Biliary ascariasis and severe bacterial outcomes: Report of three cases from a paediatric hospital in Brazil

INTRODUCTION

Biliary ascariasis, although uncommon, can lead to infectious complications and severe outcomes. This study reported three patients with biliary ascariasis and who were admitted to a paediatric hospital in Salvador, Brazil.

CASE REPORTS

Case 1: A 1-year-old boy, with HIV, hospitalised with diarrhoea, fever, pain, and abdominal distension. He underwent an exploratory laparotomy, which showed peritonitis secondary to a perforation of the hepatic duct by ascaris. Case 2: A 3-year-old boy admitted with fever, abdominal pain and jaundice. Imaging examination was suggestive of ascaris in the intrahepatic biliary tract and a hepatic abscess. Case 3: A 7-year-old boy who was hospitalised with a history of abdominal colic, jaundice and fever, with a suggestive image of ascaris in the biliary tract and evolution to sepsis.

DISCUSSION

Three cases of biliary ascariasis were reported with severe infectious complications involving peritonitis, hepatic abscess and sepsis.

CONCLUSION

In endemic regions, biliary ascariasis should be considered in cases with jaundice, abdominal pain and fever, due to its morbidity and risk of complications.

[Effects of the environment on health of feral pigeons (Columba livia)]

We examined 80 feral pigeons and their fecal samples from two feral pigeon lofts of the "Pigeon Action of Basel" (Switzerland) for different pathogens. The tested material harbored four pathogenic agents transmissible to humans (Chlamydia spp., Salmonella spec., Campylobacter jejuni, Cryptococcus neoformans) In addition several pathogens were found which are no zoonotic agents but potentially pathogenic for the pigeons themselves, such as Trichomonas gallinae, coccidia, helminths, ectoparasites and fungi. The number of pathogens and parasites detected in the fecal samples varied significantly between the two localities. The pigeons of the two investigated breeding flocks differed in nutritional status and the incidence of two species of feather lice, Columbicola columbae and Campanulotes bidentatus compar. The prevalence of Trichomonas gallinae between juveniles and adults was not significantly different but juveniles exhibited significantly heavier infestation if infected. Individuals with a good nutritional status tend to show heavier infestation with Trichomonas gallinae compared to birds with moderate or poor nutritional status. Birds with a poor nutritional status tend to suffer from a heavier infestation with the feather louse C. columbae, and birds with a good nutritional status show significant heavier infestation with C. bidentatus compar. It was remarkable that one of the two investigated breeding populations almost gave up its breeding activity for two years because of the loss of its familiar food source. Nevertheless, this population showed a better nutritional status than the population without restrictions in the acquisition of food. This fact could be interpreted by the existence of a biological control mechanism for suppression of the reproduction in degraded environmental conditions to ensure the survival of the adults. If this assumption is correct, the feeding of feral pigeons by animal lovers possibly causes impairment of pigeon's health in consequence of continuation of the breeding activity in spite of declined living conditions in the city.

Scabies mites alter the skin microbiome and promote growth of opportunistic pathogens in a porcine model

Background

The resident skin microbiota plays an important role in restricting pathogenic bacteria, thereby protecting the host. Scabies mites (Sarcoptes scabiei) are thought to promote bacterial infections by breaching the skin barrier and excreting molecules that inhibit host innate immune responses. Epidemiological studies in humans confirm increased incidence of impetigo, generally caused by Staphylococcus aureus and Streptococcus pyogenes, secondary to the epidermal infestation with the parasitic mite. It is therefore possible that mite infestation could alter the healthy skin microbiota making way for the opportunistic pathogens. A longitudinal study to test this hypothesis in humans is near impossible due to ethical reasons. In a porcine model we generated scabies infestations closely resembling the disease manifestation in humans and investigated the scabies associated changes in the skin microbiota over the course of a mite infestation.

Methodology/Principal Findings

In a 21 week trial, skin scrapings were collected from pigs infected with S. scabies var. suis and scabies-free control animals. A total of 96 skin scrapings were collected before, during infection and after acaricide treatment, and analyzed by bacterial 16S rDNA tag-encoded FLX-titanium amplicon pyrosequencing. We found significant changes in the epidermal microbiota, in particular a dramatic increase in Staphylococcus correlating with the onset of mite infestation in animals challenged with scabies mites. This increase persisted beyond treatment from mite infection and healing of skin. Furthermore, the staphylococci population shifted from the commensal S. hominis on the healthy skin prior to scabies mite challenge to S. chromogenes, which is increasingly recognized as being pathogenic, coinciding with scabies infection in pigs. In contrast, all animals in the scabies-free cohort remained relatively free of Staphylococcus throughout the trial.

Conclusions/Significance

This is the first experimental in vivo evidence supporting previous assumptions that establishment of pathogens follow scabies infection. Our findings provide an explanation for a biologically important aspect of the disease pathogenesis. The methods developed from this pig trial will serve as a guide to analyze human clinical samples. Studies building on this will offer implications for development of novel intervention strategies against the mites and the secondary infections.

Scabies is a neglected, contagious skin disease caused by a parasitic mite Sarcoptes scabiei. It is highly prevalent world-wide, and now recognized as a possible underlying factor for secondary bacterial infections with potential serious downstream complications. There is currently few experimental data demonstrating directly that mite infestation promotes bacterial infections. Due to remarkable similarities in terms of immunology, physiology and skin anatomy between pigs and humans, we developed a sustainable porcine model enabling in vivo studies of scabies mite infestations. Here, we investigated the impact of the scabies mite infection on the normal pig skin microbiota in the inner ear pinnae in young piglets. Samples obtained prior to, during infection and after acaricide treatment were analyzed by sequencing of bacterial 16S rDNA. We report that scabies infestation has an impact on the host's skin microbiota. Staphylococcus abundance increased with the onset of infection and remained beyond treatment and healing. A shift from commensal to pathogenic Staphylococci was observed. This study supports the link between scabies and Staphylococcus infections, as seen in humans. It is the first in vivo demonstration of a mite induced shift in the skin microbiota, providing a basis for a similar study in humans.

Analysis of a summary network of co-infection in humans reveals that parasites interact most via shared resources

Simultaneous infection by multiple parasite species (viruses, bacteria, helminths, protozoa or fungi) is commonplace. Most reports show co-infected humans to have worse health than those with single infections. However, we have little understanding of how co-infecting parasites interact within human hosts. We used data from over 300 published studies to construct a network that offers the first broad indications of how groups of co-infecting parasites tend to interact. The network had three levels comprising parasites, the resources they consume and the immune responses they elicit, connected by potential, observed and experimentally proved links. Pairs of parasite species had most potential to interact indirectly through shared resources, rather than through immune responses or other parasites. In addition, the network comprised 10 tightly knit groups, eight of which were associated with particular body parts, and seven of which were dominated by parasite-resource links. Reported co-infection in humans is therefore structured by physical location within the body, with bottom-up, resource-mediated processes most often influencing how, where and which co-infecting parasites interact. The many indirect interactions show how treating an infection could affect other infections in co-infected patients, but the compartmentalized structure of the network will limit how far these indirect effects are likely to spread.

Equine disease surveillance: quarterly summary

Equine infectious anaemia in Europe Equine herpesvirus in the UK Summary of surveillance testing, July to September 2012 These are among matters discussed in the quarterly equine disease surveillance report for July to September 2012, prepared by Defra, the Animal Health Trust and the British Equine Veterinary Association.

Live cell fluorescence microscopy to study microbial pathogenesis

Advances in microscopy and fluorescent probes provide new insight into the nanometer-scale biochemistry governing the interactions between eukaryotic cells and pathogens. When combined with mathematical modelling, these new technologies hold the promise of qualitative, quantitative and predictive descriptions of these pathways. Using the light microscope to study the spatial and temporal relationships between pathogens, host cells and their respective biochemical machinery requires an appreciation for how fluorescent probes and imaging devices function. This review summarizes how live cell fluorescence microscopy with common instruments can provide quantitative insight into the cellular and molecular functions of hosts and pathogens.

Concomitant infections, parasites and immune responses

Concomitant infections are common in nature and often involve parasites. A number of examples of the interactions between protozoa and viruses, protozoa and bacteria, protozoa and other protozoa, protozoa and helminths, helminths and viruses, helminths and bacteria, and helminths and other helminths are described. In mixed infections the burden of one or both the infectious agents may be increased, one or both may be suppressed or one may be increased and the other suppressed. It is now possible to explain many of these interactions in terms of the effects parasites have on the immune system, particularly parasite-induced immunodepression, and the effects of cytokines controlling polarization to the Th1 or Th2 arms of the immune response. In addition, parasites may be affected, directly or indirectly, by cytokines and other immune effector molecules and parasites may themselves produce factors that affect the cells of the immune system. Parasites are, therefore, affected when they themselves, or other organisms, interact with the immune response and, in particular, the cytokine network. The importance of such interactions is discussed in relation to clinical disease and the development and use of vaccines.

[The mechanisms of the pathogenicity of bacteria in different infections]

The following ultrastructural formations are found in the bacteria of various infections: fibrillar and drop-like microcapsules, an increase of nucleotide size and number, micropyles. The dynamics of staphylococcus L-form formation in sepsis as well as the phenomenon of incomplete phagocytosis and endocytobiosis were studied. The latter is observed in mixed infection: dysentery bacteria lamblia, gonococci and trichomonas. These alterations indicate increased bacterial pathogenicity and seem to reflect the evolution of the bacteria adaptive mechanisms under the conditions of antibiotic therapy.

[Outbreaks of food poisonings of microbial and parasitic origins]

In order to know the agents and foods related more frequently with food-borne disease outbreaks, we reviewed all the outbreaks studied between 1980 and 1989 by the National Laboratory of Public Health. A total of 79 outbreaks of food-borne diseases of microbial origin were reviewed. The causative agent was identified in 50 (73%) outbreaks. Twenty-four per cent of the outbreaks occurred in parties, 10.3 per cent in school or nurseries, 8.6 per cent in restaurants and 8.6 per cent in hospitals. Staphylococcus aureus was the most common agent, causing 48.2 per cent of the outbreaks. Salmonella enterica was involved in 34 per cent of them. The most frequent serovar was typhimurium. Foods involved were: cheese in 29.3 per cent of the cases; cakes in 15.5 per cent; cooked meat in 15.1 per cent; milk in 13.8 per cent; and fish and seafood in 7.0 per cent of the cases. Since the number of studied incidents represents only a small proportion of all the outbreaks occurring in the country, the constant exchange of information among the laboratories which work on the problem and the promotion of the health care team are necessary in order to improve the epidemiologic surveillance systems and the study and prevention of food-borne disease and food poisoning outbreaks.

[Microbiological evaluation of the effectiveness of gynalgin in the treatment of vaginitis]

The microbiological effectiveness of the preparation Gynalgin produced by POLFA Pharmaceutical Works in Rzeszów was assessed in cases of vulvovaginitis in 55 patients with clinically diagnosed inflammatory conditions of the lower genital tract, who were given Gynalgin tablets in 10-day courses. Vaginal smears were examined three times for the presence of bacteria, fungi and trichomonas vaginalis (before and immediately after the treatment, and two weeks later). In the initial examination in five vaginal smears mixed bacterial flora was found, in 6 smears trichomonas was present, in 4--bacteria and fungi, and in one--trichomonas and fungi. After the treatment in control examinations I and II the number of the isolated bacterial strains was lower, trichomonas was no longer present, and the number of fungi was reduced evidently. In the light of these microbiological examinations Gynalgin was found to exert a strong fungicidal, bactericidal and antitrichomonal activity, and the results of laboratory investigations agreed with those of clinical trials of Gynalgin effectiveness.