Ridding Children of Common Worm Infections

Worm infections in children are still with us in spite of greatly improved sanitation in the United States. Indoor flush toilets, paved streets, high living standards, and the like have not eliminated these parasites.     

Severe Iron Deficiency Anemia and Lice Infestation

Background

Lice infestation is a commonly encountered disorder in emergency medicine. The louse survives from a blood meal from its host; hence, iron deficiency anemia is a theoretic possibility. A limited number of reports of severe iron deficiency anemia have appeared in the veterinary literature, but a thorough review of the medical literature did not reveal a single instance in human beings.

Objective

We report a small case series of patients with heavy louse infestation and profound iron deficiency anemia.

Case report

The index case along with two other cases discovered from an exhaustive search of 4 years of the institution’s Emergency Department records all had heavy infestation with head and body lice. Laboratory evaluation revealed serum hemoglobin levels under 6 gm/dL, low serum ferritin levels, and microcytic red blood cell indices. All patients were admitted to the hospital, received transfusions, and had evaluation of their anemia. No patient had evidence of gastrointestinal blood loss or alternative explanation for their anemia.

Conclusions

Although cause and effect cannot be established from this case series, to the best of our knowledge, this is the first published evidence of a provocative association of louse infestation and severe iron deficiency anemia in humans.     

住院精神病患者呼吸道感染的分析与控制

住院精神病患者因伴有思维、情感、意志、行为及社会能力退缩等认知功能障碍,严重影响患者个体生活质量,导致免疫功能低下,致使呼吸道感染率居高不下。为了解其易感因素,本文对1998年1月～2 0 0 3年3月18374人次住院精神病患者进行呼吸道感染原因调查,并采取积极有效的控制措施,最大限度地减少了呼吸道感染的发生,现报告如下。1　对象与方法1.1　对象。1998年1月～2 0 0 3年3月所有住院精神病患者。共调查18374人次,发生医院感染85 6人次,其中呼吸道感染6 0 5人次,男36 9例(6 0 .11% ) ,女2 36例(39.89% ) ,年龄12～92岁,平均年龄4 2 .7岁。…     

Piperazine neurotoxicity: Worm wobble revisited

Piperazine has been used to treat pinworm and roundworm infections for over 40 years. Piperazine-induced cerebellar ataxia, causing the dropping of objects, clumsiness, and gait abnormalities, has been infrequently reported, usually in the setting of overdose or renal insufficiency. The unusual case of an otherwise well child who developed ataxia following seven days of piperazine citrate therapy is reported.     

Diagnosis and management of bedbugs: an emerging U.S. Infestation

Bedbug infestations are on the rise in the United States among people of all socioeconomic groups. Bedbug bites typically cause pruritic wheals with central punctum on exposed skin, which are noted upon awakening. The diagnosis is confirmed by identifying fecal smears and blood spots on the bed linens and mattress or by identifying the culprit bug. Extermination of bedbugs using cleaning techniques and pesticides is necessary to prevent recurrence.     

Assessment of Immune Activation in Mice before and after Eradication of Mite Infestation

Mite infestation of mice remains a persistent problem for many institutions, leading to numerous health problems and creating unknown and unwanted variables for research. In this study, mice with mite infestation demonstrated significantly higher levels of inflammatory cytokines, both at draining lymph nodes (axillary) and systemically, as compared with mice without mites. In addition, histologic evaluation revealed significant inflammation in mite-infested mice. Inflammatory changes were still present in the skin of mice at 6 to 8 wk after treatment, despite absence of detectable infestation at that time. Because these significant and lasting local and systemic changes have the potential to alter research findings, eradication of mites infestations should be an important goal for all institutions.Abbreviation: KC, keratinocyte-derived chemokine; MIP, macrophage inflammatory proteinLaboratory mice can harbor several species of acarids (fur mites), including Myobia musculi, Radfordia affinis, Myocoptes musculinus, and Psorergates simplex.^{11,14,29,40,45} Fur mites are an excluded pathogen in most research facilities, particularly within barrier suites, and in order to control or avoid mite infestations, many facilities, including those with ongoing infestations, will not accept infested animals from outside sources. Such policies can prevent or halt collaborative research between investigators in different institutions because mite infestation is a sporadic or endemic problem in many facilities that house mice under conventional conditions, despite attempts at eradication.^{12,22,25,43,62,69}Mite infestations cause several health problems in mice, including ulcerative dermatitis, amyloidosis, and other immune system alterations.^{2,12,22,27,29-31,37,44,45,61} For example, mite infestations are associated with increased serum concentrations of IgE and IgG in mice.^30,44,48 Alterations in immune responses could alter research data and thereby perhaps alter the associated conclusions.^36,65,66,70 Mice with mite infections often develop dermatitis, which can lead to bacterial infection and additional changes in immune status.^{15,30,31,45,61} Because any pathogenic infection can cause variability and alter basal measures of immune function, clinical chemistry, and behavior in mice, maintaining laboratory rodents in a disease-free state is crucial to their use for the collection of valid research data.⁵¹The eradication of external parasites is a difficult process. Many reports have been published that attempt mite eradication using various drug treatments,^{5-7,17,18,23,24,35,39,41-43,46,47,49,50,57,59,67} with each method having distinct advantages and disadvantages. Some, but not all, of these treatment regimens have been compared directly.¹⁰ The mite life cycle complicates treatment, because eggs and larvae can be less susceptible to drugs than are adult parasites.^2,19,20,55 In addition, mite eggs can contaminate the environment, providing a source for re-infection of treated animals.^20,63,64 Some drugs (for example, ivermectin) have been associated with toxicity and death in mice, especially among specific transgenic lines.^{8,12,28,53,55,69} Other drugs may require frequent or repeated treatment of the mice. Furthermore, the drugs themselves may have properties that alter physiology or immune function in animals.^2,13,60 The development of new veterinary drugs for treatment of parasites has increased the available therapies for rodent acariasis. Compounds such as fipronil and selamectin provide good efficacy against external parasites with limited side effects in mammals.^9,22,68Our facility housed a large colony of mice that occupied several rooms and were infested with Myocoptes musculinus and Myobia musculi. Although the majority of mite-infested mice had mild or no dermatitis, some infected mice had severe dermatitis. The goal of this study was to evaluate the local and systemic immune response in mice infested with mites. To our knowledge, this study is the first to comprehensively compare cytokine levels and histologic findings in mite-infested, treated, and mite-negative mice. We hypothesized that the immune response would be altered in mite-infested mice as demonstrated by significantly elevated cytokine levels in the draining lymph nodes or spleen as compared with mice that had never been infested with mites. In addition, we hypothesized that significant pathologic changes in the epidermis, dermis, and subcutaneous tissues would be present in response to mite infestation.     

Oriental Cholangiohepatitis (Clonorchiasis Infestation) Caused by Clonorchis Sinensis

Background: Oriental Cholangiohepatitis (Clonorchis infestation) is caused by Clonorchis sinensis, a liver fluke endemic to China. Objective: To discuss the presentation of clonorchiasis and diagnosis of this condition in the emergency department (ED). Case Report: This is a case report of a Chinese woman who recently immigrated to the United States and was evaluated in a tertiary care urban ED. The patient presented with complaints of abdominal pain and was found on imaging to have clonorchiasis infestation of the bile ducts. She was admitted and treated for cholangitis and clonorchiasis infestation with piperacillin/tazobactam and praziquantel. Conclusion: History and imaging play an important role in diagnosis of this endemic parasitic abdominal infection.     

艾滋病相关性卡氏肺孢子虫肺炎误诊分析

目的:探讨艾滋病相关性卡氏肺孢子虫肺炎(PCP)的影像学误诊原因.方法:回顾性分析15例艾滋病合并PCP患者的临床表现、影像特征等临床资料.结果:该病影像学改变以双肺呈弥漫性渗出性病变或网格状改变,肺门、纵隔淋巴结肿大为主;还可见肺部局限性渗出性病变、胸腔积液等.结论:对本病的影像表现缺乏认识是造成误诊的根本原因.接诊有上述主要影像表现的患者,仔细询问与PCP有关的病史,并行相关的实验室检查是减少误诊的关键.     

幽门螺旋杆菌感染患者白细胞介素-8与肿瘤坏死因子-α的关系

目的 分析幽门螺旋杆菌(HP)感染时血清及胃黏膜组织中白细胞介素-8(IL-8)和肿瘤坏死因子-a(TNF-a)的水平,探讨它们之间的关系.方法 采用放射免疫法和酶联免疫吸附实验夹心法分别检测HP阳性患者在治疗前后血清和胃黏膜组织中的IL-8,TNF-a的水平.结果 HP感染程度越严重者,胃黏膜组织中IL-8,TNF-a水平越高,各组间差异均有统计学显著性意义(P<0.05).HP根除后血清、胃黏膜组织中IL-8,TNF-a水平明显下降,与根徐前相比差异有统计学意义(P<0.05).结论 IL-8,TNF-a与HP感染密切相关,且参与了胃黏膜损伤的病理过程.     

Furuncular Myiasis From Dermatobia Hominus: A Case of Human Botfly Infestation

Background: Travelers to tropical regions are at risk for a myriad of exotic illnesses. Malaria and dengue are diagnoses that are associated with insect bites, in particular, mosquito bites, acquired while traveling in foreign, tropical countries. Infestation with Dermatobia hominus, the human botfly, endemic to South and Central America, is usually transferred via a mosquito vector. The human botfly should be considered in patients who have traveled to these endemic regions and present with a mosquito bite history and non-healing skin lesions. Objectives: We present this case to increase awareness among emergency physicians regarding furuncular myiasis from the human botfly. Case Report: A 39-year-old pregnant woman presented to the Emergency Department (ED) with an intensely pruritic lesion to the right calf and mild systemic symptoms 6 weeks after travel to Belize. The lesion she thought was a mosquito bite had persisted despite escalating treatment modalities and had been incorrectly diagnosed by multiple physicians. Conclusion: Parasitic disease is not always a systemic process. Botfly infestation presents as local boil-like lesions that are irritating and uncomfortable. Once correctly identified, it can be easily treated in the ED.     

Infestation of wild-caught American bullfrogs (Rana catesbeiana) by multiple species of metazoan parasites.

The American bullfrog (Rana catesbeiana) is an aquatic, carnivorous member of the family Ranidae that is used extensively in physiology education programs and in various physiology, toxicology, sensorineural, and genetics research. Eleven bullfrogs purchased from a vendor distributing wild-caught frogs for use in a physiology research protocol were emaciated but otherwise showed no apparent clinical signs of illness. Necropsies performed on selected emaciated frogs indicated heavy infestation with multiple species of endoparasites. Identified helminths included Gorgodera amplicava, Haematolechus breviplexus, Clinostomum spp, Contracaecum spp, Cosmocercoides dukae, and Eustrongyloides spp. Grossly, parasitized bullfrogs showed encysted trematode larvae within skeletal muscle, nematode impaction of the intestinal tract, and lack of coelemic fat stores. Histopathologic lesions were restricted primarily to the gastrointestinal tract and consisted of parasitic granulomas associated with Contracaecum spp. The parasitic lesions may have been associated with the poor body condition of the bullfrogs. Food crickets maintained in-house were negative for parasite larvae or ova. Heavy parasitism of wild-caught bullfrogs may confound research protocols and markedly impair animal health. We encourage researchers to purchase laboratory-bred and -reared bullfrogs and to routinely monitor the parasite status of colony frogs.     

Effect of Sowing Date and Cultivars on Aphid Infestation in Wheat with Climate Change Adaptation Perspective

Four field experiments, two experiments each during winter season of 2012–2013 and 2013–2014, were conducted to evaluate effect of sowing time and four wheat cultivars on population of wheat aphids. Wheat crop was found infested with Rhopalosiphum padi and Sitobion avenae in various proportions in different experiments. During vegetative crop phase, December (late) sown crop had in general higher aphid population than November (timely) sown crop, while during reproductive crop stage, timely sown crop harboured more aphids on ear heads than late planted one. October (early) and January (very late) sown crop evaded aphid attack on ear heads. Significant differences in peak aphid populations among different plantings indicated that alteration of sowing time might disturb phenological synchrony between aphids and wheat crop, affecting pest population. Aphid population was positively influenced by the temperature. Sowing dates were also found to significantly affect the crop yield. Among varieties, WR-544 was observed to have lower number of aphids than other cultivars during vegetative crop stage. Because alteration in sowing time is deemed to be one of the adaptation strategies to sustain agricultural productivity under climate change, effect of sowing time on aphid population is the need to be heeded while formulating such strategy for effective crop management.     

Chemical Inhibition of Bacterial Ribosome Biogenesis Shows Efficacy in a Worm Infection Model

The development of antibacterial compounds that perturb novel processes is an imperative in the challenge presented by widespread antibiotic resistance. While many antibiotics target the ribosome, molecules that inhibit ribosome assembly have yet to be used in this manner. Here we show that a novel inhibitor of ribosome biogenesis, lamotrigine, is capable of rescuing Caenorhabditis elegans from an established Salmonella infection, revealing that ribosome biogenesis is a promising target for the development of new antibiotics.     

Children of alcoholics

Parental alcoholism affects 27 million children, but few of these children receive supportive care. The most consistent predictor of alcoholism is alcoholism in a biologic parent. A child's self-concept is derived largely from experiences at home and identification with the parents. Family physicians are in a unique position to recognize parental alcoholism, provide empathic concern for the children and direct them to supportive programs.