Stool Ova Research Articles

Practical guide for the diagnosis of helminth ova in stools

Practical guide for the diagnosis of helminth ova in stools

Strongyloides stercoralis infection masquerading as malignant ascites in a case of angiosarcoma.

Strongyloides stercoralis is a parasitic nematode that infects millions of people worldwide. It primarily infects humans but can also be found in domestic animals and primates. The severity of infection varies from asymptomatic to life-threatening complications. We present a case of a 56-year-old male with a known case of angiosarcoma liver with massive ascites and low-grade fever. He was clinically diagnosed as having malignant ascites and was planned for chemotherapy. During therapeutic cum diagnostic ascitic tap, cell block sections revealed the presence of cross sections of nematode S. stercoralis gravid uterus with eggs. Later, stool for ova and cysts also revealed multiple larval forms of the nematode. S. stercoralis hyperinfection is often accompanied by sepsis or meningitis with enteric organisms. Patient was started on tab. ivermectin 12 mg once a day for two days (in the standard dosage of 200 mcg/kg) was then repeated in the same dosage for another two days after two weeks, and gradually the ascites settled. Post-treatment ascitic tap cell block preparations did not show any parasites. Patient has been on follow-up for 6 months, and he remains asymptomatic.

High-throughput detection of parasites and ova in stool using the fully automatic digital feces analyzer, orienter model fa280

BackgroundIntestinal parasitic infections can harm health by causing malnutrition, anemia, impaired growth and cognitive development, and alterations in microbiota composition and immune responses. Therefore, it is crucial to examine stool samples to diagnose parasitic infections. However, the traditional microscopic detection method is time-consuming, labor-intensive, and dependent on the expertise and training of microscopists. Hence, there is a need for a low-complexity, high-throughput, and cost-effective alternative to labor-intensive microscopic examinations.MethodsThis study aimed to compare the performance of a fully automatic digital feces analyzer, Orienter Model FA280 (People’s Republic of China) with that of the formalin-ethyl acetate concentration technique (FECT). We assessed and compared the agreement between the FA280 and the FECT for parasite detection and species identification in stool samples. The first part of the study analyzed 200 fresh stool samples for parasite detection using the FECT and FA280. With the FA280, the automatic feces analyzer performed the testing, and the digital microscope images were uploaded and automatically evaluated using an artificial intelligence (AI) program. Additionally, a skilled medical technologist conducted a user audit of the FA280 findings. The second set of samples comprised 800 preserved stool samples (preserved in 10% formalin). These samples were examined for parasites using the FECT and FA280 with a user audit.ResultsFor the first set of stool samples, there was no statistically significant difference in the pairwise agreements between the FECT and the FA280 with a user audit (exact binomial test, P = 1). However, there were statistically significant differences between the pairwise agreements for the FECT and the FA280 with the AI report (McNemar’s test, P < 0.001). The agreement for the species identification of parasites between the FA280 with AI report and FECT showed fair agreement (overall agreement = 75.5%, kappa [κ] = 0.367, 95% CI 0.248–0.486). On the other hand, the user audit for the FA280 and FECT showed perfect agreement (overall agreement = 100%, κ = 1.00, 95% CI 1.00–1.00). For the second set of samples, the FECT detected significantly more positive samples for parasites than the FA280 with a user audit (McNemar’s test, P < 0.001). The disparity in results may be attributed to the FECT using significantly larger stool samples than those used by the FA280. The larger sample size used by the FECT potentially contributed to the higher parasite detection rate. Regarding species identification, there was strong agreement between the FECT and the FA280 with a user audit for helminths (κ = 0.857, 95% CI 0.82–0.894). Similarly, there was perfect agreement for the species identification of protozoa between the FECT and the FA280 with user audit (κ = 1.00, 95% CI 1.00–1.00).ConclusionsAlthough the FA280 has advantages in terms of simplicity, shorter performance time, and reduced contamination in the laboratory, there are some limitations to consider. These include a higher cost per sample testing and a lower sensitivity compared to the FECT. However, the FA280 enables rapid, convenient, and safe stool examination of parasitic infections.Graphical

Diarrhea don’ts: Reducing inappropriate stool cultures and ova and parasite testing for nosocomial diarrhea

Diarrhea that develops in patients after 72 hours of hospitalization is likely to have a nosocomial or iatrogenic etiology. Testing with stool cultures and stool ova and parasites (O&P) is not recommended. Our goal was to reduce this inappropriate testing within a large, urban safety-net hospital system. This was a quality improvement project. We created a best practice advisory (BPA) within the electronic medical record that fires when a stool culture or O&P order is placed 72 hours after admission for any immunocompetent patient. It states that stool testing is low yield and offers the option to remove the order. We measured weekly counts of stool culture and stool O&P orders pre- and postintervention. We also measured the BPA acceptance rate, the 24-hour stool testing reorder rate, and Clostridioides difficile infection rates. Data were analyzed using Welch tests as well as a quasi-experimental pre- and postintervention interrupted time series regression analysis. Stool culture orders decreased by 24.4% (P < .001). There was a significant level difference and slope difference with linear regression. Five of the 11 hospitals had a significant reduction in stool culture orders. Stool O&P orders decreased by 18.2% (P < .01). Three of the 11 hospitals had a significant reduction in stool O&P orders. Our intervention successfully reduced inappropriate stool testing within a large safety-net hospital system.

Nematode Toxocara canis as a Probable Epidemic, Sanitary and Hygienic Threat to Public Health in the Southern Region of the Russian Federation

Introduction: According to the World Health Organization, Toxocara canis, a nematode in the order Ascarididia, is an epidemic and epizootic risk factor for humans and animals around the world and in the Russian Federation. Human toxocariasis is one of the commonest parasitic zoonoses with up to 900 million incident cases registered annually in different age and social groups of the population and a global public health problem of our time. Objective: To study the nematode Toxocara canis (Werner, 1782) as a health risk factor for the population of southern regions the Russian Federation. Materials and methods: We estimated the incidence of larval toxocariasis in the population of 10 districts and two cities of Karachay-Cherkessia based on the results of enzyme immunoassay of blood samples of 6,000 people in 2019–2022. The Tiascar diagnostic test kit (2017) was applied showing toxocariasis for the antibody titer ≥ 1:800 and infestation with Toxocara larvae for those of 1:200 and 1:400. The stool ova and parasite test was used to study 600 dog stool samples from the study areas. In addition, 1,200 soil samples were tested for the presence of Toxocara canis eggs. Results: We established that the incidence rate of larval toxocariasis in the population of 10 districts and two cities of Karachay-Cherkessia varied from 2.00 to 5.40 %. Toxocara canis larvae were not found in human feces, since humans are a biological dead end for this species of worms. Toxocara canis infestation rates in feces of dogs ranged from 2.7 ± 0.4 to 6.9 ± 0.8 eggs/g, potentially accounting for a high level of soil contamination with eggs. The current epidemic situation of human toxocariasis in the Karachay-Cherkess Republic is relatively favorable owing to planned preventive measures. Yet, this constituent entity is at risk of the disease in the future since the number of children, adults and migrants with larval toxocariasis shows a dynamic growth throughout the year. Conclusion: Incidence rates of larval toxocariasis in the child population and migrants demonstrate a 2.74–2.78-fold increase during the year. Toxocara canis eggs contaminate 46 to 94 % of soils in different areas of the republic posing high risks of larval toxocariasis for the local population. In terms of canine toxocariasis, the Karachay-Cherkess Republic can be attributed to disadvantaged territories of the North Caucasian Federal District.

Performance characteristics of diagnostic assays for schistosomiasis in Ontario, Canada.

Due to lower intensity of infection and greater intervals from last exposure, parasitologic detection methods for schistosomiasis are poorly sensitive in non-endemic areas, challenging accurate diagnosis. We evaluated parasitologic versus indirect detection methods for schistosomiasis. We included specimens submitted for Schistosoma serology, and stool for ova and parasite microscopy. Three real-time PCR assays targeting Schistosoma mansoni and S. haematobium were performed. Primary outcome measures were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), where both microscopy and serology were the composite reference standard against serum PCR. Of 8168 serum specimens submitted for Schistosoma serology, 638 (7.8%) were reactive and 6705 (82.1%) were non-reactive. Of 156,771 stool specimens submitted for ova and parasite testing, 46 (0.03%) were positive for eggs of S. mansoni. Four (0.5%) urine specimens were positive for eggs of S. haematobium. Combined serum PCRs targeting S. mansoni had a sensitivity and specificity of 27.8% (95% CI = 18.3-39.1%) and 100% (95% CI = 83.9-100%), respectively, with PPV of 100% (95% CI = 100%) and NPV of 26.9% (95% CI = 24.3-29.7%). The one serum sample positive for S. haematobium was also detectable by our S. haematobium PCR. No cross-reactivity was observed for all three PCR assays. Although serology is highly sensitive, parasitologic tests signify active infection, but are limited by low population-level sensitivity, particularly in non-endemic settings. Although serum PCR offered no performance advantage over stool microscopy, its role in diagnostic parasitology should be pursued due to its high-throughput and operator-independent nature.

S2781 Crohn’s Disease Presenting as Oropharyngeal Candidiasis

Introduction: Oral lesions are easily visualized and often a sign of systemic disease. One such entity, oropharyngeal candidiasis, is a frequent finding in immunocompromised patients. Oropharyngeal candidiasis as a presenting finding in Crohn’s disease (CD) is exceedingly rare. We present the case of newly diagnosed CD manifesting with oropharyngeal candidiasis in the absence of any other immunosuppressing conditions. Case Description/Methods: A 38-years-old male with no prior medical history presented to the hospital with 1 week of sore throat, white discoloration of the oral cavity, and odynophagia. On review of systems, he also reported intermittent abdominal pain, episodic hematochezia, and a 20lb unintentional weight loss over the past several months. He took no medications and denied any high-risk sexual behavior. On physical exam, his oropharyngeal cavity was coated with white plaques on the buccal mucosa, tongue base, and palate, consistent with a clinical diagnosis of oropharyngeal candidiasis. Initial blood work was remarkable for a leukocytosis of 15,000 and CRP of 15. His HIV serology, EBV (IgG, IgM), and autoimmune workup (ANA, Anti-dsDNA) were negative. Stool multiplex PCR assay and stool ova and parasites were negative as well. His fecal calprotectin was 2399 ug/g. Computed tomography scan of the abdomen and pelvis showed pan-colitis. He subsequently underwent upper and lower endoscopy revealing innumerable ulcers with white exudate on the oropharynx and multiple ulcers throughout the colon. Biopsies demonstrated severe colitis, cryptitis, and crypt abscesses, and a diagnosis of CD was made. The patient started high dose steroids in conjunction with anti-fungal medications and had rapid resolution of all symptoms. Discussion: Oropharyngeal candidiasis is commonly seen in patients with a recent use of antibiotics, steroids, and immunocompromised states. In patients with CD, it is almost exclusively related to the use of steroids, biologics, or other immunosuppressant medications. Oropharyngeal candidiasis as a presenting symptom in CD is extremely rare with only one case being reported in the medical literature. Our case highlights the importance of keeping a broad differential in patients presenting with oropharyngeal candidiasis, but seemingly without typical risk factors.Figure 1.: Ulcers seen during the colonoscopy procedure.

S2662 Systemic AL Amyloidosis From Plasma Cell Neoplasm in Younger Population Presenting With Gastrointestinal Symptoms Primarily

Introduction: AL amyloidosis, known previously as primary amyloidosis, is a disorder in which fragments of monoclonal light chains deposit throughout various tissues. The incidence of amyloidosis increases after the age of 40 and a mean age of 63 years old at diagnosis. However, less than 5% of patients are diagnosed at 40 years or younger. Here we explore the case of a patient presenting with gastrointestinal symptoms diagnosed with systemic AL amyloidosis at 32 years old. Case Description/Methods: 32-year-old male presented to the emergency department with abdominal pain and hematochezia The pain was mainly in the left lower quadrant and was not associated with any nausea or vomiting. He also admitted to a 4-5 kilogram weight loss over the past year. CT abdomen and pelvis showed mild colonic wall thickening. Presumptive treatment for colitis was started but patient was not improving. Stool ova and parasites and blood cultures were negative. Biopsy specimens obtained during colonoscopy and endoscopy showed amyloidosis in the gastroesophageal junction, gastric, duodenal, terminal ileum , and colonic mucosa. Bone marrow biopsy from the right iliac showed kappa type clonal plasma cell population that made up 20-25% of marrow cellularity, consistent with plasma cell neoplasm. It was also positive for amyloid staining of small-sized blood vessels. Ultrasound-guided liver biopsy was positive for amyloidosis and fibrosis in the liver parenchyma and negative for malignancy. In summary, the test results were congruent with systemic amyloidosis involving the GI tract, liver, and multiple other organs. Discussion: AL amyloidosis, also known as systemic amyloidosis, occurs as a result of deposition of amyloid in tissue. Amyloid fibrils are composed of insoluble low molecular weight protein subunits. Deposition of amyloid into various tissues causes cellular stress and death, subversion of normal structure, organ dysfunction, and eventually death. This case illustrates the rare diagnosis of early-onset AL amyloidosis with widespread end-organ damage in multiple organ systems. It is especially important to consider both generalized symptoms, such as weight loss, as well as specific symptoms relating to end organ dysfunction, such as abdominal pain and hematochezia. GI symptoms tend to be less common, but when they are present, it may include macroglossia, dysphagia, bleeding or malabsorption. The GI tract may be involved at any level, as was the case with this patient.

Daily Gastrointestinal Symptoms And Weight Loss In A Young Female Athlete

HISTORY: 21-year-old female college ice hockey player with PMH of depression/anxiety on sertraline presents with a 3-month history of abdominal pain, nausea, vomiting, and diarrhea. This was accompanied by a 15-pound weight loss since freshman year of college. She states that she experiences emesis and diarrhea daily, however feels like she has a normal appetite and eats until she feels full. She presented to the ED, prior to our visit, for abdominal pain and vomiting, and was prescribed a PPI with no lab work at the time. At our visit, she did report feeling anxious as she had ended a 3-year long relationship which she described as being “toxic.” PHYSICAL EXAMINATION: General Appearance: Anxious appearing young Caucasian female in no acute distress with mild hand tremor Abdominal: Tenderness to palpation over the epigastric region without rebound tenderness. Prominent aortic pulse noted in abdomen. No lower quadrant or right upper quadrant tenderness to palpation. Resp: No acute respiratory distressCV: Regular rate and rhythm. No murmurs or clicks. No cyanosis of the fingers or lips. DIFFERENTIAL DIAGNOSIS: 1) Gastroesophageal reflux disease 2) Inflammatory Bowel Disease/Irritable Bowel Syndrome 3) Celiac disease4) H. Pylori TEST AND RESULTS: Fecal studies (calprotectin feces, stool culture, stool leukocytes, H Pylori stool, stool ova and parasites, FOBT) returned negative. TSH levels returned undetectable with free thyroxine levels returning elevated at 5.45. CMP returned borderline abnormal with mildly decreased CO2 and mildly increased BUN. CBC, ESR, CRP, celiac disease panel all negative. FINAL WORKING DIAGNOSIS: Thyrotoxicosis secondary to Grave’s disease TREATMENT AND OUTCOMES: The athlete was held from sporting activity due to concern for caloric deficiency as well as increased cardiac load to due hypermetabolic state. She was referred to Endocrinology where her thyrotropin receptor antibody returned positive consistent with Grave’s disease. She was initiated on atenolol for symptomatic control.

Helicobacter pylori Chronic Gastritis in Children and Adolescents was not Associated with Anaemia

Background: Helicobacter pylori (H. pylori) colonizes the gastric mucosa, leading to chronic inflammation. Epidemiological studies have demonstrated that H. pylori infection is high in areas with a high prevalence of anaemia. Consequently, patients infected with H. pylori are at a higher risk of anaemia. However, the relationship between H. pylori and anaemia remains controversial. Therefore, a study conducted among children with chronic abdominal pain with organic dyspepsia (chronic gastritis due to H. pylori and (or?) Esophagitis), and a functional disorder (Irritable Bowel Syndrome), will be appropriate. Objective: Compare the prevalence of Anaemia in children and adolescents with chronic abdominal pain, divided into: 1) Non-ulcer dyspepsia associated with H. pylori gastritis., 2) Dyspepsia associated with chronic Esophagitis, and Irritable Bowel Syndrome. Methods: The study was a single-centre, observational retrospective cohort. Inclusion and Exclusion Criteria. All children must be well categorized with signs and symptoms consistent with chronic abdominal pain and aged between 5-and 18 years. Exclusion criteria: genetic, metabolic, immune, cardiac, hepatic or renal diseases, neurodevelopmental delay, and previous surgery. Laboratory tests were performed for all patients: complete blood cell count, Erythrocyte Sedimentation Rate, urinalysis, stool for ova &amp; parasites, and H. pylori serology. Another diagnostic test was decided at the discretion of the gastroenterology team. The chronic dyspeptic syndrome with non-ulcer dyspepsia associated with H. pylori if they presented both results: the rapid urease test positive and the histological examination of the gastric mucosa confirming the presence of the bacterium. Dyspepsia associated with chronic Esophagitis was based on clinical symptoms/signs and endoscopic and histologic evaluation. Patients with IBS were diagnosed according to Rome Criteria. Results: Three hundred and seven children/adolescents: H. pylori gastritis (154, 50%), Esophagitis (41, 14%), and IBS (112, 36%) were included. There was a non-statistically significant difference in the baseline characteristics (sex, first-born child, age of mothers, age of fathers, crowding index, duration of pain symptoms, headache and limb pain, overweight/obesity and malnutrition) between the three groups. Clinical characteristics demonstrated: H. pylori and Esophagitis have epigastric pain and IBS periumbilical pain. There was a non-statistically significant difference in haemoglobin values and red cell parameters between the three groups in laboratory investigation. The prevalence of anaemia was very low, with no difference between the groups. Urinalysis and stool for ova &amp; parasites were negative in all children. Conclusion: Anaemia was not present in children with chronic abdominal pain, both organic and functional disorders. Age, good nutritional status, good sanitation and hygiene may have contributed to the results in this study.

Intestinal parasites in stool testing among refugees at a primary care clinic in Toronto, Canada

BackgroundEnteric parasites are endemic in many of the countries from which refugees originate. Clinical guidelines vary in approaches to screening for and treating intestinal parasites in refugee receiving countries. This study aims to investigate the prevalence and species of intestinal parasites identified in stool ova and parasite (O&P) specimens in a sample of newly arrived refugees in Toronto, Canada.MethodsWe conducted a retrospective chart review of 1042 refugee patients rostered at a specialized primary care clinic in Toronto from December 2011 to September 2016. Patients who completed recommended stool O&P analyses were included. Basic sociodemographic and clinical variables and results of stool O&P were examined.Results419 patients (40.2%) had a stool O&P positive for any protozoan or helminth species. Sixty-nine patients (6.6%) had clinically significant parasite species (excluding B hominis, D fragilis, and E dispar, given their lower risk for causing symptoms/complications): 2.3% had clinically significant protozoans and 4.2% had helminths on stool analysis.ConclusionGiven the relatively low prevalence of clinically significant parasites identified, our findings do not support universal screening for enteric parasites with stool O&P among refugee claimants/asylum seekers. However, stool analysis should be considered in certain clinical situations, as part of a more tailored approach.

Care of the Immigrant Child.

Care of the Immigrant Child.

S2637 Kombucha-Induced Liver Injury

Introduction: Kombucha is a beverage prepared from the cultures of bacteria and yeast, which has described hepatoprotective properties.1 There are few cases in which hepatotoxicity has been described. 2 We present a rare case of kombucha induced liver injury. Case Description/Methods: A healthy 33-year-old female presented to urgent care with cervical lymphadenopathy, rash, and fever to 102F. She tested negative for COVID-19, streptococcus, and mononucleosis. One week later, she developed abdominal pain and jaundice, prompting her presentation to the emergency department. Here, labs showed an AST 223 IU/L, ALT 270 IU/L, ALP 713 IU/L, total bilirubin 11.4 mg/dL (direct 7.7 mg/dL), albumin 2.6 g/dL, GGTP 202 IU/L, and normal coagulation studies. Infectious work-up including hepatitis A, B, C, D, and E, CMV, EBV, HIV, stool ova and parasites, and blood cultures which were all negative. Additional metabolic and immunologic workup was all negative. Abdominal ultrasound showed no evidence of biliary ductal dilatation or obstruction, and MRCP was normal. Liver biopsy is depicted in image 1. She reported consuming 12 ounces of kombucha daily for 5 months prior to presentation, and denied prescription, over the counter, and herbal medications. She was advised to abstain from kombucha, which resulted in resolution of her liver injury. Discussion: In the absence of serologic, radiographic, and histologic evidence of autoimmune hepatitis, viral or parasitic infection, obstructive pathology, and resolution of liver enzymes with cessation of imbibement, Kombucha induced liver toxicity was diagnosed as the reason for cholestatic jaundice. Her RUCAM score of 7 suggests a “probable” causality of kombucha ingestion as the etiology of liver injury.3 We present this case to enhance awareness of potential hepatotoxicity from kombucha and to encourage research into the mechanism by which this beverage can cause hepatotoxicity. (Figure Presented).

S2651 Acute Liver Infarct with a Superimposed Liver Abscess as a Consequence of Hypercoagulable State in a Patient with COVID-19 Without Respiratory Manifestations

Introduction: COVID-19 infection have been associated to a hypercoagulable state. We present a case of a 66-year-old man with SARS-CoV-2 infection without respiratory symptoms that debuted with thrombosis of the portal vein and branches of the hepatic artery, liver infarction and superimposed hepatic abscess as the only clinical manifestation. Hepatocellular carcinoma, liver cirrhosis, intra-abdominal and pelvic inflammation or infection were absent. No history of coagulopathies reported. We postulate that the hypercoagulable state associated to COVID-19 led to thrombosis of the portal vein and branches of the hepatic artery leading to patient's clinical presentation and ultimate complications. Case Description/Methods: A 66-year-old man presented to the ED complaining of fever, night sweats, generalized malaise, unintentional weight loss, and epigastric pain. Ten days prior, a COVID- 19 PCR test was done with positive results. Physical examination demonstrated bilateral clear lungs and a benign abdomen. Labs showed neutrophilic leukocytosis, reactive thrombocytosis, normocytic normochromic anemia, elevation of liver enzymes and inflammatory markers. Abdominal US revealed acute PVT. He was admitted and started on vancomycin, piperacillin/tazobactam and full anticoagulation with enoxaparin. Chest CT scan excluded pulmonary consolidations and ground glass opacities. Abdominopelvic contrast CT scan confirmed the PVT involving the main, right and left portal veins without collateral vessels. No other infectious foci was identified. Contrast MRI findings were consistent with a multiseptated liver abscess within the left liver lobe lateral segment and PVT associated with a large infarction involving the right liver lobe anterior segment and the left liver lobe medial and lateral segments. Blood and urine cultures, stool ova and parasite, E. histolytica IgG ELISA and viral hepatitis panel were negative. After 12 days, the patient was discharged to complete 4 weeks of antibiotics and 6 months of full anticoagulation. Follow-up contrast CT scan showed new cavernous transformation of the porta hepatis and resolution of the liver abscess. Discussion: Physicians should be aware that patients with COVID-19 infection can debut with thromboembolic phenomenon and potential involvement of hepatic circulation as the only clinical manifestation of COVID-19. Prompt recognition can help physicians to direct appropriate therapy earlier for these complications, which can have a significant impact in patient's outcomes and prognosis. (Table Presented).

Stunting in pre-school and school-age children in the Peruvian highlands and its association with Fasciola infection and demographic factors

Fascioliasis is a zoonotic trematode infection that is endemic in the highlands of Peru. Chronic fascioliasis can be asymptomatic and remain undiagnosed for years. Chronic malnutrition in children, as manifested by stunting, leads to delayed cognitive development and lost productivity. We hypothesized that fascioliasis is among the factors associated with stunting in children from endemic areas. We conducted a cross-sectional study among children attending pre-school and school in 26 communities in the Anta province in the Cusco region of Peru. We conducted interviews to collect information on demographic, socioeconomic, and medical history. Blood was collected and tested for complete cell count and FAS2 ELISA for Fasciola antibodies. Three stool samples per participant were tested for parasites by Kato-Katz and Lumbreras rapid sedimentation methods. Chronic fascioliasis was determined by the presence of ova in stool. Children’s height, weight, and age were recorded and used to calculate height for age Z scores (HAZ). Three thousand children participated in the study. Nine percent (264) of children had at least one positive test for Fasciola infection, 6% (164) had chronic fascioliasis, and 3% (102) had only positive antibody tests. The median HAZ was -1.41 (IQR: -2.03 to -0.81) and was similar in males and females. Twenty six percent (776) of children had stunting with HAZ < -2. Children with chronic fascioliasis had a lower median HAZ than children without Fasciola (-1.54 vs. -1.4, p = 0.014). History of treatment for malnutrition, history of treatment for anemia, having other helminths in stool, lower socioeconomic score, living at a higher elevation, and fewer years of schooling of both parents were associated with a lower HAZ score. In a multiple regression analysis, older age and a lower socioeconomic score were associated with a lower HAZ score. While fascioliasis and other helminths were associated with lower HAZ, they were not independent of the socioeconomic score.

A Rare Case of Fasciola Hepatica and its Treatment

Fascioliasis is a re-emerging food-borne parasitic zoonosis which presents with nonspecific clinical symptoms. Definitive diagnosis requires demonstration of parasitic ova in stool which may often be elusive. Imaging plays a crucial role in raising the possibility of this diagnosis early in the disease course. Contrast-Enhanced Computed Tomography (CECT) of the abdomen was performed in a 44-year-old male with fever, right upper quadrant pain and dyspepsia. The patient later underwent an ultrasound-guided biopsy of liver lesions. The stool examination for ova was negative. Biopsy of the liver lesions showed ill-defined granulomas. Imaging plays a crucial role in establishing the early diagnosis of hepatic fascioliasis especially in nonendemic regions where the clinical suspicion for this diagnosis is low. This article places emphasis on the description of typical imaging features of this condition and the usage of additional investigative/testing techniques recommended by the Center for Disease Control and Prevention (CDC).

715. A 79 year old Female with Bloody Diarrhea and Hypovolemic Shock: Keep the Differential Diagnosis Open

BackgroundSchistosomiasis is considered one of the neglected tropical diseases which is rarely seen in USA. We are reporting herein a case of intestinal schistosomiasis presented as bloody diarrhea and hypovolemic shock at Monmouth Medical Center, New Jersey.Methods: Case ReportA 79 year old female presented with bleeding into her colostomy bag and associated left lower abdominal pain for one day duration. She has a history of colon cancer diagnosed 25years ago, which was treated with chemotherapy and a left hemicolectomy with colostomy formation. On admission, her blood pressure was 78/51 mm Hg. She looked pale and her abdominal examination revealed tenderness in left lower quadrant. Laboratory findings showed hemoglobin of 5.3 g/dl. CT abdomen showed extensive colitis. She was resuscitated and treated with Piperacillin-Tazobactum for 6 days with minimal improvement. Stool for ova and parasites were negative. EGD was unremarkable with no evidence of acute bleeding. Colonoscopy showed severe ulcerative colitis in the distal 30cm of colon. Pathology revealed ischemic and necrotic tissue with numerous calcified schistosoma eggs in the colon (Figure 1). After furthering questioning, the patient mentioned that she travelled to South China 8months prior to presentation. Patient was then treated with Praziquental for one day for possible Schistosomiasis Japonicum, given the regional distribution. The patient showed marked clinical improvement and was discharged home later.Figure 1: Histopathology image showing calcified schistosoma eggs in colon ResultsIntestinal Schistosomiasis is a parasitic disease which peaks at age 15-20yrs, older patients usually have less parasitic burden. Symptoms include diarrhea, abdominal pain, dyspepsia and malnutrition. Heavily infected patients can have hemorrhagic diarrhea, obstruction and ischemic colitis. Definitive diagnosis requires egg identification. Treatment is relatively safe and effective, especially in the developed countries where the resistance to Praziquantel (PZQ) has not been reported yet.ConclusionEven though the worms that cause the disease are not found in USA, this case highlights the importance of recognizing Schistosomiasis especially in New Jersey, due to the high traveling immigrant population, as early recognition and treatment reduces morbidity and mortality.Disclosures All Authors: No reported disclosures

Urticaria: clinical profile, laboratory evaluation, serum IgE evaluation and its significance

Background: Urticaria is a recurrent pruritic skin disease characterised by wheals and or angioedema. The recurrent nature of urticaria, pruritus and wheals impacts negatively on the quality of life of patients. Prevalence studies, type, trigger factors and patient related factors including serum IgE vary depending on site of study. These factors were not documented in our patients. The aim of this study is to determine the clinical characteristics of our urticaria patients and determine the proportion of urticaria patients who have elevated Sr IgE, Eosinophilia, Basophilia, Hepatitis B and C virus seropositivity. Also, to correlate elevated Sr IgE with age, gender, presence of atopy, dermographism, type of urticaria, raised eosinophil count and resolution with anti-histamines.&#x0D; Methods: A retrospective case review was conducted on 43 patients who attended the dermatology outpatient clinic from January 2017 to December 2018. The sociodemographic and clinical parameters of patients was documented using a questionnaire. Investigation results (Sr IgE levels, Eosinophil and Basophil counts, Hepatitis B and C virus seropositivity, stool ova and parasite) were extracted from cases records. Data was analyzed using SPSS version 22. Univariate descriptive statistics such as means, medians, frequencies and proportions are presented.&#x0D; Results: Prevalence of urticaria was 4.2% and the mean age of the patients was 40.6±15.6 years. Patients were made up 62.8% males and 37.2% females. A history of atopy was noted in 34.9%, urticaria was acute and chronic in 4.7% and 95.3% respectively. Angioedema was present in 44.2% and absent in 53.5%. Majority of the patients (67.4%) were treated with anti-histamines. Serum IgE was elevated in 43.8%, Eosinophilia in 27.30%, Basophilia in 0%, hepatitis B seropositivity in 10%, hepatitis C seropositivity in 0% and a positive stool ova/parasite test in 2.3%.&#x0D; Conclusions: Urticaria is more prevalent in males. Prevalence is more in those over 40 years of age and prevalence increases with age. Atopy and angioedema is demonstrable in some patients. Basophilia is low in urticaria. Eosinophilia and a raised serum IgE is found in some patients. Parasitology is low in urticaria.

Assessing the Impact of Electronic Ordering on Stool Parasite Testing Practices in an Academic Medical Center

Abstract Introduction While microscopic stool ova and parasite examination (MSOP) is the traditional testing method for intestinal parasites, it has low diagnostic yield when used inappropriately. To promote stewardship at our institution, MSOP was only orderable utilizing paper requisitions. The only stool parasite testing orderable in our electronic ordering system was the Giardia / Cryptosporidium immunoassay (available as stool O&amp;P screen), which has adequate sensitivity to detect the most common regional intestinal parasites. This was changed during two regional cyclosporiasis outbreaks, when MSOP was added to our electronic ordering system (EOS) to facilitate Cyclospora detection (available as stool O&amp;P examination). The stool O&amp;P screen was also changed to Giardia and Cryptosporidium antigen to better reflect the testing performed. We aimed to measure the impact of this change in terms of test utilization. Methods We quantitated the amount of testing performed pre- and post-intervention over 12-month periods, outside of the outbreak period. We performed chart reviews of 141 patients who received stool parasite testing (Giardia/Cryptosporidium immunoassay and/or MSOP) and compared the proportion of appropriate vs. inappropriate stool parasite testing before (n = 73) and after (n = 68) MSOP was added to the EOS. We used the following criteria to define appropriate MSOP testing; the presence of (1) any travel history outside the continental US, (2) immunocompromised status or (3) intestinal parasite mentioned as a differential diagnosis in medical record. MSOP was considered overordered in patients who failed to fulfill criteria. Testing was deemed underordered if only Giardia/Cryptosporidium immunoassay was ordered on patients who fulfilled criteria for MSOP. Both underordering and overordering were considered inappropriate testing. Statistically significant differences were calculated using Fisher’s exact test (p&amp;lt;0.05). Results The number of patients tested per month by MSOP increased from an average of 10 pre-intervention to 56 post-intervention (p&amp;lt;0.0001). The proportion of appropriate MSOP utilization increased from 44% to 58% of (p=0.13). Inappropriate testing happened in both periods, though underordering was significantly higher pre-intervention (89% vs. 10% of inappropriate testing, p&amp;lt;0.0001), while overordering was significantly higher post intervention (90% vs. 11% of inappropriate testing, p&amp;lt;0.0001). Pre-intervention, 34 of 38 patients in whom underordering occurred were immunocompromised patients tested by the Giardia/Cryptosporidium immunoassay only. Notably, all patients who had intestinal parasite mentioned as a differential diagnosis in the electronic medical record were tested by MSOP, regardless of its availability in the ordering system. Conclusion These findings suggest that omission of MSOP from the electronic ordering system can prevent appropriate testing, particularly in immunocompromised patients. Transitioning to an electronic ordering format can promote overall test utilization and decrease the amount of inappropriately narrow testing, though this also promotes inappropriately broad testing which may represent an opportunity for future clinical decision support interventions.

Utility of the Rapid Antigen Detection Test E. histolytica Quik Chek for the Diagnosis of Entamoeba histolytica Infection in Nonendemic Situations.

Entamoeba histolytica infection is an increasingly common sexually transmitted infection in Japan. Currently, stool ova and parasite examination (O&P) is the only approved diagnostic method. Here, we assessed the utility of the commercially available rapid antigen detection test (Quik Chek) for E. histolytica A multicenter cross-sectional study was conducted. Stool samples that had been submitted for O&P were included. The samples were subjected to both Quik Chek and PCR, and the Quik Chek results were assessed in comparison with PCR as the reference standard. E. histolytica infection was confirmed in 5.8% (38/657) of the samples and comprised 20 diarrheal and 18 nondiarrheal cases. The overall sensitivity and specificity of Quik Chek were 44.7% (95% confidence interval, 30.1 to 60.3) and 99.8% (99.1 to 100), respectively. The sensitivity of Quik Chek was higher for diarrheal cases (60.0%) than for nondiarrheal cases (27.8%). Furthermore, the combined use of Quik Chek with O&P increased the sensitivity (78.9%), especially for diarrheal cases (up to 90%). The E. histolytica burden assessed by quantitative PCR was similar between Quik Chek-positive and -negative samples. The Quik Chek assay sensitivity was lower for cyst-containing stools than for trophozoite-containing stools, although it was shown that cultured E. histolytica clinical strains from Quik Chek-negative cyst-containing stools exhibited antigenicity in vitro The present study confirmed the high specificity of Quik Chek for E. histolytica infection. Combined use with O&P increased the sensitivity of detection, facilitating the use of Quik Chek in point-of-care settings in nonendemic situations.