Stool Examination For Parasites Research Articles

Are artefacts misleading the diagnosis of Ascaris lumbricoides in microscopy? Observations.

Stool has multiple components, which include undigested food material, plant, animal products, normal intestinal microbiome, and parasites. Due to the existence of all the elements, stool parasite examination is cumbersome, especially with identification of the eggs of Ascaris lumbricoides. We examined 650 stool samples of pregnant women before anti-helminthic treatment. We found that the prevalence ofAscaris lumbricoideswas 5.4% (95% CI 3.8-7.4, n = 35) by a single observer in microscopy, and the majority (33/35) were identified as decorticated fertilized eggs. The prevalence of Ascaris by molecular methods was 2.6% (95% CI 1.5-4.2%, n = 17). Five samples were positive by both methods. The prevalence of structures resemblingAscariswas 4.6% (95% CI 3.1-6.5, n = 30). Three of the positive samples were confirmed with sequencing. With the subjective nature of microscopy along with the naked eye examination, errors can happen. Hence adequate training and confirmation with molecular techniques for identification of Ascaris lumbricoides are advisable.

A Five-Year Retrospective Investigation of the Prevalence of Intestinal Parasites at Mizan-Tepi University Teaching Hospital, Southwest Ethiopia.

Intestinal parasites are responsible for a significant amount of disease and mortality around the world. In developing nations, intestinal parasites are a severe public health issue. Intestinal parasite infections are one of the most common illnesses in the world. They're frequently linked to poor personal and environmental cleanliness, as well as low-quality drinking water. The aim of this study is to investigate the prevalence of intestinal parasites and their shifting trends during a five-year period at Mizan-Tepi University of Teaching Hospital (MTUTH). A cross-sectional retrospective survey using the past five years' (2017 to 2021) clinical records obtained from MTUTH Mizan-Aman town Southern west Ethiopia. Patients with complete age, sex, and stool parasite examination (direct wet mount or concentration techniques) records on the parasitology registration book were included. Data were entered and analysed using a Microsoft Excel sheet. The parasite prevalence was calculated using frequency and percentages. Overall, 17,030 patient records of the past five years were reviewed from the registration books of parasitology laboratory departments at MTUTH and only 546 records were taken for this study. Of these 336 (61.50%) were female and the rest 210 (38.50%) were males. One hundred eighty-two (182) 33.33% of patients had one or more intestinal parasites over five years from 2017 to 2021. From total of 546 patients' records 17.77% in 2017, 18.89% in 2018, 23.44% in 2019, 19.96% in 2020 and 19.96% in 2021 had complete information. Intestinal parasite prevalence was high among patients who visited the Mizan-Tepi University of Teaching Hospital during the five-year period. Helminthes and protozoan parasites prevalence was higher in the 15-45 years age category. In order to avoid intestinal parasite-related disease, strategies other than mass drug administration are required.

Colonic mucosal eosinophilia in children without inflammatory bowel disease

Children undergoing colonoscopy and mucosal biopsies may show increased colonic mucosal eosinophils, which may or may not be associated with inflammatory bowel disease. There is not much clinical data on American children who have isolated increased colonic mucosal eosinophils. We sought to study the clinical correlates of children without inflammatory bowel disease who show increased mucosal eosinophils to understand their clinical presentation, etiological associations, and outcome. A retrospective analysis of children seen at a tertiary-level Children's hospital was performed by reviewing their medical charts and extracting pertinent data. There were 110 children in the study who had increased colonic mucosal eosinophils. Most children presented with abdominal pain, but several of them also had constipation, blood in stools, and diarrhea. Food allergies, irritable bowel syndrome, asthma, and lactase deficiency were the top four conditions present in these patients. Pathology of the colonic distribution revealed involvement of more than two colonic regions in 86% of the subjects, and only two subjects showing epithelial or crypt involvement by eosinophils. All subjects had a good outcome. Children with colonic mucosal eosinophilia (CME) who do not have an inflammatory bowel disease most frequently present with abdominal pain and primarily an increase of lamina propria eosinophils in two or more colonic regions. Based on the etiological associations we noted in the study, a work-up of children with CME may encompass detailed history for functional gastrointestinal disorders and lactose intolerance, testing for food and environmental allergies, stool examination for parasites, and peripheral blood counts. Almost all children had resolution of symptoms in the studied period suggesting that CME in children has a good clinical outcome.

Anemia and Associated Factors Among Pregnant Women Attending Antenatal Care at Madda Walabu University Goba Referral Hospital, Bale Zone, Southeast Ethiopia.

BackgroundGlobally, anemia is a public health problem, particularly in developing countries, including Ethiopia. Pregnant women are at a higher risk for anemia and anemic pregnant women often develop complications. Early diagnosis of pregnant women for anemia saves both the life of the newborn and hers. Therefore, the present study intended to assess anemia and its associated factors among pregnant women attending at Madda Walabu University Goba referral hospital.MethodsAn institutional-based cross-sectional study was conducted from April 3 to May 3, 2019, among pregnant women attending Madda Walabu University Goba referral hospital. A total of 353 respondents were included in the study by using systematic random sampling techniques. Data were collected using both face-to-face interview and hemoglobin measurement. The collected data were entered into SPSS and analyzed using both bi-variable and multiple logistic regressions. Finally, statistical significance was declared at a p-value of less than 0.05 in the multiple logistic regressions.ResultsIn this study, the prevalence of anemia was 46.2% (95%CI: 40.9%, 51.5%). Factors significantly associated with anemia were positive stool examination for parasites (AOR=2.9, 95%CI 1.255–6.856), lower consumption of fruits and vegetables (AOR=2.7, 95%CI 1.47–4.86), no iron supplementation (AOR=2.2, 95%CI 1.07–4.45), large family size (AOR=2.1, 95%CI 1.13–3.77), and absence of abortion history (AOR=0.4, 95%CI 0.24–0.77).Conclusions and RecommendationPrevalence of anemia among pregnant women was high. Pregnant women with a previous history of abortion, positive stool for parasite, lower consumption of fruits and vegetables, no iron supplementation and large family size above five were risk factors for anemia. Therefore, encouraging pregnant women to take iron supplementation and to eat fruits and vegetables are important.

Child health, parasites and lower socioeconomic status: Outcomes of a long-term screening, intervention and training study by health volunteers in rural Nepal.

BackgroundNepal is a developing country with limited resources for health provision due to its geographic difficulties and frequent natural disasters, such as floods and earthquakes. Children are at risk of growth retardation due to inadequate food intake and unhealthy environment. Lower back pain is common among the adults and causes limitations in daily activities. Material/methodsA group of voluntary Turkish medical students, doctors and civil members conducted a field study, together with Nepalese doctors (MDs) and local volunteers, concerned with health-screening, intervention practices and on-site training in rural Nepal between 2013 and 2015. Physical examination of participants, together with stool examinations for parasites were done and those for whom treatment was indicated were referred to MDs who also ran a field pharmacy containing donated medications. ResultsTotally, 1148 individuals-725 children and 423 adults-were screened between 2013 and 2015. Musculoskeletal problems and upper respiratory tract infections were primary complaints among adults and sick children, respectively. Three-quarters of 203 collected stools had ≥ 1 parasite(s). ConclusionsGrowth retardation in children observed during the study, the burden of intestinal parasites on Nepalese children and unavailability of effective health services for citizens in rural areas should direct local authorities to allocate greater resources for country's health infrastructure improvement and to provide a higher standard of childhood nutrition.

Çocukluk Çağındaki Kronik Ürtikerli Olguların Etiyolojik Açıdan Değerlendirilmesi

Objective: The etiology of chronic urticaria is usually considered idiopathic. There is limited data regarding childhood chronic urticaria in the literature. The aim of the study was to investigate the factors that can play a role in the etiology of chronic urticaria in children and the related clinical and laboratory findings. Material and Methods: We retrospectively evaluated the medical records of 80 children aged under 18 years who attended our clinic and were diagnosed with chronic urticaria. Clinical characteristics, laboratory findings and tests for atopy, infection, autoimmunity and physical urticaria were evaluated. Results: Eighty children with chronic urticaria were enrolled in the study. The mean age of the patients was 10.2±4.1 years. 41 (51.2%) of the patients were female. Of the study population, 46.3% and 53.7% were diagnosed as having chronic spontaneous urticaria and chronic physical urticaria, respectively. The most common comorbid diseases were; autoimmune disease (10%) (5 autoimmune thyroiditis, 1 juvenile rheumatoid arthritis, 1 diabetes, 1 acute rheumatic carditis), chronic gastritis or reflux (8.7%) and nonsteroidal anti-inflammatory drug allergy (5%). Of the patients, 23.7% had atopy, 16.4% had Helicobacter pylori positivity, 20.3% had thyroid autoantibody, 33.3% had antinuclear antibody (ANA) positivity, 25% had food additive related urticaria and 6.7% had positive stool examination for parasites. Autologous serum skin test (ASST) results were positive in 37.8% of the patients. The comparison of patients with positive and negative ASST showed no statistically significant differences in terms of age, gender, presence of atopy, autoimmune disease, ANA positivity, presence of antithyroid antibody and H. pylori positivity. Among the causes of physical urticaria, dermographism, cholinergic urticaria, delayed pressure urticaria, and cold and solar urticaria were found in 45%, 32.4%, 8.7%, 8% and 4.7%, respectively. Conclusion: The etiology of childhood chronic urticaria is mainly related to autoimmunity and physical urticaria. Identification of clinical features and possible causes will contribute to a better management of chronic urticaria in children.

Blastocystis sp. Infection Mimicking Clostridium Difficile Colitis.

We report an unusual case of severe diarrhea related to Blastocystis sp. infection in a patient with end stage renal disease on hemodialysis. The patient was admitted due to profuse diarrhea associated with fever and leukocytosis. Pertinent stool work-up such as leukocytes in stool, stool culture, clostridium difficile toxin B PCR, and serology for hepatitis A, hepatitis B, and hepatitis C and cytomegalovirus screening were all negative. Ova and parasite stool examination revealed Blastocystis sp. The patient was given intravenous metronidazole with clinical improvement by day three and total resolution of symptoms by day ten.

The IgE response to Ascaris molecular components is associated with clinical indicators of asthma severity

Background Asthma is a common chronic disease worldwide and Ascaris lumbricoides infection (ascariasis) is frequent in tropical regions. However, the effect of ascariasis on asthma severity has not been sufficiently explored. We sought to evaluate the influence of the IgE immune response to Ascaris extract and purified house dust mites (HDM) and Ascaris allergens on indicators of asthma severity in patients living in the tropics.Methods Asthmatic patients from Cartagena, Colombia were recruited. Clinical assessment included questionnaires, physical examination, allergy skin tests, spirometry, parasite stool examination and IgE antibody measurements. Asthma was diagnosed by a physician according to validated criteria. Indicators of severity were occurrence of severe dyspnea episodes, night awakenings events, > 4 emergency room (ER) visits and hospitalizations during the last year. Specific IgE to Der p 2, Ascaris spp., Blomia tropicalis and Dermatophagoides pteronyssinus extracts was determined by ImmunoCap. IgE to tropomyosins (Asc l 3, Blo t 10 and Der p 10), Blo t 5 and Asc s 1 was detected by ELISA. Logistic regression analyses were used to explore the relationships between sensitization and indicators of asthma severity.Results After adjustment for HDM sensitization, Ascaris sensitization remained associated with severe dyspnea (aOR: 1.90, 95% CI: 1.08 - 3.34, p = 0.03) and > 4 ER visits (aOR: 2.23, 95% CI: 1.15 - 4.30, p = 0.02). We also found that sensitization to the species specific markers Blo t 5 and Asc s 1, as well as the cross-reactive tropomyosins of D. pteronyssinus and Ascaris were associated with > 4 ER visits. Der p 2 sensitization was associated with bronchodilator responsiveness (aOR: 2.24: 1.25-4.02, p = 0.01). Remarkably, significantly higher IgE levels to HDM species specific allergens were found in Ascaris sensitized patients.Conclusions In this tropical population, IgE sensitization to Ascaris and the cross-reactive tropomyosins was frequent and associated with clinical indicators of asthma severity. The significant relationship between sensitization to the nematode-specific marker Asc s 1 and ER attendance supports these findings. Moreover, ascariasis increases the human IgE responses to HDM specific allergens.

The natural history of chronic urticaria in childhood: A prospective study

There are few prospective studies on the natural course of chronic urticaria (CU) in children. We sought to examine the natural history of CU in children and to identify predictors for remission. Children 4 to 15 years of age with CU were investigated with a complete blood cell count, erythrocyte sedimentation rate, antinuclear antibody titer, complement CH50 level, thyroid studies, autologous serum skin test, skin-prick tests, food challenges, and stool examination for parasites. They were considered to be in remission if symptoms did not recur for at least 12 months without medication. In all, 92 children (53.3% female) with CU were recruited and followed up for a median duration of 4.3 years (range 2.5-5.8 years). Chronic autoimmune urticaria (CAU) was identified in 40% of the patients. Food allergy was found in 8.7% and parasitic infestations in 5.4%. Remission rates at 1, 3, and 5years after the onset of CU symptoms were 18.5%, 54%, and 67.7%, respectively. The remission rate did not differ in CAU compared with non-CAU. No predictor of CU remission was identified. The basophil histamine release assay was not performed. Children with CU have a favorable outcome. CAU did not have an intractable course.

Allergy sensitization and asthma among 13-14 year old school children in Nigeria

The prevalence of asthma and role of atopy in asthma among children has not been clearly defined in Nigeria. To determine the prevalence of asthma and investigate risk factors related to allergy sensitization among urban and rural school children in southwest Nigeria. Validated ISAAC questionnaire was administered to 1736 high school children in randomly selected schools in rural and urban communities. Identified asthma cases were matched to controls. Allergy skin tests, blood eosinophil count, serum IgE and stool examination for parasites were performed. Dust samples from homes were also collected and analyzed for allergens. The prevalence of asthma was 7.5% (95% CI 6.0 to 9.2%) and 8% (95% CI 6.0-10.4%) in the rural and urban communities respectively . Risk factors for asthma included cigarette-smoking, cats in the home and family size. Eosinophil count (109/L) was elevated in asthmatics [0.70 (95% CI 0.48-1.11) vs. 0.32 (95% CI 0.19-0.69); p<0.01], but IgE levels were similar between the two groups (298±229 IU/mL vs. 288±257; p=0.97). Positive skin tests to cat hair, cockroach, mango blossom and mouse epithelium were more frequent in asthmatics than in healthy controls, especially in the rural communities. There was no correlation between allergens in dust collected from homes and skin test reactivity. Asthma prevalence is similar in rural and urban children in Southwest Nigeria and atopy with elevated IgE was not observed to be a major factor for asthma in our cohort of children in both communities.

Lymphocytic duodenosis: Aetiology and long-term response to specific treatment

BackgroundThe clinical significance of lymphocytic duodenosis remains unclear. AimTo prospectively assess the aetiology of lymphocytic duodenosis and the patterns of clinical presentation. MethodsNinety consecutive patients with lymphocytic duodenosis and clinical symptoms of the coeliac disease spectrum were prospectively included. All subjects underwent serological testing and HLA genotyping for coeliac disease, assessment of Helicobacter pylori infection, and parasite stool examination. Intake of non-steroidal anti-inflammatory drugs was also recorded. The final aetiology of lymphocytic duodenosis was evaluated on the basis of the long-term response to specific therapy. ResultsMore than one initial potential aetiology was observed in 44% of patients. The final diagnosis was gluten-sensitive enteropathy alone or associated with Helicobacter pylori infection in 43.3%, Helicobacter pylori infection (without gluten-sensitive enteropathy) in 24.4%, non-steroidal anti-inflammatory drugs intake in 5.5%, autoimmune disease in 3.3%, and parasitic infection in 2.2%. Among first degree relatives and patients with chronic diarrhoea, the most common final diagnosis was gluten-sensitive enteropathy. In contrast, in the group presenting with chronic dyspepsia the most common diagnosis was Helicobacter pylori infection (‘Diarrhoea’ vs ‘Dyspepsia’ groups, p=0.008). ConclusionsLymphocytic duodenosis is often associated with more than one potential initial aetiology. Clinical presentation may be useful to decide the initial therapeutic approach with these patients.

High Throughput Multiplex PCR and Probe-based Detection with Luminex Beads for Seven Intestinal Parasites

Polymerase chain reaction (PCR) assays for intestinal parasites are increasingly being used on fecal DNA samples for enhanced specificity and sensitivity of detection. Comparison of these tests against microscopy and copro-antigen detection has been favorable, and substitution of PCR-based assays for the ova and parasite stool examination is a foreseeable goal for the near future. One challenge is the diverse list of protozoan and helminth parasites. Several existing real-time PCR assays for the major intestinal parasites-Cryptosporidium spp., Giardia intestinalis, Entamoeba histolytica, Ancylostoma duodenale, Ascaris lumbricoides, Necator americanus, and Strongyloides stercoralis-were adapted into a high throughput protocol. The assay involves two multiplex PCR reactions, one with specific primers for the protozoa and one with specific primers for the helminths, after which PCR products are hybridized to beads linked to internal oligonucleotide probes and detected on a Luminex platform. When compared with the parent multiplex real-time PCR assays, this multiplex PCR-bead assay afforded between 83% and 100% sensitivity and specificity on a total of 319 clinical specimens. In conclusion, this multiplex PCR-bead protocol provides a sensitive diagnostic screen for a large panel of intestinal parasites.

776 Iron Deficiency Anemia Associated with Helicobacter Pylori Gastric Infection in Children

Background: An association between Helicobacter pylori (H.pylori) infection and iron deficiency anemia has been reported recently in children. Aim: To investigate a causal aβociation between H. pylori infection and iron deficiency anemia. Methods: Four patients, boys aged between 6 and 14 years, were admitted for severe pale without gastrointestinal symptoms. An extensive initial work-up was ordered that included the hematologic profile, multiple stool examinations for parasites and H.pylori antibody. Endoscopy was performed and antral biopsy specimens were taken for rapid urease test and histology. Eradication therapy was administered for 2 weeks. Oral iron therapy was prescribed after eradication. The hematologic profile were aβeβed after the iron therapy. Results: We present four patients with iron deficiency anemia and poor nutritional iron intake, gastrointestinal bleeding, chronic inflammation were excluded on the basis of specific tests. Iron deficiency anemia was defined as a hemoglobin concentration of leβ than 12 g/dl (6.3-7.0 g/dl), serum iron concentration leβ than 6.6 μmol/L (3.4- 4 μmol/L), a serum ferritin concentration leβ than 20 ng/ml (10-17 ng/ml). IgG antibody titer to H.pylori was positive in all the patients. Upper gastrointestinal endoscopy revealed a marked antral nodularity. A rapid urease test result was positive. Histopathology revealed chronic gastritis. H. pylori was succeβfully eradicated. Oral iron therapy was prescribed and 3 months later hematologic profile normalized. Conclusions: A diagnosis of H. pylori infection should be taken in children with iron deficiency anemia even in the absence of gastrointestinal symptoms. H. pylori infection is a risk factor for iron deficiency anemia.

Congestive heart failure as presentation of acute lymphoblastic leukaemia with eosinophilia

A previously healthy 17-year-old girl presented with the sudden onset of chest tightness accompanied by dyspnoea on exertion. Physical examination showed splinter haemorrhages and a grade III/VI systolic murmur at the left sternal border with no radiation. Laboratory data showed a white cell count of 49·8 × 109/l with 63% eosinophils (absolute eosinophil count of 31·4 × 109/l). The eosinophils showed no vacuolation or degranulation. Biochemical studies showed normal levels of creatine kinase and creatine kinase MB, but an elevated troponin-I of 2·19 (normal <0·034 ng/ml). Transthoracic echocardiography in the parasternal long-axis view disclosed an intracardiac thrombus (arrows), seen attached to the mitral valve at the left ventricular posterior wall, associated with mild mitral regurgitation (left panel: AO, aorta; LA, left atrium; LV, left ventricle, RV, right ventricle). The multidetector-row computed tomography image disclosed diffuse mural thrombus that occurred more in association with the posterior wall (arrows, right panel). A bone marrow biopsy demonstrated precursor B lymphoblastic leukaemia with 40% lymphoblasts and an increase of eosinophils and their precursors. Cytogenetic analysis of the bone marrow aspirate showed t(3;6)(p22;p24). Further studies relevant to a hypereosinophilic disorder disclosed normal levels of interleukin 5, no FIP1L1-PDGFRA fusion gene and negative stool examination for parasites and ova. The patient received chemotherapy according to a high-risk protocol for acute lymphoblastic leukaemia, which resulted in bone marrow remission and a return of the peripheral eosinophil count to normal by 8 weeks. Subsequent echocardiography showed resolution of the left ventricular endocardial thrombosis.

Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients

The etiologies of chronic urticaria (CU) in childhood remains incompletely understood because of limited data in children. The objective of this study was to examine some of the possible etiologies of CU in children by focusing on the functional autoantibody to FcepsilonRIalpha and IgE, thyroid autoimmunity, urticarial vasculitis, parasitic infestation and food allergy. Children 4-15 yr of age with CU were investigated for complete blood count, erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), CH(50), free-T4 (FT(4)), thyroid stimulating hormone (TSH), anti-thyroglobulin and anti-microsomal antibody, autologous serum skin test (ASST), skin prick tests (SPT) for foods, food challenges, and stool examination for parasites. Ninety-four children who met the criteria for CU were recruited. Patients with physical urticaria were excluded. Eosinophilia and elevated ESR were found in 23% and 13%, respectively. High ANA titers were found in 2%. None of these patients had clinical features of urticarial vasculitis, abnormal CH(50) level, abnormal TSH and FT(4). Anti-thyroglobulin and anti-microsomal antibodies were not detected. Positive ASST was found in 38%. There were no differences in medication requirement and CU remission between patients with positive and negative ASST. Parasites were found in 5% without clinical correlation. SPT to foods was positive in 35%. Positive food challenges were found in six/nine patients with positive history of food allergy and two/seven patients with negative history. Food avoidance was beneficial to the subgroup of patients with positive history of food allergy only.

Gastric Migration of Intestinal Ascariasis

Journal of Ultrasound in MedicineVolume 27, Issue 12 p. 1799-1801 Just Images Gastric Migration of Intestinal Ascariasis B-Mode Sonographic Depiction Nitin P. Ghonge MD, DNB, Nitin P. Ghonge MD, DNB [email protected] Diwan Chand Imaging Research Center, New Delhi, India.Search for more papers by this author Nitin P. Ghonge MD, DNB, Nitin P. Ghonge MD, DNB [email protected] Diwan Chand Imaging Research Center, New Delhi, India.Search for more papers by this author First published: 01 December 2008 https://doi.org/10.7863/jum.2008.27.12.1799Citations: 3 Address correspondence to Nitin P. Ghonge, MD, DNB, Diwan Chand Imaging Research Center, 10B, K. G. Marg, New Delhi-110 001, India., Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume27, Issue12December 2008Pages 1799-1801 RelatedInformation

A 3-Year-Old Girl with Intermittent Fever and Abdominal Pain

&lt;P&gt;This previously healthy 3-year-old girl was admitted following a 3-month history of intermittent fever and abdominal pain. She initially had a 2-week history of intermittent vomiting and fever without diarrhea. Although this resolved, she continued to have 2 weeks of intermittent periumbilical abdominal pain and fever on a daily basis. After 2 weeks, she developed 3 weeks of watery, non-bloody diarrhea with continued intermittent fever. She had been treated with multiple doses of acetaminophen during her illness. She was seen during this time period in several emergency rooms. Over the course of the illness, she had lost 5 pounds. Birth history was unremarkable. The family history was only remarkable because her mother had had a recent illness, which had consisted of vomiting, fever, and diarrhea. Her past medical history was significant for recurrent episodes of otitis media with bilateral myringotomy tube placement at 1 year of age. At home, there is one dog, one old cat, and four kittens. Her mother is a food handler. Evaluation at an outside hospital included normal electrolytes, ALT 116 IU/mL, albumin 3.1 mg/dL, and negative stool culture, rotavirus antigen test, and stool examination for parasites.&lt;/P&gt;&lt;H4&gt;Key Learning Points&lt;/H4&gt;&lt;OL&gt;&lt;LI&gt;Ten percent to 15% of healthy school-age children have functional chronic abdominal pain.&lt;/LI&gt;&lt;LI&gt;Ultrasonography is the best initial test for imaging the biliary tract.&lt;/LI&gt;&lt;LI&gt;Choledochal cysts can be several centimeters in diameter and are sometimes palpable. There’s generally no liver dysfunction until the biliary tract obstruction becomes complete.&lt;/LI&gt;&lt;LI&gt;Asymptomatic small-bowel intussusceptions are seen regularly on computerized tomography scans. They are evanescent, and don’t cause obstruction. No treatment is necessary unless they persist and lead to a small bowel obstruction.&lt;/LI&gt;&lt;LI&gt;The likelihood of lead poisoning is higher in children who ingest coins or other foreign objects.&lt;/LI&gt;&lt;/OL&gt;&lt;H4&gt;ABOUT THE AUTHOR&lt;/H4&gt;&lt;P&gt;Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL&lt;/P&gt;

Risk factors for asthma and allergy associated with urban migration: background and methodology of a cross-sectional study in Afro-Ecuadorian school children in Northeastern Ecuador (Esmeraldas-SCAALA Study).

BackgroundAsthma and allergic diseases are becoming increasingly frequent in children in urban centres of Latin America although the prevalence of allergic disease is still low in rural areas. Understanding better why the prevalence of asthma is greater in urban migrant populations and the role of risk factors such as life style and environmental exposures, may be key to understand what is behind this trend.Methods/designThe Esmeraldas-SCAALA (Social Changes, Asthma and Allergy in Latin America) study consists of cross-sectional and nested case-control studies of school children in rural and urban areas of Esmeraldas Province in Ecuador. The cross-sectional study will investigate risk factors for atopy and allergic disease in rural and migrant urban Afro-Ecuadorian school children and the nested case-control study will examine environmental, biologic and social risk factors for asthma among asthma cases and non-asthmatic controls from the cross-sectional study. Data will be collected through standardised questionnaires, skin prick testing to relevant aeroallergen extracts, stool examinations for parasites, blood sampling (for measurement of IgE, interleukins and other immunological parameters), anthropometric measurements for assessment of nutritional status, exercise testing for assessment of exercise-induced bronchospasm and dust sampling for measurement of household endotoxin and allergen levels.DiscussionThe information will be used to identify the factors associated with an increased risk of asthma and allergies in migrant and urbanizing populations, to improve the understanding of the causes of the increase in asthma prevalence and to identify potentially modifiable factors to inform the design of prevention programmes to reduce the risk of allergy in urban populations in Latin America.

Humane Infektion mit Dicrocoelium dendriticum

MEDICAL HISTORY AND PHYSICAL EXAMINATION: A 36-year-old German reported having had chronic-relapsing diarrhea, right upper abdominal pain and weight-loss for about two years. His last journey had taken him to Morocco three and a half years ago. The physical examination was unremarkable except for an abdominal tenderness to palpation in the right upper quadrant. LABORATORY: The serum level of bilirubin was slightly raised to 1.13 mg/dl (<1.10 mg/dl) and the level of IgE was raised to 253 U/ml (<100 U/ml). All other laboratory findings were within normal limits. Stool examinations showed eggs of Dicrocoelium dendriticum. The abdominal ultrasound was unremarkable except for mild steatosis. The patient denied consumption of liver or liver-products within the past weeks. Spurious infection due to eating infected liver could thus be excluded. The patient was treated for dicrocoeliasis with praziquantel (3 x 600 mg/day for three days). Further stool examinations for parasites were negative. Since the patient still had gastrointestinal discomfort, we decided to give a further therapy with triclabendazole (700 mg, single dose). Five weeks after the second treatment the patient was almost free of symptoms and stool examinations for parasites remained negative. Dicrocoeliasis can be associated with chronic diarrhea. Stool examinations for parasites are very important in patients with gastrointestinal symptoms.

A 44-year-old woman with diarrhoea and double vision

A 44-year-old white woman was seen in May, 1996, complaining of diarrhoea for 6 months and recent onset of double vision. General and neurological examination was unremarkable, except she could not move her left eye outwards. She was extensively investigated to find the cause of her chronic diarrhoea. Abdominal ultrasonography, proctosigmoidoscopy, small and large bowel contrast radiography, and tests for faecal occult blood were all normal. Stool examination for parasites and yeasts, bacterial cultures, and Sudan stain for fat were negative.