Detection of circulating E/S antigens in the sera of patients with fascioliasis by IELISA: a tool of serodiagnosis and assessment of cure

An IELISA was developed to evaluate the performance of Fasciola E/S antigens in diagnosis and cure assessment of human Fasciola infection. Twenty patients with acute (prepatent) fascioliasis and another 20 with patent infection were enrolled in the study. Patients were treated with TCZ and followed at 1, 3 and 6 months after therapy. At inspection, the sensitivity of the test to diagnose prepatent cases was 100% compared to 70% for patent infections. There was a gradual decrease of antigenaemia over the follow-up period in acute cases. In chronic cases antigen disappeared from 13 cases (65%) at 1 month; this proportion did not change at 3 or 6 months.     

Ectopic fascioliasis mimicking a colon tumor

Fasciola hepatica, a leaf shaped trematode that is common in cattle, sheep and goats, is acquired by eating raw water plants like watercress or drinking water infected with the encysted form of the parasite. The varied clinical presentations of fascioliasis still make a high index of suspicion mandatory. Besides having a wide spectrum of hepatobiliary symptoms like obstructive jaundice, cholangitis and liver cirrhosis, the parasitic infection also has extrabiliary manifestations. Until recently, extrahepatic fascioliasis has been reported in the subcutaneous tissue, brain, lungs, epididymis, inguinal lymph nodes, stomach and the cecum. In this report, a strange manifestation of the fasciola infection in a site other than the liver, a colonic fascioliasis, is presented.     

三氯苯达唑对斯氏狸殖吸虫童虫作用的透射电镜观察

目的探索三氯苯达唑治疗大鼠斯氏狸殖吸虫童虫感染的最适剂量;进一步探讨三氯苯达唑杀灭斯氏狸殖吸虫的机理。方法40只SD大鼠随机分成3组实验组和对照组,每组10只大鼠。将斯氏狸殖吸虫囊蚴经腹腔注射感染各组大鼠。感染后第39d分别用不同剂量三氯苯达唑治疗实验组大鼠,治疗结束后第22d剖杀大鼠,对检获的虫体用透射电镜观察其超微结构的变化。结果三氯苯达唑对童虫体壁和肠壁的超微结构有不同程度的损坏,但低剂量组轻微,中剂量组对虫体的破坏作用比低剂量组强,但尚不能致死虫体,而高剂量组对虫体的破坏是致死性的;对照组大鼠检获的虫体未出现改变。结论三氯苯达唑治疗大鼠斯氏狸殖吸虫童虫感染的最适剂量为200?/?.d,它对斯氏狸殖吸虫的作用机理除了损伤虫体体壁外,还可破坏虫体肠壁的超微结构。     

片形吸虫病11例临床分析

目的 总结片形吸虫病的临床资料,为片形吸虫病的防治积累临床经验。方法 回顾性分析11例片形吸虫病病例的流行病学特点、实验室资料、临床特征和治疗方案。结果 11例片形吸虫病患者均来自宾川县州城镇,有家庭聚集现象,以农民为主,青年女性多见。患者均有发热、肝区疼痛、肝大,ALT和AST轻度升高,ALP和GGT明显升高,嗜酸性粒细胞增多,红细胞沉降率增快,CRP和免疫球蛋白升高。10例血象高,9例有不同程度的贫血,骨髓培养和血培养阴性,甲、乙、丙、丁、戊型肝炎病原学阴性,CT/磁共振成像均提示肝实质内散在多发低密度影,肝占位性病变,AFP及癌胚抗原正常。给予三氯苯达唑驱虫治疗,同时保肝、对症支持治疗,疗效显著。结论 要重视片形吸虫病在大理州宾川县的流行,诊断时要关注流行病学史。该病预防的关键是加强健康宣教,提高居民食品卫生意识,加强牲畜的治疗和放牧管理,防止粪便污染,改善椎实螺孳生环境。     

Circulating antibodies and antigens correlate with egg counts in human fascioliasis

We explored the relationships between specific IgG antibody levels and circulating E/S antigen to intensity of Fasciola infection in the human host. Twenty patients with patent infection and six healthy individuals were enrolled in the study. Intensity of infection was determined by repeated egg counts in stools, while IgG antibodies against adult Fasciola gigantica somatic FI, FII and against E/S antigens were measured as ELISA O.D. readings. The level of circulating E/S antigens was determined by IELISA. Positivity as well as levels of antibodies and antigen correlated with infection intensity. These findings may disclose in the future a relation between morbidity in the acute phase and worm load.     

Fascioliasis: sonographic abnormalities of the biliary tract and evolution after treatment with triclabendazole

Diagnosis of infection with the liver fluke Fasciola hepatica is usually difficult. Ultrasonography (US) might be a useful diagnostic alternative, and we assessed the value of sequential US in the diagnosis and monitoring of fascioliasis in 76 patients at baseline and for 60 days after treatment with triclabendazole. At baseline, biliary abnormalities were observed in 52 patients. Crescent-shaped parasites were seen in 11 patients; in 2 cases parasites were spontaneously moving and in 4 patients parasites were motionless. Postprandial examination revealed parasites adhering to the gallbladder wall in a further 5 cases. In 3 further cases, gallbladder contents were mobile but did not sediment downwards after patients changed position. Non-specific abnormalities were: impaired gallbladder contractility (n = 23), gallbladder tenderness (n = 19), debris (n = 6), calculi (n = 5), wall thickening (n = 2) and bile duct dilatation (n = 12). During day 1-7, Fasciola-like crescents in the gallbladder or passing through the bile duct were detected in another 15 patients, impaired gallbladder contractility in 16, gallbladder tenderness in 16, and bile duct dilatation in an additional 28 patients. Thirty-two patients with these US abnormalities experienced colic-like abdominal pain accompanied by increased alkaline phosphatase in 25 cases. During day 30-60, abnormalities regressed completely in 45 patients; 2/6 triclabendazole failures were evident by detection of living parasites. Biliary tract abnormalities are frequently observed by US, but the detection-rate of Fasciola hepatica is disappointingly low despite the parasite's relatively large size. US findings must therefore be interpreted together with other clinical measurements. The visualization of parasites being expelled through the dilated common bile duct allowed the causal interpretation of post-therapeutic abdominal pain and increase of liver enzymes. When triclabendazole is given on suspicion, visualization of worm expulsion and bile duct dilatation by US may be used to confirm diagnosis.     

Patient with advanced intrahepatic cholangiocarcinoma with long-term survival successfully treated with a combination of surgery and chemotherapy

Intrahepatic cholangiocarcinoma (ICC) is a relatively rare malignancy arising from the biliary epithelium. Prognosis is typically poor. Currently, aggressive surgical resection is the only treatment modality that offers patients any chance of long-term survival. Here, we present the case of a 57-year-old woman in whom we diagnosed ICC, with the tumor occupying the entire left and caudate hepatic lobes and daughter nodules in the right lobe. She underwent hepatectomy of segments I to VI, combined with intraoperative microwave coagulation therapy for nodules in the residual liver. Three months after the surgical resection, she had recurrence of the disease. The patient subsequently received weekly intraarterial chemotherapy with irinotecan (CPT-11), and a partial response was observed which persisted for 18 months. Subsequent computed tomography revealed the regrowth of three tumors, and she therefore underwent a repeat resection 24 months after the first surgical operation. In postoperative-month (POM) 32, she received systemic chemotherapy with tegatur/gimeracil/oteracil potassium (S-1)/cisplatin for multiple small nodules in her lung. Following three cycles of chemotherapy with a stable disease response, partial resections of the lung were performed. Third and fourth hepatectomies were performed in POMs 46 and 59, respectively. Five years and 5 months after the first hepatectomy, she is alive with small lesions in her lung. This multimodal approach may be effective for ICC.     

Advanced gastric cancer with multiple lymph node metastasis successfully treated with etoposide, adriamycin and cisplatin

Gastric cancer usually shows poor sensitivity to chemotherapy, and the presence of lymph node metastases is associated with extremely poor prognosis, especially when the number of such nodes is more than 10. We report here a case of advanced gastric cancer with histopathologically confirmed metastases in 15 regional lymph nodes, in which the recurrent tumor was sensitive to combination chemotherapy. Distal gastrectomy with lymphadenectomy was performed for the primary tumor. A hard (recurrent) tumor was detected in the upper abdomen 5 months postoperatively. Abdominal CT revealed two tumors measuring 3.5 x 1.8 and 3.3 x 2 cm in diameter at the front of the pancreatic head, which suggested recurrence. Etoposide, adriamycin and cisplatin (EAP) chemotherapy (20 mg/kg adriamycin, 100 mg/kg etoposide and 50 mg/kg cisplatin (CDDP)) was administered every 6 weeks. The tumors regressed and became undetectable on CT after four cycles. At that stage, CDDP was replaced with 400 mg/kg carboplatin, which was administered every 1 or 2 months. The patient had no recurrence 8 years after surgery. For treatment of advanced gastric cancer with multiple lymph node metastases, a wide resection of the tumor should be performed followed by treatment of the residual tumor cells with a suitable combination chemotherapy taking into consideration the characteristics of the tumor and the condition of the host. We present a patient with gastric cancer and histopathologically confirmed metastases in 15 regional lymph nodes, who was successfully treated by surgery followed by EAP adjuvant chemotherapy. The patient remains alive and well at 8 years after surgery.     

The Northern Bolivian Altiplano: a region highly endemic for human fascioliasis.

The worldwide importance of human infection by Fasciola hepatica has been recognized in recent years. The endemic region between Lake Titicaca and the valley of La Paz, Bolivia, at 3800-4100 m altitude, presents the highest prevalences and intensities recorded. Large geographical studies involving Lymnaea truncatula snails (malacological, physico-chemical, and botanic studies of 59, 28 and 30 water bodies, respectively, inhabited by lymnaeids; environmental mean temperature studies covering a 40-year period), livestock (5491 cattle) and human coprological surveys (2723 subjects, 2521 of whom were school children) were conducted during 1991-97 to establish the boundaries and distributional characteristics of this endemic Northern Altiplano region. The endemic area covers part of the Los Andes, Ingavi, Omasuyos and Murillo provinces of the La Paz Department. The human endemic zone is stable, isolated and apparently fixed in its present outline, the boundaries being marked by geographical, climatic and soil-water chemical characteristics. The parasite distribution is irregular in the endemic area, the transmission foci being patchily distributed and linked to the presence of appropriate water bodies. Prevalences in school children are related to snail population distribution and extent. Altiplanic lymnaeids mainly inhabit permanent water bodies, which enables parasite transmission during the whole year. A confluence of several factors mitigates the negative effects of the high altitude.     

A case of advanced intrahepatic cholangiocarcinoma successfully treated with chemosensitivity test-guided systemic chemotherapy

Intrahepatic cholangiocarcinoma (ICC) is a relatively rare and highly fatal neoplasm that arises from the biliary epithelium. Prognosis is generally poor and survival is limited to a few months. Here we present a case of advanced ICC successfully treated by chemosensitivity test-guided systemic chemotherapy combining S-1 and cisplatin (CDDP). A 65-year-old woman with a liver tumor was referred to our hospital on November 21, 2007. Abdominal ultrasonography and computed tomography (CT) showed low-density masses of 50 and 15 mm in diameter, respectively in segment Ⅷ of the liver and in the enlarged lymph node in the para-aorta. Ultrasonography-guided fine needle biopsy diagnosed the tumors as ICC. Since the patient was inoperable for lymph node metastasis, she underwent systemic chemotherapy with gemcitabine. Six months after initiation of chemotherapy, CT revealed ICC progression in the liver and pleural dissemination with pleural effusion. The patient was admitted to our hospital for anticancer drug sensitivity testing on June 9, 2008. Based on the sensitivity test results, we elected to administer systemic chemotherapy combining S-1 and CDDP. Two months into the second chemotherapy treatment, CT revealed a reduction of the tumors in the liver and lymph node and a decrease in pleural effusion.After eight cycles of the second chemotherapy, 17 mo after ICC diagnosis, she is alive and well with no sign of recurrence. We conclude that chemosensitivity testing may effectively determine the appropriate chemotherapy regimen for advanced ICC.     

巨片形吸虫病快速诊断胶体金免疫层析试条的研制与评价

目的建立快速、简便诊断巨片形吸虫病的胶体金免疫层析试条方法。方法提取巨片形吸虫总RNA,通过RT-PCR获得FgCL1-YN基因片段,并克隆入pET28a(+)表达载体,异丙基-β-D-硫代半乳糖苷(IPTG)诱导表达得到重组蛋白(r FgCL1-YN);将r FgCL1-YN和羊抗鼠IgG抗体分别包被于硝酸纤维素膜的适宜位置作为检测带和质控带,以胶体金标记抗人IgG4抗体的鼠单抗作为检测试剂,制备检测特异性IgG4型抗体的免疫层析试条。用该试条检测巨片形吸虫病患者(30份)、日本血吸虫病患者(15份)以及健康人(32份)血清,评价其诊断价值,同时用ELISA法进行平行检测作为对照。结果试条检测法的敏感性为100%(30/30),特异性为97.9%(46/47),总体符合率为98.7%(76/77)。ELISA法检测的敏感性、特异性和总体符合率分别100%(30/30)、100%(47/47)和100%(77/77)。试条法与ELISA法的敏感性、特异性和总体符合率,经四格表确切概率法检验,P值分别为1、0.5和0.5,全部大于0.05。显示,试条法与ELISA法检测巨片形吸虫病患者血清的结果高度一致。另外,试条法的检测时间为10min,血清用量低于10μL,且具较高的敏感度。结论以r FgCL1-YN建立的快速诊断胶体金免疫层析试条,检测巨片形吸虫病具有较高的诊断价值。     

Autoimmune neutropenia successfully treated with cyclosporine

A case history is presented concerning a 59-year-old female patient with chronic autoimmune neutropenia complicated by recurrent skin infections, mucositis, and conjunctivitis. For subjective reasons she refused treatment with prednisone, but eventually cyclosporine led to an important clinical improvement and an increase of the peripheral granulocyte count. Treatment modalities of autoimmune neutropenia are briefly discussed.     

Norovirus gastroenteritis successfully treated with nitazoxanide

Infectious diarrhea is a common occurrence in the immunosuppressed population. We present a 43-year-old individual with large-volume stool output Norovirus acute gastroenteritis in the setting of relapsed refractory acute myelogenous leukemia, hematopoietic stem cell transplantation, and biopsy-proven cutaneous and pulmonary graft-versus-host disease. Therapeutic options such as intravenous immunoglobulin or reduction of immunosuppressants were not a feasible choice. A prompt clinical cure was achieved with nitazoxanide, a broad-spectrum antimicrobial agent. Nitazoxanide may be a safe therapeutic alternative, in which a reduction in immunosuppression may not be a viable option.     

Aplastic anemia successfully treated with rituximab

An otherwise healthy 73-year-old female was admitted to our department in 1997 because of easy bruising and a platelet count of 12 x 10(9)/L. The patient was taking no medications. Bone marrow examination revealed erythroid hyperplasia, megakaryocytic hypoplasia, and no sign of malignancy. Chromosome analysis showed a normal karyotype. There was serological evidence of previous infection with parvovirus B19. No antibodies to HBV, HCV, CMV, or EBV were found. ANA and cardiolipin antibodies were not detected. Treatment with prednisolone was without effect, but 3 weeks after i.v. gamma-globulin therapy, the platelet count was normal, 233 x 10(9)/L. Two years later, the patient was readmitted with a platelet count of 11 x 10(9)/L. At this time, treatment with corticosteroids, azathioprine, and gamma-globulin had only a temporary effect, and further therapy was stopped because of side effects. During the next 3 years, the patient developed transfusion-dependent anemia, and her white blood cell count decreased to 1.8 x 10(9)/L. A new bone marrow examination showed aplastic anemia with bone marrow cellularity about 10%. After an intracerebral hemorrhage, the patient accepted treatment with rituximab and received 4 weekly doses of 375 mg/m2. This therapy was followed by an increase in the platelet count to 232 x 10(9)/L, white blood cell count to 6.8 x 10(9)/L, and no more need for blood transfusions. A bone marrow examination 5 months after treatment with rituximab showed hyperplastic myelopoiesis, normoblastic erythropoiesis, and slightly reduced megakaryopoiesis. The use of anti-CD20 monoclonal antibody in aplastic anemia warrants further investigation.     

A population-based coprological study of human fascioliasis in a hyperendemic area of the Bolivian Altiplano

Summary The community of Chijipata Alta, at an altitude of 3850 m, near the southern coast of Lake Titicaca in the Northern Altiplano of Bolivia, was surveyed for human fascioliasis. The global prevalence (66.7%) and intensity (eggs per gram of faeces - epg: range: 24–4440; arithmetic mean: 1001; geometric mean: 390) proved to be the highest known in the world by means of coprological techniques. These results suggest the existence of highly hyperendemic subzones among the large human fascioliasis-endemic zone of the Bolivian Northern Altiplano. Despite the decrease in prevalence and intensity from children (75.0%, 24–4440 epg) to adults (41.7%, 144–864 epg), our findings show that in an hyperendemic zone adult subjects either maintain the parasites acquired when young or are newly infected as the consequence of inhabiting a zone of high infection risk.     

Cerebral cysticercosis successfully treated with praziquantel

A 28-year-old woman presented with signs of relapsing meningeal inflammation 5 months after immigration from Chile. Cerebral cysticercosis was diagnosed with computed tomography (CT) scan, showing signs of intracranial hypertension and cystic lesions, and was confirmed by serological investigation. After treatment with praziquantel all clinical symptoms disappeared. A CT scan obtained 6 months after treatment showed almost complete resolution of the cystic changes in the brain.