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Haque E, Muhsen IN, Rasheed W, Fakih RE, Aljurf M. Parasitic infections in hematopoietic stem cell transplant recipients. Transpl Infect Dis 2023; 25 Suppl 1:e14160. [PMID: 37793057 DOI: 10.1111/tid.14160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Hematopoietic stem cell transplantation (HSCT) is a vital treatment for various hematological disorders. However, HSCT recipients face increased risks of infectious complications due to immunosuppression. Parasitic infections are a significant concern in this vulnerable population and can lead to substantial morbidity and mortality. This review examines parasitic infections in HSCT recipients, focusing on major infections affecting different organ systems, including intestinal parasites (Giardia spp., Entamoeba histolytica, and Cryptosporidium spp.), hematologic parasites (Plasmodium spp. and Babesia spp.), and tissue/visceral parasites (Toxoplasma gondii, Leishmania spp., and Trypanosoma cruzi). METHODS A systematic search of relevant literature was conducted and included studies up to August 2023. Databases included PubMed, Google Scholar, were queried using specific keywords related to parasitic infections in HSCT patients. The epidemiology, risk factors, clinical presentation, diagnostic methods, and treatment approaches for each infection were evaluated. RESULTS AND CONCLUSION Knowing the epidemiology, risk factors, and clinical presentations are crucial for timely intervention and successful management. By emphasizing early detection, effective therapies, and the unique challenges posed by each of these infections, this review highlights the importance of tailored strategies for HSCT recipients. Future research can further refine management protocols to enhance care and outcomes for these patients.
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Affiliation(s)
- Emaan Haque
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ibrahim N Muhsen
- Department of Medicine, Section of Hematology and Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Walid Rasheed
- Department of Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Riad El Fakih
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Adult Hematology and Stem Cell Transplant, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Powers SJ, Castell N, Vistein R, Kalloo AN, Izzi JM, Gabrielson KL. Bacterial Cholecystitis and Cholangiohepatitis in Common Marmosets ( Callithrix jacchus). Comp Med 2023; 73:173-180. [PMID: 36944497 PMCID: PMC10162377 DOI: 10.30802/aalas-cm-22-000075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/26/2022] [Accepted: 11/23/2022] [Indexed: 03/23/2023]
Abstract
The common marmoset (Callithrix jacchus), a New World NHP, has emerged as important animal model in multiple areas of translational biomedical research. The quality of translational research in marmosets depends on early diagnosis, treatment, and prevention of their spontaneous diseases. Here, we characterize an outbreak of infectious cholangiohepatitis that affected 7 adult common marmosets in a single building over a 10-mo period. Marmosets presented for acute onset of lethargy, dull mentation, weight loss, dehydration, hyporexia, and hypothermia. Blood chemistries at presentation revealed markedly elevated hepatic and biliary enzymes, but mild neutrophilia was detected in only 1 of the 7. Affected marmosets were unresponsive to rigorous treatment and died or were euthanized within 48 h of presentation. Gross and histopathologic examinations revealed severe, necrosuppurative cholangiohepatitis and proliferative cholecystitis with bacterial colonies and an absence of gallstones. Perimortem and postmortem cultures revealed single or dual isolates of Escherichia coli and Pseudomonas aeruginosa. Other postmortem findings included bile duct hyperplasia, periportal hepatitis, bile peritonitis, ulcerative gastroenteritis, and typhlitis. Environmental contamination of water supply equipment with Pseudomonas spp. was identified as the source of infection, but pathogenesis remains unclear. This type of severe, infectious cholangiohepatitis with proliferative cholecystitis with Pseudomonas spp. had not been reported previously in marmosets, and we identified and here describe several contributing factors in addition to contaminated drinking water.
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Affiliation(s)
- Sarah J Powers
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Natalie Castell
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Vistein
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anthony N Kalloo
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York; and
- Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessica M Izzi
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kathleen L Gabrielson
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ma S, Yan H, Shi W, You Y, Zhong ZD, Hu Y. Giardia lamblia mimicking acute graft versus host disease after allogeneic hematopoietic stem cell transplantation: A case report. Medicine (Baltimore) 2020; 99:e21752. [PMID: 32872067 PMCID: PMC7437731 DOI: 10.1097/md.0000000000021752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE As the major complications post allogeneic hematopoietic stem cell transplantation (allo-HSCT), gastrointestinal disorders were most commonly ascribed to acute graft-versus-host disease (aGVHD) and opportunistic infections. Though Giardia lamblia (G lamblia) is the most common waterborne parasite of intestinal infection worldwide, seldom has it been reported in a patient with acute severe aplastic anemia after allo-HSCT. PATIENT CONCERNS A 23-year-old male with severe aplastic anemia developed diarrhea, abdominal cramps, bloating, nausea, vomiting, fever, weight loss, and fatigue after allo-HSCT. DIAGNOSIS Stool examinations for ova and parasites showed Giardia trophozoites and cysts. INTERVENTIONS Methylprednisolone was stopped and the patient was intravenously treated with a 7-day course of metronidazole (500 mg, tid.). Simultaneously, cyclosporine (5 mg/kg) was continually utilized for suspicious gut GVHD. OUTCOMES The Giardia lamblia in stool turned negative and his symptoms were resolved after the 7-day course. LESSONS Incorporating non-invasive monitoring of stool examination for ova and parasites in the follow-up algorithm for post-HSCT patients can expedite clinical decision-making in the differential diagnoses for aGVHD even in the non-endemic area. Metronidazole therapy can be well-tolerated in HSCT patients with giardiasis.
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Araki H, Shimizu S, Hayashi K, Yamada T, Kusakabe A, Kanie H, Mizuno Y, Kojima I, Saitou A, Nagao K, Suzuki Y, Toyohara T, Suzuki T, Uchida E, Uno K, Nakazawa T. Acute Acalculous Cholecystitis Caused by Giardia lamblia. Intern Med 2017; 56:1657-1662. [PMID: 28674353 PMCID: PMC5519466 DOI: 10.2169/internalmedicine.56.8087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
We report a case of a 70-year-old man with acute acalculous cholecystitis caused by Giardia lamblia. Contrast-enhanced computed tomography (CT) showed distention of the gallbladder due to a pericholecystic abscess without gallstones. Magnetic resonance cholangiopancreatography and drip infusion cholecystocholangiography-CT demonstrated a stricture of the hilar bile duct and cystic duct obstruction. We conducted transpapillary bile duct brush cytology and a biopsy of the hilar bile duct stricture; numerous active trophozoites of Giardia lamblia were observed without malignant findings. We considered this bile duct lesion to be biliary giardiasis. Biliary giardiasis should be taken into consideration when diagnosing acute acalculous cholecystitis.
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Affiliation(s)
- Hiromichi Araki
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Shuya Shimizu
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Katsumi Hayashi
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Tomonori Yamada
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Atsunori Kusakabe
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Hiroshi Kanie
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Yusuke Mizuno
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Issei Kojima
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Akitoshi Saitou
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Kazuhiro Nagao
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Yuka Suzuki
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Tadashi Toyohara
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Takanori Suzuki
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Erika Uchida
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Konomu Uno
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
| | - Takahiro Nakazawa
- Department of Gastroenterology, Japanese Red Cross Nagoya Daini Hospital, Japan
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Lübbert C, Schneitler S. Parasitic and infectious diseases of the biliary tract in migrants and international travelers. Expert Rev Gastroenterol Hepatol 2016; 10:1211-1225. [PMID: 27677833 DOI: 10.1080/17474124.2016.1240614] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In recent years, global and regional crises have led to extraordinary worldwide migration, accompanied by an increase in long-distance travel from Western countries. Both are linked to a rising incidence of rare parasitic and infectious diseases in first world countries, including in the biliary tract. Areas covered: A selective literature research in PubMed was performed to review the most important parasitic and infectious biliary diseases, which are caused by a wide variety of pathogens and may be latent over long periods, with chronic courses leading to cholangitis, hepatic failure or development of cholangiocarcinoma. Parasites such as Ascaris, Fasciola and Clonorchis/Opisthorchis are particularly important and may trigger biliary diseases or predisposition for bacterial superinfections. Viral or protozoal cholangitis is mainly a problem of impaired immunity. Expert commentary: Currently, these entities are still rare in migrants and long-distance travelers. However, a significant increase in Western countries has to be expected. Incidences are most likely underestimated because of protracted clinical latency. Diagnosis depends on the relevant pathogens, the host's immune status and the extent or distribution of biliary obstruction. Modern tomographic methods, ERCP and specific microbiological/parasitological/virological tests are of crucial diagnostic importance. Antimicrobial/antiparasitic/antiviral therapy along with ERCP and interventional sonography/radiology provide effective treatment options.
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Affiliation(s)
- Christoph Lübbert
- a Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology , Leipzig University Hospital , Leipzig , Germany.,b Interdisciplinary Center for Infectious Diseases , Leipzig University Hospital , Leipzig , Germany
| | - Sophie Schneitler
- a Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology , Leipzig University Hospital , Leipzig , Germany
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Imai K, Misawa K, Matsumura T, Fujikura Y, Mikita K, Tokoro M, Maeda T, Kawana A. Progressive HIV-associated Cholangiopathy in an HIV Patient Treated with Combination Antiretroviral Therapy. Intern Med 2016; 55:2881-2884. [PMID: 27725553 PMCID: PMC5088554 DOI: 10.2169/internalmedicine.55.6826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We herein describe a case of progressive human immunodeficiency virus (HIV)-associated cholangiopathy despite normalization of laboratory parameters, which had indicated liver dysfunction, after the initiation of combined anti-retroviral therapy (cART). HIV-associated cholangiopathy remains important as a differential diagnosis of bile duct disorders, although it is considered to be a rare disease in the era of cART. Magnetic resonance cholangiopancreatography could thus be a powerful tool for the diagnosis and follow-up of this disease.
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Affiliation(s)
- Kazuo Imai
- Division of Infectious Diseases and Pulmonary Medicine, Department of Internal Medicine, National Defense Medical College, Japan
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Abstract
There are an estimated 40 million HIV infected individuals worldwide, with chronic liver disease being the 2nd leading cause of mortality in this population. Elevated liver functions are commonly noted in HIV patients and the etiologies are varied. Viral hepatitis B and C, fatty liver and drug induced liver injury are more common. Treatment options for viral hepatitis C are rapidly evolving and are promising, but treatments are limited for the other conditions and is primarily supportive. Opportunistic infections of the liver are now uncommon. Irrespective of etiology, management requires referral to specialized centers and with due diligence mortality can be reduced.
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Ajumobi A, Daniels J, Sostre C, Trevino H. Giardiasis in a hematopoietic stem cell transplant patient. Transpl Infect Dis 2014; 16:984-7. [DOI: 10.1111/tid.12272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/10/2014] [Accepted: 07/03/2014] [Indexed: 11/26/2022]
Affiliation(s)
- A.B. Ajumobi
- Department of Internal Medicine; Division of Gastroenterology; University of Texas Health Science Center; San Antonio Texas USA
| | - J.A. Daniels
- Department of Pathology; University of Texas Health Science Center; San Antonio Texas USA
| | - C.F. Sostre
- Department of Internal Medicine; Division of Gastroenterology; Audie L Murphy Memorial VA Hospital; San Antonio Texas USA
| | - H.H. Trevino
- Department of Internal Medicine; Division of Gastroenterology; Audie L Murphy Memorial VA Hospital; San Antonio Texas USA
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Devarbhavi H, Sebastian T, Seetharamu SM, Karanth D. HIV/AIDS cholangiopathy: clinical spectrum, cholangiographic features and outcome in 30 patients. J Gastroenterol Hepatol 2010; 25:1656-60. [PMID: 20880175 DOI: 10.1111/j.1440-1746.2010.06336.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS AIDS cholangiopathy is presently considered rare and has been reported mainly from the West. With the HIV epidemic in India, we have encountered an increasing number of patients. We aimed to study these patients and determine differences from earlier experiences. METHODS We describe the clinical presentation, cholangiographic features, and outcome and determine differences reported in Western literature. RESULTS From Jan 1999 to May 2009, 30 patients (27 men) with AIDS cholangiopathy were seen. The most common mode of transmission was heterosexual (n = 28) followed by blood transfusion (n = 2). Abdominal pain (n = 20) of biliary origin, was the commonest manifestation followed by an asymptomatic group (n = 6) and a third group (n = 3) with pain due to pancreatitis. Ultrasonography of the abdomen was abnormal in all patients. Papillary stenosis (n = 23) was the most common cholangiographic feature followed by sclerosing cholangitis (n = 5). Abdominal pain resolved reliably and promptly after endoscopic sphincterotomy. Cholangiographic abnormalities regressed during follow up on antiretroviral therapy in 10 patients. Seven patients on anti retroviral therapy developed de novo cholangiopathy, with a precipitous drop in CD4 count of whom two had a worse prognosis. None had Kaposi's sarcoma. CONCLUSIONS In contrast to Western literature, HIV cholangiopathy was seen predominantly in patients who acquired HIV by heterosexual transmission. De novo development of cholangiopathy on antiretroviral therapy may indicate the occurrence of resistance. Papillary stenosis is the most common feature. Abdominal pain resolved with sphincterotomy. Regression of cholangiographic abnormality occurred with anti retroviral medications. Median survival following cholangiopathy diagnosis was 34 months, higher than reported in previous studies.
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Affiliation(s)
- Harshad Devarbhavi
- Department of Gastroenterology, St. John's Medical College Hospital, Bangalore, India.
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Derouin F, Lagrange-Xelot M. Treatment of parasitic diarrhea in HIV-infected patients. Expert Rev Anti Infect Ther 2008; 6:337-49. [PMID: 18588498 DOI: 10.1586/14787210.6.3.337] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parasitic infections responsible for diarrhea have a worldwide distribution, overlapping with AIDS in most countries. Indeed, highly active antiretroviral therapy has markedly reduced the incidence of most parasitic opportunistic infections, but parasite-related diarrhea remains frequent and probably underestimated in developing countries. In this review, we focus on the advances in molecular epidemiology, diagnosis and current treatment of the most prevalent parasitic infections in HIV-infected patients. Most of these parasites are protozoa, whose diagnosis at the laboratory requires some adapted technique and expertise. We highlight the importance of diagnosis and the skill of the laboratory of parasitology, since most parasitic infections responsible for diarrhea in AIDS patients can be treated.
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Affiliation(s)
- Francis Derouin
- Laboratory of Parasitology and Mycology, University Paris 7 and Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, 1 Avenue Claude Vellefaux, 75475 Paris Cedex 10, France.
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Njemanze PC, Njemanze J, Skelton A, Akudo A, Akagha O, Chukwu AA, Peters C, Maduka O. High-frequency ultrasound imaging of the duodenum and colon in patients with symptomatic giardiasis in comparison to amebiasis and healthy subjects. J Gastroenterol Hepatol 2008; 23:e34-42. [PMID: 17645477 DOI: 10.1111/j.1440-1746.2007.05056.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
AIM The application of ultrasound may be suitable for evaluating the effects of intestinal cytoskeletal rearrangement of the duodenum and colon as a result of exposure to live Giardia lamblia trophozoites. We studied the sonographic appearance of the duodenum and colon in giardiasis compared with amebiasis and healthy subjects. METHODS Sonographic images obtained from 100 consecutive patients with symptomatic giardiasis were compared to those taken from 40 patients with amebiasis and 40 healthy subjects. B-mode ultrasound examination of the duodenum and colon was performed using a 7.5 MHz annular array transducer. Gray scale images with water contrast were acquired. RESULTS Normal duodenum and colon echoanatomy were demonstrated. Giardial lesions of the duodenum and colon were associated with increased wall thickness when compared with healthy subjects (P < 0.05). Furthermore, giardial lesions were characterized by increased wall echogenicity, flattening or loss of duodenal folds and/or colonic haustration, hyperechoic floating foci (HFF) demonstrating chaotic motility, increased peri-lesional tissue echogenicity, and altered colonic peristalsis. In amebiasis, focal hyperechoic wall thickening was seen at lesion sites identified as amebomas with increased wall echogenicity, but otherwise normal duodenal folds and colonic haustration. There were no HFF with chaotic motility, rather intestinal contents showed bulk motility in patients with amebiasis. There was no focal colonic wall motion abnormality observed. CONCLUSION B-mode imaging with water contrast demonstrated details of duodenal and colonic echoanatomy. There were sonographic features of giardial lesions of the duodenum and colon that were distinct from those in amebiasis and healthy subjects.
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Affiliation(s)
- Philip C Njemanze
- Institute of Non-invasive Imaging for Parasitology, International Institutes of Advanced, Research and Training, Chidicon Medical Center, Owerri, Imo State, Nigeria.
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14
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Abstract
Giardia lamblia, the cause of human giardiasis, is among the most common intestinal protozoa worldwide. Human infection may range from asymptomatic shedding of giardial cysts to symptomatic giardiasis, being responsible for abdominal cramps, nausea, acute or chronic diarrhoea, with malabsorption and failure of children to thrive. At present, treatment options include the nitroimidazoles derivatives; especially metronidazole, which has been the mainstay of treatment for decades and is still widely used. The increasing number of reports of refractory cases with this group of drugs and other antigiardial agents, has raised concern and led to a search for other compounds, some of which have arisen due to the introduction of drugs initially addressed to other diseases. The present article examines some of the most important points of antigiardial pharmacotherapy available at present and the future prospects of development of new agents.
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Affiliation(s)
- Angel A Escobedo
- Jefe del departamento de Microbiología y Parasitología, Hospital Pediatrico Universitario Pedro Borrás, Ciudad de La Habana, CP, Cuba.
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Carter JE, Nelson JJ, Eves M, Boudreaux C. Giardia lamblia infection diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Diagn Cytopathol 2007; 35:363-5. [PMID: 17497659 DOI: 10.1002/dc.20636] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The protozoan Giardia lamblia is a major cause of gastrointestinal disease worldwide. We report the case of a 59-yr-old male who presented to his primary care physician with complaints of abdominal pain and weight loss. Imaging studies revealed a liver mass and a pancreatic head mass. Biopsy of the liver mass proved to be benign, and endoscopic ultrasound-guided fine-needle aspiration of the mass in the head of the pancreas showed no evidence of malignancy; however, numerous pear-shaped, binucleated, flagellated organisms morphologically consistent with trophozoites of Giardia lamblia were identified in the specimen. With the increasing use of endoscopic ultrasound-guided fine-needle aspiration for sampling of gastrointestinal, hepatobiliary, and pancreatic lesions, cytopathologists examining such specimens will need to be familiar with the diagnostic characteristics of this protozoal parasite.
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Affiliation(s)
- J Elliot Carter
- University of South Alabama, Department of Pathology, Mobile, Alabama 36617, USA.
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Abstract
AIDS is an advanced disease with systemic and infectious complications that can be fatal. When a patient with AIDS presents with right upper quadrant or midepigastric pain, cholestasis, and symptoms of cholangitis, AIDS cholangiopathy should be suspected and appropriate diagnostic and therapeutic interventions should be initiated. Opportunistic infections such as Cryptosporidium and cytomegalovirus are the most common cause of AIDS cholangiopathy. Four distinct cholangiographic abnormalities have been demonstrated by endoscopic retrograde cholangiopancreatography, the most common being papillary stenosis with sclerosing cholangitis. Antimicrobial therapy is often ineffective. Highly active antiretroviral therapy may enhance immune function and offers the best medical therapy to clear the opportunistic infections. Ursodeoxycholic acid has a limited benefit in patients with sclerosing cholangitis and cholestasis. Endoscopic sphincterotomy has been shown to relieve pain and biliary obstruction in patients with papillary stenosis. Balloon dilation of strictures and stent placement decompress the biliary system and may be helpful. Cholecystectomy is recommended to treat acalculous cholecystitis, and celiac plexus block may be offered to patients with terminal disease and intractable abdominal pain.
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Affiliation(s)
- Tony E. Yusuf
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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