chronic perilesional edema requiring immunosuppressive therapy. Although guidelines recommend methotrexate (MTX) as an alternative to long-term steroids, limited information is available regarding when to start a steroid-sparing agent (SSA) and alternative SSAs in case of MTX failure or intolerance.MethodsRetrospective chart review.ResultsThree patients with complicated NCC followed at a single tertiary care center are described in this study: Patient 1 with subarachnoid NCC (age 64, female), patient 2 with subarachnoid and intraventricular NCC (age 48, male) and patient 3 with parenchymal NCC (age 43, male). Patients 1–3 were followed clinically and radiographically for 8, 1.5 and 3 years, respectively. Patient 1 was treated with antihelminthic therapy and steroids for 24 months. She was transitioned to MTX for 1 month, but developed ulcerative stomatitis, leukopenia and transaminitis. She completed a treatment course of steroids, complicated by osteoporosis. Patient 2 was treated with 12 months of antihelminthic therapy and steroids with resolution of a previously positive cysticercal antigen in spinal fluid. Imaging revealed persistent inflammation in spite of adequate antihelminthic therapy. He was started on MTX and has remained on this medication for 5 months. Patient 3 was treated with two courses of antihelminthic therapy. He developed perilesional edema despite treatment with steroids and MTX uptitrated to 20 mg weekly. Adalimumab was added to his regimen and he had a rapid radiographic resolution of edema and clinical improvement in seizures. His seizures returned during an interruption in his adalimumab treatment and again resolved with re-initiation of this medication.ConclusionSSAs are beneficial in the long-term treatment of patients with subarachnoid NCC or chronic perilesional edema. The formulation of guidelines that include multiple options for SSAs will be essential in guiding management of complicated NCC. Disclosures All authors: No reported disclosures.

A TALE OF A TRAVELING FLUKE

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Paragonimiasis causes a range of pulmonary symptoms. Paragonimiasis is common in Eastern/Southeastern Asia, but in the era of worldwide travel this diagnosis should be considered more routinely. CASE PRESENTATION: A 21-year-old man with a MLH1 gene mutation was noted to have a left pleural effusion on surveillance imaging in December 2018. He had onset of progressive chest pain and fatigue around February 2018, and earlier, in summer 2017, had traveled to Singapore, Indonesia, and Thailand, where he ate fresh water crab and swam in fresh water. Vital signs were normal. Lab studies were notable for 19% eosinophils on differential count. A pigtail catheter was placed. Fluid was yellow, with pH 7.53, LDH 3,325 (serum 167), glucose < 5, total protein 8.3 (serum 8.7), and cell count with 52% eosinophils, 2% neutrophils, 19% lymphocytes. Cultures, cytology and flow cytometry were negative. There was high suspicion for paragonimiasis given consumption of fresh water crab, travel, and pleural/peripheral eosinophilia. Computerized tomographic imaging showed a left-sided pneumothorax, trapped lung, loculated material in the pleural space, and a cystic lesion. He underwent thoracoscopic decortication and removal of the cystic lung lesion. Surgical pathology revealed chronic fibrous pleuritis and cystic lung lesion with necrotizing granulomatous inflammation. He received empiric treatment with praziquantel given severity of disease and anticipated delay in serologic results. DISCUSSION: Paragonimiasis, or lung fluke, is acquired by eating raw or undercooked crustaceans. It often presents as pulmonary disease but rarely can produce gastrointestinal, dermatologic, or neurologic manifestations. It can be asymptomatic or cause eosinophilic pleural effusion, pneumothorax, or hemoptysis. Disease is classified into early or late infection. Early infection (first 2 months) involves larvae migrating into the pleural cavity. Late infection causes inflammation/fibrosis of the pleural cavity. Peripheral and pleural eosinophilia are characteristic. Diagnosis is confirmed by serology or microscopy (eggs in sputum, lung lavage, or stool). Serology is most useful with isolated pleural disease or extrapulmonary disease. Treatment is with praziquantel 75 mg/kg/day for 3 days. Those with high disease burden or chronic infection may require retreatment. If disease is untreated, the initial manifestations are likely to recur. Our patient’s peripheral eosinophilia resolved after surgery and antihelminthic therapy. Paragonimiasis serology was positive. CONCLUSIONS: Paragonimiasis should be considered in those with a history of travel to endemic regions presenting with pulmonary processes. Praziquantel is effective and well-tolerated, but extensive pulmonary disease may require surgical intervention. Reference #1: DeFrain, M, Hooker, R. North American Paragonimiasis: Case Report of a Severe Clinical Infection. CHEST 2002; 121:1368-1372 Reference #2: Kim, Hyun Jo. Pneumothorax Induced by Pulmonary Paragonimiasis: Two Cases Report. Korean J Thorac Cardiovasc Surgery. 2014 Jun 47(3) 310-312. Reference #3: Centers for Disease Control and Prevention (CDC). Human paragonimiasis after eating raw or undercooked crayfish--Missouri, July 2006-September 2010. MMWR Morb Mortal Wkly Rep 2010; 59:1573. DISCLOSURES: No relevant relationships by Christine Nayar, source=Web Response No relevant relationships Added 03/17/2019 by Daniel Sterman, source=Web Response, value=Consulting fee Removed 03/17/2019 by Daniel Sterman, source=Web Response No relevant relationships Added 03/17/2019 by Daniel Sterman, source=Web Response, value=Consulting fee Removed 03/17/2019 by Daniel Sterman, source=Web Response No relevant relationships Added 03/17/2019 by Daniel Sterman, source=Web Response, value=Consulting fee Removed 03/17/2019 by Daniel Sterman, source=Web Response No relevant relationships Added 03/17/2019 by Daniel Sterman, source=Web Response, value=Consulting fee Removed 03/17/2019 by Daniel Sterman, source=Web Response No relevant relationships Added 03/17/2019 by Daniel Sterman, source=Web Response, value=Consulting fee Removed 03/17/2019 by Daniel Sterman, source=Web Response No relevant relationships Added 03/17/2019 by Daniel Sterman, source=Web Response, value=Travel Removed 03/17/2019 by Daniel Sterman, source=Web Response No relevant relationships Added 03/17/2019 by Daniel Sterman, source=Web Response, value=Travel Removed 03/17/2019 by Daniel Sterman, source=Web Response No relevant relationships Added 03/17/2019 by Daniel Sterman, source=Web Response, value=Consulting fee Removed 03/17/2019 by Daniel Sterman, source=Web Response

Trichinosis is a topical health issue

A review of trichinosis literature is presented. In the Russian Federation, from a few dozen to several hundred cases of trichinosis are registered annually, caused by 4 types of trichinae: T. spiralis, T. pseudospiralis, T. nativa and T. britovi. Adults and larvae develop in the same host, which is both final and intermediate. Adults live in the small intestine, and the larvae develop inside the skeletal muscle fibers. Infection occurs when eating meat containing live larvae. Clinical symptoms of trichinosis include nausea, vomiting, diarrhea, fever lasting from several days to a month, then myalgia, facial swelling, eyelids, maculo-papular, urticarial exanthema join. Complications of trichinosis: myocarditis (the most common cause of death), pneumonia, meningoencephalitis. Albendazole and mebendazole are most effective as antihelminthic therapy.

Клинический опыт длительной антигельминтной терапии у больных альвеококкозом

Клинический опыт длительной антигельминтной терапии у больных альвеококкозом