Peter D Burbelo
Full Text Available BACKGROUND: Onchocerciasis, an infection caused by the filarial nematode Onchocerca volvulus, is a major public health concern. Given the debilitating symptoms associated with onchocerciasis and concerns about recrudescence in areas of previous onchocerciasis control, more efficient tools are needed for diagnosis and monitoring of control measures. We investigated whether luciferase immunoprecipitation systems (LIPS may be used as a more rapid, specific, and standardized diagnostic assay for Onchocerca volvulus infection. METHODS: Four recombinantly produced Onchocerca volvulus antigens (Ov-FAR-1, Ov-API-1, Ov-MSA-1 and Ov-CPI-1 were tested by LIPS on a large cohort of blinded sera comprised of both uninfected controls and patients with a proven parasitic infection including Onchocerca volvulus (Ov, Wuchereria bancrofti (Wb, Loa loa (Ll, Strongyloides stercoralis (Ss, and with other potentially cross-reactive infections. In addition to testing all four Ov antigens separately, a mixture that tested all four antigens simultaneously was evaluated in the standard 2-hour incubation format as well as in a 15-minute rapid LIPS format. FINDINGS: Antibody responses to the four different Ov antigens allowed for unequivocal differentiation between Ov-infected and uninfected control sera with 100% sensitivity and 100% specificity. Analysis of the antibody titers to each of these four antigens in individual Ov-infected sera revealed that they were markedly different and did not correlate (r(S = -0.11 to 0.58; P = 0.001 to 0.89 to each other. Compared to Ov-infected sera, patients infected with Wb, Ll, Ss, and other conditions had markedly lower geometric mean antibody titers to each of the Ov 4 antigens (P<0.0002 for each antigen. The simplified method of using a mixture of the 4 Ov antigens simultaneously in the standard format or a quick 15-minute format (QLIPS showed 100% sensitivity and 100% specificity in distinguishing the Ov-infected sera from the
Meyrowitsch, D W; Simonsen, P E; Magnussen, P
The tolerance of Onchocerca volvulus-infected individuals to diethylcarbamazine (DEC)-medicated salt (0.33% w/w) was assessed in 1996 in Tanzania in a double-blind placebo-controlled hospital-based trial involving 4 groups, each of 10 adult males. Groups I and II had O. volvulus microfilariae (mf) only, group III had both O. volvulus and Wuchereria bancrofti mf, and group IV had W. bancrofti mf only. Groups I, III and IV received DEC-medicated salt, whereas group II was a control to group I and received normal cooking salt. Medication was given for 10 days. The most pronounced adverse reactions in groups I and III were mild-to-moderate itching and rash, beginning after 3-4 days and lasting for the remaining medication period. The reactions did not interfere with normal daily activities. By 20 days after the end of medication, adverse reactions had disappeared in all individuals. The low daily dose of DEC had no significant effect on the O. volvulus pre-medication mf geometric mean intensities (GMIs). In contrast, the medication significantly reduced the pre-medication W. bancrofti mf GMIs. The prospects for using DEC-medicated salt for control of bancroftian filariasis in areas where incidental infections with O. volvulus occur are discussed.
Full Text Available Abstract Background Onchocerca volvulus, the causative agent of river blindness, is transmitted through the black fly Simulium damnosum s.l., which breeds in turbulent river waters. To date, the number of flies attacking humans has only been determined by standard fly collectors near the river or the village. In our study, we counted the actual number of attacking and successfully feeding S. damnosum s.l. flies landing on individual villagers during their routine day-time activities in two villages of the Sudan-savannah and rainforest of Cameroon. We compared these numbers to the number of flies caught by a standard vector-collector, one positioned near the particular villager during his/her daily activity and the other sitting at the nearest Simulium breeding site. Results Using these data obtained by the two vector-collectors, we were able to calculate the Actual Index of Exposure (AIE. While the AIE in the savannah was on average 6,3%, it was 34% in the rainforest. The Effective Annual Transmission Potential (EATP for individual villagers was about 20 fold higher in the rainforest compared to the savannah. Conclusions Here we show for the first time that it is possible to determine the EATP. Further studies with more subjects are needed in the future. These data are important for the development of future treatment strategies.
Strote, G; Bonow, I
The electron microscopic investigation of the anterior part of the infective third-stage juvenile of Onchocerca volvulus provides first insights into the structure of the excretory system of this developmental stage of the parasite. The most anterior part of this system consists of a cell process of the syncytial excretory cells. At this height the excretory cells enclose the cuticle-lined excretory channel. The channel is in the process of elongation in the anterior-posterior direction, indicated by cell division in this region. More posteriad an ampulla-like structure is forming in the cytoplasm of the excretory cells. The inner surface of this ampulla is lined with a small number of single microvilli. In this part of the system the cytoplasm of the excretory cells is rich in Golgi bodies and endocytic vesicles. The ampulla has direct access to the exterior by the excretory duct. The excretory duct is a cuticle-lined structure surrounded by supporting fibres of an additional cell. This duct cell connects the excretory duct to the body-wall cuticle at the excretory pore. Adjacent to the region of the excretory system a cell is found that resembles a gland cell. This cell is in close contact to the ventral nerve cord. The genital primordia of the third-stage juvenile consist of several dividing cells. The female genital primordium is seen at the junction of the muscular with the glandular oesophagus and the male primordium can be found at the junction of the glandular oesophagus with the gut.
Convit, Jacinto; Schuler, Harland; Borges, Rafael; Olivero, Vimerca; Domínguez-Vázquez, Alfredo; Frontado, Hortencia; Grillet, María E
Onchocerciasis is caused by Onchocerca volvulus and transmitted by Simulium species (black flies). In the Americas, the infection has been previously described in 13 discrete regional foci distributed among six countries (Brazil, Colombia, Ecuador, Guatemala, Mexico and Venezuela) where more than 370,000 people are currently considered at risk. Since 2001, disease control in Venezuela has relied on the mass drug administration to the at-risk communities. This report provides empirical evidence of interruption of Onchocerca volvulus transmission by Simulium metallicum in 510 endemic communities from two Northern foci of Venezuela, after 10-12 years of 6-monthly Mectizan (ivermectin) treatment to all the eligible residents. In-depth entomologic and epidemiologic surveys were serially conducted from 2001-2012 in selected (sentinel and extra-sentinel) communities from the North-central (NC) and North-east (NE) onchocerciasis foci of Venezuela in order to monitor the impact of ivermectin treatment. From 2007-2009, entomological indicators in both foci confirmed that 0 out of 112,637 S. metallicum females examined by PCR contained L3 infection in insect heads. The upper bound of the 95% confidence intervals of the infective rate of the vector reached values below 1% by 2009 (NC) and 2012 (NE). Additionally, after 14 (NC) and 22 (NE) rounds of treatment, the seasonal transmission potential (±UL CIs) of S. metallicum was under the critical threshold of 20 L3 per person per season. Serological analysis in school children Venezuela.
Full Text Available Control of onchocerciasis as a public health problem in Africa relies on annual mass ivermectin distribution. New tools are needed to achieve elimination of infection. This study determined in a small number of Onchocerca volvulus infected individuals whether moxidectin, a veterinary anthelminthic, is safe enough to administer it in a future large study to further characterize moxidectin's safety and efficacy. Effects on the parasite were also assessed.Men and women from a forest area in South-eastern Ghana without ivermectin mass distribution received a single oral dose of 2 mg (N = 44, 4 mg (N = 45 or 8 mg (N = 38 moxidectin or 150 µg/kg ivermectin (N = 45 with 18 months follow up. All ivermectin and 97%-100% of moxidectin treated participants had Mazzotti reactions. Statistically significantly higher percentages of participants treated with 8 mg moxidectin than participants treated with ivermectin experienced pruritus (87% vs. 56%, rash (63% vs. 42%, increased pulse rate (61% vs. 36% and decreased mean arterial pressure upon 2 minutes standing still after ≥5 minutes supine relative to pre-treatment (61% vs. 27%. These reactions resolved without treatment. In the 8 mg moxidectin and ivermectin arms, the mean±SD number of microfilariae/mg skin were 22.9±21.1 and 21.2±16.4 pre-treatment and 0.0±0.0 and 1.1±4.2 at nadir reached 1 and 3 months after treatment, respectively. At 6 months, values were 0.0±0.0 and 1.6±4.5, at 12 months 0.4±0.9 and 3.4±4.4 and at 18 months 1.8±3.3 and 4.0±4.8, respectively, in the 8 mg moxidectin and ivermectin arm. The reduction from pre-treatment values was significantly higher after 8 mg moxidectin than after ivermectin treatment throughout follow up (p<0.01.The 8 mg dose of moxidectin was safe enough to initiate the large study. Provided its results confirm those from this study, availability of moxidectin to control programmes could help them achieve onchocerciasis elimination
Brattig, Norbert W; Schwohl, Arline; Hoerauf, Achim; Büttner, Dietrich W
Prostaglandins generated by multiple tissue and immune cells exhibit regulatory effects on the vascular and immune systems. Prostaglandin E(2) (PGE(2)), in particular, affects innate as well as adaptive immune mechanisms. We identified PGE(2) in host immune cells adjacent to Onchocerca volvulus in subcutaneous onchocercomas and the affected skin. Using immunohistology, PGE(2) was predominantly detected in infiltrating macrophages but also in plasma cells. Consecutive sections revealed concomitant presence of PGE(2) and transforming growth factor-beta (TGF-beta), representing a second immunoregulative mediator in macrophages and plasma cells. TGF-beta was preferentially observed in the infiltrating macrophages in patients with a generalized hyporeactive onchocerciasis and less in patients with the hyperreactive form. The presence of PGE(2) and TGF-beta in adjoining host cells infiltrating in the onchocercoma and dermis may indicate containment of inflammatory responses that could favour survival of the filarial parasite.
Newland, H S; White, A T; Greene, B M; D'Anna, S A; Keyvan-Larijani, E; Aziz, M A; Williams, P N; Taylor, H R
Ivermectin has shown promise as a potentially safe and effective microfilaricidal drug for the treatment of onchocerciasis. Several limited studies have shown it to have fewer side effects, especially ocular complications, than the currently available drug, diethylcarbamazine. The detailed ocular findings in 200 moderately to heavily infected Liberians who were enrolled in a safety and dose-finding study are presented. They received either 0, 100, 150, or 200 micrograms/kg of ivermectin and were followed up for 12 months. In clinical studies so far carried out ivermectin in a dose of 100, 150, or 200 micrograms/kg has not been associated with any major adverse reactions nor were there any sight-threatening effects even in the presence of severe ocular disease. Each of these doses significantly reduced the ocular microfilaria load for at least 12 months when compared with either the placebo (p less than 0.05) or pretreatment values (p less than 0.001). However, the 100 and 150 micrograms/kg doses caused fewer minor side effects than the higher dose. These results confirm that ivermectin in a single oral dose may be a safe and effective microfilaricidal drug for the treatment of onchocerciasis and that it appears to be free of major ocular side effects.
Hess, Jessica A; Zhan, Bin; Bonne-Année, Sandra; Deckman, Jessica M; Bottazzi, Maria Elena; Hotez, Peter J; Klei, Thomas R; Lustigman, Sara; Abraham, David
Human onchocerciasis is a neglected tropical disease caused by Onchocerca volvulus and an important cause of blindness and chronic disability in the developing world. Although mass drug administration of ivermectin has had a profound effect on control of the disease, additional tools are critically needed including the need for a vaccine against onchocerciasis. The objectives of the present study were to: (i) select antigens with known vaccine pedigrees as components of a vaccine; (ii) produce the selected vaccine antigens under controlled conditions, using two expression systems and in one laboratory and (iii) evaluate their vaccine efficacy using a single immunisation protocol in mice. In addition, we tested the hypothesis that joining protective antigens as a fusion protein or in combination, into a multivalent vaccine, would improve the ability of the vaccine to induce protective immunity. Out of eight vaccine candidates tested in this study, Ov-103, Ov-RAL-2 and Ov-CPI-2M were shown to reproducibly induce protective immunity when administered individually, as fusion proteins or in combination. Although there was no increase in the level of protective immunity induced by combining the antigens into one vaccine, these antigens remain strong candidates for inclusion in a vaccine to control onchocerciasis in humans. Copyright © 2014 Australian Society for Parasitology Inc. Published by Elsevier Ltd. All rights reserved.
Paul B. Keiser; Stacey M. Reynolds; Kwablah Awadzi; Eric A. Ottesen; Mark J. Taylor; Thomas B. Nutman
.... To investigate the role of the Wolbachia bacterial endosymbiont of Onchocerca volvulus in these reactions, serum samples collected before and after treatment with either anthelmintic were assessed...
Crainey, James L; Silva, Túllio R R da; Encinas, Fernando; Marín, Michel A; Vicente, Ana Carolina P; Luz, Sérgio L B
We report here the first complete mitochondria genome of Onchocerca volvulus from a focus outside of Africa. An O. volvulus mitogenome from the Brazilian Amazonia focus was obtained using a combination of high-throughput and Sanger sequencing technologies. Comparisons made between this mitochondrial genome and publicly available mitochondrial sequences identified 46 variant nucleotide positions and suggested that our Brazilian mitogenome is more closely related to Cameroon-origin mitochondria than West African-origin mitochondria. As well as providing insights into the origins of Latin American onchocerciasis, the Brazilian Amazonia focus mitogenome may also have value as an epidemiological resource.
Cotton, James A.; Bennuru, Sasisekhar; Grote, Alexandra; Harsha, Bhavana; Tracey, Alan; Beech, Robin; Doyle, Stephen R.; Dunn, Matthew; Dunning Hotopp, Julie C.; Holroyd, Nancy; Kikuchi, Taisei; Lambert, Olivia; Mhashilkar, Amruta; Mutowo, Prudence; Nursimulu, Nirvana; Ribeiro, Jose M. C.; Rogers, Matthew B.; Stanley, Eleanor; Swapna, Lakshmipuram S.; Tsai, Isheng J.; Unnasch, Thomas R.; Voronin, Denis; Parkinson, John; Nutman, Thomas B.; Ghedin, Elodie; Berriman, Matthew; Lustigman, Sara
Human onchocerciasis is a serious neglected tropical disease caused by the filarial nematode Onchocerca volvulus that can lead to blindness and chronic disability. Control of the disease relies largely on mass administration of a single drug, and the development of new drugs and vaccines depends on a better knowledge of parasite biology. Here, we describe the chromosomes of O. volvulus and its Wolbachia endosymbiont. We provide the highest-quality sequence assembly for any parasitic nematode to date, giving a glimpse into the evolution of filarial parasite chromosomes and proteomes. This resource was used to investigate gene families with key functions that could be potentially exploited as targets for future drugs. Using metabolic reconstruction of the nematode and its endosymbiont, we identified enzymes that are likely to be essential for O. volvulus viability. In addition, we have generated a list of proteins that could be targeted by Federal-Drug-Agency-approved but repurposed drugs, providing starting points for anti-onchocerciasis drug development. PMID:27869790
Cruz-Ortiz, Nancy; Gonzalez, Rodrigo J.; Lindblade, Kim A.; Richards, Frank O.; Sauerbrey, Mauricio; Zea-Flores, Guillermo; Dominguez, Alfredo; Oliva, Orlando; Catú, Eduardo; Rizzo, Nidia
In Latin America, onchocerciasis is targeted for elimination by 2012 through twice-yearly mass treatment of the eligible population with ivermectin. In Guatemala, two of the four historical endemic foci have demonstrated elimination of transmission, following World Health Organization guidelines. Using established guidelines ophthalmological, serological, and entomological evaluations were conducted in 2007-8 to determine the transmission status of onchocerciasis in the Huehuetenango focus. The prevalence of Onchocerca volvulus microfilariae in the anterior segment of the eye in 365 residents was 0% (95% confidence interval [CI] 0–0.8%), the prevalence of infection of O. volvulus in Simulium ochraceum among 8252 flies collected between November 2007 and April 2008 was 0% (95% CI 0–0.02%), and the prevalence of antibodies to a recombinant O. volvulus antigen in 3118 school age children was 0% (95% CI 0–0.1%). These results showed transmission interruption; thus, in 2009 mass treatment was halted and posttreatment surveillance began. To verify for potential recrudescence an entomological evaluation (from December 2010 to April 2011) was conducted during the 2nd and 3rd year of posttreatment surveillance. A total of 4587 S. ochraceum were collected, and the prevalence of infection of O. volvulus was 0% (95% CI 0–0.04%). Transmission of onchocerciasis in the Huehuetenango focus has been eliminated. PMID:22970346
Use of the recombinant Onchocerca volvulus protein Ov20/OvS1 for the immunodiagnostic differentiation between onchocerciasis and mansonelliasis and for the characterization of hyperreactive onchocerciasis (sowda)
Mpagi, J. L; Büttner, D. W; Tischendorf, F. W; Erttmann, K. D; Brattig, N. W
... of Onchocerca volvulus infection (sowda). The specificity of the IgG4 Western blot was 98% for the differentiation between persons with onchocerciasis and Mansonella microfilariae (mf) carriers (125 persons with M...
Rodrigo J Gonzalez
Full Text Available BACKGROUND: Elimination of onchocerciasis (river blindness through mass administration of ivermectin in the six countries in Latin America where it is endemic is considered feasible due to the relatively small size and geographic isolation of endemic foci. We evaluated whether transmission of onchocerciasis has been interrupted in the endemic focus of Escuintla-Guatemala in Guatemala, based on World Health Organization criteria for the certification of elimination of onchocerciasis. METHODOLOGY/PRINCIPAL FINDINGS: We conducted evaluations of ocular morbidity and past exposure to Onchocerca volvulus in the human population, while potential vectors (Simulium ochraceum were captured and tested for O. volvulus DNA; all of the evaluations were carried out in potentially endemic communities (PEC; those with a history of actual or suspected transmission or those currently under semiannual mass treatment with ivermectin within the focus. The prevalence of microfilariae in the anterior segment of the eye in 329 individuals (> or =7 years old, resident in the PEC for at least 5 years was 0% (one-sided 95% confidence interval [CI] 0-0.9%. The prevalence of antibodies to a recombinant O. volvulus antigen (Ov-16 in 6,432 school children (aged 6 to 12 years old was 0% (one-sided 95% IC 0-0.05%. Out of a total of 14,099 S. ochraceum tested for O. volvulus DNA, none was positive (95% CI 0-0.01%. The seasonal transmission potential was, therefore, 0 infective stage larvae per person per season. CONCLUSIONS/SIGNIFICANCE: Based on these evaluations, transmission of onchocerciasis in the Escuintla-Guatemala focus has been successfully interrupted. Although this is the second onchocerciasis focus in Latin America to have demonstrated interruption of transmission, it is the first focus with a well-documented history of intense transmission to have eliminated O. volvulus.
González-Muñoz, M; Gárate, T; Puente, S; Subirats, M; Moneo, I
The host immune response in onchocerciasis is believed to contribute to the clinical manifestations of infection. Mazzotti and chronic inflammatory reactions might be mediated by mechanisms involving specific IgE and reactivity of mast cells and basophils to the parasite antigens. In this report, we show that Onchocerca volvulus antigens are capable of inducing histamine release. Three types of extracts were prepared from the parasite: soluble total, surface, and cuticular collagen. Soluble extracts released histamine in all individuals with onchocerciasis at significantly higher levels (P < 0.05) than those found in endemic controls, but similar levels to those found in patients with mansonellosis. However, cuticular collagen induced significantly (P < 0.01) higher histamine release in patients with onchocerciasis than in those with mansonellosis. No reactivity against human type IV collagen was observed. Implications derived from the presence of sensitized basophils in the pathogenesis of onchocerciasis are discussed.
Borchert, Nadine; Becker-Pauly, Christoph; Wagner, Antje; Fischer, Peter; Stöcker, Walter; Brattig, Norbert W
The tissue-invasive nematode Onchocerca volvulus causes skin and eye pathology in human onchocerciasis. While the adult females reside sessile in subcutaneous nodules, the microfilariae are abundantly released from the nodules, males and juvenile worms migrate through the host tissue. Matrix-degrading metallo- and serine proteinases have been detected in excretory-secretory worm products that may be essential for migration of the mobile stages. In this study, a 1713bp long cDNA encoding for a putative proteinase of O. volvulus has been isolated. The predicted protein sequence includes a signal peptide indicating secretion to the extracellular space, a propeptide, an astacin-like protease domain, an EGF-like and a CUB-domain, thereby identifying the protein as a member of the astacin family of zinc endopeptidases. Onchoastacin, Ov-AST-1, is most closely related to a subfamily comprising nematode astacins including Caenorhabditis and Ancylostoma. Ov-AST-1 was expressed as a recombinant protein in baculovirus-infected insect cells and exhibited enzymatic activity. The exposure of onchoastacin to the host immune system is indicated by demonstration of IgG reacting with the recombinant Ov-AST-1 and with two peptides of the protein. Since a homologous metalloproteinase is part of a promising hookworm vaccine, Ov-AST-1 may be a candidate for intervention strategies in filarial infections.
Full Text Available Background & objectives: Mass administration of ivermectin drug was carried out annually between 1995 and 2001 in three villages that were endemic for onchocerciasis in the Lower Cross River Basin, Nigeria. The aim of this study was to evaluate the population dynamics (dispersion patterns, distribution, prevalence and intensity of Onchocerca volvulus microfilariae in their human host after six years of ivermectin treatment. Methods: A total of 1014 subjects from three rural areas in Etung Local Government Area of Cross River State, Nigeria were screened for skin microfilariae using standard parasitological method of diagnosis. Results: Ivermectin drug intervention had significantly reduced the prevalence of skin microfilariae (PMF from 69.3% pre-control to 39.3% and community microfilarial load (CMFL from 7.11 to 2.31 microfilariae per skin snip. Males (45% were significantly (p 0.05. The correlation between age-dependent parasite prevalence and mean abundance was also not significant (r = 0.42; p >0.05. The degree of dispersion as measured by variance to mean ratio (VMR, coefficient of variation (CV and exponent ‘K’ of the negative binomial model of distribution showed that the parasite aggregated, clumped and overdispersed in their human host. The relative index of potential infection of each age group showed that adults between the age of 21 and 50 yr accounted for 52.7% of microfilariae positive cases. Interpretation & conclusion: Aggregated and overdispersion of O. volvulus observed in this study showed that active transmission could still be going on, because the tendency of the vector, Simulium damnosum ingesting more microfilariae was high due to the aggregated and overdispersed nature of the parasite with its host.
Büttner, D W; Albiez, E J; von Essen, J; Erichsen, J
The methods used for the assessment of adult Onchocerca volvulus by histology are described. Based on the results of several studies, mainly in Liberia and Burkina Faso, the morphology of the adult filariae in histological sections is represented as far as it is relevant for the evaluation. Especially are described the morphological alterations due to old age of the worms, to chronic hyperreactivity of the human host (sowda) and effects of the macrofilaricidal suramin and of microfilaricidal drugs. Quantitative results are reported on untreated adult O. volvulus from various countries, the changes of the worm population during 12 years of vector control in Burkina Faso and the effects of suramin, diethylcarbamazine, metrifonate, and ivermectin. The data from the histological examinations are compared with those gained from the examination of worms isolated by the collagenase technique in the same studies.
Cesbron, J Y; Hayasaki, M; Joseph, M; Lutsch, C; Grzych, J M; Capron, A
Over the past 35 yr, diethylcarbamazine (DEC) has been the most widely used agent for the treatment of filarial diseases, particularly in onchocerciasis. The microfilaricidal action of DEC has been recently shown to be mediated by blood platelets with the additional triggering of a filarial excretory Ag (FEA). This FEA could be detected by using mAb in the serum of infected patients. By using one mAb (IA2(23] directed against Onchocerca volvulus and recognizing circulating Ag (Ab1), we purified by affinity chromatography the target molecule of IA2(23) (an O. volvulus glycoprotein recognized by IA2(23) mAb). This compound had a dose-dependent effect on the cytotoxic action of DEC-treated platelets. We subsequently produced an anti-idiotype mAb to Ab1 (Ab2), and considered the possibility of replacing the O. volvulus glycoprotein recognized by IA2(23) mAb by Ab2. Ab2 was selected according to its ability to inhibit the binding of radioiodinated Ab1 to the filarial target Ag. It induced the production of anti-O. volvulus antibodies (Ab3) in rats. At a constant concentration of DEC platelets, the addition of increasing amounts of Ab2 led to a dose-dependent cytotoxic effect against parasite larvae. Experiments performed with Ab2 on detergent solubilized surface proteins of platelets identified four bands of Mr 18, 26, 43.5, and 100 kDa, supporting the idea of the presence of binding sites on the platelets for a FEA required for the microfilaricidal cytotoxicity of DEC-treated platelets.
Bennuru, Sasisekhar; Cotton, James A.; Ribeiro, Jose M. C.; Grote, Alexandra; Harsha, Bhavana; Holroyd, Nancy; Mhashilkar, Amruta; Molina, Douglas M.; Randall, Arlo Z.; Shandling, Adam D.; Unnasch, Thomas R.; Ghedin, Elodie; Berriman, Matthew
ABSTRACT Onchocerciasis (river blindness) is a neglected tropical disease that has been successfully targeted by mass drug treatment programs in the Americas and small parts of Africa. Achieving the long-term goal of elimination of onchocerciasis, however, requires additional tools, including drugs, vaccines, and biomarkers of infection. Here, we describe the transcriptome and proteome profiles of the major vector and the human host stages (L1, L2, L3, molting L3, L4, adult male, and adult female) of Onchocerca volvulus along with the proteome of each parasitic stage and of its Wolbachia endosymbiont (wOv). In so doing, we have identified stage-specific pathways important to the parasite’s adaptation to its human host during its early development. Further, we generated a protein array that, when screened with well-characterized human samples, identified novel diagnostic biomarkers of O. volvulus infection and new potential vaccine candidates. This immunomic approach not only demonstrates the power of this postgenomic discovery platform but also provides additional tools for onchocerciasis control programs. PMID:27881553
Full Text Available Nodding syndrome is a devastating neurological disorder, mostly affecting children in eastern Africa. An estimated 10 000 children are affected. Uganda, one of the most affected countries, set out to systematically investigate the disease and develop interventions for it. On December 21, 2015, the Ministry of Health held a meeting with community leaders from the affected areas to disseminate the results of the investigations made to date. This article summarizes the presentation and shares the story of studies into this peculiar disease. It also shares the results of preliminary studies on its pathogenesis and puts into perspective an upcoming treatment intervention. Clinical and electrophysiological studies have demonstrated nodding syndrome to be a complex epilepsy disorder. A definitive aetiological agent has not been established, but in agreement with other affected countries, a consistent epidemiological association has been demonstrated with infection by Onchocerca volvulus. Preliminary studies of its pathogenesis suggest that nodding syndrome may be a neuroinflammatory disorder, possibly induced by antibodies to O. volvulus cross-reacting with neuron proteins. Histological examination of post-mortem brains has shown some yet to be characterized polarizable material in the majority of specimens. Studies to confirm these observations and a clinical trial are planned for 2016.
Eisenbarth, Albert; Achukwi, Mbunkah Daniel; Renz, Alfons
Background Recent reports of transmission interruption of Onchocerca volvulus, the causing agent of river blindness, in former endemic foci in the Americas, and more recently in West and East Africa, raise the question whether elimination of this debilitating disease is underway after long-term treatment of the population at risk with ivermectin. The situation in Central Africa has not yet been clearly assessed. Methods and findings Entomologic data from two former endemic river basins in North Cameroon were generated over a period of 43 and 48 months to follow-up transmission levels in areas under prolonged ivermectin control. Moreover, epidemiologic parameters of animal-borne Onchocerca spp. transmitted by the same local black fly vectors of the Simulium damnosum complex were recorded and their impact on O. volvulus transmission success evaluated. With mitochondrial DNA markers we unambiguously confirmed the presence of infective O. volvulus larvae in vectors from the Sudan savannah region (mean Annual Transmission Potential 2009–2012: 98, range 47–221), but not from the Adamawa highland region. Transmission rates of O. ochengi, a parasite of Zebu cattle, were high in both foci. Conclusions/significance The high cattle livestock density in conjunction with the high transmission rates of the bovine filaria O. ochengi prevents the transmission of O. volvulus on the Adamawa plateau, whereas transmission in a former hyperendemic focus was markedly reduced, but not completely interrupted after 25 years of ivermectin control. This study may be helpful to gauge the impact of the presence of animal-filariae for O. volvulus transmission in terms of the growing human and livestock populations in sub-Saharan countries. PMID:26926855
Full Text Available Recent reports of transmission interruption of Onchocerca volvulus, the causing agent of river blindness, in former endemic foci in the Americas, and more recently in West and East Africa, raise the question whether elimination of this debilitating disease is underway after long-term treatment of the population at risk with ivermectin. The situation in Central Africa has not yet been clearly assessed.Entomologic data from two former endemic river basins in North Cameroon were generated over a period of 43 and 48 months to follow-up transmission levels in areas under prolonged ivermectin control. Moreover, epidemiologic parameters of animal-borne Onchocerca spp. transmitted by the same local black fly vectors of the Simulium damnosum complex were recorded and their impact on O. volvulus transmission success evaluated. With mitochondrial DNA markers we unambiguously confirmed the presence of infective O. volvulus larvae in vectors from the Sudan savannah region (mean Annual Transmission Potential 2009-2012: 98, range 47-221, but not from the Adamawa highland region. Transmission rates of O. ochengi, a parasite of Zebu cattle, were high in both foci.The high cattle livestock density in conjunction with the high transmission rates of the bovine filaria O. ochengi prevents the transmission of O. volvulus on the Adamawa plateau, whereas transmission in a former hyperendemic focus was markedly reduced, but not completely interrupted after 25 years of ivermectin control. This study may be helpful to gauge the impact of the presence of animal-filariae for O. volvulus transmission in terms of the growing human and livestock populations in sub-Saharan countries.
Lipopolysaccharide-like molecules derived from Wolbachia endobacteria of the filaria Onchocerca volvulus are candidate mediators in the sequence of inflammatory and antiinflammatory responses of human monocytes.
Brattig, N W; Rathjens, U; Ernst, M; Geisinger, F; Renz, A; Tischendorf, F W
The majority of Onchocerca volvulus-infected persons show signs of cellular anergy, and long-time survival of adult and larval parasites in subcutaneous tissue is observed. The mechanisms leading to immunological hyporesponsiveness are poorly understood. Monocytes/macrophages represent a link between the innate and acquired immune system and are candidate cells to promote inflammatory and antiinflammatory processes. In the present study we have shown that products of microfilarial (O. volvulus) and adult (O. volvulus and O. ochengi) parasites affect monocytes in vitro. An early production of TNF-alpha by exposed monocytes was followed by the production of IL-10 and a reduced expression of HLA-DR and the costimulatory molecules B7-1 and B7-2, while other adhesion receptors remained unaffected. Downregulation of the functional membrane receptors failed to occur after treatment of the cells with anti-IL-10 antibodies. The engagement of CD14, a dominant membrane receptor on monocytes and major binding protein for lipopolysaccharides, was indicated by partial blocking of monocyte modulation by neutralizing antibodies to CD14 and by the antagonistic lipid A analog compound 406. Lipopolysaccharide-like molecules were detected in sterile products of O. volvulus stages which could originate from Wolbachia bacteria related to Gram-negative Rickettsiales, known to be abundant in the hypodermis and the female reproductive organs of O. volvulus. The present results indicate that the monocyte/macrophage may be a major target cell for immunomodulatory parasite-derived and intraparasitic, bacteria-derived molecules, thereby contributing to the host's cellular hyporesponsiveness.
Rodríguez-Pérez, Mario A; Lizarazo-Ortega, Cristian; Hassan, Hassan K; Domínguez-Vásquez, Alfredo; Méndez-Galván, Jorge; Lugo-Moreno, Patricia; Sauerbrey, Mauricio; Richards, Frank; Unnasch, Thomas R
Entomologic and serologic surveys were performed in four sentinel communities in the Oaxaca focus in southern Mexico to assess the level of transmission and exposure incidence to Onchocerca volvulus. All communities have been receiving ivermectin mass treatment twice per year since 1997. In one community, parasite DNA was detected by polymerase chain reaction-enzyme-linked immunosorbent assay in 2004 in one pool of 50 vector heads of 170 such pools (8,500 flies) examined, which indicated an estimated transmission potential of 6.7 third-stage larvae/person/year. No evidence for transmission was found in the three other communities in 13,650 flies examined. All persons in a cohort consisting of 117 children in the four communities remained serologically negative for antibodies recognizing a cocktail of recombinant antigens over a four-year period from 2001 to 2004, which indicated an exposure incidence of 0%. Taken together, these data suggest that transmission has been suppressed in the four communities.
Awadzi, K; Attah, S K; Addy, E T; Opoku, N O; Quartey, B T
Ivermectin, at the standard dose of 150 micrograms/kg bodyweight, does not kill the adult worms of Onchocerca volvulus and does not disrupt embryogenesis or spermatogenesis. Repeated standard doses, if maintained, arrest microfilarial production but result in only a mild-to-modest macrofilaricidal effect. We investigated whether high doses would effectively kill the adult worms, and whether cessation of microfilarial production could be reproduced by an equivalent, single, high dose. One hundred men participated in a double-blind placebo-controlled trial and received increasing doses of ivermectin from 150 micrograms/kg to 1600 micrograms/kg bodyweight. Nodules were excised at day 180 and examined by histopathology. Total doses of ivermectin up to 1600 micrograms/kg were not significantly more effective than 150 micrograms/kg. Moreover, they did not reproduce the marked inhibitory effects of the repeat standard-dose regimens on embryogenesis, nor the modest effect on adult worm viability, at comparable total doses. These effects may be functions of multiplicities of dosages rather than of the total dose. Our findings also suggest that repeated high-dose regimens are unlikely to be more effective than a similar number of 150 micrograms/kg doses. This deficiency of ivermectin requires that the search for macrofilaricides remains a top priority.
Thuy-Huong Ta Tang
Full Text Available We present filaria-nested polymerase chain reaction (PCR, which is based on amplification of first internal transcribed spacer rDNA to distinguish three parasitic filarial species (Onchocerca volvulus, Mansonella ozzardiand Mansonella perstans that can be found in the Amazon Region. Nested PCR-based identifications yielded the same results as those utilizing morphological characters. Nested PCR is highly sensitive and specific and it detects low-level infections in both humans and vectors. No cross-amplifications were observed with various other blood parasites and no false-positive results were obtained with the nested PCR. The method works efficiently with whole-blood, blood-spot and skin biopsy samples. Our method may thus be suitable for assessing the efficacy of filaria control programmes in Amazonia by recording parasite infections in both the human host and the vector. By specifically differentiating the major sympatric species of filaria, this technique could also enhance epidemiological research in the region.
Gómez-Priego, Alberto; Mendoza, Raymundo; de-la-Rosa, Jorge-Luis
Studies to determine the prevalence of antibodies to Onchocerca volvulus, prior to and after actions carried out to interrupt transmission, are scarce in Mexico. Here we report the prevalence of immunoglobulin G (IgG) and IgG4 antibodies in an enzyme-linked immunosorbent assay (ELISA) against a crude extract of O. volvulus adult worm in serum samples from persons under noninterrupted biannual treatment with ivermectin in areas of onchocercosis endemicity in Mexico. To perform the prevalence studies, the ELISA procedures were first evaluated. Serological studies were performed with serum samples from skin microfilaria carriers from Guatemala and from people microfilariodermic negative living in the same area as the Guatemalan patients. Sensitivity values for IgG or IgG4 detection were 71 and 86%, while specificities were 92 and 100%, respectively. No anti-O. volvulus antibodies were found in samples from nonendemic controls from Mexico, but 3 of 71 samples from residents in the onchocercosis area of Oaxaca, Mexico, and who have been under ivermectin treatment during the last 10 years were only positive to IgG. Notwithstanding that the IgG4 isotype was not detected and a low (4.2%) anti-O. volvulus IgG antibody prevalence was found, a seroepidemiological follow-up must be performed in order to confirm interruption of onchocercosis transmission in the area of Oaxaca, Mexico, in which onchocercosis is endemic.
Gutiérrez-Peña, E J; Knab, J; Büttner, D W
The participation of neutrophil granulocytes in the cellular reaction to skin microfilariae of Onchocerca volvulus was studied by immunohistochemistry. Skin biopsies were obtained from adult Liberian and Ugandan patients with generalized onchocerciasis after exposure to topically applied diethylcarbamazine (DEC) and from untreated patients. After DEC many damaged microfilariae were observed either in dermal infiltrates or in epidermal microabscesses consisting both of neutrophils and eosinophils. Infiltrates and microabscesses contained some intact granulocytes and many neutrophils releasing myeloperoxidase, elastase, lactoferrin, defensin, lysozyme, alpha 1-antitrypsin and alpha 1-antichymotrypsin. Eosinophils discharged peroxidase and cationic proteins. Released granule proteins and remnants of disrupted granulocytes were found on the surface and in close proximity of damaged microfilariae in dermal infiltrates and epidermal microabscesses. In larger microabscesses neutrophils were predominant. These observations show that neutrophils and not only eosinophils recruit, accumulate, localize around and release their helminthotoxic granule proteins such as myeloperoxidase onto or closely around skin microfilariae of O. volvulus after topical DEC administration. The association between these processes and the damage of the microfilariae indicated that neutrophils together with eosinophils attack and damage microfilariae of O. volvulus after DEC treatment in the skin.
Joseph D Turner
Full Text Available BACKGROUND: The risk of severe adverse events following treatment of onchocerciasis with ivermectin in areas co-endemic with loiasis currently compromises the development of control programmes and the treatment of co-infected individuals. We therefore assessed whether doxycycline treatment could be used without subsequent ivermectin administration to effectively deliver sustained effects on Onchocerca volvulus microfilaridermia and adult viability. Furthermore we assessed the safety of doxycycline treatment prior to ivermectin administration in a subset of onchocerciasis individuals co-infected with low to moderate intensities of Loa loa microfilaraemia. METHODS: A double-blind, randomized, field trial was conducted of 6 weeks of doxycycline (200 mg/day alone, doxycycline in combination with ivermectin (150 microg/kg at +4 months or placebo matching doxycycline + ivermectin at +4 months in 150 individuals infected with Onchocerca volvulus. A further 22 individuals infected with O. volvulus and low to moderate intensities of Loa loa infection were administered with a course of 6 weeks doxycycline with ivermectin at +4 months. Treatment efficacy was determined at 4, 12 and 21 months after the start of doxycycline treatment together with the frequency and severity of adverse events. RESULTS: One hundred and four (60.5% participants completed all treatment allocations and follow up assessments over the 21-month trial period. At 12 months, doxycycline/ivermectin treated individuals had lower levels of microfilaridermia and higher frequency of amicrofilaridermia compared with ivermectin or doxycycline only groups. At 21 months, microfilaridermia in doxycycline/ivermectin and doxycycline only groups was significantly reduced compared to the ivermectin only group. 89% of the doxycycline/ivermectin group and 67% of the doxycycline only group were amicrofilaridermic, compared with 21% in the ivermectin only group. O. volvulus from doxycycline groups were
Rodríguez-Pérez, Mario A; Lutzow-Steiner, Miguel A; Segura-Cabrera, Aldo; Lizarazo-Ortega, Cristian; Domínguez-Vázquez, Alfredo; Sauerbrey, Mauricio; Richards, Frank; Unnasch, Thomas R; Hassan, Hassan K; Hernández-Hernández, Raymundo
The impact of quarterly Mectizan (ivermectin) treatments on transmission, microfiladermia, and ocular lesions was evaluated in two formerly hyperendemic communities (Las Golondrinas and Las Nubes II) located in the main endemic focus for onchocerciasis in Southern Chiapas, Mexico. The data suggest that Onchocerca volvulus transmission has been suppressed after elimination of microfiladermia in these two communities. Increasing the frequency of Mectizan treatment to four times per year appears to have resulted in the rapid suppression of transmission in communities with residual transmission.
Full Text Available Abstract Background The human parasite Onchocerca volvulus harbours Wolbachia endosymbionts essential for worm embryogenesis, larval development and adult survival. In this study, the development of Wolbachia-depleted microfilariae (first stage larvae to infective third stage larvae (L3 in the insect vector Simulium damnosum was analysed. Methods Infected volunteers in Cameroon were randomly and blindly allocated into doxycycline (200 mg/day for 6 weeks or placebo treatment groups. After treatment, blackflies were allowed to take a blood meal on the volunteers, captured and dissected for larval counting and DNA extraction for quantitative real-time PCR analysis. Results PCR results showed a clear reduction in Wolbachia DNA after doxycycline treatment in microfilariae from human skin biopsies with > 50% reduction at one month post-treatment, eventually reaching a reduction of > 80%. Larval stages recovered from the insect vector had similar levels of reduction of endosymbiotic bacteria. Larval recoveries were analysed longitudinally after treatment to follow the kinetics of larval development. Beginning at three months post-treatment, significantly fewer L3 were seen in the blackflies that had fed on doxycycline treated volunteers. Concomitant with this, the proportion of second stage larvae (L2 was significantly increased in this group. Conclusions Doxycycline treatment and the resulting decline of Wolbachia endobacteria from the microfilaria resulted in retarded development of larvae in the insect vector. Thus, anti-wolbachial treatment could have an additive effect for interrupting transmission by reducing the number of L3 that can be transmitted by blackflies.
Lefoulon, Emilie; Giannelli, Alessio; Makepeace, Benjamin L; Mutafchiev, Yasen; Townson, Simon; Uni, Shigehiko; Verocai, Guilherme G; Otranto, Domenico; Martin, Coralie
The genus Onchocerca includes 34 described species and represents one of the largest genera of the filarial nematodes within the family Onchocercidae. Representative members of this genus are mainly parasites of ungulates, with some exceptions such as Onchocerca lupi and Onchocerca volvulus, infecting carnivores and/or humans. For a long time, the evolutionary relationships amongst onchocercids remained poorly studied, as the systematics of this genus was impaired by the high morphological variability of species included in the taxon. Although some molecular phylogenies were developed, these studies were mainly focused on bovine Onchocerca spp. and O. volvulus, including assessments of Wolbachia endosymbionts. In the present study, we analysed 13 Onchocerca spp. from a larger host spectrum using a panel of seven different genes. Analysis of the coxI marker supports its usefulness for the identification of species within the genus. The evolutionary history of the genus has been herein revised by multi-gene phylogenies, presenting three strongly supported clades of Onchocerca spp. Analyses of co-evolutionary scenarios between Onchocerca and their vertebrate hosts underline the effect of domestication on Onchocerca speciation. Our study indicates that a host switch event occurred between Bovidae, Canidae and humans. Cophylogenetic analyses between Onchocerca and the endosymbiotic bacterium Wolbachia indicate the strongest co-evolutionary pattern ever registered within the filarial nematodes. Finally, this dataset indicates that the clade composed by O. lupi, Onchocerca gutturosa, Onchocerca lienalis, Onchocerca ochengi and O. volvulus derived from recent speciation. Copyright © 2017. Published by Elsevier Ltd.
Pion, Sébastien D S; Grout, Lise; Kamgno, Joseph; Nana-Djeunga, Hugues; Boussinesq, Michel
Reduction in Onchocerca volvulus skin microfilarial densities after treatment with ivermectin shows wide between-host variation. Data from two separate studies conducted in Cameroon on onchocerciasis patients treated for the first time with ivermectin were analyzed to identify host factors associated with microfilarial density at different time-points after treatment. In one site (Nkam valley), the dataset included 103 adult males for whom age, number of palpable onchocercal nodules and microfilarial densities on D0 (pre-treatment), D15, D80 and D180 were available. In the other site (Vina valley), analyses were conducted on 965 individuals of both sexes aged 5 years and over; in this dataset, available information included age, gender, exact dose of ivermectin received, onchocerciasis endemicity level in the village of residence and microfilarial densities on D0 and D180. Negative binomial regression models of microfilarial density at the different intervals post-treatment were fitted, using maximum likelihood, with the available independent variables. Gender and age were found to be associated with microfilarial density on D180. The initial microfilarial density influenced post-treatment densities at all the time-points. All other things being equal, microfilarial densities on D180 were higher in individuals harbouring a higher number of nodules or living in communities with high endemicity levels. This study demonstrates that O. volvulus microfilarial density measured after a first treatment with ivermectin, and thus probably the rate of skin repopulation by microfilariae (mf) varies according to several host factors. Should such factors also influence ivermectin efficacy after repeated treatment, then they should be taken into account to determine whether sub-optimal responses to treatment reported from various areas in Africa are actually due to parasite-related factors, particularly to the emergence of resistant populations.
Armoo, Samuel; Doyle, Stephen R; Osei-Atweneboana, Mike Y; Grant, Warwick N
Wolbachia are intracellular bacteria found in arthropods and several filarial nematode species. The filarial Wolbachia have been proposed to be involved in the immunopathology associated with onchocerciasis. Higher Wolbachia-to-nematode ratios have been reported in the savannah-ecotype compared to the forest-ecotype, and have been interpreted as consistent with a correlation between Wolbachia density and disease severity. However, factors such as geographic stratification and ivermectin drug exposure can lead to significant genetic heterogeneity in the nematode host populations, so we investigated whether Wolbachia copy number variation is also associated with these underlying factors. Genomic DNA was prepared from single adult nematodes representing forest and savannah ecotypes sampled from Togo, Ghana, Côte d'Ivoire and Mali. A qPCR assay was developed to measure the number of Wolbachia genome(s) per nematode genome. Next-generation sequencing (NGS) was also used to measure relative Wolbachia copy number, and independently verify the qPCR assay. Significant variation was observed within the forest (range: 0.02 to 452.99; median: 10.58) and savannah (range: 0.01 to 1106.25; median: 9.10) ecotypes, however, no significant difference between ecotypes (P = 0.645) was observed; rather, strongly significant Wolbachia variation was observed within and between the nine study communities analysed (P = 0.021), independent of ecotype. Analysis of ivermectin-treated and untreated nematodes by qPCR showed no correlation (P = 0.869); however, an additional analysis of a subset of the nematodes by qPCR and NGS revealed a correlation between response to ivermectin treatment and Wolbachia copy number (P = 0.020). This study demonstrates that extensive within and between population variation exists in the Wolbachia content of individual adult O. volvulus. The origin and functional significance of such variation (up to ~ 100,000-fold between worms; ~10 to 100
Garner, Amanda L; Gloeckner, Christian; Tricoche, Nancy; Zakhari, Joseph S; Samje, Moses; Cho-Ngwa, Fidelis; Lustigman, Sara; Janda, Kim D
Onchocerciasis, or river blindness, is a neglected tropical disease that affects more than 37 million people worldwide, primarily in Africa and Central and South America. We have disclosed evidence that the larval-stage-specific chitinase, OvCHT1, may be a potential biological target for affecting nematode development. On the basis of screening efforts, closantel, a known anthelmintic drug, was discovered as a potent and highly specific OvCHT1 inhibitor. Originally, closantel's anthelmintic mode of action was believed to rely solely on its role as a proton ionophore; thus, the impact of each of its biological activities on O. volvulus L3 molting was investigated. Structure-activity relationship studies on an active closantel fragment are detailed, and remarkably, by use of a simple salicylanilide scaffold, compounds acting only as protonophores or chitinase inhibitors were identified. From these data, unexpected synergistic protonophore and chitinase inhibition activities have also been found to be critical for molting in O. volvulus L3 larvae.
Segura-Cabrera, Aldo; Bocanegra-García, Virgilio; Lizarazo-Ortega, Cristian; Guo, Xianwu; Correa-Basurto, José; Rodríguez-Pérez, Mario A.
Onchocerciasis is a leading cause of blindness with at least 37 million people infected and more than 120 million people at risk of contracting the disease; most (99%) of this population, threatened by infection, live in Africa. The drug of choice for mass treatment is the microfilaricidal Mectizan® (ivermectin); it does not kill the adult stages of the parasite at the standard dose which is a single annual dose aimed at disease control. However, multiple treatments a year with ivermectin have effects on adult worms. The discovery of new therapeutic targets and drugs directed towards the killing of the adult parasites are thus urgently needed. The chitinase of filarial nematodes is a new drug target due to its essential function in the metabolism and molting of the parasite. Closantel is a potent and specific inhibitor of chitinase of Onchocerca volvulus (OvCHT1) and other filarial chitinases. However, the binding mode and specificity of closantel towards OvCHT1 remain unknown. In the absence of a crystallographic structure of OvCHT1, we developed a homology model of OvCHT1 using the currently available X-ray structures of human chitinases as templates. Energy minimization and molecular dynamics (MD) simulation of the model led to a high quality of 3D structure of OvCHIT1. A flexible docking study using closantel as the ligand on the binding site of OvCHIT1 and human chitinases was performed and demonstrated the differences in the closantel binding mode between OvCHIT1 and human chitinase. Furthermore, molecular dynamics simulations and free-energy calculation were employed to determine and compare the detailed binding mode of closantel with OvCHT1 and the structure of human chitinase. This comparative study allowed identification of structural features and properties responsible for differences in the computationally predicted closantel binding modes. The homology model and the closantel binding mode reported herein might help guide the rational development of
Jessica A Hess
Full Text Available In some regions in Africa, elimination of onchocerciasis may be possible with mass drug administration, although there is concern based on several factors that onchocerciasis cannot be eliminated solely through this approach. A vaccine against Onchocerca volvulus would provide a critical tool for the ultimate elimination of this infection. Previous studies have demonstrated that immunization of mice with Ov-103 and Ov-RAL-2, when formulated with alum, induced protective immunity. It was hypothesized that the levels of protective immunity induced with the two recombinant antigens formulated with alum would be improved by formulation with other adjuvants known to enhance different types of antigen-specific immune responses.Immunizing mice with Ov-103 and Ov-RAL-2 in conjunction with alum, Advax 2 and MF59 induced significant levels of larval killing and host protection. The immune response was biased towards Th2 with all three of the adjuvants, with IgG1 the dominant antibody. Improved larval killing and host protection was observed in mice immunized with co-administered Ov-103 and Ov-RAL-2 in conjunction with each of the three adjuvants as compared to single immunizations. Antigen-specific antibody titers were significantly increased in mice immunized concurrently with the two antigens. Based on chemokine levels, it appears that neutrophils and eosinophils participate in the protective immune response induced by Ov-103, and macrophages and neutrophils participate in immunity induced by Ov-RAL-2.The mechanism of protective immunity induced by Ov-103 and Ov-RAL-2, with the adjuvants alum, Advax 2 and MF59, appears to be multifactorial with roles for cytokines, chemokines, antibody and specific effector cells. The vaccines developed in this study have the potential of reducing the morbidity associated with onchocerciasis in humans.
Hess, Jessica A; Zhan, Bin; Torigian, April R; Patton, John B; Petrovsky, Nikolai; Zhan, Tingting; Bottazzi, Maria Elena; Hotez, Peter J; Klei, Thomas R; Lustigman, Sara; Abraham, David
In some regions in Africa, elimination of onchocerciasis may be possible with mass drug administration, although there is concern based on several factors that onchocerciasis cannot be eliminated solely through this approach. A vaccine against Onchocerca volvulus would provide a critical tool for the ultimate elimination of this infection. Previous studies have demonstrated that immunization of mice with Ov-103 and Ov-RAL-2, when formulated with alum, induced protective immunity. It was hypothesized that the levels of protective immunity induced with the two recombinant antigens formulated with alum would be improved by formulation with other adjuvants known to enhance different types of antigen-specific immune responses. Immunizing mice with Ov-103 and Ov-RAL-2 in conjunction with alum, Advax 2 and MF59 induced significant levels of larval killing and host protection. The immune response was biased towards Th2 with all three of the adjuvants, with IgG1 the dominant antibody. Improved larval killing and host protection was observed in mice immunized with co-administered Ov-103 and Ov-RAL-2 in conjunction with each of the three adjuvants as compared to single immunizations. Antigen-specific antibody titers were significantly increased in mice immunized concurrently with the two antigens. Based on chemokine levels, it appears that neutrophils and eosinophils participate in the protective immune response induced by Ov-103, and macrophages and neutrophils participate in immunity induced by Ov-RAL-2. The mechanism of protective immunity induced by Ov-103 and Ov-RAL-2, with the adjuvants alum, Advax 2 and MF59, appears to be multifactorial with roles for cytokines, chemokines, antibody and specific effector cells. The vaccines developed in this study have the potential of reducing the morbidity associated with onchocerciasis in humans.
Rodríguez-Pérez, Mario A; Unnasch, Thomas R; Domínguez-Vázquez, Alfredo; Morales-Castro, Alba L; Peña-Flores, Graciela P; Orozco-Algarra, María E; Arredondo-Jiménez, Juan I; Richards, Frank; Vásquez-Rodríguez, Miguel A; Rendón, Vidal García
All endemic communities of the Oaxaca focus of onchocerciasis in southern Mexico have been treated annually or semi-annually with ivermectin since 1994. In-depth epidemiologic assessments were performed in communities during 2007 and 2008. None of the 52,632 Simulium ochraceum s.l. collected in four sentinel communities was found to contain parasite DNA when tested by polymerase chain reaction-enzyme-linked immunosorbent assay (PCR-ELISA), resulting in an upper bound of the infection rate in the vectors of 0.07/2,000. The prevalence of microfilariae (mf) in the cornea and/or anterior chamber of the eye was also zero (0 of 1,039 residents examined; 95%-UL = 0.35%). Similarly, all 1,164 individuals examined by skin biopsy were mf negative (95%-UL = 0.31%), and sera collected from 3,569 children from 25 communities did not harbor Ov16 IgG4-antibodies (95%-UL = 0.09%). These meet the criteria for absence of morbidity and parasite transmission in the Oaxaca focus. As a result mass treatments with ivermectin were halted in 2009.
Thiele, Elizabeth A; Cama, Vitaliano A; Lakwo, Thomson; Mekasha, Sindeaw; Abanyie, Francisca; Sleshi, Markos; Kebede, Amha; Cantey, Paul T
Microscopic evaluation of skin biopsies is the monitoring and evaluation (M and E) method currently used by multiple onchocerciasis elimination programs in Africa. However, as repeated mass drug administration suppresses microfilarial loads, the sensitivity and programmatic utility of skin snip microscopy is expected to decrease. Using a pan-filarial real-time polymerase chain reaction with melt curve analysis (qPCR-MCA), we evaluated 1) the use of a single-step molecular assay for detecting and identifying Onchocerca volvulus microfilariae in residual skin snips and 2) the sensitivity of skin snip microscopy relative to qPCR-MCA. Skin snips were collected and examined with routine microscopy in hyperendemic regions of Uganda and Ethiopia (N= 500 each) and "residual" skin snips (tissue remaining after induced microfilarial emergence) were tested with qPCR-MCA. qPCR-MCA detected Onchocerca DNA in 223 residual snips: 139 of 147 microscopy(+) and 84 among microscopy(-) snips, suggesting overall sensitivity of microscopy was 62.3% (139/223) relative to qPCR-MCA (75.6% in Uganda and 28.6% in Ethiopia). These findings demonstrate the insufficient sensitivity of skin snip microscopy for reliable programmatic monitoring. Molecular tools such as qPCR-MCA can augment sensitivity and provide diagnostic confirmation of skin biopsies and will be useful for evaluation or validation of new onchocerciasis M and E tools.
Stephen R Doyle
Full Text Available Treatment of onchocerciasis using mass ivermectin administration has reduced morbidity and transmission throughout Africa and Central/South America. Mass drug administration is likely to exert selection pressure on parasites, and phenotypic and genetic changes in several Onchocerca volvulus populations from Cameroon and Ghana-exposed to more than a decade of regular ivermectin treatment-have raised concern that sub-optimal responses to ivermectin's anti-fecundity effect are becoming more frequent and may spread.Pooled next generation sequencing (Pool-seq was used to characterise genetic diversity within and between 108 adult female worms differing in ivermectin treatment history and response. Genome-wide analyses revealed genetic variation that significantly differentiated good responder (GR and sub-optimal responder (SOR parasites. These variants were not randomly distributed but clustered in ~31 quantitative trait loci (QTLs, with little overlap in putative QTL position and gene content between the two countries. Published candidate ivermectin SOR genes were largely absent in these regions; QTLs differentiating GR and SOR worms were enriched for genes in molecular pathways associated with neurotransmission, development, and stress responses. Finally, single worm genotyping demonstrated that geographic isolation and genetic change over time (in the presence of drug exposure had a significantly greater role in shaping genetic diversity than the evolution of SOR.This study is one of the first genome-wide association analyses in a parasitic nematode, and provides insight into the genomics of ivermectin response and population structure of O. volvulus. We argue that ivermectin response is a polygenically-determined quantitative trait (QT whereby identical or related molecular pathways but not necessarily individual genes are likely to determine the extent of ivermectin response in different parasite populations. Furthermore, we propose that genetic
Strote, G; Bonow, I; Attah, S
A detailed morphological investigation of the anterior sensory organs, the nerve ring and a glomerulus-like structure in male Onchocerca volvulus was performed by means of electron microscopy. The 8 head papillae are arranged in the common 4 + 4 pattern of most filarial worms in circles around the mouth opening. The amphidial openings are found between the circles of inner and outer papillae on both sides of the mouth. Inside, several additional nerve axons are seen in the tissue of the anterior tip not related to one of the identified papillar structures. The inner and outer papillae exhibit a remarkably different fine structure, and are part of a complex system of at least 2 different receptor cell types at the anterior tip of the worm. The amphidial channel contains 8 modified cilia; accessory axons are associated with the cytoplasm of the sheath cell. The anterior nerve ring of male worms is located about 150 micrometers posterior from the outermost tip of the head region. It consists of several fibres coiled around the oesophagus. The comparison of the fine structure of the central nervous system did not show the expected morphological differences associated with the heterogeneous age distribution in the natural worm population. This was in contrast to previous findings with respect to tissues in different parts of the worm. The study also provides the first evidence that suggests the existence of an excretory organ in a filarial worm in the region of the anterior nerve ring. Paired glomerulus-like structures in the lateral chords and a canal formed by a projection of the basal zone of the cuticles were identified.
Giannelli, Alessio; Latrofa, Maria S.; Dantas-Torres, Filipe; Trumble, Nicole Scotty; Chavkin, Matt; Kennard, Gavin; Eberhard, Mark L.; Bowman, Dwight D.
Infections with Onchocerca lupi nematodes are diagnosed sporadically in the United States. We report 8 cases of canine onchocercosis in Minnesota, New Mexico, Colorado, and Florida. Identification of 1 cytochrome c oxidase subunit 1 gene haplotype identical to 1 of 5 from Europe suggests recent introduction of this nematode into the United States. PMID:25897859
La variabilité génétique d'#Onchocerca volvulus$ a été étudiée sur plusieurs isolats du Cameroun. Cette filaire est la deuxième cause infectieuse de cécité dans le monde et affecte, selon l'OMS, environ 17 millions de personnes en Afrique, en Amérique Centrale et en Amérique du Sud. La complexité de l'épidémiologie de l'onchocercose apparaît liée à l'existence de différentes souches du parasite qui sont à l'origine de taux de cécités très variables selon les régions étudiées. Plusieurs types ...
ABSTRACT. A survey of the distribution of Simulium species complex population and its infection rate with ... Statistical analysis using t-test and ANOVA revealed that there was no significant .... B.A. Bissan, Y. (1995): Impact of combined.
Zhao, Guangyu; Du, Lanying; Xiao, Wenjun; Sun, Shihui; Lin, Yongping; Chen, Min; Kou, Zhihua; He, Yuxian; Lustigman, Sara; Jiang, Shibo; Zheng, Bo-Jian; Zhou, Yusen
Our previous studies have shown the adjuvanticity of an Onchocerca volvulus recombinant protein, Ov-ASP-1 (ASP-1), when administered in an aqueous formulation with bystander vaccine antigens or commercial vaccines. In this study, we reported a novel formulation that took advantage of the protein nature of the ASP-1 adjuvant by creating recombinant fusion protein vaccines linking the highly conserved extracellular domain of M2 protein (M2e) consensus sequence of H5N1 influenza viruses with the ASP-1 adjuvant. Two recombinant fusion proteins designated M2e-ASP-1 and M2e3-ASP-1 were studied, in which ASP-1 was fused with one or three tandem copies of the M2e antigen. Our results show that these novel recombinant influenza vaccines, particularly M2e3-ASP-1, induced strong anti-M2e-specific humoral and cellular immune responses in the established mouse model. Furthermore, M2e3-ASP-1 was able to provide significant cross-clade protection against divergent H5N1 viruses. Consequently, this study has demonstrated a potential novel vaccine formulation that could provide a complementary prophylactic strategy in preventing the threat of future influenza outbreak resulting from rapid evolution of the H5N1 virus and co-circulation of multiple antigenic variants in various regions. Copyright © 2010 Elsevier Ltd. All rights reserved.
Awadzi, K; Opoku, Nicholas O; Attah, Simon K; Lazdins-Helds, Janis K; Kuesel, Annette C
.... The Onchocerciasis Control Programme (OCP) had established procedures to detect O. volvulus infections via the localized skin reaction induced by killing of microfilariae upon skin exposure to diethylcarbamazine via a patch (OCP-patch...
Ortega, M; Oliver, M; Ramírez, A
In Guatemala, there is no doubt about the participation of Simulium ochraceum as vector of Onchocerciasis. However, in Mexico practically there are not studies focussed to determine the role of this species in the transmission. The objective of the present investigation was to determine which of the 3 species of Simulium founded in the Soconusco region of Chiapas, is the main, and which were secondary in the transmission of Onchocerciasis in that area. The locality of Morelos, in the Huixtla "municipio" of Chiapas, localized a 1200 meters over the sea level (mosl) were selected to carried out the present study. According to own parasitological studies, this locality is considered as highly endemic (more than 66% prevalence). From March 1979 to March, 1981, we performed captures of Simulium sp caught on human bait. Quantitative studies and of transmission potentials were also performed. The following results were obtained: a) Absolute black flies densities (nulliparous and pariparous) and infected black flies (with L1 and L2 larvae): S. ochraceum, S. metallicum and S. callidum, in that order was the distribution of densities. Infected black flies were obtained in the 3 species. However, in despite of an irregular distribution in all the year, it was possible to identify 2 peaks of maximum infection of S. ochraceum in March, 1979 and March 1981. b) Monthly bite densities and infective bites.(ABSTRACT TRUNCATED AT 250 WORDS)
Ortega Gutiérrez, M; Ramírez, A; Miranda, R
In this research we tried to demonstrate differences in transmission intensities of onchocerciasis by Simulium ochraceum in the community of Golondrinas, Municipality of Acacoyagua in the Soconusco area of the state of Chiapas. Adult females of this species were captured in the center of the villages, the coffee plantation, and the corn bean planted plots, during 7 to 10 consecutive days of the months of June, August, November and December of 1983, and January, March, and May of 1984. Captures were made from 7:00 to 11:00 h, by two persons (a human bait and a collector) in each of the mentioned areas. Variations in densities of S. ochraceum were not statistically significant among the different areas, although there was a predominance in the center of the villages during all the time periods. There was not a statistical significance in the number of oviparous females, although again the center of 50 villages showed the highest percentages (43.5%), as compared to the coffee plantation (37.8%), and the corn-bean plots (33.8%). Regarding the ratio infection: infectivity, only the infective mosquitoes with L3 showed a statistical significance in the three types of areas, being highest in the center of the villages. Transmission potentials were: center of the village 28.5 L3/human/period; coffee plantation, 73 L3/human/period; corn-bean plot, 5.8 L3/human/period. We discuss the possibility that the differences in densities among the various areas might depend on the variations of the breeding sites, mobility or permanence of the individuals during the hours of greater activity of S. ochraceum, and the wind and light local conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
Full Text Available Wild female black flies attracted to a man or an idling automobile were collected at Oita, Japan where five cases of zoonotic onchocerciasis had occurred. Among the five Simulium species captured, 2% of Simulium bidentatum, the predominant species, were infected with filarial larvae. There were at least two types of infective larvae, types A and B, based on morphometric observation. Moreover, molecular analysis of the mitochondrial cytochrome c oxidase subunit 1 (CO1 gene revealed that types A and B were represented by a single unknown species of Onchocerca and two species, i.e., Onchocerca dewittei japonica from wild boar, the causative agent of zoonotic onchocerciasis in Japan, and an undescribed Onchocerca sp. from wild boar, respectively. Phylogenetic analysis based on the sequences of the mitochondrial 12S ribosomal RNA (12S rRNA gene also showed that type A is likely to be an unknown species of Onchocerca. Natural infection of black flies with infective larvae of O. dewittei japonica and O. sp. was demonstrated for the first time. The present study strongly suggests that S. bidentatum plays a role as a vector in the transmission of zoonotic onchocerciasis due to O. dewittei japonica in Japan.
Philip J Cooper
Full Text Available Trends in prevalence rates of onchocercal ocular lesions were examined over the period 1980 to 1990 using data from two cross-sectional surveys. There was evidence for increasing prevalence of anterior chamber microfilariae, iridocyclitis, optic atrophy, and chorioretinopathy. Large increases in prevalence, in particular, were seen for posterior segment lesions: optic atrophy increased from 2.7% to 6.4% and chorioretinopathy from 8.8% to 35.6%. Greatest increases in these lesions were seen in the Chachi which was attributed to the large increases in prevalence of microfilariae in the anterior chamber particularly in those aged 30 years or greater. The study findings suggest that ocular onchocerciasis is evolving in parallel with the well documented parasitological changes.
Full Text Available Several Simulium species were investigated as to their biting habits and natural infections with filarial larvae at Ban Pan Fan, Chiang Mai Province, in northern Thailand. Female adults flies landing on or flighting around a human and a water buffalo were collected during the daytime from 06.00 to 19.00 hours on 22 June 2001. As a result, 217 S. nodosum, 86 S. asakoae and two S. nigrogilvum were obtained from a human attractant, and 416 S. nodosum, 25 S. nakhonense, 16 S. asakoae, four 5. fenestratum and two S. nigrogilvum, from a water buffalo. The blood-feeding was confirmed only for S. nodosum and S. nigrogilvum on humans, and for S. nodosum and S. nakhonense on water buffalos. Dissections of these simuliids showed that S. nodosum was naturally infected with developing filarial larvae. Two types of microfilariae were distinguished but only one type of infective larvae. These larvae resembled Onchocerca suzukii, a parasite from a wild Japanese bovid, suggesting that an unknown Onchocerca species from ruminants was transmitted in Thailand. Infection rates with all stages of larvae and third-stage larvae were 2.3 % (14/608 and 1 .0 % (6/608, respectively. This is the first report of natural infections of black flies with Onchocerca larvae in Southeast Asia, and the involved black fly species is shown to be not only anthropophilic but also zoophilic in this region.
Tritten, Lucienne; O'Neill, Maeghan; Nutting, Chuck; Wanji, Samuel; Njouendoui, Abdel; Fombad, Fanny; Kengne-Ouaffo, Jonas; Mackenzie, Charles; Geary, Timothy
A combination of deep-sequencing and bioinformatics analysis enabled identification of twenty-two microRNA candidates of potential nematode origin in plasma from Loa loa-infected baboons and a further ten from the plasma of an Onchocerca ochengi-infected cow. The obtained data were compared to results from previous work on miRNA candidates from Dirofilaria immitis and O. volvulus found in host circulating blood, to examine the species specificity of the released miRNA. None of the miRNA candidates was found to be present in all four host-parasite scenarios and most of them were specific to only one of them. Eight candidate miRNAs were found to be identical in the full sequence in at least two different infections, while nine candidate miRNAs were found to be similar but not identical in at least four filarial species.
... Complications Possible complications of volvulus are: Secondary peritonitis Short bowel syndrome (after removal of a large part of the ... obstruction Nausea and vomiting - adults Peritonitis - secondary Shock Short bowel syndrome Review Date 7/22/2016 Updated by: Subodh ...
Lustigman, Sara; Makepeace, Benjamin L; Klei, Thomas R; Babayan, Simon A; Hotez, Peter; Abraham, David; Bottazzi, Maria Elena
Human onchocerciasis - commonly known as river blindness - is one of the most devastating yet neglected tropical diseases, leaving many millions in sub-Saharan Africa blind and/or with chronic disabilities. Attempts to eliminate onchocerciasis, primarily through the mass drug administration of ivermectin, remains challenging and has been heightened by the recent news that drug-resistant parasites are developing in some populations after years of drug treatment. Needed, and needed now, in the fight to eliminate onchocerciasis are new tools, such as preventive and therapeutic vaccines. This review summarizes the progress made to advance the onchocerciasis vaccine from the research laboratory into the clinic. Copyright © 2017 Elsevier Ltd. All rights reserved.
Full Text Available Gastric volvulus is an uncommon condition more so in the paediatric age group. The cause of gastric volvulus may be idiopathic or secondary to various congenital or acquired conditions. In this short series of three patients, one had volvulus which was due to ligamentous laxity and mobile spleen, second had congenital postero-lateral diaphragmatic defect and the third had hiatus hernia.
Gooyit, Major; Tricoche, Nancy; Lustigman, Sara; Janda, Kim D
The L3-stage-specific chitinase OvCHT1 has been implicated in the development of Onchocerca volvulus, the causative agent of onchocerciasis. Closantel, a known anthelmintic drug, was previously discovered as a potent and specific OvCHT1 inhibitor. As closantel is also a known protonophore, we performed a simple scaffold modulation to map out the structural features that are relevant for its individual or dual biochemical roles. Furthermore, we present that either OvCHT1 inhibition or protonophoric activity was capable of affecting O. volvulus L3 molting and that the presence of both activities in a single molecule yielded more potent inhibition of the nematode's developmental process.
The L3-stage-specific chitinase OvCHT1 has been implicated in the development of Onchocerca volvulus, the causative agent of onchocerciasis. Closantel, a known anthelmintic drug, was previously discovered as a potent and specific OvCHT1 inhibitor. As closantel is also a known protonophore, we performed a simple scaffold modulation to map out the structural features that are relevant for its individual or dual biochemical roles. Furthermore, we present that either OvCHT1 inhibition or protonophoric activity was capable of affecting O. volvulus L3 molting and that the presence of both activities in a single molecule yielded more potent inhibition of the nematode’s developmental process. PMID:24918716
Full Text Available Twenty-seven species of the genus Onchocerca (Nematoda; Filarioidea can cause a vector-borne parasitic disease called onchocercosis. Most Onchocerca species infect wild and domestic ungulates or the dog, and one species causes river blindness in humans mainly in tropical Africa. The European red deer (Cervus e. elaphus is host to four species, which are transmitted by blackflies (simuliids or biting midges (ceratopogonids. Two species, Onchocerca flexuosa and Onchocerca jakutensis, produce subcutaneous nodules, whereas Onchocerca skrjabini and Onchocerca garmsi live free in the hypodermal serous membranes. During the hunting season, September 2013, red deer (n = 25, roe deer (Capreolus c. capreolus, n = 6 and chamois (Rupicapra r. rupicapra, n = 7, all shot in the Grisons Region (Switzerland were investigated for the presence of subcutaneous nodules which were enzymatically digested, and the contained Onchocerca worms were identified to species by light and scanning electron microscopy as well as by PCR/sequencing. In addition, microfilariae from skin samples were collected and genetically characterized. Neither nodules nor microfilariae were discovered in the roe deer and chamois. Adult worms were found in 24% of red deer, and all of them were identified as O. jakutensis. Two morphologically different microfilariae were obtained from five red deer, and genetic analysis of a skin sample of one red deer indicated the presence of another Onchocerca species. This is the first report of O. jakutensis in Switzerland with a prevalence in red deer similar to that in neighbouring Germany.
Krueger, A; Fischer, P; Morales-Hojas, R
Filarial parasites of the genus Onchocerca are found in a broad spectrum of ungulate hosts. One species, O. volvulus, is a human parasite that can cause severe disease (onchocerciasis or 'river blindness'). The phylogenetic relationships and the bionomics of many of the nearly 30 known species remain dubious. Here, the phylogeny of 11 species representing most major lineages of the genus is investigated by analysing DNA sequences from three mitochondrial genes (ND5, 12S and 16S rRNA) and portions of the intergenic spacer of the nuclear 5s rRNA. Special emphasis is given to a clade containing a yet unassigned specimen from Uganda (O. sp. 'Siisa'), which appears to be intermediate between O. volvulus and O. ochengi. While the latter can be differentiated by the O-150 tandem repeat commonly used for molecular diagnostics, O. volvulus and O. sp.'Siisa' cannot be differentiated by this marker. In addition, a worm specimen from an African bushbuck appears to be closely related to the bovine O. dukei and represents the basal taxon of the human/bovine clade. At the base of the genus, our data suggest O. flexuosa (red deer), O. ramachandrini (warthog) and O. armillata (cow) to be the representatives of ancient lineages. The results provide better insight into the evolution and zoogeography of Onchocerca. They also have epidemiological and taxonomic implications by providing a framework for more accurate molecular diagnosis of filarial larvae in vectors.
Full Text Available Sigmoid volvulus complicating pregnancy is an extremely rare complication with fewer than 76 cases reported in literature. We report a case of sigmoid volvulus complicating pregnancy. The sigmoid colon was resected and Hartman′s colostomy was performed. The patient had a successful recovery. Aggressive resuscitation followed by early surgical intervention should be undertaken to reduce maternal and fetal morbidity and mortality.
Sana, Landolsi; Ali, Gassara; Kallel, Helmi; Amine, Baklouti; Ahmed, Saadaoui; Ali, Elouer Mohamed; Wajdi, Chaeib; Saber, Mannaï
We report a case of spontaneous transverse colon volvulus in a young healthy woman. It constitutes an unusual case since it occurred in a young healthy woman with a subacute onset and no aetiological factor has been found. Its diagnosis is still challenging. Prompt recognition with emergency intervention constitutes the key to successful outcome.
Atamanalp, Sabri Selçuk; Öztürk, Gürkan
To review the clinical outcomes of 9 patients with sigmoid volvulus (SV), a rare complication during pregnancy. Materials and methods: The clinical records of the patients were reviewed retrospectively. Results: The age range of the patients was 24-39 years (mean: 30.6 years). All patients were multiparous, and 6 patients (66.7%) were in the third trimester when diagnosed with SV. The main clinical features were abdominal pain/tenderness, obstipation, and distention in all patients (100.0%...
Atamanalp, Sabri Selcuk; Kisaoglu, Abdullah; Ozogul, Bunyami; Kantarci, Mecit; Disci, Esra; Bulut, O Hakan; Aksungur, Nurhak; Atamanalp, Refik Selim
Sigmoid volvulus during pregnancy is a rare complication, and as of 2012, fewer than 100 cases had been reported. In this report, we present a 30 year-old pregnant woman with sigmoid volvulus, and we discuss this rare entity.
Atamanalp, Sabri Selcuk; Kisaoglu, Abdullah; Ozogul, Bunyami; Kantarci, Mecit; Disci, Esra; Bulut, O. Hakan; Aksungur, Nurhak; ATAMANALP, Refik Selim
Sigmoid volvulus during pregnancy is a rare complication, and as of 2012, fewer than 100 cases had been reported. In this report, we present a 30 year-old pregnant woman with sigmoid volvulus, and we discuss this rare entity.
Full Text Available Sigmoid volvulus although a common cause of large bowel obstruction in the elderly, is encountered rarely in the pediatric age group. We report a case of sigmoid volvulus in a 10 - year - old child. The various predisposing factors for sigmoid volvulus in children are discussed, and th e literature on the subject is also reviewed.
Budhichandra Singh; Mahele; Tozo; Gyan Singh; Manihar Singh
Sigmoid volvulus although a common cause of large bowel obstruction in the elderly, is encountered rarely in the pediatric age group. We report a case of sigmoid volvulus in a 10 - year - old child. The various predisposing factors for sigmoid volvulus in children are discussed, and th e literature on the subject is also reviewed.
Berg, Anna Korsgaard; Perdawood, Sharaf
This case presents a synchronous sigmoid- and caecum volvulus in a 69-year old man with Parkinson's disease, hypertension and previous history of colonic volvulus. On admission the patient had abdominal pain, nausea, vomiting and constipation. The CT scan showed a sigmoid volvulus with a dilated...
Full Text Available Abstract Background Among ocular vector-borne pathogens, Onchocerca volvulus, the agent of the so-called “river blindness”, affects about 37 million people globally. Other Onchocerca spp. have been sporadically reported as zoonotic agents. Cases of canine onchocerciasis caused by Onchocerca lupi are on the rise in the United States and Europe. Its zoonotic role has been suspected but only recently ascertained in a single case from Turkey. The present study provides further evidence on the occurrence of O. lupi infesting human eyes in two patients from Turkey (case 1 and Tunisia (case 2. The importance of obtaining a correct sample collection and preparation of nematodes infesting human eyes is highlighted. Methods In both cases the parasites were identified with morpho-anatomical characters at the gross examination, histological analysis and anatomical description and also molecularly in case 1. Results The nematode from the first case was obviously O. lupi based on their morphology at the gross examination, histological analysis and anatomical description. In the second case, although the diagnostic cuticular characters were not completely developed, other features were congruent with the identification of O. lupi. Furthermore, the morphological identification was also molecularly confirmed in the Turkish case. Conclusions The results of this study suggest that O. lupi infestation is not an occasional finding but it should be considered in the differential diagnosis of other zoonotic helminths causing eye infestation in humans (e.g., D. immitis and Dirofilaria repens. Both cases came from areas where no cases of canine onchocerciasis were previously reported in the literature, suggesting that an in depth appraisal of the infestation in canine populations is necessary. Physicians and ophthalmologists are advised on how to preserve nematode samples recovered surgically, to allow a definitive, correct etiological diagnosis.
Blake, Erin; Gonzalez, Eduardo; Pieracci, Frederic
Background. Sigmoid volvulus is a rare complication of pregnancy and the puerperium. Case. A 19-year-old patient, gravida 1 para 0 at 41 0/7 weeks of gestation, admitted for late-term induction of labor underwent an uncomplicated primary low transverse cesarean delivery for arrest of descent. Her postoperative period was complicated by sudden onset of abdominal pain and the ultimate diagnosis of sigmoid volvulus. Conclusion. Prompt surgical evaluation of an acute abdomen in the postpartum period is essential; delayed diagnosis and treatment can lead to significant maternal morbidity and mortality.
Dequiedt, C; Milicevic, M
Sigmoid volvulus is a significant cause of bowel obstruction and will become a major cause in the future given its prevalence in the elderly and/or institutionalized patients. Furthermore that's the first cause of bowel obstruction in pregnant women. Given it's a non specific clinical presentation, the clinician has to do complementary exams, above all the x ray examinations. So, the role of radiologist is primordial in diagnostic, sometimes in the treatment given important morbidity and mortality of this pathology. We bring you here a typical case of sigmoid volvulus in 60 years old patient seen in emergency department for bloating and vomiting since several days.
Kelsey E. Ward
Full Text Available Background. Sigmoid volvulus is a rare complication of pregnancy and the puerperium. Case. A 19-year-old patient, gravida 1 para 0 at 41 0/7 weeks of gestation, admitted for late-term induction of labor underwent an uncomplicated primary low transverse cesarean delivery for arrest of descent. Her postoperative period was complicated by sudden onset of abdominal pain and the ultimate diagnosis of sigmoid volvulus. Conclusion. Prompt surgical evaluation of an acute abdomen in the postpartum period is essential; delayed diagnosis and treatment can lead to significant maternal morbidity and mortality.
Joy R Guderian
Full Text Available The prevalence of onchocerciasis infection was determined in communities on 7 rivers located in the northern area of the cantón San Lorenzo, province of Esmeraldas. Diagnosis of the infection was obtained by skin biopsies and recombinant-antigen based-serology. No evidence of infection was detected in 9 communities studied along the Río Mataje, which forms the frontier between Ecuador and Colombia, nor in 10 adjacent communities located on 5 interior rivers. Evidence for Onchocerca volvulus infection was found in 4 communities on the Río Tululví with the following prevalence: La Boca (3.5% by biopsy and 3.9% by serology, Guayabal (9.1% by both biopsy and serology, La Ceiva (51.5% by biopsy and 53% by serology, and Salidero (4% by biopsy and 7.7% by serology. A few individuals in these communities were seropositive for O. volvulus in the absence of detectable dermal microfilariae: these might harbor very light or prepatent infections. No clinical disease attributable to onchocerciasis was found. The infected communities will be included in the ivermectin-based National Control Program for the disease, with no evidence of the infection having extended north of the Ecuadorian-colombian border
Full Text Available We encountered a case of gallbladder volvulus in an 88-year-old thin female in which the initial presentation was more consistent with that of acute appendicitis. After complete work-up, including physical exam, lab work, and computed tomography, the definite diagnosis of gallbladder volvulus was not made until intraoperative visualization was obtained. Gallbladder volvulus is a rare but serious condition, which requires a high clinical suspicion so prompt surgical intervention can be undertaken.
Meytes, Vadim; Schulberg, Steven P; Morin, Nicholas; Glinik, Galina
The incidence of hypothyroidism presenting with sigmoid volvulus, a phenomenon known as myxedema pseudovolvulus, is exceedingly rare. A male in his late thirties presented to our institution with a chief complaint of abdominal pain. The patient underwent CT scan, which was consistent with massive colonic dilatation with sigmoid volvulus. He was taken to the operating room for exploration and was found to have sigmoid volvulus and underwent a segmental resection. Postoperatively, the patient was newly diagnosed with severe hypothyroidism.
Meytes, Vadim; Schulberg, Steven P.; Morin, Nicholas; Glinik, Galina
The incidence of hypothyroidism presenting with sigmoid volvulus, a phenomenon known as myxedema pseudovolvulus, is exceedingly rare. A male in his late thirties presented to our institution with a chief complaint of abdominal pain. The patient underwent CT scan, which was consistent with massive colonic dilatation with sigmoid volvulus. He was taken to the operating room for exploration and was found to have sigmoid volvulus and underwent a segmental resection. Postoperatively, the patient w...
Rodríguez-Pérez, M A; Rivas-Alcalá, A R
The treatment and control of onchocerciasis in Mexico has been supported only on the administration of diethylcarbamazine and the removal of adult worms, which are in the onchocercomata. These actions seems to have diminished the prevalence and incidence of blindness in those individuals who are affected by this parasitosis. However, there has not been an important impact on onchocerciasis transmission. The objective of this paper is to critically analyze and discuss subjects related to diagnosis, treatment and control of onchocerciasis transmission in Mexico. Chemical vector control has been successfully achieved in other world regions; however, in Mexico, it has not been fully accepted as part of the integral onchocerciasis control due to several causes. Moreover, there has been few scientific research activities toward the search of new options for vector control. Recently, results of research on ivermectin (a microfilaricide agent) have indicated that this drug is effective and safe for the treatment of onchocerciasis. Additionally, it has been reported that ivermectin has an effect on the onchocerciasis transmission. However, there are several unanswered questions about the efficacy of ivermectin in stopping onchocerciasis transmission. In this report, the main efforts carried out in Mexico against onchocerciasis are analysed and problems related with diagnosis, treatment and control are also discussed. Some parameters for the correct evaluation of onchocerciasis control, with entomological emphasis, are proposed.
Gonzalez, Rodrigo J; Cruz-Ortiz, Nancy; Rizzo, Nidia; Richards, Jane; Zea-Flores, Guillermo; Domínguez, Alfredo; Sauerbrey, Mauricio; Catú, Eduardo; Oliva, Orlando; Richards, Frank O; Lindblade, Kim A
.... We evaluated whether transmission of onchocerciasis has been interrupted in the endemic focus of Escuintla-Guatemala in Guatemala, based on World Health Organization criteria for the certification...
Millet, Ingrid; Orliac, Celine; Alili, Chakib; Taourel, Patrice [Hopital Lapeyronie, Department of Radiology, Montpellier (France); Guillon, Francoise [University Hospital of Montpellier, Department of Surgery, Montpellier (France)
To assess the diagnostic performance of CT signs of gastric volvulus in both confirmed cases and control subjects. We retrospectively reviewed CT findings in 10 patients with surgically confirmed acute gastric volvulus and 20 control subjects with gastric distension. Two radiologists independently evaluated CT images for risk factors of gastric volvulus, direct findings of gastric volvulus by assessing gastric dilatation, the presence of an antropyloric transition point, the respective position of the different stomach segments and of the greater and lesser curvatures, stenosis of the gastric segments through the oesophageal hiatus and for findings of gastric ischemia. The sensitivity and specificity of each finding were calculated. The most sensitive direct signs of gastric volvulus were an antropyloric transition point without any abnormality at the transition zone and the antrum at the same level or higher than the fundus. The presence of both these two findings as diagnostic criteria of gastric volvulus had 100 % sensitivity and specificity for the diagnosis of gastric volvulus. There was no association between CT signs of ischemia and final bowel ischemia at pathology. CT is both highly sensitive and specific for diagnosing acute gastric volvulus. (orig.)
Bharti; Sanjay,; Neeraj K; Rajendra Kumar
Sigmoid volvulus is an extremely rare cause of intestinal obstruction. The pregnancy itself clouds the clinical picture of sigmoid volvulus, leads to delay in diagnosis with an increases risk of gangrene formation of the gut. Here at our institution a 23 year old lady of 8 months pregnancy with chronic constipation and progressive abdom...
Full Text Available Background: Intestinal volvulus (IV can occur at various sites of the gastrointestinal tract. In Europe, IV in children is most frequently due to malrotation but in Asia Ascaris infestation is a common cause. This report reviews the experience with IV in children in Tunisia; analyzes the aetiologies as well as the clinical presentations and the benefits of the Ladd′s procedure in the treatment of the IV. Patients and Methods: The authors retrospectively reviewed the case records of all children with IV from January 2000 to December 2009 at the Tunis Children′s Hospital. Results: There were 22 boys and nine girls with an age range of one day to four years. Twenty-five (80% patients presented during the neonatal period. The most common presentation was bilious vomiting and dehydration. The aetiology was identified in all patients: Anomalies in rotation (n=22, omphalo-mesenteric duct (n=3, internal hernia (n=3, cystic lymphangioma (n=2, caocal volvulus (n=1. The bowel resection rate for gangrene was 16%. All patients with malrotation had Ladd′s procedure performed. Five patients (19% developed wound infections. One patient presented with adhesive small bowel obstruction. There were no recurrences following Ladd′s procedure for malrotation. Two neonates (6% died from overwhelming infections. Intestinal volvulus in our environment differs in aetiology from other reports. The resection rates are not similar, however. Conclusion: Early diagnosis reduced the high morbidity and mortality in our study.
Full Text Available We describe Onchocerca dewittei japonica n. subsp. from the Japanese wild boar, Sus scrofa leucomystax, in Oita, Kyushu Island, where all seven animals examined were found to be infected. This study began with efforts to identify the causative species in a recent case of zoonotic onchocerciasis. Compared with Onchocerca dewittei dewittei from Sus scrofa jubatus in Malaysia, which was reexamined here, our new subspecies has much greater space between the ridges on the females. In addition, its microfilariae (from uteri are shorter (192-210 μm compared with 228-247 μm, and only the posterior third of the microfilarial body is coiled, instead of the entire body. The Onchocerca species parasitic in suids (these two subspecies and O. ramachandrini from the warthog in the Ethiopian region form a group sharing several characters. Among the most unusual characters are the body swellings (a specialized apparatus for mating, known in only a few other genera. In addition, longitudinal cuticular crests were found on males of both subspecies from wild boar and on females of O. ramachandrini.
Seow-En, I; Seow-Choen, F
Definitive surgical management of sigmoid volvulus is usually via a midline laparotomy or laparoscopy. We report our experience with a series of five consecutive cases over a 10-year period. All patients had definitive surgery via a left iliac fossa mini-incision after prior decompression. For four patients, it was the first episode of sigmoid volvulus and one patient had a recurrent sigmoid volvulus after previous sigmoid colectomy. The latter patient had pan colonic megacolon diagnosed at initial surgery. All five cases were surgically treated successfully via a mini-incision on the left iliac fossa. There were no instances of recurrence at a median follow-up duration of 95 months (range 7-132 months). A left iliac fossa mini-incision is sufficient for the definitive management of non-perforated sigmoid volvulus. Larger studies are warranted to draw definitive conclusions.
Şen, Metin; Turan, Mustafa; Topçu, Ömer; Koyuncu, Ayhan; Karadayı, Kürşat; Aydın, Cengiz
Abstract Aim. The aim of this retrospective study is to assess the mortality and morbidity after different types operations for sigmoid volvulus. Method. The results of surgical treatment of our patients with sigmoid volvulus were analyzed retrospectively. The patients were divided into two groups: Group-1: Single Stage Surgery (SSS) and Group-2: Hartmann’s Procedure (HP). Results. Total 51 patients aged 65.9 years in average (between 22-88 years) were included. In comparing the morbidity rat...
Metin Şen; Mustafa Turan; Ömer Topçu; Ayhan Koyuncu; Kürşat Karadayı; Cengiz Aydın
Aim. The aim of this retrospective study is to assess the mortality and morbidity after different types operations for sigmoid volvulus. Method. The results of surgical treatment of our patients with sigmoid volvulus were analyzed retrospectively. The patients were divided into two groups: Group-1: Single Stage Surgery (SSS) and Group-2: Hartmann’s Procedure (HP). Results. Total 51 patients aged 65.9 years in average (between 22-88 years) were included. In comparing the morbidity rates of SSS...
Conclusions: Sigmoid volvulus is a medical emergency and diagnosis requires a high index of suspicion. Emergent EDDR and decompression tube placement should be utilized as a first line treatment for patients with uncomplicated sigmoid volvulus.
Full Text Available In order to clarify the genetic differences between Onchocerca dewittei japonica, the causative agent of zoonotic onchocerciasis in Japan and a related undescribed Onchocerca sp., both parasitizing wild boar (Sus scrofa of which the infective larval stages are indistinguishable from each other, we compared the sequences of the mitochondrial cytochrome c oxidase subunit 1 (CO1 gene region from four infective larvae (recovered from experimentally infected black flies, one microfilaria, and one adult of O. dewittei japonica, and from one infective larva (recovered from an experimentally infected black fly, one microfilaria, and a pool of several microfilariae of O. sp. The length of the CO1 gene region was 649 bp for all samples but there was a difference of 8.8 to 9.4% in the sequences between the two species although there were intraspecific variations of 0 to 0.5%. The CO1 sequences of O. sp. did not correspond to any of those deposited in the databases. Our study provides evidence that O. dewittei japonica and O. sp. are genetically different from each other.
Full Text Available Sigmoid volvulus is an extremely rare cause of intestinal obstruction. The pregnancy itself clouds the clinical picture of sigmoid volvulus, leads to delay in diagnosis with an increases risk of gangrene formation of the gut. Here at our institution a 23 year old lady of 8 months pregnancy with chronic constipation and progressive abdominal distension presented. Her clinical examination and investigations revealed possibility of fecal impaction in colon and single viable fetus. Exploratory laparotomy was done, volvulus of sigmoid colon filled with enormous fecolith was found. Resection of bowel loop was done and a healthy preterm baby was delivered by caesarian section. Proximal diversion end colostomy was done. Both mother and child were healthy at one month follow up. However an early diagnosis and intervention as in our case, which would require a high index of clinical suspicion, could significantly improve the maternal and fetal prognosis. A review of literature did not reveal a sigmoid volvulus with enormous fecolith and good outcome of mother and baby. KEYWORDS: Sigmoid Volvulus; Pregnancy; Intestinal obstruction .
deC Bronsvoort Barend M
Full Text Available Abstract Background Human onchocerciasis or river blindness, caused by the filarial nematode Onchocerca volvulus, is currently controlled using the microfilaricidal drug, ivermectin. However, ivermectin does not kill adult O. volvulus, and in areas with less than 65% ivermectin coverage of the population, there is no effect on transmission. Therefore, there is still a need for a macrofilaricidal drug. Using the bovine filarial nematode O. ochengi (found naturally in African cattle, the macrofilaricidal efficacy of the modified flubendazole, UMF-078, was investigated. Methods Groups of 3 cows were treated with one of the following regimens: (a a single dose of UMF-078 at 150 mg/kg intramuscularly (im, (b 50 mg/kg im, (c 150 mg/kg intraabomasally (ia, (d 50 mg/kg ia, or (e not treated (controls. Results After treatment at 150 mg/kg im, nodule diameter, worm motility and worm viability (as measured by metabolic reduction of tetrazolium to formazan declined significantly compared with pre-treatment values and concurrent controls. There was abrogation of embryogenesis and death of all adult worms by 24 weeks post-treatment (pt. Animals treated at 50 mg/kg im showed a decline in nodule diameter together with abrogated reproduction, reduced motility, and lower metabolic activity in isolated worms, culminating in approximately 50% worm mortality by 52 weeks pt. Worms removed from animals treated ia were not killed, but exhibited a temporary embryotoxic effect which had waned by 12 weeks pt in the 50 mg/kg ia group and by 24 weeks pt in the 150 mg/kg ia group. These differences could be explained by the different absorption rates and elimination half-lives for each dose and route of administration. Conclusion Although we did not observe any signs of mammalian toxicity in this trial with a single dose, other studies have raised concerns regarding neuro- and genotoxicity. Consequently, further evaluation of this compound has been suspended. Nonetheless
Full Text Available Resection is the most common treatment choice for sigmoid volvulus, a common complication in our region. A new minimally invasive technique for sigmoid resection with local anesthesia was done in this study. This method is invented to avoid general on regional anesthesia in high-risk patients. Nineteen patients were evaluated and then 14 were enrolled in this study. Sigmoidectomy with a left lower quadrant incision was performed and demographic data, the length of hospital stay, complications and procedure time were recorded. The mean age of participants was 65.68, and the male to female ratio was 1:2.7. The mean duration of the operation was 91.42 min. Complications include one case each of wound hematoma and wound infection. The intraoperative pain score was 1.2/10 and postoperative pain score was 2.35/10. The mean hospital staying was 8.3 days. By meticulous patient selection, sigmoidectomy under local anesthesia for sigmoid volvulus could be a surgeons’ armamentarium in special situations.
Ba, P A; Diop, B; Soumah, S A
The aim of this study is to report our experience in the management of sigmoid volvulus in a tropical environment. This retrospective study covers the period from June 1, 2010, to December 31, 2013, in the department of emergency surgery at the regional hospital of Thiés: 40 patients were admitted with sigmoid volvulus: 36 men and 4 women, with a mean age of 45 years (20-89 years). Twelve had chronic constipation. All four signs of occlusion were present in 72.5% of cases. Abdominal radiography confirmed the diagnosis in all cases. The volvulus resolved spontaneously in one patient, while the other 39 required laparotomy: 25 had a one-stage colectomy, and 11 patients a sigmoidectomy with a temporary colostomy. Two patients underwent a sigmoidopexy, one with a simple closure of a perforated duodenal ulcer. The morbidity rate was 7.5%, due mainly to complications of infection. The mortality rate was 10%. After a mean follow-up of 2.77 months (range: 15 days-12 months), no recurrences were observed. Sigmoid volvulus is a common condition in Africa especially in younger patients. The diagnosis is easy, based on clinical and abdominal radiography findings. Several procedures have been described but the one-stage colectomy remains the method of choice, especially in tropical areas where socioeconomic conditions are difficult.
Cho-Ngwa, Fidelis; Monya, Elvis; Azantsa, Boris K; Manfo, Faustin Pascal T; Babiaka, Smith B; Mbah, James A; Samje, Moses
Onchocerciasis is the world's second leading infectious cause of blindness. Its control is currently hampered by the lack of a macrofilaricidal drug and by severe adverse events observed when the lone recommended microfilaricide, ivermectin is administered to individuals co-infected with Loa loa. Therefore, there is the need for a safe and effective macrofilaricidal drug that will be able to cure the infection and break transmission cycles, or at least, an alternative microfilaricide that does not kill L. loa microfilariae (mf). Fourteen extracts from two medicinal plants, Tragia benthami and Piper umbellatum were screened in vitro against Onchocerca ochengi parasite and L. loa mf. Activities of extracts on male worms and microfilariae were assessed by motility reduction, while MTT/Formazan assay was used to assess biochemically the death of female worms. Cytotoxicity and acute toxicity of active extracts were tested on monkey kidney cells and Balb/c mice, respectively. At 500 μg/mL, all extracts showed 100 % activity on Onchocerca ochengi males and microfilariae, while 9 showed 100 % activity on female worms. The methylene chloride extract of Piper umbellatum leaves was the most active on adult male and female worms (IC50s: 16.63 μg/mL and 35.65 μg/mL, respectively). The three most active extracts on Onchocerca ochengi females were also highly active on Loa loa microfilariae, with IC50s of 35.12 - 13.9 μg/mL. Active extracts were generally more toxic to the worms than to cells and showed no acute toxicity to Balb/c mice. Phytochemical screening revealed the presence of saponins, steroids, tannins and flavanoids in the promising extracts. These results unfold potential sources of novel anti-Onchocerca lead compounds and validate the traditional use of the plants in onchocerciasis treatment.
Nyongbela Kennedy D
Full Text Available Abstract Background The current treatment of onchocerciasis relies on the use of ivermectin which is only microfilaricidal and for which resistant parasite strains of veterinary importance are increasingly being detected. In the search for novel filaricides and alternative medicines, we investigated the selective activity of crude extracts of Margaritaria discoidea and Homalium africanum on Onchocerca ochengi, a model parasite for O. volvulus. These plants are used to treat the disease in North West Cameroon. Methods Sixteen crude extracts were prepared from various parts of M. discoidea and H. africanum using different organic solvents. The filaricidal activities were determined in vitro. Cytotoxicity of the active extracts was assessed on monkey kidney epithelial cells in vitro and the selectivity indices (SI of the extracts determined. Acute toxicity of the promising extracts was investigated in mice. Results Four out of the 16 extracts showed microfilaricidal activity based on motility reduction, whereas, none showed macrofilaricidal activity based on the MTT/formazan assay. The methylene chloride extract of H. africanum leaves (HLC recorded the lowest IC50 of 31.25 μg/mL and an IC100 of 62.5 μg/mL. The SI for the active extracts ranged from 0.5 - 2.63. No form of acute toxicity was observed in mice. Phytochemical analysis revealed the presence of anthraquinones, sterols and terpenoids in the promising extracts. Conclusions The non-polar extracts of M. discoidea and H. africanum are potential sources of new microfilaricidal lead compounds, and the results support their use in traditional medicine.
Full Text Available Introduction: Sigmoid volulus is by far the most common type of volvulus, accounting for 75 to 90 % of all volvulus. Most common presenting symptom is abdominal pain and constipation. . It may be initially managed by sigmoidoscopy or rectal tube insertion but where fear of compromised vascular supply of the sigmoid colon is associated, immediate laparotomy after resuscitation must be undertaken to avoid gangrene and septic shock. The primary objective of the study is to demonstrate the most suitable procedure for management of patients with sigmoid volvulus needing emergency surgery. Methodology: All patients presenting with volvulus and needing emergency operative intervention during 1 years duration from January 2010 to December 2011 were included in this study. Total 41 patients were included in the study of which 25 presented with gangrenous sigmoid colon on laparotomy and viable sigmoid colon was present in the remaining 16 cases. Comparison is done with respect to mortality and early morbidity associated with different operative procedures. Results: Highest mortality i.e. 33.3% observed among patients who underwent primary resection and anastomosis without proximal colostomy. Wound infection was more common following all forms of stoma procedure. Conclusion: Hartmann’s procedure goes a long way in decreasing mortality due to sigmoid volvulus in the emergency setting. [National J of Med Res 2012; 2(2.000: 226-228
Tudor, Poliana; Turcitu, Mihai; Mateescu, Cosmin; Dantas-Torres, Filipe; Tudor, Niculae; Bărbuceanu, Florica; Ciuca, Lavinia; Burcoveanu, Ioana; Acatrinei, Dumitru; Rinaldi, Laura; Mateescu, Romanița; Bădicu, Adina; Ionașcu, Iuliana; Otranto, Domenico
Onchocerca lupi is a filarial nematode, which infects the scleral conjunctival tissue of dogs, wolves and cats. Whilst adult nematodes localize in the conjunctive tissue of sclera or in the retrobulbar, microfilariae are found in the skin, and they are rarely diagnosed in asymptomatic animals. Since the first report of human ocular infection 5 years ago, up to 10 zoonotic cases have been identified in patients worldwide. We report, for the first time in Romania, three cases of canine ocular onchocercosis in dogs. Fragments of the harvested worms were characterized morphologically and molecularly. This article expands knowledge on the distribution of this parasite in Eastern Europe and sounds an alarm bell for ophthalmologists about the possible occurrence of human cases of O. lupi infection.
Full Text Available Volvulus is an unusual condition in Western countries, generally isolated to elderly patients with multiple comorbidities. This report describes an unusual case of a very large gangrenous sigmoid volvulus in a young, otherwise healthy 25-year-old female. A review of the diagnosis and management is subsequently described. Without a consideration of the atypical demographics for sigmoid volvulus, the case illustrates the potential morbidity due to a delayed diagnosis. Early identification and management are crucial in treating sigmoid volvulus before the appearance of gangrene and necrosis, thereby avoiding further complications and associated mortality. [West J Emerg Med. 2012; 13(1:100–102.
Weingrow, Daniel; McCague, Andrew; Shah, Ravi; Lalezarzadeh, Fariborz
Volvulus is an unusual condition in Western countries, generally isolated to elderly patients with multiple comorbidities. This report describes an unusual case of a very large gangrenous sigmoid volvulus in a young, otherwise healthy 25-year-old female. A review of the diagnosis and management is subsequently described. Without a consideration of the atypical demographics for sigmoid volvulus, the case illustrates the potential morbidity due to a delayed diagnosis. Early identification and management are crucial in treating sigmoid volvulus before the appearance of gangrene and necrosis, thereby avoiding further complications and associated mortality. PMID:22461935
Nikolaos Katsikogiannis; Nikolaos Machairiotis; Paul Zarogoulidis; Eirini Sarika; Aikaterini Stylianaki; Maria Zisoglou; Vasilis Zervas; Metaxia Bareka; Christos Christofis; Alkis Iordanidis
Acute sigmoid volvulus is typically caused by an excessively mobile and redundant segment of colon with a stretched mesenteric pedicle. When this segment twists on its pedicle, the result can be obstruction, ischemia and perforation. A healthy, 18-year-old Caucasian woman presented to the emergency department complaining of cramping abdominal pain, distention, constipation and obstipation for the last 72 h, accompanied by nausea, vomiting and abdominal tenderness. The patient had tympanitic p...
Parolini, Filippo; Orizio, Paolo; Bulotta, Anna Lavinia; Garcia Magne, Miguel; Boroni, Giovanni; Cengia, Gianpaolo; Torri, Fabio; Alberti, Daniele
Sigmoid volvulus (SV) is extremely uncommon in children and is usually associated with a long-standing history of constipation or pseudo-obstruction. An early diagnosis and management are crucial in order to prevent the appearance of hemorrhagic infarction of the twisted loop, avoiding further complications such as necrosis, perforation and sepsis. In patients with no evidence of peritonitis or ischemic bowel, treatment starts with resuscitation and detorsion of the SV, accomplished by means ...
Full Text Available INTRODUCTION: Filarial worms are nematodes that live in lymphatic s and subcutaneous tissues. Eight filarial species are known to infect humans out of which most serious filarial infections are caused mostly by four parasites like Wuchereria bancrofti, Brugia malayi, Onchocerca volvulus and Loa loa. These parasites ar e transmitted by specific species of mosquitoes or other arthropods. The clinical manife stations of filarial diseases develop relatively slowly, these infections should be consi dered to induce chronic diseases with possible long- term debilitating effects. Characteristically , filarial disease is more acute and intense in newly exposed individuals than in natives of endemic areas.  Lymphatic filariasis (LF causes lymphoedema, hydrocele and acute attacks of dermato- lymphangio-adenitis.  It represents a major public health problem in tropical and subtropical regions of the world.  It is mainly a disease of the adult and older age-classes and appear s to be more prevalent in males.  Lymphatic filariasis is a major tropical disease aff ecting approximately 120 million people worldwide. India contributes about 40% of the tota l global burden and accounts for about 50% of the people at the risk of infection. A recent sur vey has shown that out of the 25 States/Union territories in India, 22 are endemic and nine state s (Andhra Pradesh, Bihar, Gujarat, Kerala, Maharashtra, Orissa, Tamil Nadu, Utter Pradesh and West Bengal contribute to about 95% of total burden. W. bancrofti is the predominant species accounting for about 98% of the national burden. [5
Kwa, M.S.G.; Okoli, M.N.; Schulz-Key, H.; Okongkwo, P.O.; Roos, M.H.
A P-glycoprotein gene probe from the sheep parasitic nematode Haemonchus contortus was developed and used to analyse restriction fragment length polymorphisms between susceptible isolates and isolates resistant to either benzimidazole; levamisole and benzimidazole; or benzimidazole, ivermectin and
Kwa, M.S.G.; Okoli, M.N.; Schulz-Key, H.; Okongkwo, P.O.; Roos, M.H.
A P-glycoprotein gene probe from the sheep parasitic nematode Haemonchus contortus was developed and used to analyse restriction fragment length polymorphisms between susceptible isolates and isolates resistant to either benzimidazole; levamisole and benzimidazole; or benzimidazole, ivermectin and c
Isam M A Zarroug
Full Text Available The abundance of onchocerciasis vectors affects the epidemiology of disease in Sudan, therefore, studies of vector dynamics are crucial for onchocerciasis control/elimination programs. This study aims to compare the relative abundance, monthly biting-rates (MBR and hourly-based distribution of onchocerciasis vectors in Abu-Hamed and Galabat foci. These seasonally-based factors can be used to structure vector control efforts to reduce fly-biting rates as a component of onchocerciasis elimination programs.A cross-sectional study was conducted in four endemic villages in Abu-Hamed and Galabat foci during two non-consecutive years (2007-2008 and 2009-2010. Both adults and aquatic stages of the potential onchocerciasis vector Simulium damnosum sensu lato were collected following standard procedures during wet and dry seasons. Adult flies were collected using human landing capture for 5 days/month. The data was recorded on handheld data collection sheets to calculate the relative abundance, MBR, and hourly-based distribution associated with climatic factors. The data analysis was carried out using ANOVA and Spearman rank correlation tests.Data on vector surveillance revealed higher relative abundance of S. damnosum s.l. in Abu- Hamed (39,934 flies than Galabat (8,202 flies. In Abu-Hamed, vector populations increased in January-April then declined in June-July until they disappeared in August-October. Highest black fly density and MBR were found in March 2007 (N = 9,444, MBR = 58,552.8 bites/person/month, and March 2010 (N = 2,603, MBR = 16,138.6 bites/person/month while none of flies were collected in August-October (MBR = 0 bites/person/month. In Galabat, vectors increased in September-December, then decreased in February-June. The highest vector density and MBR were recorded in September 2007 (N = 1,138, MBR = 6,828 bites/person/month and September 2010 (N = 1,163, MBR = 6,978 bites/person/month, whereas, none appeared in collection from April to June. There was a significant difference in mean monthly density of S. damnosum s.l. across the two foci in 2007-2008 (df = 3, F = 3.91, P = 0.011. Minimum temperature showed significant correlation with adult flies counts in four areas sampled; the adult counts were increased in Nady village (rs = 0.799 and were decreased in Kalasecal (rs = -0.676, Gumaiza (rs = -0.585, and Hilat Khateir (rs = -0.496. Maximum temperature showed positive correlation with black fly counts only in Galabat focus. Precipitation was significantly correlated with adult flies counts in Nady village, Abu-Hamed, but no significance was found in the rest of the sampled villages in both foci. Hourly-based distribution of black flies showed a unimodal pattern in Abu-Hamed with one peak (10:00-18:00, while a bimodal pattern with two peaks (07:00-10:00 and (14:00-18:00 was exhibited in Galabat.Transmission of onchocerciasis in both foci showed marked differences in seasonality, which may be attributed to ecology, microclimate and proximity of breeding sites to collection sites. The seasonal shifts between the two foci might be related to variations in climate zones. This information on black fly vector seasonality, ecology, distribution and biting activity has obvious implications in monitoring transmission levels to guide the national and regional onchocerciasis elimination programs in Sudan.
Treatment of co-infection with bancroftian filariasis and onchocerciasis: a safety and efficacy study of albendazole with ivermectin compared to treatment of single infection with bancroftian filariasis
Makunde, William H; Kamugisha, Leo M; Massaga, Julius J; Makunde, Rachel W; Savael, Zakana X; Akida, Juma; Salum, Fred M; Taylor, Mark J
Background In order to use a combination of ivermectin and albendazole for the elimination of lymphatic filariasis, it is important to assess the potential risk of increased adverse events in individuals infected with both lymphatic filariasis and onchocerciasis. We compared the safety and efficacy of albendazole (400 mg) in combination with ivermectin (150 micrograms/kg), for the treatment of co-infections of Wuchereria bancrofti and Onchocerca volvulus with single infection of W. bancrofti. Methods The safety study on co-infections was a crossover, double blind design, while for the single infection of bancroftian filariasis an open design comparing two treatments was used. For co-infection, one group was allocated a single dose of ivermectin (150 micrograms/kg) plus albendazole (400 mg) (Group A). The other group received placebo (Group B). Five days later the treatment regime was reversed, with the Group A receiving placebo and Group B receiving treatment. For the single bancroftian filariasis infection, one group received a single dose of albendazole (400 mg) plus ivermectin (150 μg/kg) (Group C) while the other group received a single dose of albendazole (400 mg) alone (Group D). Blood and skin specimens were collected on admission day, day 0, and on days 2, 3, and 7 to assess drug safety and efficacy. Thereafter, blood and skin specimens were collected during the 12 months follow up for the assessment of drug efficacy. Study individuals were clinically monitored every six hours during the first 48 hours following treatment, and routine clinical examinations were performed during the hospitalisation period and follow-up. Results In individuals co-infected with bancroftian filariasis and onchocerciasis, treatment with ivermectin and albendazole was safe and tolerable. Physiological indices showed no differences between groups with co-infection (W. bancrofti and O. volvulus) or single infection (W. bancrofti). The frequency of adverse events in co-infected
Reddi, Bhavani Rao; Konkena, Janardhan Rao; Bogarapu, Chaitanya Babu; Kollu, Srinu Babu; Neelam, Prasad
Jejunal diverticulosis is a rare asymptomatic entity . In literature, there are only few cases of jejunal diverticulosis where small gut volvulus is reported. The disease entity is important as it may masquerade as hemorrhage, obstruction, or perforation which are life threatening. We report a rare case of small bowel volvulus secondary to jejunal diverticulosis.
the rapid diagnosis of acute abdominal pathology and, in particular, acute gastric volvulus. ... S Afr J Rad 2013;17(1):21-23. DOI:10.7196/SAJR.817. Fig. 1. ... a predisposing factor for the development of mesenteroaxial gastric volvulus.
Lena M. O'Keefe
Full Text Available Volvulus in the pediatric population commonly occurs in the small bowel associated with malrotation or internal hernia whereas sigmoid volvulus (SV is extremely rare. Herein we report a case of SV, review the literature and provide a suggested algorithm for diagnosis and management.
Desai, Naman S; Sodickson, Aaron D; Askari, Reza; Seshadri, Anupamaa J; Gates, Jonathan D; Khurana, Bharti
We describe the radiological and intraoperative correlation of large bowel obstruction due to sigmoid volvulus in a 52-year-old female. The purpose of this article is to emphasize the importance of recognizing sigmoid volvulus as a cause of bowel obstruction in patients presenting with abdominal pain, since it can lead to bowel ischemia and necrosis.
Rasmussen, L; Qvist, N; Hansen, L P;
Intestinal malrotation without volvulus in infants and children is often difficult to diagnose because of less dramatic clinical features, e.g. failure to thrive and intermittent bile stained vomiting, compared to the patients with volvulus. A plain x-ray of the abdomen may show the characteristic...
Prabhu, Shailesh Mukund; Venkatesan, Bhuvaneswari; Shetty, Gurucharan; Narula, Mahender Kaur; Chauhan, Udit; Udiya, Alok Kumar
Recurrent sigmoid volvulus is a clinical entity characterized by recurrent episodes of partial or complete sigmoid volvulus. Although it is commonly seen in the elderly, it can be occasionally seen in younger patients. Patients with recurrent partial sigmoid volvulus are relatively asymptomatic or present with mild abdominal pain. Early diagnosis and treatment is essential to prevent conversion to acute gangrenous volvulus. We present a case of recurrent partial sigmoid volvulus in association with eventration of diaphragm in a 26-year-old man.
Díaz Plasencia, J; Huaynalaya, E; Rodríguez, F; Rebaza, H
This retrospective study evaluated predisposing factors, clinical picture and the methods of treatment related to morbidity and mortality of 19 small bowel volvulus (SBV) who underwent operation at Belen Hospital (Trujillo-Peru) during the last 26 years (1966-1992). The SBV was 1.6% of all cases of intestinal obstruction in this period and 10.8% of all intestinal volvulus. The median age was of 43 +/- 20.5 years (range, 6 to 78 years) and the majority of them were between 41 and 60 years. Sixteen cases (84.2%) were men from Indian and Spanish extraction and most of them were farmers and came from the Sierra of the Department of La Libertad. Two cases (10.5%) had non-related antecedents previous surgery. In six patients (31.6%) the volvulus was less than seven day's duration and in thirty (68.4%) it was more eight day's duration with previous attacks of obstruction (median: 19.3 days, range: 17 hours to 94 days). Pain, vomiting and distention were present in almost all of these cases. The most frequent abdominal finding was distention. The location of the volvulus was: ileum, 12 cases (63.2%), root of mesentery, 4 cases (21%) and jejunum, 3 cases (15.8%). Gangrenous bowel was present in six patients (31.5) and gangrenous intestine with perforation in two cases (10.5%) who underwent resection of the involved segment with primary anastomosis. In this group one patient (5.2%) died of sepsis and the wound infection rate was of 37.5%. There was no statistically significant correlation with the duration of illness and the presence of gangrenous loops or the mortality rate (p > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Full Text Available INTRODUCTION: A clinically significant endemic focus of onchocerciasis existing in Esmeraldas Province, coastal Ecuador has been under an ivermectin mass drug administration program since 1991. The main transmitting vector in this area is the voracious blackfly, Simulium exiguum. This paper describes the assessments made that support the decision to cease mass treatment. METHODOLOGY AND PRINCIPLE FINDINGS: Thirty-five rounds of ivermectin treatment occurred between 1991-2009 with 29 of these carrying >85% coverage. Following the guidelines set by WHO for ceasing ivermectin distribution the impact on parasite transmission was measured in the two vector species by an O-150 PCR technique standard for assessing for the presence of Onchocerca volvulus. Up to seven collection sites in three major river systems were tested on four occasions between 1995 and 2008. The infectivity rates of 65.0 (CI 39-101 and 72.7 (CI 42-116 in 1995 dropped to zero at all seven collection sites by 2008. Assessment for the presence of antibodies against O. volvulus was made in 2001, 2006, 2007 and 2008 using standard ELISA assays for detecting anti-Ov16 antibodies. None of total of 1810 children aged 1-15 years (between 82 and 98% of children present in the surveyed villages tested in the above years were found to be carrying antibodies to this antigen. These findings were the basis for the cessation of mass drug treatment with ivermectin in 2009. SIGNIFICANCE: This fulfillment of the criteria for cessation of mass distribution of ivermectin in the only known endemic zone of onchocerciasis in Ecuador moves the country into the surveillance phase of official verification for national elimination of transmission of infection. These findings indicate that ivermectin given twice a year with greater than 85% of the community can move a program to the final stages of verification of transmission interruption.
Lovato, Raquel; Guevara, Angel; Guderian, Ronald; Proaño, Roberto; Unnasch, Thomas; Criollo, Hipatia; Hassan, Hassan K; Mackenzie, Charles D
A clinically significant endemic focus of onchocerciasis existing in Esmeraldas Province, coastal Ecuador has been under an ivermectin mass drug administration program since 1991. The main transmitting vector in this area is the voracious blackfly, Simulium exiguum. This paper describes the assessments made that support the decision to cease mass treatment. Thirty-five rounds of ivermectin treatment occurred between 1991-2009 with 29 of these carrying >85% coverage. Following the guidelines set by WHO for ceasing ivermectin distribution the impact on parasite transmission was measured in the two vector species by an O-150 PCR technique standard for assessing for the presence of Onchocerca volvulus. Up to seven collection sites in three major river systems were tested on four occasions between 1995 and 2008. The infectivity rates of 65.0 (CI 39-101) and 72.7 (CI 42-116) in 1995 dropped to zero at all seven collection sites by 2008. Assessment for the presence of antibodies against O. volvulus was made in 2001, 2006, 2007 and 2008 using standard ELISA assays for detecting anti-Ov16 antibodies. None of total of 1810 children aged 1-15 years (between 82 and 98% of children present in the surveyed villages) tested in the above years were found to be carrying antibodies to this antigen. These findings were the basis for the cessation of mass drug treatment with ivermectin in 2009. This fulfillment of the criteria for cessation of mass distribution of ivermectin in the only known endemic zone of onchocerciasis in Ecuador moves the country into the surveillance phase of official verification for national elimination of transmission of infection. These findings indicate that ivermectin given twice a year with greater than 85% of the community can move a program to the final stages of verification of transmission interruption.
Full Text Available 77 cases of intestinal volvulus seen during the last 6 years have been analysed; majority belong to 20-40 years age group. More than 50% presented after 72 hours of onset of symptoms. Small bowel was the site of volvulus in 65% of cases, transverse colon in 2.6% and sigmoid in 23.4%. 32.5% cases had strangulation obstruc-tion. Volvulus was of primary idiopathic variety in 84.5% of cases. Resection was required in 52%. The overall mortality was 10.5% in the series.
Abadía-Barnó, Pedro; Coll-Sastre, Magdalena; Picón-Serrano, Carmen; Sanjuanbenito-Dehesa, Alfonso; Cabañas-Montero, Jacobo
The gallbladder volvulus is defined as the rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. It is an extremely rare surgical disease and definitive diagnosis is usually made during surgery. A 78 year old woman presented with upper right quadrant abdominal pain, with no comorbidities and no other accompanying symptoms. Analysis revealed haemodynamic instability and leukocytosis. Computed tomography of abdomen showed an acute cholecystitis. During emergency right hypochondrium laparotomy, the gallbladder was found to be twisted counterclockwise with huge gangrenous gallbladder distal. Open cholecystectomy was performed and after the surgery, the patient was discharged in a few days. Gallbladder volvulus, or gallbladder torsion, is a rare condition and should be considered when clinical and imaging findings of complicated cholecystitis are present. The performance of urgent laparoscopic surgery would be first option to avoid perforation, peritonitis and haemodynamic instability. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.
Katsikogiannis, Nikolaos; Machairiotis, Nikolaos; Zarogoulidis, Paul; Sarika, Eirini; Stylianaki, Aikaterini; Zisoglou, Maria; Zervas, Vasilis; Bareka, Metaxia; Christofis, Christos; Iordanidis, Alkis
Acute sigmoid volvulus is typically caused by an excessively mobile and redundant segment of colon with a stretched mesenteric pedicle. When this segment twists on its pedicle, the result can be obstruction, ischemia and perforation. A healthy, 18-year-old Caucasian woman presented to the emergency department complaining of cramping abdominal pain, distention, constipation and obstipation for the last 72 h, accompanied by nausea, vomiting and abdominal tenderness. The patient had tympanitic percussion tones and no bowel sounds. She was diagnosed with acute sigmoid volvulus. Although urgent resective surgery seems to be the appropriate treatment for those who present with acute abdominal pain, intestinal perforation or ischemic necrosis of the intestinal mucosa, the first therapeutic choice for clinically stable patients in good general condition is considered, by many institutions, to be endoscopic decompression. Controversy exists on the decision of the time, the type of definitive treatment, the strategy and the most appropriate surgical technique, especially for teenagers for whom sigmoid resection can be avoided. PMID:22754489
Full Text Available Acute sigmoid volvulus is typically caused by an excessively mobile and redundant segment of colon with a stretched mesenteric pedicle. When this segment twists on its pedicle, the result can be obstruction, ischemia and perforation. A healthy, 18-year-old Caucasian woman presented to the emergency department complaining of cramping abdominal pain, distention, constipation and obstipation for the last 72 h, accompanied by nausea, vomiting and abdominal tenderness. The patient had tympanitic percussion tones and no bowel sounds. She was diagnosed with acute sigmoid volvulus. Although urgent resective surgery seems to be the appropriate treatment for those who present with acute abdominal pain, intestinal perforation or ischemic necrosis of the intestinal mucosa, the first therapeutic choice for clinically stable patients in good general condition is considered, by many institutions, to be endoscopic decompression. Controversy exists on the decision of the time, the type of definitive treatment, the strategy and the most appropriate surgical technique, especially for teenagers for whom sigmoid resection can be avoided.
Full Text Available Aim. The aim of this retrospective study is to assess the mortality and morbidity after different types operations for sigmoid volvulus. Method. The results of surgical treatment of our patients with sigmoid volvulus were analyzed retrospectively. The patients were divided into two groups: Group-1: Single Stage Surgery (SSS and Group-2: Hartmann’s Procedure (HP. Results. Total 51 patients aged 65.9 years in average (between 22-88 years were included. In comparing the morbidity rates of SSS group to the HP group, it revealed no statistically significant differences. All died patients (12/51, 25.5% were above 70 years old and had comorbidities. Overall, there were 12 patients (12/51, 23.52% with sigmoid colon necrosis at exploratory laparotomy. While 4 of them were in SSS group, 8 of them were in HP group. Three of four (75% sigmoid colon necrosis patients in SSS group, and 4 of 8 sigmoid colon necrosis patients in (50% HP group were died. Conclusion. We want to notice that, there would be a high risk of complication, if the situation accompanies a sigmoid colon necrosis at laparotomy. Late admisson and patient’s negative general condition also play an important role in anastomosis safety.
Sala-Hernández, Ángela; Pous-Serrano, Salvador; Lucas-Mera, Elí; Carvajal-Amaya, Nicolás
Acute colonic volvulus accounts for 10% of all intestinal obstructions being the transverse colon volvulus an exceptional localization (2-4%). Late diagnosis is made as there are no pathognomonic clinical or radiological findings for this pathology. We present the case of an 81 year-old male with acute transverse colon volvulus that involved the gastric antrum causing irreversible ischemia. Subtotal gastrectomy, subtotal colectomy and reconstruction with Y en Roux gastrojejunostomy and ileosigmoid anastomosis was performed given the good overall status of the patient. Decompressive colonoscopy is not advised given the high probability of ischemic lesions in these cases; surgical exploration is mandatory in these circumstances. Surgical detortion with or without colopexia carries important recurrence rates. Treatment of choice includes colectomy with or without primary anastomosis. There are no reports on gastric ischemic necrosis in the setting of a transverse colon volvulus making this case unusual and unique.
Jia-Li Hu; Wei-Zhong Chen
Jejunal diverticulosis is uncommon and often asymptomatic.It can produce significant complications,and some complications are potentially life threatening and require early surgical treatment,such as obstruction,hemorrhage and perforation.There is no consensus on the management of this disease.Only a few cases of jejunal diverticulosis with midgut volvulus have been reported.We herein report a case of 57-year-old woman with jejunal diverticulosis causing small bowel volvulus who complained of intermittent upper abdominal pin-prick for 5 years that eventually progressed to a complete obstruction.The computed tomography scans revealed a mesenteric vessel "whirlpool" and laparotomy showed midgut volvulus secondary to jejunal diverticula.This case highlights jejunal diverticulosis causing small bowel volvulus as an uncommon mechanism of small bowel obstruction,which should be included in the differential diagnosis of small bowel obstruction.
Full Text Available Sigmoid colon is the most frequent site for a volvulus and volvulus of the sigmoid colon(SV is characterized by a high morbidity and mortality. The objective of this study was toevaluate predicting factors for mortality in the SV cases. Between January 1994 andDecember 2001, the records of patients operated on due to SV at Dicle University Hospital(DUH were retrospectively reviewed. The epidemiological, clinical, and laboratory featureswere evaluated as probable risk factors for mortality. Variables associated with SV weredetermined using logistic regression models. Of 90 patients, 80 (88.9% were male, and 10(11.1% were female. The mean age was 58.8±12.9 (19-85 and 63.6±16.1 (23-83 for thepatients with uneventful outcome (Group 1 and for the patients with fatal outcome (Group2, respectively (p=0.000. The period of symptoms before admission (PSBA were 2.2±0.73(1-4 days and 5.6±1.7 (2-10 days in Group 1 and Group 2 respectively (p=0.000. While the73.8 % of patients in the Group 1 were operated on an emergency state, 100 % of patients inthe Group 2 were operated on an emergency state (p=0.002. In the univariate analysis, othersignificant risk factors were significantly fluid-electrolyte imbalance, elevated abdominalpressure (EAP, cardiovascular disease, respiratory disease, leukocytosis, hypotension,presence of necrosis, and presence of major contamination (p=0.000. These variables wereentered into the logistic regression model for revealing the risk factors for mortality. Inmultivariate analysis, long PSBA [Odds Ratio (OR =17.17, 95% Confidence Interval (CI=2.86-103.07, P=0.002], presence of cardiovascular disease at the admission (OR=0.19,CI=0.001-0.52, P=0.019 and age (OR=0.87, CI=0.77-0.99, P=0.046 were foundsignificantly predictive for mortality. EAP, fluid-electrolyte imbalance, respiratory disease,and presence of major contamination were not statistically significant factors for mortalityafter sigmoid volvulus. In our study, we
Ahmad, Anis; Shing, Koh Kai; Tan, Khim Khee; Krasu, Mary; Bickle, Ian; Chong, Vui Heng
Bowel obstruction is rare in pregnancy, and delay in recognition can lead to serious maternal and fetal complications. Most reported causes of bowel obstruction in pregnancy (adhesions, intussusception, hernia, and carcinoma) require surgical intervention. Sigmoid volvulus is an acute surgical cause that can now be managed successfully without surgery. We report the case of 33-year-old lady who presented with a sigmoid volvulus that was successfully managed with urgent endoscopic decompression.
Parolini, Filippo; Orizio, Paolo; Bulotta, Anna Lavinia; Garcia Magne, Miguel; Boroni, Giovanni; Cengia, Gianpaolo; Torri, Fabio; Alberti, Daniele
Sigmoid volvulus (SV) is extremely uncommon in children and is usually associated with a long-standing history of constipation or pseudo-obstruction. An early diagnosis and management are crucial in order to prevent the appearance of hemorrhagic infarction of the twisted loop, avoiding further complications such as necrosis, perforation and sepsis. In patients with no evidence of peritonitis or ischemic bowel, treatment starts with resuscitation and detorsion of the SV, accomplished by means of sigmoidoscopy and concomitant rectal tube placement. The bowel is then prepared and surgery is undertaken electively during the same hospitalization. We report a detailed review of the literature focusing on technical details, risks and benefits of endoscopic management of SV in childhood.
Kim, Mi Kyung; Lee, Jong Beum; Kim, Gi Hyeon; Lee, Hwa Yeon; Kim, Yang Soo; Song, In Sup [Chung-Ang University Hospital, Seoul (Korea, Republic of)
A very rare case of multi-organ volvulus, serially involving the spleen, colon and stomach, is presented in a 24-year-old female patient with Down syndrome. This case is of interest because of the three different types of volvulus or torsion that occurred serially over thirteen years in the same patient. We report the imaging findings and suggest possible pathogenesis by a review of the operation record and literature.
Lee, Jin Hee; Kim, Yong Woon; Byun, Kyung Hwan; Kim, Byung Ki; Kee, Se Kook; Kim, Hyung Tae; Kim, Jae Hi [College of Medicine, Pochon CHA Univ., Pochon (Korea, Republic of)
Gastric volvulus can either present as an acute or chronic symptoms according to the degree of gastric rotation and subsequent obstruction. The diagnosis of gastric volvulus is often difficult and is mainly based on imaging studies, We describe a case of mesenteroaxial gastric volvulus associated with paraesophageal hernia, well demonstrated on upper gastrointestinal (UGI) series and coronal reconstructed CT image.
Enzo Fabrício Ribeiro Nascimento
Full Text Available Colonic obstruction due to sigmoid colon volvulus during pregnancy is a rare but complication with significant maternal and fetal mortality. We describe a case of sigmoid volvulus in a patient with 33 weeks of gestation that developed complete necrosis of the left colon. Case. 27-year-old woman was admitted with 3 days of abdominal distention, vomit, and the stoppage of the passage of gases and feces. She was admitted with poor clinical conditions with septic shock, acute respiratory distress syndrome, and signs of diffuse peritonitis. Abdominal radiography showed severe dilation of the colon with horseshoe signal suggesting a sigmoid volvulus, pneumoperitoneum and we could not we could not identify fetal heartbeats. With a diagnosis of complicate sigmoid volvulus she was underwent to the laparotomy where we found necrosis of all descending colon due to double twist volvulus of the sigmoid. We performed a colectomy with a confection of a proximal colostomy, and closing of the rectal stump. Due to an uncontrollable uterine bleeding during cesarean due, it was required a hysterectomy. The patient had an uneventful postoperative course thereafter and was discharged on a regular diet on the 15th postoperative day.
Ribeiro Nascimento, Enzo Fabrício; Chechter, Michelle; Fonte, Fábio Piovezan; Puls, Nara; Valenciano, Juliana Santos; Fernandes Filho, Cláudio Luciano Penna; Nonose, Ronaldo; Bonassa, Crhistiny Emmanuelle Gabriel; Martinez, Carlos Augusto Real
Colonic obstruction due to sigmoid colon volvulus during pregnancy is a rare but complication with significant maternal and fetal mortality. We describe a case of sigmoid volvulus in a patient with 33 weeks of gestation that developed complete necrosis of the left colon. Case. 27-year-old woman was admitted with 3 days of abdominal distention, vomit, and the stoppage of the passage of gases and feces. She was admitted with poor clinical conditions with septic shock, acute respiratory distress syndrome, and signs of diffuse peritonitis. Abdominal radiography showed severe dilation of the colon with horseshoe signal suggesting a sigmoid volvulus, pneumoperitoneum and we could not we could not identify fetal heartbeats. With a diagnosis of complicate sigmoid volvulus she was underwent to the laparotomy where we found necrosis of all descending colon due to double twist volvulus of the sigmoid. We performed a colectomy with a confection of a proximal colostomy, and closing of the rectal stump. Due to an uncontrollable uterine bleeding during cesarean due, it was required a hysterectomy. The patient had an uneventful postoperative course thereafter and was discharged on a regular diet on the 15th postoperative day. PMID:22567527
Full Text Available Filarial nematodes cause chronic and profoundly debilitating diseases in both humans and animals. Applications of novel technology are providing unprecedented opportunities to improve diagnosis and our understanding of the molecular basis for host-parasite interactions. As a first step, we investigated the presence of circulating miRNAs released by filarial nematodes into the host bloodstream. miRNA deep-sequencing combined with bioinformatics revealed over 200 mature miRNA sequences of potential nematode origin in Dirofilaria immitis-infected dog plasma in two independent analyses, and 21 in Onchocerca volvulus-infected human serum. Total RNA obtained from D. immitis-infected dog plasma was subjected to stem-loop RT-qPCR assays targeting two detected miRNA candidates, miR-71 and miR-34. Additionally, Brugia pahangi-infected dog samples were included in the analysis, as these miRNAs were previously detected in extracts prepared from this species. The presence of miR-71 and miR-34 discriminated infected samples (both species from uninfected samples, in which no specific miRNA amplification occurred. However, absolute miRNA copy numbers were not significantly correlated with microfilaraemia for either parasite. This may be due to the imprecision of mf counts to estimate infection intensity or to miRNA contributions from the unknown number of adult worms present. Nonetheless, parasite-derived circulating miRNAs are found in plasma or serum even for those species that do not live in the bloodstream.
Tritten, Lucienne; Burkman, Erica; Moorhead, Andrew; Satti, Mohammed; Geary, James; Mackenzie, Charles; Geary, Timothy
Filarial nematodes cause chronic and profoundly debilitating diseases in both humans and animals. Applications of novel technology are providing unprecedented opportunities to improve diagnosis and our understanding of the molecular basis for host-parasite interactions. As a first step, we investigated the presence of circulating miRNAs released by filarial nematodes into the host bloodstream. miRNA deep-sequencing combined with bioinformatics revealed over 200 mature miRNA sequences of potential nematode origin in Dirofilaria immitis-infected dog plasma in two independent analyses, and 21 in Onchocerca volvulus-infected human serum. Total RNA obtained from D. immitis-infected dog plasma was subjected to stem-loop RT-qPCR assays targeting two detected miRNA candidates, miR-71 and miR-34. Additionally, Brugia pahangi-infected dog samples were included in the analysis, as these miRNAs were previously detected in extracts prepared from this species. The presence of miR-71 and miR-34 discriminated infected samples (both species) from uninfected samples, in which no specific miRNA amplification occurred. However, absolute miRNA copy numbers were not significantly correlated with microfilaraemia for either parasite. This may be due to the imprecision of mf counts to estimate infection intensity or to miRNA contributions from the unknown number of adult worms present. Nonetheless, parasite-derived circulating miRNAs are found in plasma or serum even for those species that do not live in the bloodstream.
Atamanalp, S. Selcuk; Keles, M. Sait; Aydinli, Bulent
Objective: This study aimed to determine the serum potassium concentrations in patients with sigmoid volvulus (SV), which is a rare large bowel obstruction. Materials and Methods: The records of 86 patients with SV were reviewed retrospectively, while the records of 41 patients diagnosed with obstructive rectosigmoid cancer (ORC) were considered as the control group and as such, served as a source for comparison. Results: The analysis revealed a mean serum potassium concentration of 3.9 ± 0.6 mEq/L for the patients with SV, while the mean potassium concentration was 3.9 ± 0.5 mEq/L for the patients diagnosed with ORC (t:0.1, P>0.05). The number of hypokalemic and hyperkalemic patients identified in this study sample were 11 versus 5 patients and 1 versus 0 patients, respectively for the SV and ORC groups (x2 = 0.1 and 0.5, respectively with a P>0.05). Conclusions: No cause-and-effect relationship was observed between the serum potassium concentrations and SV. The serum potassium concentration is not pathognomonic for SV. PMID:25610090
Saravia Burgos, Jaime; Acosta Canedo, Abel
The etiology of Megacolon is multiple. One of these causes and the most frequent is Chagas disease. Its complication: sigmoid volvulus was de main diagnosis in the admitted patients at the Bolivian and Japanese Gastroenterological Institute of Cochabamba Bolivia. It usually affects people of a low economic income. In this Gastroenterological Hospital a transversal and prospective study has been done, in order to know the real incidence and the physiopathology of this disease. In a six year period, from 2000 to 2006, 8.954 patients were admitted to the Hospital: of these, 814 (9.09%), where diagnosticated as lower intestinal obstruction. In 608 (74.7%) the final diagnosis was sigmoid torsion. Radiological diagnosis was made in 84% of the patients and endoscopic decompression was successful in 88.7%. As reported in the medical literature, the main cause of megacolon in this part of the world is Chagas disease. In our investigation 22% (98 patients), were serology positive to Chagas disease, and another 21.44% (95 patients) were serology negative. They were coca leaf chewers. One of coca leaf compounds is cocaine which blocks the adrenaline and noradrenaline degradation by mean of monoamine oxidase inactivation. These two hormones stay a long term of time in the target organ: the large bowel. By this mean chronic and persistent vessel constriction develops intestinal wall atrophy and lower resistance to the intraintestinal pressure.
Full Text Available Gastric volvulus, especially cases with an acute onset, may result in strangulation, perforation, peritonitis, shock and death. The disease is rarely seen in children, but early diagnosis and treatment is essential due to its life-threatening potential. In patients with acute gastric volvulus, the clinical Borchardt triade may be observed, which is characterized by acute severe pain and distension in the upper abdomen or lower thoracic region, retching and the inability to pass a nasogastric tube. In this article, We aimed to emphasize the Borchardt’s triad by presenting a pediatric case who was diagnosed with Borchardt’s triad and who had acute mesenteric axial gastric volvulus which diaphragmatic hernia and mobile (wandering spleen were accompanied.
Sadatomo, Ai; Miyakura, Yasuyuki; Zuiki, Toru; Koinuma, Koji; Horie, Hisanaga; Lefor, Alan T; Yasuda, Yoshikazu
We report the first case of sigmoid volvulus after laparoscopic surgery for sigmoid colon cancer. The patient is a 75-year-old man who presented with the sudden onset of severe abdominal pain. He had undergone laparoscopic sigmoidectomy for cancer 2 years before presentation. CT scan showed a distended sigmoid colon with a mesenteric twist, or "whirl sign." Colonoscopy showed a mucosal spiral and luminal stenosis with dilated sigmoid colon distally and ischemic mucosa. The diagnosis of ischemic colonic necrosis due to sigmoid volvulus was established. Resection of the necrotic sigmoid colon was performed and a descending colon stoma was created. A long remnant sigmoid colon and chronic constipation may contribute to the development of sigmoid volvulus after laparoscopic sigmoidectomy. Prompt diagnosis is essential for adequate treatment, and colonoscopy aids in the diagnosis of ischemic changes in patients without definitive findings of a gangrenous colon.
Ranjan, Abhishek; Jain, Vishesh; Sharma, Shilpa; Gupta, Devendra Kumar
Sigmoid volvulus is a rare and potentially life-threatening condition that is usually seen in adults, however, when diagnosed in children, it is often associated with Hirschsprung's disease (HD). We report a case of an 11-year-old boy who presented with a history of constipation since 1.5 months of age, with acute onset of severe abdominal pain and marked distention of the abdomen. Sigmoid volvulus was suspected, detected and successfully managed with resection of the sigmoid colon and primary Scott Boley's pull-through. This report underscores the importance of suspecting sigmoid volvulus in the pertinent clinical setting; also, a primary definitive procedure can be performed in select cases.
Nuevo, Sergio Pozo; Macías Robles, María Dolores; Delgado Sevillano, Ramón; Pérez-Gallarza, Susana Serrano
We describe a challenging case of sigmoid volvulus where a previously unrecognised anatomical condition, rather than the patient's age, was the main predisposing factor. A man in his thirties presented to the emergency department with a 3-day history of constipation and acute abdominal pain. Initial assessment and studies were inconclusive, but a CT scan revealed torsion of the large bowelSigmoid volvulus is a frequent cause of bowel obstruction that can be missed if appropriate imaging is not available. Clinical presentation and blood analysis can be similar to the findings in acute abdomen caused by other more common causes.
Mejía Camacho David
Full Text Available Intestinal malrotation with volvulus and extensive necrosisis is the deadliest emergency faced by the pediatric surgeon. Treatment consists in surgical repair using the technique described by William Ladd in 1936. In some cases where viability is in questionable a sec- ond look laparotomy upon placement of drains has been described. We report the case of a one month old infant with cloacal extrophy who had an intestinal volvulus. During the surgical procedure necro- sis of more than 90% of the vowel was seen. Surgical drains were placed and second look laparotomy six weeks later was performed with intestinal recovery of 70%.
Full Text Available BACKGROUND: Among the arthropod-borne nematodes infesting dogs, Onchocerca lupi (Spirurida: Onchocercidae is of increasing zoonotic concern, with new human cases of infection diagnosed in Turkey, Tunisia, Iran and the USA. Knowledge of the biology of this nematode is meagre. This study aimed at assessing the distribution and periodicity of O. lupi microfilariae from different body regions in naturally infested dogs. METHODOLOGY/PRINCIPAL FINDINGS: Skin samples were collected from six dogs infested with O. lupi but without apparent clinical signs. Two skin samples were collected from 18 anatomical regions of dog 1 at necropsy. In addition, single skin biopsies were performed from the forehead, inter-scapular and lumbar regions of dogs 2-6, in the morning, afternoon, and at night. Two aliquots of the sediment of each sample were microscopically observed, microfilariae counted and morphologically and molecularly identified. Most of the 1,667 microfilariae retrieved from dog 1 were in the right ear (59.6%, nose (26.5%, left ear (6.7%, forehead (3.0%, and inter-scapular (2.9% regions. In dogs 2-6, the overall mean number of microfilariae was larger on the head (n = 122.8, followed by the inter-scapular (n = 119.0 and lumbar (n = 12.8 regions. The overall mean number of microfilariae was larger in the afternoon (153.4, followed by night (75.4 and morning (25.8. CONCLUSIONS: Onchocerca lupi microfilariae were more common in the head (i.e., ears and nose than in the remaining part of the dog's body, indicating they tend to aggregate in specific body regions, which are the best sites to collect skin samples for diagnostic purposes. The periodicity pattern of microfilariae of O. lupi and their concentration in specific body regions is most likely a result of the co-evolution with their as-yet-unknown vector. The detection of skin microfilariae in asymptomatic animals, suggests the potential role of these animals as carriers and reservoirs of O. lupi.
Feng Shiting, E-mail: email@example.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Chan Tao, E-mail: firstname.lastname@example.org [Department of Diagnostic Radiology, University of Hong Kong, Room 406, Block K, Queen Mary Hospital (Hong Kong); Sun Canhui, E-mail: email@example.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Li Ziping, E-mail: firstname.lastname@example.org [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Guo Huanyi, E-mail: email@example.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Yang Guangqi, E-mail: firstname.lastname@example.org [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Peng Zhenpeng, E-mail: email@example.com [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China); Meng Quanfei, E-mail: firstname.lastname@example.org [Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58th The Second Zhongshan Road, Guangzhou 510080 (China)
Objective: Evaluate the use of MDCT with 3D CT angiography (CTA) and CT portal venography (CTPV) reconstruction for the diagnosis of small bowel volvulus (SBV). Methods: Multiphasic MDCT findings in nine patients (seven males and two females, age range 2-70) with surgically proven SBV were retrospectively reviewed. Non-contrast and double phase contrast enhanced MDCT including 3D CTA and CTPV reconstruction were performed in all the patients. Two experienced abdominal radiologists evaluated the images and defined the location, direction and degree of SBV. Results: On axial MDCT images, all cases show segmental or global dilatation of small intestine. Other findings include circumferential bowel wall thickening in eight cases, halo appearance and hyperemia in seven cases, whirl sign in six cases, beak-like appearance in six cases, closed loops in six cases and ascites in one case. CTA/CTPV showed abnormal courses involving main trunks of superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in seven cases, with or without distortion of their tributaries. Normal course of SMA but abnormal course of SMV was seen in the other two cases. Of all the nine cases, whirl sign was seen in six cases and barber's pole sign in five cases. Dilated SMV was observed in eight cases and abrupt termination of SMA was found in one case. Compared with surgical findings, the location, direction and degree of SBV were correctly estimated in all cases based on CTA/CTPV. Conclusion: Multiphasic MDCT with CTA/CTPV reconstruction can play an important role in the diagnosis of SBV. The location, direction and degree of SBV can all be defined preoperatively using this method.
Conclusion: When surgery is performed due to the urgent colonic obstruction in colonic volvulus diagnosed patients, a colon tumour should be considered in the same column loops or in the distal colon. We believe that CT is the method that should be preferred in large-bowel obstruction suspected patients.
Serafeimidis, Costas; Waqainabete, Ifereimi; Creaton, Anne; Vakamacawai, Esala; Kumar, Ronal
Sigmoid volvulus in pregnancy is a very rare condition. Despite this, clinicians should have a high index of suspicion of this condition if they encounter a pregnant woman with symptoms suggestive of bowel obstruction. Incorrect diagnosis may be catastrophic, resulting in major complications, including fetal and maternal death.
Full Text Available Sigmoid volvulus is an important surgical emergency which requires rapid detorsion of the affected bowel. Prompt diagnosis is crucial. It should be one of the differentials to be considered in patients presenting with abdominal distension and signs of intestinal obstruction. This case presentation serves to highlight one such example; the clinical presentation, radiological findings and management are discussed.
Santín-Rivero, Jorge; Núñez-García, Edgar; Aguirre-García, Manuel; Hagerman-Ruiz-Galindo, Gonzalo; de la Vega-González, Francisco; Moctezuma-Velasco, Carla Rubi
Small bowel volvulus is a rare cause of intestinal obstruction in adult patients. This disease is more common in children and its aetiology and management is different to that in adults. A 30 year-old male with sarcoidosis presents with acute abdomen and clinical data of intestinal obstruction. Small bowel volvulus is diagnosed by a contrast abdominal tomography and an exploratory laparotomy is performed with devolvulation and no intestinal resection. In the days following surgery, he developed a recurrent small bowel volvulus, which was again managed with surgery, but without intestinal resection. Medical treatment for sarcoidosis was started, and with his clinical progress being satisfactory,he was discharged to home. Making an early and correct diagnosis of small bowel volvulus prevents large intestinal resections. Many surgical procedures have been described with a high rate of complications. Therefore, conservative surgical management (no intestinal resection) is recommended as the best treatment with the lowest morbidity and mortality rate. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.
Full Text Available We present a case of gastric volvulus in a 91-year-old woman. The patient presented with abdominal pain, recurrent episodes of hematemesis, acute respiratory failure, and severe hypotension. The diagnosis of gastric volvulus was suspected by esophagogastroduodenoscopy, and confirmed later by both esophageal and upper gastrointestinal contrast study and abdominal computed tomography. Management consisted of intubation and mechanical ventilation, fluid loading and transfusion, vasopressor infusion, and surgical reduction of the volvulus.
Li, Xiao-Bing; Guan, Wen-Xian; Gao, Yuan
A volvulus, which is torsion of the bowel and its mesentery, is a medical emergency. Small bowel volvulus rarely occurs in adults, although it has been reported in the presence of small bowel diverticulum. Multislice computed tomography (CT) angiography, by demonstrating the mesenteric vessels, can be of help in the diagnosis of small bowel volvulus, especially when CT or gastrointestinal studies fail to show the diverticulum. We present the multislice CT angiography findings of a 64-year-old woman with chronic intermittent volvulus resulting from jejunal diverticulosis, surgically confirmed. To our knowledge, no similar case has been reported previously in the literature.
Zeng, Mary; Amodio, John; Schwarz, Steve; Garrow, Eugene; Xu, Jiliu; Rabinowitz, Simon S
While sigmoid volvulus is commonly seen in older patients, it is rarely encountered in children and younger adults. Consequently, heightened awareness of this entity is required to avoid a delay in diagnosis. Among the pediatric and adult cases of colonic volvulus previously reported in the English literature, 23 of the affected individuals have also been diagnosed with Hirschsprung disease (HD). This report describes a 12-year-old male with a history of chronic constipation who presented with vomiting and abdominal distension and was found to have sigmoid volvulus with previously unrecognized HD. The case presentation is followed by a review of the literature describing colonic volvulus secondary to HD in children.
Liddicoat, A J; Lloyd, D C
The diagnostic use of ionizing radiation during pregnancy is to be avoided whenever possible due to the risk to the unborn child. However, vomiting presenting after the first trimester of pregnancy is unusual, and if severe or persistent, requires investigation. We present a case where reluctance to expose the fetus to radiation could have resulted in a potentially serious delay in the diagnosis of maternal small bowel volvulus.
Atef, Mejri; Emna, Trigui
Abstract Bochdalek hernias in adulthood are rare. Symptomatic Bochdalek hernias in adults are rarer, but may lead to fatal complications. Patients with acute gastric volvulus on diaphragmatic hernia are a diagnostic and therapeutic emergency. Here, we report a case of a 56-year-old woman diagnosed with epigastric pain, cough, vomiting since 2 weeks and shortness of breath. Complicated Bochdalek hernia was an incidental finding, diagnosed by chest radiograph, computed tomography (CT), and bari...
Samuel, Jonathan C; Msiska, Nelson; Muyco, Arturo P; Cairns, Bruce A; Charles, Anthony G
SUMMARY Sigmoid volvulus is a common cause of bowel obstruction.We describe mesosigmoidopexy, an accepted surgical technique for the management of non-gangrenous sigmoid volvulus, and provide anatomic correlations supporting the therapy. Mesosigmoidopexy should be considered as a rational alternative to resection and anastomosis when operating on non-gangrenous sigmoid volvulus. PMID:22184737
Pastore, Valentina; Basile, Angela; Cocomazzi, Raffaella; Pastore, Marlena; Bartoli, Fabio
Sigmoid volvulus (SV) is an extremely rare cause of bowel obstruction in the newborn period. We report a neonatal case of SV misdiagnosed as small bowel volvulus. At laparotomy, the classical findings of SV were observed without gangrene. The operative procedure consisted of simple detorsion without sigmoidopexy.
Hougaard, Helene Tarri; Qvist, Niels
Volvulus is an axial twist of any part of the gastrointestinal tract along its mesentery. If it goes unattended, it will cause bowel obstruction and bowel ischaemia with gangrene and perforation. The primary treatment is endoscopic desufflation, but the place for elective surgery is controversial....... Volvulus is a rare condition in Western Europe and North America that most often affects elderly of either gender....
Full Text Available Sigmoid volvulus (SV is an extremely rare cause of bowel obstruction in the newborn period. We report a neonatal case of SV misdiagnosed as small bowel volvulus. At laparotomy, the classical findings of SV were observed without gangrene. The operative procedure consisted of simple detorsion without sigmoidopexy.
Kumar, Sanjeev; Gautam, Shefali; Prakash, Ravi; Sidhartha, Kanishka; Shashikant
Intestinal obstruction due to sigmoid colon volvulus during pregnancy is a rare complication but associated with significant fetomaternal mortality. We describe a case of sigmoid volvulus in a patient with 37 wk pregnancy causing huge dilation of left colon. Patient developed rectovaginal fistula following nonmedical method to relieve distention by inserting stick as told by patient.
V. de Vos
Full Text Available Acute intestinal obstruction due to volvulus is described as the cause of death in an adult white rhinoceros cow. It is also pointed out that the gross anatomical features which predispose volvulus in the horse, are also present in the white rhinoceros and is considered to have some significance in the aetiology of the present case.
Turner, Joseph D; Tendongfor, Nicholas; Esum, Mathias; Johnston, Kelly L; Langley, R Stuart; Ford, Louise; Faragher, Brian; Specht, Sabine; Mand, Sabine; Hoerauf, Achim; Enyong, Peter; Wanji, Samuel; Taylor, Mark J
The risk of severe adverse events following treatment of onchocerciasis with ivermectin in areas co-endemic with loiasis currently compromises the development of control programmes and the treatment...
Susan Toebosch; Vera Tudyka; Ad Masclee; Ger Koek
The exact aetiology of sigmoid volvulus in Parkinson's disease (PD) remains unclear.A multiplicity of factors may give rise to decreased gastrointestinal function in PD patients.Early recognition and treatment of constipation in PD patients may alter complications like sigmoid volvulus.Treatment of sigmoid volvulus in PD patients does not differ from other patients and involves endoscopic detorsion.If feasible,secondary sigmoidal resection should be performed.However,if the expected surgical morbidity and mortality is unacceptably high or if the patient refuses surgery,percutaneous endoscopic colostomy (PEC) should be considered.We describe an elderly PD patient who presented with sigmoid volvulus.She was treated conservatively with endoscopic detorsion.Surgery was consistently refused by the patient.After recurrence of the sigmoid volvulus a PEC was placed.
Yeh, W C; Wang, H P; Chen, C; Wang, H H; Wu, M S; Lin, J T
Midgut malrotation and volvulus, found mostly in children, are rare and difficult to diagnose preoperatively in adults. We report 2 cases in which a 68-year-old man and a 75-year-old woman presented with intermittent cramping abdominal pain, abdominal distention, and vomiting. Abdominal sonography demonstrated wrapping of the superior mesenteric vein and bowel loops around the superior mesenteric artery (the "whirlpool sign") in both patients. Abdominal CT revealed similar findings. The diagnoses of midgut volvulus and mesenteric malrotation were made, and the patients underwent laparotomy. The man was confirmed to have duodenojejunal malrotation and volvulus, and the woman had cecal volvulus. The whirlpool sign is valuable for the preoperative diagnosis of mesenteric vessel malrotation and midgut volvulus.
Jun Seok Park; Seong Jae Cha; Beom Gyu Kim; Yong Seok Kim; Yoo Shin Choi; In Talk Chang; Gwang Jun Kim; Woo Seok Lee; Gi Hyeon Kim
Fetal midgut volvulus is quite rare,and most cases areassociated with abnormalities of intestinal rotation orfixation.We report a case of midgut volvulus withoutmalrotation,associated with a meconium pellet,duringthe gestation period.This 2.79 kg,33-wk infant was bornvia a spontaneous vaginal delivery caused by pretermlabor.Prenatal ultrasound showed dilated bowel loopswith the appearance of a 'coffee bean sign" This patienthad an unusual presentation with a distended abdomenshowing skin discoloration.An emergency laparotomyrevealed a midgut volvulus and a twisted small bowel,caused by complicated meconium ileus.Such nonspecificprenatal radiological signs and a low index of suspicionof a volvulus during gestation might delay appropriatesurgical management and result in ischemic necrosis of the bowel.Preterm labor,specific prenatal sonographicfindings (for example,the coffee bean sign) and bluishdiscoloration of the abdominal wall could suggestintrauterine midgut volvulus requiring prompt surgicalintervention.
Toebosch, Susan; Tudyka, Vera; Masclee, Ad; Koek, Ger
The exact aetiology of sigmoid volvulus in Parkinson's disease (PD) remains unclear. A multiplicity of factors may give rise to decreased gastrointestinal function in PD patients. Early recognition and treatment of constipation in PD patients may alter complications like sigmoid volvulus. Treatment of sigmoid volvulus in PD patients does not differ from other patients and involves endoscopic detorsion. If feasible, secondary sigmoidal resection should be performed. However, if the expected surgical morbidity and mortality is unacceptably high or if the patient refuses surgery, percutaneous endoscopic colostomy (PEC) should be considered. We describe an elderly PD patient who presented with sigmoid volvulus. She was treated conservatively with endoscopic detorsion. Surgery was consistently refused by the patient. After recurrence of the sigmoid volvulus a PEC was placed.
Inaba, Kazuki; Sakurai, Yoichi; Isogaki, Jun; Komori, Yoshiyuki; Uyama, Ichiro
Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal hernia, volvulus, and gastroesophageal reflux.
Aswani, Yashant; Anandpara, Karan Manoj; Hira, Priya
Wandering spleen is a rare medical entity in which the spleen is orphaned of its usual peritoneal attachments and thus assumes an ever wandering and hypermobile state. This laxity of attachments may even cause torsion of the splenic pedicle. Both gastric volvulus and wandering spleen share a common embryology owing to maldevelopment of the dorsal mesentery. Gastric volvulus complicating a wandering spleen is, however, an extremely unusual association, with a few cases described in literature. We present a case of a young female who presented with acute abdominal pain and vomiting. Radiological imaging revealed a intrathoracic gastric volvulus, torsion in an ectopic spleen, and additionally demonstrated a pancreatic volvulus - an unusual triad, reported only once, causing an acute abdomen. The patient subsequently underwent an emergency surgical laparotomy with splenopexy and gastropexy.
Uni, Shigehiko; Fukuda, Masako; Agatsuma, Takeshi; Bain, Odile; Otsuka, Yasushi; Nakatani, Jun; Matsubayashi, Makoto; Harada, Masashi; Omar, Hasmahzaiti; Ramli, Rosli; Hashim, Rosli; Azirun, Mohd Sofian; Takaoka, Hiroyuki
Human zoonotic onchocercosis is caused by Onchocerca dewittei japonica, parasitic in wild boars (Sus scrofa leucomystax) in Japan. Previously, microfilariae longer than those of Onchocerca dewittei japonica were observed in skin snips from wild boars during the study of O. dewittei japonica. Moreover, the third-stage larvae (L3) of these longer microfilariae were obtained from the blackfly Simulium bidentatum after experimental injections. Based on morphometric and molecular studies, similar L3 were found in blackflies during fieldwork in Oita, Japan. However, except for O. dewittei japonica, adult worms of Onchocerca have not been found in wild boars. In this study, we discovered adult females of a novel Onchocerca species in the skin of a wild boar in Oita, and named it Onchocerca takaokai n. sp. Females of this new species had longer microfilariae and differed from O. dewittei japonica in terms of their morphological characteristics and parasitic location. The molecular characteristics of the cytochrome c oxidase subunit 1 and 12S rRNA genes of the new species were identical to those of the longer microfilariae and L3 previously detected, but they differed from those of O. dewittei japonica at the species level. However, both species indicated a close affinity among their congeners and Onchocerca ramachandrini, parasitic in the warthog in Africa, was basal in the Suidae cluster of the 12S rRNA tree.
Jabbour, Gaby; Afifi, Ibrahim; Ellabib, Mohamed; El-Menyar, Ayman; Al-Thani, Hassan
Patient: Male, 23 Final Diagnosis: Acute spontaneous gastric volvulus Symptoms: — Medication: — Clinical Procedure: Laparotomy Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Acute gastric volvulus is a surgical emergency that requires early recognition and treatment. Acute idiopathic mesenteroaxial gastric volvulus is a rare sub-type and there are few cases reported in children and there are even fewer reports in adults. Case Report: We report a rare case of a 23-year-old man who presented with a 1-day history of vomiting, epigastric pain, distention, and constipation. The diagnosis for mesenteroaxial type gastric volvulus was confirmed by abdominal radiography and computed tomography. The patient was successfully treated by laparotomy with resection of the ischemic stomach wall and anastomosis. Acute spontaneous mesenteroaxial gastric volvulus is rare in adults and early diagnosis is challenging due to non-specific symptoms. A missed or delayed diagnosis may result in serious complications due to gastric obstruction. Conclusions: A patient presenting with severe epigastric pain and clinical evidence of gastric outlet obstruction should be considered as a surgical emergency to rule out gastric volvulus. High index of suspicion, early diagnosis and prompt surgical management are important for favorable outcome in patients with acute spontaneous gastric volvulus. PMID:27112797
Oh, Sarah K.; Han, Bokyung K.; Levin, Terry L.; Blitman, Netta M. [Children' s Hospital at Montefiore Medical Center, Department of Radiology, Bronx, NY (United States); Murphy, Robyn [Morristown Memorial Hospital, Department of Radiology, Morristown, NJ (United States); Ramos, Carmen [Children' s Hospital at Montefiore Medical Center, Department of Pediatric Surgery, Bronx, NY (United States)
Gastric volvulus in children is uncommon, and characteristic radiographic findings might not be recognized. To present the spectrum of clinical and imaging findings, correlate the type of gastric volvulus with clinical outcome, and identify imaging findings to aid in early diagnosis. Medical records and imaging findings of ten children with gastric volvulus were reviewed. Imaging included abdominal radiographs, upper gastrointestinal (UGI) series, and CT. The diagnosis (organoaxial, mesenteroaxial or mixed type) was made on the UGI series (n = 9) and CT (n = 1), and confirmed surgically in seven children. Patients were classified based on presentation: four acute, four chronic, and two neonatal. All of the acute group (three mesenteroaxial and one mixed type) had abnormal radiographic findings: three spherical gastric distension, four paucity of distal gas, three elevated left hemidiaphragm, one overlapping pylorus and gastric fundus, one unusual nasogastric tube course, and one situs inversus. All underwent emergent surgery. Three had diaphragmatic abnormalities. One had heterotaxy. Patients in the chronic group (three organoaxial, one mesenteroaxial) had long-standing symptoms. Most had associated neurologic abnormalities. In the neonatal group, organoaxial volvulus was found incidentally on the UGI series. A spectrum of findings in gastric volvulus exists. Mesenteroaxial volvulus has greater morbidity and mortality. Radiographic findings of spherical gastric dilatation, paucity of distal gas and diaphragmatic elevation are suggestive of acute volvulus, particularly in patients with predisposing factors. (orig.)
Marine, Megan B.; Cooper, Matthew L.; Delaney, Lisa R.; Karmazyn, Boaz [Riley Hospital for Children, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Jennings, Samuel Gregory [Indiana University School of Medicine, Department of Radiology and Imaging Sciences, Indianapolis, IN (United States); Rescorla, Frederick J. [Indiana University School of Medicine, Department of Pediatric Surgery, Indianapolis, IN (United States)
Colonic volvulus is rare in children and associated with colonic dysmotility. Diagnosis of colonic volvulus on radiographs in these patients can be challenging. The purpose of the study was to identify the accuracy of abdominal radiographs and findings suggestive of colonic volvulus. A retrospective (2003- 2014) study of all children with colonic volvulus proven surgically or endoscopically reviewed their medical charts for underlying disease and clinical presentation as well as their original radiograph reports. Two pediatric radiologists (reader 1 and reader 2) independently reviewed the radiographs. The kappa test was used to evaluate interobserver variability. There were 19 cases of colonic volvulus in 18 patients (11 males) a mean age 14 years. Cecal volvulus was the most common finding at 14/19 cases (74%). Sixteen of 18 (89%) patients had neurological impairment and 10 of 18 (56%) had intestinal dysmotility. The most common presentation was abdominal distension (14/19 [74%]) and pain (11/19 [58%]). Colonic volvulus was diagnosed in only 7/16 (44%) of the abdominal radiographs. The specific finding of a coffee-bean sign was retrospectively observed only by reader 2 in two cases. Absence of rectal gas and focal colonic loop dilation were the most common findings by the readers (average 73.5% and 87%, respectively) with Kappa values of 0.3 and 0.38, respectively. Diagnosis of colonic volvulus in children can be challenging. Radiologists should be alerted to the possibility of colonic volvulus when there is focal colonic loop distention or absent rectal gas. (orig.)
Full Text Available Intestinal obstruction complicating pregnancy is an extremely rare complication during pregnancy. Volvulus of the sigmoid colon is the most common cause of intestinal obstruction complicating pregnancy accounting for upto 44% of the aetiology. We report a case of sigmoid volvulus complicating pregnancy in a woman with 34 weeks amenorrhoea which was diagnosed early in spite of its late presentation and successfully managed with resection and primary anastamosis. Sigmoid volvulus complicating pregnancy carries a high maternal mortality and morbidity, fetal mortality and needs a high index of suspicion and early surgical intervention. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000: 1273-1275
Esterson, Yonah B; Villani, Robert; Dela Cruz, Ronald A; Friedman, Barak; Grimaldi, Gregory M
Here we report the case of a pregnant 28-year-old who presented with acute upper abdominal pain. CT demonstrated midgut volvulus with short segment occlusion of the superior mesenteric artery (SMA). Emergent detorsion of the small bowel was performed, at which time underlying intestinal malrotation was discovered. Following detorsion, the SMA had a bounding pulse and did not require thrombectomy or revascularization. Fewer than 25 cases of midgut volvulus during pregnancy have been reported over the past 20years. To our knowledge, this is the first report of maternal midgut volvulus in which imaging captures the resultant occlusion of the SMA.
Rommel Singh Mohi
Full Text Available The incidence of the diverticulum of the small bowel varies from 0.2-1.3% in autopsy studies to 2.3% when assessed on enteroclysis. It occurs mostly in patients in the 6th decade of their life. Of all the small bowel diverticuli, jejunal diverticulum is the most common type. This rare entity is usually asymptomatic. However, they may cause chronic non-specific symptoms for a long period of time like dyspepsia, chronic postprandial pain, nausea, vomiting, borborgymi, alternating diarrhoea and constipation, weight loss, anaemia, steatorrhea or rarely lead to complications like haemorrhage, obstruction, perforation. Obstruction can be due to enterolith, adhesions, intussusception, and volvulus. The condition is difficult to diagnose because patients are generally presented with symptoms that mimic other diseases. It is important for clinicians to have awareness of this entity. Here, we present a case of multiple jejunal diverticuli with a history of repeated attacks of diverticulitis over past 20 years, which were misdiagnosed and now presented with intestinal obstruction due to volvulus of the involved segment along with mesentery around its axis. Resection of the diverticuli segment of jejunum was done with end-to-end jejuno-jejunal anastomosis. The patient is asymptomatic since 10 months of follow-up.
Arumugam, Sridhar; Wei, Junfei; Liu, Zhuyun; Abraham, David; Bell, Aaron; Bottazzi, Maria Elena; Hotez, Peter J; Zhan, Bin; Lustigman, Sara; Klei, Thomas R
The Brugia malayi Bm-103 and Bm-RAL-2 proteins are orthologous to Onchocerca volvulus Ov-103 and Ov-RAL-2, and which were selected as the best candidates for the development of an O. volvulus vaccine. The B. malayi gerbil model was used to confirm the efficacy of these Ov vaccine candidates on adult worms and to determine whether their combination is more efficacious. Vaccine efficacy of recombinant Bm-103 and Bm-RAL-2 administered individually, concurrently or as a fusion protein were tested in gerbils using alum as adjuvant. Vaccination with Bm-103 resulted in worm reductions of 39%, 34% and 22% on 42, 120 and 150 days post infection (dpi), respectively, and vaccination with Bm-RAL-2 resulted in worm reductions of 42%, 22% and 46% on 42, 120 and 150 dpi, respectively. Vaccination with a fusion protein comprised of Bm-103 and Bm-RAL-2 resulted in improved efficacy with significant reduction of worm burden of 51% and 49% at 90 dpi, as did the concurrent vaccination with Bm-103 and Bm-RAL-2, with worm reduction of 61% and 56% at 90 dpi. Vaccination with Bm-103 and Bm-RAL-2 as a fusion protein or concurrently not only induced a significant worm reduction of 61% and 42%, respectively, at 150 dpi, but also significantly reduced the fecundity of female worms as determined by embryograms. Elevated levels of antigen-specific IgG were observed in all vaccinated gerbils. Serum from gerbils vaccinated with Bm-103 and Bm-RAL-2 individually, concurrently or as a fusion protein killed third stage larvae in vitro when combined with peritoneal exudate cells. Although vaccination with Bm-103 and Bm-RAL-2 individually conferred protection against B. malayi infection in gerbils, a more consistent and enhanced protection was induced by vaccination with Bm-103 and Bm-RAL-2 fusion protein and when they were used concurrently. Further characterization and optimization of these filarial vaccines are warranted.
Full Text Available The Brugia malayi Bm-103 and Bm-RAL-2 proteins are orthologous to Onchocerca volvulus Ov-103 and Ov-RAL-2, and which were selected as the best candidates for the development of an O. volvulus vaccine. The B. malayi gerbil model was used to confirm the efficacy of these Ov vaccine candidates on adult worms and to determine whether their combination is more efficacious.Vaccine efficacy of recombinant Bm-103 and Bm-RAL-2 administered individually, concurrently or as a fusion protein were tested in gerbils using alum as adjuvant. Vaccination with Bm-103 resulted in worm reductions of 39%, 34% and 22% on 42, 120 and 150 days post infection (dpi, respectively, and vaccination with Bm-RAL-2 resulted in worm reductions of 42%, 22% and 46% on 42, 120 and 150 dpi, respectively. Vaccination with a fusion protein comprised of Bm-103 and Bm-RAL-2 resulted in improved efficacy with significant reduction of worm burden of 51% and 49% at 90 dpi, as did the concurrent vaccination with Bm-103 and Bm-RAL-2, with worm reduction of 61% and 56% at 90 dpi. Vaccination with Bm-103 and Bm-RAL-2 as a fusion protein or concurrently not only induced a significant worm reduction of 61% and 42%, respectively, at 150 dpi, but also significantly reduced the fecundity of female worms as determined by embryograms. Elevated levels of antigen-specific IgG were observed in all vaccinated gerbils. Serum from gerbils vaccinated with Bm-103 and Bm-RAL-2 individually, concurrently or as a fusion protein killed third stage larvae in vitro when combined with peritoneal exudate cells.Although vaccination with Bm-103 and Bm-RAL-2 individually conferred protection against B. malayi infection in gerbils, a more consistent and enhanced protection was induced by vaccination with Bm-103 and Bm-RAL-2 fusion protein and when they were used concurrently. Further characterization and optimization of these filarial vaccines are warranted.
Flores-Ríos, Enrique; Méndez-Díaz, Cristina; Rodríguez-García, Esther; Pérez-Ramos, Tania
Wandering spleen is a rare condition, characterized by a mobile spleen that is attached only by an elongated vascular pedicle, allowing it to migrate to any part of the abdomen or pelvis. Mesenteroaxial gastric volvulus usually occurs in children and may be associated with wandering spleen. Both entities result from abnormal laxity or absence of the peritoneal attachments due to abnormal fusion of the peritoneal mesenteries. Pancreatic volvulus is a very rare anomaly, with only a few isolated case reports described in association with wandering spleen. Anomalous right sided descending and sigmoid colon is a very rare entity and its association with wandering spleen has not been previously reported. We report a case of wandering spleen associated with mesenteroaxial gastric volvulus, pancreatic volvulus and rightward shift of the splenic flexure of the colon and right sided descending and sigmoid colon in a young female.
Full Text Available Sigmoid volvulus is abnormal rotation of sigmoid colon along it’s mesenteric axis which may results in effects ranging from partial to complete obstruction of bowel to vascular compromise, culminating in gangrene of bowel. Sigmoid volvulus is responsible for about 4 - 24% of all acute intestinal obstruction. Retrospectiv ely for last 3 years all cases of acute intestinal obstruction admitted to surgery were reviewed and study of sigmoid volvulus cases done. We analysed 247 cases of acute intestinal obstruction retrospectively over a period of 3 years . 50 cases are due to s igmoid volvulus. Most of cases are around 41 - 60 years. Most of cases present with pain abdomen , abdominal distention , constipation. Diagnosis is made by plain x - ray abdomen. Most cases treated with Derotation , resection and anastomosis. Out of 50 cases 6 d eaths occurred.
Full Text Available Sigmoid volvulus is an extremely rare disease among young adults. This may cause delay in diagnosis and treatment and so it may cause life threatening ischemia and necrosis at the colon. In this article we present the case which was confirmed to be sigmoid volvulus with tomographic examinations which was carried upon suspicion of sigmoid volvulus in a 17 years old girl who attended with increasing abdominal pain, constipation, obstipation and distention complaints. Taking a detailed history, performing a physical examination and evaluation of laboratory tests of a patient presenting with complaints like abdominal pain, constipation and distention are the most essential steps to diagnose the sigmoid volvulus. The most important method for early diagnosis in young adults is to keep the diagnosis in mind. So it would be possible to plan advanced radiologic and endoscopic examinations which would confirm the diagnosis. J Clin Exp Invest 2014; 5 (1: 122-125
Jeffrey J. Leow
Conclusion: While rare, adult midgut volvulus has the potential for morbidity and mortality if not diagnosed early with intestinal ischaemia and related sequlae. Clinicians should consider this and if in doubt, perform an early contrast CT scan.
Resta, G; Scagliarini, L; Bandi, M; Vedana, L; Marzetti, A; Ferrocci, G; Santini, M; Anania, G; Cavallesco, G; Baccarini, M
We report a case of sigmoid volvulus post-stapled transanal rectal resection (STARR) for obstructed defecation. The patient, a 68-yearold woman with chronic constipation and dolichosigma, two days post-STARR presented severe abdominal pain. CT revealed sigmoid ischemia. The patient underwent resection of the sigmoid colon with end colostomy (Hartmann's procedure). Can STARR procedure produce a serious complication as sigmoid volvulus in patient with dolichosigma and obstructed defecation syndrome?
Albert, Ann A; Nolan, Tracy L; Weidner, Bryan C
Sigmoid volvulus, a condition generally seen in debilitated elderly patients, is extremely rare in the pediatric age group. Frequent predisposing conditions that accompany pediatric sigmoid volvulus include intestinal malrotation, omphalomesenteric abnormalities, Hirschsprung's disease, imperforate anus and chronic constipation. A 16-year-old previously healthy African American male presented with a 12 hour history of sudden onset abdominal pain and intractable vomiting. CT was consistent with sigmoid volvulus. A contrast enema did not reduce the volvulus, but it was colonoscopically reduced. Patient condition initially improved after colonoscopy, but he again became distended with abdominal pain, so he was taken to the operating room. On exploratory laparotomy, a band was discovered where the mesenteries of the sigmoid and small bowel adhered and created a narrow fixation point around which the sigmoid twisted. A sigmoidectomy with primary anastomosis was performed. The diagnosis of sigmoid volvulus may be more difficult in children, with barium enema being the most consistently helpful. Seventy percent of cases do not involve an associated congenital problem, suggesting that some pediatric patients may have congenital redundancy of the sigmoid colon and elongation of its mesentery. The congenital band found in our patient was another potential anatomic factor that led to sigmoid volvulus. Pediatric surgeons, accustomed to unusual problems in children, may thus encounter a condition generally found in the debilitated elderly patient.
Full Text Available Background/aims: the sigmoid colon is the most frequent site for a volvulus. In this report, we review our experience with sigmoid colon volvulus. Methodology: we present our experience of 81 cases of sigmoid volvulus admitted to our department. Results: preoperative endoscopic volvulus detortion was attempted in all patients, and in 39 of them the procedure was successful. The success rate of endoscopic detortion for sigmoid colon volvulus with a flexible colonoscope (60% was higher than with a rigid rectosigmoidoscope (42%. In 19 of these 39 non-operatively devolvulated patients, sigmoid resection with primary anastomosis was performed within 7-10 days after reduction, but 20 patients did not accept the elective operation after a non-operative treatment. Among the 61 patients undergoing urgent or elective operation for sigmoid volvulus, there were 17 laparotomies laparatomies with only detortion, 19 resections with elective anastomosis, 6 resections with primary anastomosis, and 19 resections with a Hartmann’s pouch. There were 9 deaths (21% among 42 patients who underwent an emergency operation, and one (5.2% among the 19 patients who had elective surgery died because of a cerebral embolus. Conclusions: initial therapy with endoscopy affords decompression and an adequate preparation of patients for surgical resection, and a flexible colonoscope has notable advantages over rigid instruments for the detortion process.
Full Text Available Background: the diagnostic and therapeutic management of colonic volvulus remains nowadays controversial. The election of the type of surgery, its timing, or the use of non-operative decompression must be based on the experience of a multidisciplinary team, the clinical condition of the patient, and the type of volvulus. Objectives: the purpose of this study is to review our experience and results in the treatment of patients with colonic volvulus. Material and methods: we performed a retrospective study of patients diagnosed of colonic volvulus between January 1990 and September 2008 in our institution. Results: we included a total of 75 patients with a mean age of 72.7 years and, in most cases, with associated comorbidities and constipation. The most frequently involved segment was sigmoid colon (85.3%. A rectal tube insertion was used as the only therapeutic measure in 17 patients (22.4%, colonoscopic decompression in 17 (22.4%, and surgery in 41 patients (55.2%. Intestinal resection with primary anastomosis was the most common surgical option. Postoperative morbidity was 43%, being wound infections the most frequent complication. In the group of non-surgical treatment morbidity was 26.4%, albeit with a higher and early rate of recurrences. Conclusions: treatment of colonic volvulus present important morbidity and mortality rates, and its treatment must be individualized. Resective surgery with primary anastomosis in clinically stable patients is the most appropriate therapeutic option, offering the lower recurrence rates.Introducción: el manejo diagnóstico-terapéutico del vólvulo de colon continúa siendo un tema controvertido en la actualidad. En base a la situación clínica del paciente, a la experiencia de un equipo multidisciplinar, deben elegirse el tipo de cirugía, momento de su realización y el empleo de otras opciones descompresivas. Objetivos: los objetivos del presente trabajo son revisar nuestra experiencia y resultados en
Cheryl de Silva
Full Text Available Transverse colonic accounts for 2–4% of all forms of colonic volvulus and has its highest mortality rate (33 [1–3]. Only forty cases of pediatric transverse colonic volvulus have been reported in the literature to date . We report on a 16-year-old female with congenital myotonic dystrophy who underwent operative repair for transverse colonic volvulus, the first reported case of these two entities in combination.
Background: the diagnostic and therapeutic management of colonic volvulus remains nowadays controversial. The election of the type of surgery, its timing, or the use of non-operative decompression must be based on the experience of a multidisciplinary team, the clinical condition of the patient, and the type of volvulus. Objectives: the purpose of this study is to review our experience and results in the treatment of patients with colonic volvulus. Material and methods: we performed a retrosp...
Full Text Available Abstract Introduction Isolated hypoganglionosis is a rare cause of intestinal innervation defects. It is characterized by sparse and small myenteric ganglia, absent or low acetylcholinesterase activity in the lamina propria and hypertrophy of the muscularis mucosae, principally in the region of the colon and rectum. It accounts for 5% of all intestinal neuronal malformations. To the best of our knowledge, only 92 cases of isolated hypoganglionosis were reported from 1978 to 2009. Isolated hypoganglionosis usually manifests as enterocolitis or poor bowel function, and is diagnosed in infancy or childhood. We report the first case of isolated hypoganglionosis presenting with sigmoid volvulus in a 34-year-old woman. Case presentation A 34-year-old Asian woman had progressively increasing abdominal pain and had not passed stool or flatus for two days. A physical examination revealed a distended abdomen with sluggish gut sounds. A computerized tomography (CT scan demonstrated gross dilatation of the sigmoid colon (maximal diameter 14.3 cm suggestive of sigmoid volvulus. During emergency laparotomy, sigmoidectomy with a side-to-side colorectal anastomosis was performed. Histopathology of the resected specimen showed occasional ganglion cells and hypertrophied nerve bundles in the muscle layers, suggesting hypoganglionosis. Colonoscopy was performed, and multiple full-thickness biopsies were taken that showed hypoganglionosis of the entire large bowel. Our patient underwent total colectomy with an ileorectal anastomosis. Subsequently our patient reported a dramatic improvement in her bowel function. Conclusions Isolated hypoganglionosis is a rare cause of intestinal dysganglionosis and cannot be differentiated from Hirschsprung's disease based on clinical presentation. This case report describes an atypical presentation of the disease. A definitive diagnosis requires histopathological analysis of full-thickness intestinal biopsies. Treatment should be
Aftab, Zia; Toro, Adriana; Abdelaal, Abdelrahmam; Dasovky, Mohammed; Gehani, Salahdin; Abdel Mola, Abdelatif; Di Carlo, Isidoro
Sigmoid volvulus is a rare, but serious, complication that can occur during pregnancy. We present a case of a 33-year-old pregnant female in the third trimester with a sigmoid volvulus. Detorsion of the volvulus was performed during colonoscopy. The patient underwent an elective sigmoidectomy at a later date. Prompt diagnosis of the volvulus sigmoid is critical to minimize fetal and maternal morbidity and mortality. Sigmoidoscopic detorsion or surgical resection are the treatment options, depending on bowel viability. A review of the literature was done.
Ungcharoensuk, Charoenchai; Putaporntip, Chaturong; Pattanawong, Urassaya; Jongwutiwes, Somchai
The Ancylostoma secreted protein-2 of Necator americanus (Na-ASP-2) was one of the promising vaccine candidates against the most prevalent human hookworm species as adverse vaccine reaction has compromised further human vaccine trials. To elucidate the gene structure and the extent of sequence diversity, we determined the complete nucleotide sequence of the Na-asp-2 gene of individual larvae from 32 infected subjects living in 3 different endemic areas of Thailand. Sequence analysis revealed that the gene encoding Na-ASP-2 comprised 8 exons. Of 3 nucleotide substitutions in these exons, only one causes an amino acid change from leucine to methionine. A consensus conserved GT and AG at the 5' and the 3' boundaries of each intron was observed akin to those found in other eukaryotic genes. Introns of Na-asp-2 contained 23 nucleotide substitutions and 0-18 indels. The mean number of nucleotide substitutions per site (d) in introns was not significantly different from the mean number of synonymous substitutions per synonymous site (d(S)) in exons whereas d in introns was significantly exceeded d(N) (the mean number of nonsynonymous substitutions per nonsynonymous site) in exons (pASP-2. A recombination site was identified in an intron near the 3' portion of the gene. The positions of introns and the intron phases in the Na-asp-2 gene comparing with those in other pathogenesis-related-1 proteins of Loa loa, Onchocerca volvulus, Heterodera glycines, Caenorhabditis elegans and human were relatively conserved, suggesting evolutionary conservation of these genes. Sequence conservation in Na-ASP-2 may not compromise further vaccine design if adverse vaccine effects could be resolved whereas microheterogeneity in introns of this locus may be useful for population genetics analysis of N. americanus. Copyright © 2012 Elsevier B.V. All rights reserved.
Laith H. Jamil
Full Text Available Gastric volvulus is a life threatening condition characterized by an abnormal rotation of the stomach around an axis. Although the first line treatment of this disorder is surgical, we report here a case of gastric volvulus that was endoscopically managed using a novel strategy. An 83-year-old female with a history of pancreatic cancer status postpylorus-preserving Whipple procedure presented with a cecal volvulus requiring right hemicolectomy. Postoperative imaging included a CT scan and upper GI series that showed a gastric volvulus with the antrum located above the diaphragm. An upper endoscopy was advanced through the pylorus into the duodenum and left in this position to keep the stomach under the diaphragm. A second pediatric endoscope was advanced alongside and used to complete percutaneous endoscopic gastrostomy (PEG placement for anterior gastropexy. The patient’s volvulus resolved and there were no complications. From our review of the literature, the dual endoscopic technique employed here has not been previously described. Patients who are poor surgical candidates or those who do not require emergent surgery can possibly benefit the most from similar minimally invasive endoscopic procedures as described here.
Kazuki Inaba; Yoichi Sakurai; Jun Isogaki; Yoshiyuki Komori; Ichiro Uyama
Although mesenterioaxial gastric volvulus is an uncom-mon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesente-rioaxial intrathoracic gastric volvulus, which was success-fully treated with laparoscopic repair of the diaphrag-matic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gas-trointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparo-scopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundopli-cation. This case highlights the feasibility and effective-ness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be use-ful for preventing postoperative recurrence of hiatal her-nia, volvulus, and gastroesophageal reflux.
Full Text Available Abstract Introduction Gastric volvulus is an uncommon clinical entity, first described by Berti in 1866. It is a rotation of all or part of the stomach through more than 180°. This rotation can occur on the longitudinal (organo-axial or transverse (mesentero-axial axis. This condition can lead to a closed-loop obstruction or strangulation. Traditional surgical therapy for gastric volvulus is based on an open approach. Here we report the case of a patient with chronic intermittent gastric volvulus who underwent a successful laparoscopic treatment. Case presentation A 34-year-old woman presented with multiple episodes of recurrent upper abdominal pain associated with retching and vomiting, treated unsuccessfully with intramuscular metoclopramide. Endoscopic examination of the upper digestive tract showed a suspected rotation of the stomach, and a chronic recurrent gastric volvulus was revealed by barium meal. The patient was operated on successfully, with an anterior laparoscopic gastropexy performed as the first surgical approach. Conclusion Experience with laparoscopic anterior gastropexy is limited only to a few described cases. Our patient was clinically and radiologically followed-up for 2 years with no evidence of recurrence, either radiological or symptomatic. Based on this result, laparoscopic gastropexy can be seen and considered as an initial 'gold standard' for the treatment of gastric volvulus.
Full Text Available Sigmoid volvulus is a common cause of large bowel obstruction in western countries and Africa. It accounts for 25% of the patients admitted to the hospital for large bowel obstruction. The acute management of sigmoid volvulus is sigmoidoscopic decompression. However, the recurrence rate can be as high as 60% in some series. Recurrent sigmoid volvulus in elderly patients who are not fit for definitive surgery is difficult to manage. The percutaneous endoscopic placement of two percutaneous endoscopic colostomy tube placement is a simple and relatively safe procedure. The two tubes should be left open to act as vents for the colon from over-distending. In our opinion, this aspect is key to its success as it keeps the sigmoid colon deflated until adhesions form between the colon and the abdominal wall.
Full Text Available We report a 64 year old female who presented with epigastric pain and intractable vomiting not respond to treatment and we were not able to pass nasogastric tube. Chest x –ray shows eventration of left sided hemi diaphragm, upper gastro intestinal contrast study conform the diagnosis of gastric volvulus. Plication of left hemidiaphragm with anterior gastropexy was performed through an abdominal approach. Postoperatively the patient's symptoms improved. Acute gastric volvulus carries a mortality rate of 42–56%, secondary to gastric ischemia, perforation or necrosis.1 Emergency physicians should have suspicion about gastric volvulus when treating patients with abdominal pain and persistent vomiting. The patient should go for surgical consultation as early as possible.
Khan, Muhammad Aamir Saeed; Ullah, Sana; Beckly, David; Oppong, Fielding Christian
Treatment of recurrent sigmoid volvulus is a major challenge in frail and elderly patients with multiple co-morbidities. Early management involves endoscopic decompression with high success rate, however, its recurrence make it a real challenge as most of these patients are not suitable for major colonic resection. The aim of this study was to assess the role of percutaneous endoscopic colostomy (PEC) in the treatment of recurrent sigmoid volvulus in these patients. Twelve PEC procedures were performed in 8 patients under our care. This prevented major colonic resection in 7 patients. One patient underwent sigmoid resection and died with postoperative complications. Two patients experienced minor complications. Three patients required repeat procedures for permanent PEC tube placement. Six patients managed permanently with PEC procedure. PEC is an effective treatment for recurrent sigmoid volvulus in high-risk elderly patients.
Palmucci, Stefano; Lanza, Maria Letizia; Gulino, Fabrizio; Scilletta, Beniamino; Ettorre, Giovanni Carlo
Sigmoid volvulus complicating pregnancy is a rare, non-obstetric cause of abdominal pain that requires prompt surgical intervention (decompression) to avoid intestinal ischemia and perforation. We report the case of a 31-week pregnant woman with abdominal pain and subsequent development of constipation. Preoperative diagnosis was achieved using magnetic resonance imaging and ultrasonography: the large bowel distension and a typical whirl sign - near a sigmoid colon transition point - suggested the diagnosis of sigmoid volvulus. The decision to refer the patient for emergency laparotomy was adopted without any ionizing radiation exposure, and the pre-operative diagnosis was confirmed after surgery. Imaging features of sigmoid volvulus and differential diagnosis from other non-obstetric abdominal emergencies in pregnancy are discussed in our report, with special emphasis on the diagnostic capabilities of ultrasonography and magnetic resonance imaging.
Ahmadi, Hamid; Tehrani, Mahdieh Mohammad Khan
Wandering spleen is an uncommon entity in adults and has been described only rarely with sigmoid volvulus, that rarely affects children and adolescents. It is usually described in adults.Wandering spleen characterized by the abnormal location of the spleen, caused by incomplete fusion of the four primary splenic ligaments, allowing the spleen to be mobile within the abdomen.The wandering spleen can lead to torsion and subsequent splenic infarction or rupture. Clinical suspicion plus urgent investigation and intervention are important. We present a rare clinical case of acute abdomen due to torsion of wandering spleen and volvulus of sigmoid in a 14-year-old girl presented with painful periumbilical mass. Detorsion of sigmoid occurred while undergoing exploratory laparotomy and splenectomy was performed. The possibility of torsion and its complication like gastric, pancreas tail and colon volvulus should be kept in mind in the differential diagnosis of the acute abdomen to avoid serious complications.
Full Text Available Wandering spleen is an uncommon entity in adults and has been described only rarely with sigmoid volvulus, that rarely affects children and adolescents. It is usually described in adults.Wandering spleen characterized by the abnormal location of the spleen, caused by incomplete fusion of the four primary splenic ligaments, allowing the spleen to be mobile within the abdomen.The wandering spleen can lead to torsion and subsequent splenic infarction or rupture. Clinical suspicion plus urgent investigation and intervention are important. We present a rare clinical case of acute abdomen due to torsion of wandering spleen and volvulus of sigmoid in a 14-year-old girl presented with painful periumbilical mass. Detorsion of sigmoid occurred while undergoing exploratory laparotomy and splenectomy was performed. The possibility of torsion and its complication like gastric, pancreas tail and colon volvulus should be kept in mind in the differential diagnosis of the acute abdomen to avoid serious complications.
Full Text Available Adjuvants potentiate antigen-specific protective immune responses and can be key elements promoting vaccine effectiveness. We previously reported that the Onchocerca volvulus recombinant protein rOv-ASP-1 can induce activation and maturation of naïve human DCs and therefore could be used as an innate adjuvant to promote balanced Th1 and Th2 responses to bystander vaccine antigens in mice. With a few vaccine antigens, it also promoted a Th1-biased response based on pronounced induction of Th1-associated IgG2a and IgG2b antibody responses and the upregulated production of Th1 cytokines, including IL-2, IFN-γ, TNF-α and IL-6. However, because it is a protein, the rOv-ASP-1 adjuvant may also induce anti-self-antibodies. Therefore, it was important to verify that the host responses to self will not affect the adjuvanticity of rOv-ASP-1 when it is used in subsequent vaccinations with the same or different vaccine antigens. In this study, we have established rOv-ASP-1's adjuvanticity in mice during the course of two sequential vaccinations using two vaccine model systems: the receptor-binding domain (RBD of SARS-CoV spike protein and a commercial influenza virus hemagglutinin (HA vaccine comprised of three virus strains. Moreover, the adjuvanticity of rOv-ASP-1 was retained with an efficacy similar to that obtained when it was used for a first vaccination, even though a high level of anti-rOv-ASP-1 antibodies was present in the sera of mice before the administration of the second vaccine. To further demonstrate its utility as an adjuvant for human use, we also immunized non-human primates (NHPs with RBD plus rOv-ASP-1 and showed that rOv-ASP-1 could induce high titres of functional and protective anti-RBD antibody responses in NHPs. Notably, the rOv-ASP-1 adjuvant did not induce high titer antibodies against self in NHPs. Thus, the present study provided a sound scientific foundation for future strategies in the development of this novel protein
Wang, Jing; Tricoche, Nancy; Du, Lanying; Hunter, Meredith; Zhan, Bin; Goud, Gaddam; Didier, Elizabeth S; Liu, Jing; Lu, Lu; Marx, Preston A; Jiang, Shibo; Lustigman, Sara
Adjuvants potentiate antigen-specific protective immune responses and can be key elements promoting vaccine effectiveness. We previously reported that the Onchocerca volvulus recombinant protein rOv-ASP-1 can induce activation and maturation of naïve human DCs and therefore could be used as an innate adjuvant to promote balanced Th1 and Th2 responses to bystander vaccine antigens in mice. With a few vaccine antigens, it also promoted a Th1-biased response based on pronounced induction of Th1-associated IgG2a and IgG2b antibody responses and the upregulated production of Th1 cytokines, including IL-2, IFN-γ, TNF-α and IL-6. However, because it is a protein, the rOv-ASP-1 adjuvant may also induce anti-self-antibodies. Therefore, it was important to verify that the host responses to self will not affect the adjuvanticity of rOv-ASP-1 when it is used in subsequent vaccinations with the same or different vaccine antigens. In this study, we have established rOv-ASP-1's adjuvanticity in mice during the course of two sequential vaccinations using two vaccine model systems: the receptor-binding domain (RBD) of SARS-CoV spike protein and a commercial influenza virus hemagglutinin (HA) vaccine comprised of three virus strains. Moreover, the adjuvanticity of rOv-ASP-1 was retained with an efficacy similar to that obtained when it was used for a first vaccination, even though a high level of anti-rOv-ASP-1 antibodies was present in the sera of mice before the administration of the second vaccine. To further demonstrate its utility as an adjuvant for human use, we also immunized non-human primates (NHPs) with RBD plus rOv-ASP-1 and showed that rOv-ASP-1 could induce high titres of functional and protective anti-RBD antibody responses in NHPs. Notably, the rOv-ASP-1 adjuvant did not induce high titer antibodies against self in NHPs. Thus, the present study provided a sound scientific foundation for future strategies in the development of this novel protein adjuvant.
Full Text Available Wandering spleen and gastric volvulus are two rare entities that have been described in association with congenital diaphragmatic hernia. The diagnosis is difficult and any delay can result in ischemia and necrosis of both organs. We present a case of a 13-year-old girl, previously operated on for anterior diaphragmatic hernia and intrathoracic gastric volvulus, that presented to our service for a subdiaphragmatic gastric volvulus recurrence associated with a wandering spleen. In this report we reviewed the literature, analyzing the clinical presentation, diagnostic assessment, and treatment options of both conditions, in particular in the case associated with diaphragmatic hernia.
Jorge Luís Estepa Pérez
Full Text Available Background: Sigmoid volvulus is an emergency that occurs very frequently in the South American Andean area hospitals. It accounts for over 50% of all intestinal obstructions and still retains high mortality rates. Objective: To characterize the management of sigmoid volvulus. Methods: A prospective and descriptive study was conducted including all patients with sigmoid volvulus who attended three general community hospitals of the Cuban medical mission in Bolivia from June 2006 to June 2007 and were treated trough general surgery. We analyzed the following variables: age, sex, medical history, surgical diagnosis, classification and type of surgery, surgery performed, evolution, complications, use of antibiotic-prophylaxis and admission to intensive care units. The information was obtained from medical records, operative reports and a data collector model. Results: Sigmoid volvulus occurred more frequently in the Yapacaní hospital, department of Santa Cruz; the predominant age group was that from 55 to 64 years old as well as the predominant sex was that of males. Chagas disease was detected in most of the patients studied. Among symptoms those that predominated were distension, abdominal pain and stool detention. Decompression, devolvulation and surgical treatment were the processes followed in all cases, being the Rankin-Mikulicz colostomy the most widely used. No patients underwent a second surgery, and there were no mortality rates. Conclusions: Decompression, devolvulation and surgical treatment were the processes followed in all cases, being the Rankin-Mikulicz colostomy the most widely used. Most patients had a satisfactory evolution.
Sage Mark J
Full Text Available Abstract Introduction Transverse colon volvulus is an uncommon acute surgical presentation associated with a higher rate of mortality than volvulae at other locations along the colon. Surgical resection or correction is the only treatment, and various methods have been described in case report literature to relieve the volvulus and prevent recurrence. Case presentation We present the case of a 25-year-old Caucasian woman who was admitted with a three-day history of abdominal pain, absolute constipation and abdominal distension. Subsequent radiographic and computed tomography imaging revealed right-sided colonic dilatation suggestive of a volvulus. An emergency laparotomy was performed during which the dilated proximal bowel was decompressed and colopexy executed by using the greater omentum to fix the transverse colon at the hepatic and splenic flexures. Conclusions Volvulus of the transverse colon is rare but must form part of the clinician's differential diagnosis when encountering a patient with suspected bowel obstruction, especially in younger patients with no previous surgical history. Laparotomy is the treatment of choice and the technique of using the greater omentum as a fixing point for redundant bowel to the lateral abdominal wall is an option that may be considered especially when the bowel appears viable.
Chang, Chih-Jung; Hsieh, Tsung-Hung; Tsai, Kuang-Chau; Fan, Chieh-Min
Volvulus of the sigmoid colon is a potentially life-threatening condition rarely seen in younger age groups and is male predominant. We report a previously healthy young woman with the triad of constipation, progressive abdominal distension, and severe abdominal pain, with plain-film x-ray studies mimicking stool impaction and computed tomography disclosing the typical findings of sigmoid volvulus. The case reminds Emergency Physicians to consider sigmoid volvulus if mechanical obstruction is suspected, even in a young patient. A 33-year-old woman had the triad of symptoms for 3 days. Physical examination did not show peritoneal signs. Digital rectal examination disclosed neither palpable mass nor stool in rectum. Computed tomography revealed "coffee bean" sign and "whirl" sign. Laparoscopy demonstrated redundant sigmoid colon and she was treated with detorsion with colopexy uneventfully. Sigmoid volvulus is rarely seen in developed countries. Clinical manifestations vary with disease progression, but it typically presents with a triad of constipation, progressive abdominal distension, and severe abdominal pain. Plain-film x-ray studies can demonstrate a coffee bean or "omega loop" (inverted-U sigmoid) sign in entity occurs. The mortality rate is still >50% when bowel gangrene develops. Copyright © 2013 Elsevier Inc. All rights reserved.
Full Text Available Introduction. Restorative surgery for ulcerative colitis with ileal pouch anal anastomosis (IPAA is frequently accompanied by complications. Volvulus of the ileal pouch is one of the most rarely reported late complications and to our knowledge no report exists on reoperative surgery for this condition. Case Report. A 58-year-old woman who previously had undergone restorative proctocolectomy due to ulcerative colitis with an IPAA presented with volvulus of the pouch. She was operated with a single row pouchopexy to the presacral fascia. Two months later she returned with a recurrent volvulus. At reoperation, the pouch was found to have become completely detached from the fascia. A new pexy was made by firmly anchoring the pouch with two rows of sutures to the presacral fascia as well as with sutures to the lateral pelvic walls. At follow-up after five months she was free of symptoms. Conclusion. This first report ever on reoperative surgery for volvulus of a pelvic pouch indicates that a single row pouchopexy might be insufficient for preventing retwisting. Several rows seem to be needed.
Full Text Available Background: Vomiting is usually a late and an infrequent symptom of colonic obstructions. Contrary to this general rule, it occurs early and more frequently in some cases of sigmoid volvulus. Aim: To study the clinical significance of vomiting in patients with sigmoid volvulus. Setting: Teaching hospital in Western Orissa, India Study Design: Prospective observational study Material and Methods: Prospectively enrolled subjects with sigmoid volvulus diagnosed on the basis of clinical, radiological and laparotomy evidence were included in the study carried out in a tertiary care centre in India. Detailed history was obtained from them, especially to elicit information about the occurrence of various symptoms. Information regarding type of vomiting was also obtained. Efforts were made to exclude other causes of vomiting. Statistical tests such as Chi-Square test, Fisher's exact test or Student's t test were used. Results: Ninety-three consecutive subjects with sigmoid volvulus were enrolled. Five patients with possible other aetiologies for vomiting and seven patients with compound sigmoid volvulus were eliminated from further analysis. Two patterns of vomiting were noted in 81 evaluable patients with sigmoid volvulus. In 33 patients (Group A, vomiting preceded or coincided with the onset of other abdominal symptoms (Type 1 vomiting. In 48 patients (Group B vomiting occurred after the onset of other abdominal symptoms (Type 2 vomiting. The period between the onset of these symptoms and that of vomiting varied from a few hours to several days. Group A patients sought medical help much earlier than those of Group B. Incidences of circulatory shock (24% vs. 8%, haemorrhagic ascites (21% vs. 6% and colonic gangrene (64% vs. 35% were significantly higher in Group A than in Group B. The mortality rate (15% vs. 4% was higher in Group A as well. About 25% (n = 7 of Group A patients in contrast to 4% (n=2 of Group B required hospitalization exceeding 3
Larkin, J O
INTRODUCTION: Acute sigmoid volvulus is a well recognised cause of acute large bowel obstruction. PATIENTS AND METHODS: We reviewed our unit\\'s experience with non-operative and operative management of this condition. A total of 27 patients were treated for acute sigmoid volvulus between 1996 and 2006. In total, there were 62 separate hospital admissions. RESULTS: Eleven patients were managed with colonoscopic decompression alone. The overall mortality rate for non-operative management was 36.4% (4 of 11 patients). Fifteen patients had operative management (five semi-elective following decompression, 10 emergency). There was no mortality in the semi-elective cohort and one in the emergency surgery group. The overall mortality for surgery was 6% (1 of 15). Five of the seven patients managed with colonoscopic decompression alone who survived were subsequently re-admitted with sigmoid volvulus (a 71.4% recurrence rate). The six deaths in our overall series each occurred in patients with established gangrene of the bowel. With early surgical intervention before the onset of gangrene, however, good outcomes may be achieved, even in patients apparently unsuitable for elective surgery. Eight of the 15 operatively managed patients were considered to be ASA (American Society of Anesthesiologists) grade 4. There was no postoperative mortality in this group. CONCLUSIONS: Given the high rate of recurrence of sigmoid volvulus after initial successful non-operative management and the attendant risks of mortality from gangrenous bowel developing with a subsequent volvulus, it is our contention that all patients should be considered for definitive surgery after initial colonoscopic decompression, irrespective of the ASA score.
Youn, In Kyung; Ku, Young Mi; Lee, Su Lim [Dept. of Radiology, Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu (Korea, Republic of)
Gastric volvulus, defined as an abnormal rotation of stomach, may be idiopathic or secondary to abnormal fixation of intraperitoneal visceral ligaments. Wandering spleen is a movable spleen resulting from absence or underdevelopment of the splenic supporting ligaments that suspend the spleen to its normal position in the left part of the supramesocolic compartment of the abdomen. Wandering spleen increases the risk of splenic torsion. Both gastric volvulus and splenic torsion are potentially life-threatening if not urgently managed with surgery. Prompt and accurate diagnosis based on multidetector computed tomography (MDCT) is crucial to prevent unforeseen complications. Gastric volvulus and coexistent torsion of wandering spleen is a very rare condition. Herein, we described a case of gastric volvulus associated with wandering spleen and intestinal non-rotation in a 15-year-old girl focusing on MDCT findings.
Ahmed M. Al Maksoud
Conclusion: Diagnosis of sigmoid volvulus in pregnancy is a challenge, but a delay in diagnosis increases the rates of feto-maternal mortality. A high incidence of clinical suspicion and timely surgical intervention are the key to a favourable outcome.
Gardon, J; Gardon-Wendel, N; Demanga-Ngangue; Kamgno, J; Chippaux, J P; Boussinesq, M
In 1995, the World Bank launched an African Programme for Onchocerciasis Control to eliminate Onchocerca volvulus disease from 19 African countries by means of community-based ivermectin treatment (CBIT). Several cases of encephalopathy have been reported after ivermectin in people heavily infected with microfilariae of Loa loa (loiasis). We assessed the incidence of serious events in an area where onchocerciasis and loiasis are both endemic. Ivermectin (at 150 micrograms/kg) was given to 17877 people living in the Lékié area of Cameroon. 50 microL samples of capillary blood were taken during the daytime before treatment from all adults (aged > or = 15 years), and the numbers of L loa and Mansonella perstans microfilariae in them were counted. Patients were monitored for 7 days after treatment. Adverse reactions were classified as mild, marked, or serious. Serious reactions were defined as those associated with a functional impairment that required at least a week of full-time assistance to undertake normal activities. We calculated the relative risk of developing marked or serious reactions for increasing L loa microfilarial loads. Risk factors for serious reactions were identified and assessed with a logistic regression model. 20 patients (0-11%) developed serious reactions without neurological signs but associated with a functional impairment lasting more than a week. Two other patients were in coma for 2-3 days, associated with L loa microfilariae in cerebrospinal fluid. Occurrence of serious reactions was related to the intensity of pretreatment L loa microfilaraemia. The relative risk of developing marked or serious reactions was significantly higher when the L loa load exceeded 8000 microfilariae/mL; for serious reactions, the risk is very high (odds ratio > 1000) for loads above 50000 microfilariae/mL. Epidemiological surveys aimed at assessing the intensity of infection with L loa microfilariae should be done before ivermectin is distributed for
Navarro, Oscar M.; Daneman, Alan; Miller, Stephen F. [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)
About one-half of patients with meconium ileus (MI) present with a complication such as volvulus, atresia, meconium peritonitis or giant cystic meconium peritonitis. The treatment of these complications requires surgery. However, the preoperative diagnosis of complicated MI is difficult. We describe two neonates with complicated small-bowel obstruction, one with MI related to cystic fibrosis and the other not related to cystic fibrosis. In both, contrast enema depicted a spiral appearance of the distal small bowel, which at surgery proved to be the result of volvulus associated with antenatal bowel perforation. This appearance of the small bowel on contrast enema in this clinical setting has not been previously described. The recognition of this spiral appearance of the distal small bowel suggests the need for surgery. (orig.)
Youssef, Haney; Rashid, Sidi H; Cellador, Enrique Collantes; Baragwanath, Phil
Chronic idiopathic intestinal pseudo-obstruction (CIIP) is a rare syndrome of ineffectual gut motility associated with clinical, endoscopic and radiological exclusion of mechanical causes, as well as evidence of air-fluid levels in distended bowel loops. A case of small bowel volvulus in a patient with an established diagnosis of CIIP is presented. The case is illustrated by images of operative findings and computed tomography scan reconstruction, showing the classical appearances of small bowel volvulus. The patient recovered well after surgery and is maintained on parenteral nutrition. CIIP is a heterogeneous disorder in which the primary aims of management are nutrition, pain control and the avoidance of unnecessary repeated laparotomies. However, even in the presence of an established diagnosis of CIIP, surgeons should be vigilant to the possibility that an operable mechanical obstruction may still occur.
Matsuoka, Tasuku; Osawa, Naoshi; Yoh, Taiho; Hirakawa, Kosei
Single-port access laparoscopic surgery has recently emerged as a method to improve morbidity and cosmetic benefit of conventional laparoscopic surgery. Herein, we report the experience of transumbilical incision laparoscopic sigmoidectomy with one assist port in a 71-year-old man who had developed recurrent sigmoid volvulus in these several years since his first visit to the hospital. The patient presented abdominal distension and severe constipation. A plain x-ray film and CT of the abdomen showed grossly distended sigmoid colon loops and stenosis of recto-sigmoid colon. Sigmoid volvulus associated with megacolon was diagnosed and emergence endoscopic decompression was performed. After his condition improved, transumbilical incision laparoscopic sigmoidectomy was carried out as the minimally invasive approach, due to the several risk of patient such as aging and pulmonary disorder. Postoperative course was uneventful and on postoperative visit to the hospital he reported resolution of abdominal distension.
Diouf, Cheikh; Kane, Ahmed; Ndoye, Ndeye Aby; Ndour, Oumar; Faye-Fall, Aimé Lakh; Fall, Mbaye; Alumeti, Désiré Munyali; Ngom, Gabriel
We report an exceptional case of a 7 year-old patient with necrotic small bowel volvulus due to adult ascaris lumbricoides. At the admission, the child had intestinal obstruction evolving since two days with alteration of general state. Abdominal radiography without preparation showed small bowel air-fluid levels and tiger-stripe appearance evoking the diagnosis of acute intestinal obstruction associated with abdominal mass. After resuscitation, the surgical treatment consisted of laparotomy which showed necrotic volvulus of the terminal ileum containing adult ascaris lumbricoides. The patient underwent small bowel resection, approximately one meter of affected section was removed and then an ileostomy was performed. The evolution was favorable. The patient underwent ileorectal anastomosis four weeks later. After a 2 year follow-up period the child had no symptoms.
Aslanian, M E; Sharp, C R; Garneau, M S
A brachycephalic dog was presented with an acute onset of retching and abdominal discomfort. The dog had a chronic history of stertor and exercise intolerance suggestive of brachycephalic airway obstructive syndrome. Radiographs were consistent with a Type II hiatal hernia. The dog was referred and within hours of admission became acutely painful and developed tympanic abdominal distension. A right lateral abdominal radiograph confirmed gastric dilatation and volvulus with herniation of the pylorus through the hiatus. An emergency exploratory coeliotomy was performed, during which the stomach was derotated, and an incisional gastropexy, herniorrhaphy and splenectomy were performed. A staphylectomy was performed immediately following the exploratory coeliotomy. The dog recovered uneventfully. Gastric dilatation and volvulus is a potentially life-threatening complication that can occur in dogs with Type II hiatal hernia and should be considered a surgical emergency.
Toshio Katoh; Tsunehiko Shigemori; Ryo Fukaya; Hiroshi Suzuki
A 78-year-old woman presented with fever, severe abdominal pain, and distension. She had been institutionalized for depression and senile dementia. Laboratory examinations disclosed a leucocytosis (WBC:12 500/μL) and elevated levels of serum C-reactive protein (2.8 mEq/L). Diagnosis of acute cecal volvulus was made from a "coffee bean sign" on an abdominal computed tomography and a "beak sign" on a gastrographin enema. An emergent laparotomy confirmed the diagnosis and an ileo-colectomy with primary anastomosis wascarried out. The patient recovered after intensive respiratory care and fluid therapy, and then returned to her former institution. A review of Japanese literature disclosed that:(1) a marked increase of aged patients with mental disability presenting with cecal volvulus, (2) adoption of ileo-colectomy as the standard surgical procedure, and (3) improved survival of the patients, were observed in the last decade.
Youssef, Haney; Rashid, Sidi H; Cellador, Enrique Collantes; Baragwanath, Phil
Chronic idiopathic intestinal pseudo-obstruction (CIIP) is a rare syndrome of ineffectual gut motility associated with clinical, endoscopic and radiological exclusion of mechanical causes, as well as evidence of air–fluid levels in distended bowel loops. A case of small bowel volvulus in a patient with an established diagnosis of CIIP is presented. The case is illustrated by images of operative findings and computed tomography scan reconstruction, showing the classical appearances of small bo...
Full Text Available Type IV hiatal hernias are characterized by herniation of the stomach along with associated viscera such as the spleen, colon, small bowel, and pancreas through the esophageal hiatus. They are relatively rare, representing only about 5%–7% of all hernias, and can be associated with severe complications. We report a 71-year-old veteran wrestler who presented to our department with a type IV paraesophageal hernia containing a gastric volvulus and treated successfully with emergency operation.
da Fonseca, Leonardo Maciel; Caldeira, Daniel Adonai Machado
It is believed that sigmoid volvulus (SV) in Brazil is a frequent complication of megacolon caused by Chagas' disease (CD), differing in some characteristics from volvulus found in other countries. Bowel obstruction in patients with CD, principally when the cause is SV, may be sometimes difficult to diagnosis exclusively with plain abdominal radiograph. Fecaloma impacted in retossigmoidal area is one of the differential diagnoses. In addition, the huge amount of gas and feces, and distension of the colon normally increase the difficulty to make the correct diagnostic. The use of computer tomography (CT) scan can easy elucidate the picture of SV, and can be a great tool in cases of patients with CD and suspicion of this entity. A 62-year-old man showed bowel distention and stop disposal of gas for 5 days. He had previous diagnosis of CD. He also had been suffering from chronic constipation for several years, including impacted fecaloma, with the necessity of manual extraction. Plain abdominal radiographs showed an important colon dilatation and gross amount of feces in the sigmoid colon. Abdominal computer tomography sacan revealed dilated colon filled with feces, as well, the "whirl sign" composed of mesentery and twisted colon. When abdominal radiograph films reveal gross colonic dilatation of unknown etiology in patients with CD, a whirl sign on CT scans raises the possibility of colonic volvulus.
Inayat, Faisal; Hurairah, Abu; Shaikh, Faiq
The Marfan syndrome (MFS) is a pleiotropic, autosomal dominant disorder of connective tissue with highly variable clinical manifestations. It primarily involves the skeletal, cardiovascular, and ocular systems; however, gastrointestinal complications are rare. Herein, we describe the case of a 31-year-old male who initially presented with acute abdominal pain for one day. His imaging features revealed a dilated sigmoid colon, consistent with sigmoid volvulus that was immediately decompressed. Surgical resection was recommended to treat the sigmoid volvulus. Preceding the treatment, the patient underwent an extensive workup, including an echocardiography that revealed aortic root dilatation. His clinical history, physical exam, and echocardiographic findings raised the suspicion for MFS. Subsequently, the diagnosis of MFS was confirmed on genetic testing. This is a case that highlights the multidisciplinary (clinical, radiological, endoscopic, molecular/genetic) approach to diagnose a patient with MFS who presented with symptomatic sigmoid volvulus. As this presentation may be a harbinger of more severe manifestations of MFS, it is important to identify it as such in order to accomodate for timely management.
邹大卫; 郑毓珊; 任德胜
The authors report 2 cases of acute volvulus of stomach in children caused by congenital abnormality of the diaphragm.A boy of 3 with diaphragmatic eventration complicated with acute omento-axial volvulus of stomach was misdiagnosed as acute pancreatitis and acute gastric dilatation due to lack of obvious respiratory distress on admission.Only at laparotomy was the necrotic part of the volvular stomach found and resected and the peritoneal cavity drained.Plication of the affected hemidiaphragm and gastropexy were done 2 months later.Another boy of 4 with histus hernia complicated with acute mixed volvulus of stomach was correctly diagnosed before operation.The stomach was reduced from the thorax;followed by hiatal ring repair as well as gastropexy.Both operations were satisfactory.%@@ 小儿急性胃扭转比较少见,国内文献报告不多,我院在1982年收治伴有膈肌发育障碍的急性胃扭转2例.
Michael Safioleas; Constantinos Chatziconstantinou; Evangelos Felekouras; Michael Stamatakos; Ioannis Papaconstantinou; Anastasios Smirnis; Panagiotis Safioleas; Alkiviades Kostakis
AIM: To evaluate different types of treatment for sigmoid volvulus and clarify the role of endoscopic intervention versus surgery.METHODS: A retrospective review of the clinical presentation and imaging characteristics of 33 sigmoid volvulus patients was presented, as well as their diagnosis and treatment, in combination with a literature review.RESULTS: In 26 patients endoscopic detorsion was achieved after the first attempt and one patient died because of uncontrollable sepsis despite prompt operative treatment. Seven patients had unsuccessful endoscopic derotation and were operated on. On two patients with gangrenous sigmoid, Hartmann's procedure was performed. In five patients with viable colon, a sigmoid resection and primary anastomosis was carried out. Three patients had a lavage "on table" prior to anastomosis, while in the remaining 2 patients a diverting stoma was performed according to the procedure of the first author. Ten patients were operated on during their first hospital stay (3 to 8 d after the deflation). All patients had viable colon; 7 patients had a sigmoid resection and primary anastomosis, 2 patients had sigmoidopexy and one patient underwent a near-total colectomy. Two patients (sigmoidectomy-sigmoidopexy) had recurrences of volvulus 43 and 28 mo after the initial surgery. Among 15 patients who were discharged from the hospital after non-operative deflation, 3 patients were lost to follow-up. Of the remaining 12 patients, 5 had a recurrence of volvulus at a time in between 23 d and 14 mo. All the five patients had been operated on and in four a gangrenous sigmoid was found. Three patients died during the 30 d postoperative course. The remaining seven patients were admitted to our department for elective surgery. In these patients, 2 subtotal colectomies, 3 sigmoid resections and 2 sigmoidopexies were carried out. One patient with subtotal colectomy died. Taken together of the results, it is evident that after 17 elective operations we had
Thomas S. Churcher; Sébastien D. S. Pion; Mike Y. Osei-Atweneboana; Roger K. Prichard; Kwablah Awadzie; Michel Boussinesq; Richard C. Collins; James A. Whitwort; Maria-Gloria Basanez; David Cox
.... The variability in the rate at which Onchocerca volvulus microfilariae repopulate host's skin following ivermectin treatment is quantified using an individual-based onchocerciasis mathematical model...
Palomo, V.; Higuera, A.; Munoz, R.; Sanchez, F. [Hospital Alto Guadalquivir. Andujar. Jaen (Spain)
Midgut volvulus occurs frequently in infants and children, but is uncommon in adults. We present a case of intestinal malrotation complicated by midgut volvulus in a young woman who complained of chronic intermittent abdominal pain of increasing intensity. The radiologies diagnosis was based mainly on upper gastrointestinal barium study, and was confirmed intraoperatively. (Author) 11 refs.
Ezzedine, Khaled; Malvy, Denis; Dhaussy, Ines; Steels, Emmanuelle; Castelein, Carine; De Dobbeler, Gilbert; Heenen, Michel
Travelers to West Central Africa are at risk for infection with Onchocerca volvulus. We describe the case of an adventurous traveler who became infected with O volvulus after a 10-day stay in rural Cameroon. Two years after his return, he was diagnosed with a 3-month history of limb swelling with pruritus and fixed edema of the right arm. He was successfully treated by a single dose of ivermectin, with an additional treatment with doxycycline. The patient was followed-up during 1 year after therapy without relapse. Such travelers experiencing unusual dermatitis syndromes should prompt evaluation for onchocerciasis.
Pollack, R J; Lok, J B; Donnelly, J J
Reduced glutathione (GSH), but not its oxidized form (GSSG), stimulated development of Onchocerca lienalis microfilariae to the late first-larval stage in vitro. The degree and frequency of development was dose-related with a peak of activity at 15 mM, a concentration that is similar to known intracellular levels of GSH. To determine the mode(s) of action of this multifunctional compound, other reducing agents (L-cysteine, dithiothreitol), cysteine delivery agents (N-acetyl-L-cysteine, L-thiazolidine-4-carboxylic acid, L-2-oxothiazolidine-4-carboxylic acid), cysteine analogues (S-methyl-L-cysteine, D-glucose-L-cysteine, cysteine ethyl ester), free-component amino acids of GSH (glutamic acid, cysteine, and glycine), a specific metabolic inhibitor of gamma-glutamyl synthetase (buthionine sulfoximine), and an inhibitor of gamma-glutamyl transpeptidase (gamma-glutamyl glutamic acid) were also tested at concentrations of 0.01-50 mM in this system. N-acetyl-L-cysteine at 1-5 mM and D-glucose-L-cysteine at 2.5-10 mM significantly enhanced development. In contrast to those worms maintained in GSH-supplemented medium, microfilariae exposed to GSH for only the first 24 hr showed no enhancement by day 7 in culture. Neither buthionine sulfoximine nor gamma-glutamyl glutamic acid at 0.01-35 mM inhibited the effects of 15 mM GSH or 1 mM N-acetyl-L-cysteine. Results indicate that GSH or other cysteine analogues possessing a free sulfhydryl group must be present in the extranematodal environment to support microfilarial differentiation in vitro.
Patel, Ramnik V; Njere, Ike; Campbell, Alison; Daniel, Rejoo; Azaz, Amer; Fleet, Mahmud
A case of acute sigmoid volvulus in a 14-year-old adolescent girl presenting with acute low large bowel obstruction with a background of chronic constipation has been presented. Abdominal radiograph and CT scan helped in diagnosis. She underwent emergency colonoscopic detorsion and decompression uneventfully. Lower gastrointestinal contrast study showed very redundant sigmoid colonic loop without any transition zone and she subsequently underwent elective sigmoid colectomy with good outcome. The sigmoid volvulus should be considered in the differential diagnosis of paediatric acute abdomen presenting with marked abdominal distention, absolute constipation and pain but without vomiting. Plain abdominal radiograph and the CT scan are helpful to confirm the diagnosis. Early colonoscopic detorsion and decompression allows direct visualisation of the vascular compromise, assessment of band width of the volvulus and can reduce complications and mortality. Associated Hirschsprung's disease should be suspected if clinical and radiological features are suggestive in which case a rectal biopsy before definitive surgery should be considered.
Crainey, James L; Mattos-Glória, Aline; Hamada, Neusa; Luz, Sérgio L B
Following the success of the Onchocerciasis Elimination Programme for the Americas (OEPA), there is now just one Latin American onchocerciasis focus where onchocerciasis transmission is described as 'on-going:' the Amazonia Onchocerciasis focus. In the hyperendemic highland areas of the Amazonia focus, Simulium guianense s.l. Wise are the most important vectors of the disease. Populations of S. guianense s.l. are, however, known to vary in their cytogenetics and in a range of behaviours, including in their biting habits. In the hypoendemic lowland areas of the Amazonia focus, for example, S. guianense s.l. are generally regarded as zoophilic and consequently unimportant to disease transmission. Robust tools, to discriminate among various populations of S. guianense s.l. have, however, not yet been developed. In the work reported here, we have assessed the utility of a ribosomal DNA sequence fragment spanning the nuclear ribosomal ITS-1, ITS-2 and 5.8S sequence regions and a ∼850 nucleotide portion of the mitochondrial cytochrome oxidase gene (CO1) for species-level identification and for resolving the within species substructuring. We report here how we have generated 78 CO1 sequences from a rich set of both zoophilic and anthropophilic populations of S. guianense s.l. that were collected from eight sites that are broadly distributed across Brazil. Consistent with previous findings, our analysis supports the genetic isolation of Simulium litobranchium from S. guianense s.l. In contrast with previous findings, however, our results did not provide support for the divergence of the two species prior to the radiation of S. guianense s.l. In our analysis of the S. guianense s.l. ribosomal DNA sequence trace files we generated, we provide clear evidence of multiple within-specimen single nucleotide polymorphisms and indels suggesting that S. guianense s.l. ribosomal DNA is not a good target for conventional DNA barcoding. This is the first report of S. guianense s.l. within individual ribosomal DNA variation and thus the first evidence that the species is not subject to the normal effects of concerted evolution. Collectively, these data illustrate the need for diverse sampling in the development of robust molecular tools for vector identification and suggest that ribosomal DNA might be able to assist with resolving S. guianense s.l. species substructuring that C01 barcoding has hitherto failed to.
Full Text Available Abstract Background In western countries intestinal obstruction caused by sigmoid volvulus is rare and its mortality remains significant in patients with late diagnosis. The aim of this work is to assess what is the correct surgical timing and how the prognosis changes for the different clinical types. Methods We realized a retrospective clinical study including all the patients treated for sigmoid volvulus in the Department of General Surgery, St Maria Hospital, Terni, from January 1996 till January 2009. We selected 23 patients and divided them in 2 groups on the basis of the clinical onset: patients with clear clinical signs of obstruction and patients with subocclusive symptoms. We focused on 30-day postoperative mortality in relation to the surgical timing and procedure performed for each group. Results In the obstruction group mortality rate was 44% and it concerned only the patients who had clinical signs and symptoms of peritonitis and that were treated with a sigmoid resection (57%. Conversely none of the patients treated with intestinal derotation and colopexy died. In the subocclusive group mortality was 35% and it increased up to 50% in those patients with a late diagnosis who underwent a sigmoid resection. Conclusions The mortality of patients affected by sigmoid volvulus is related to the disease stage, prompt surgical timing, functional status of the patient and his collaboration with the clinicians in the pre-operative decision making process. Mortality is higher in both obstructed patients with generalized peritonitis and patients affected by subocclusion with late diagnosis and surgical treatment; in both scenarios a Hartmann's procedure is the proper operation to be considered.
Lee, S J; Francis, H L; Awadzi, K; Ottesen, E A; Nutman, T B
To define the changes in antibody response to Onchocerca volvulus antigens after treatment of patients with onchocerciasis, IgG and IgE antibodies were examined quantitatively and qualitatively in 21 patients and 3 control individuals before and sequentially for 14 days after treatment with diethylcarbamazine. The quantitative levels of IgE and IgG responses (both polyclonal and O. volvulus-specific) remained essentially unchanged for all patients, but 9 of the 21 patients showed intensified responses to one or more parasite-specific antigens, and 8 of 21 developed antibodies to previously undetected antigens. There was a significant correlation between the intensities of infection and the development of newly recognized anti-O. volvulus antibodies. These studies demonstrate that O. volvulus-specific IgE and IgG antibody responses are, at least transiently, enhanced by treatment with diethylcarbamazine and that after treatment, parasites possibly release antigens previously hidden from the host's immune response.
Razi, Kasra; Light, Duncan; Horgan, Liam
Morgagni hernias are a rare form of congenital diaphragmatic hernias, thus there is paucity in literature about the diagnosis and management of the condition. We report an 83-year-old woman who presented with vomiting and a metabolic acidosis with a previous computed tomography diagnosis of Bochdalek's hernia. Diagnostic laparoscopy revealed a Morgagni hernia containing transverse colon, greater curvature of the stomach and a partial gastric volvulus. The hernia was reduced with the sac untouched, and the defect was closed with a composite mesh using tac fixation. The operation was done successfully in 45 minutes with no complications.
Waluza, J J; Aronson, D C; Nyirenda, D; Zoetmulder, F A N; Borgstein, E S
Volvulus of the transverse colon is very rare in children. Three cases that occurred in a short time span are described and the scarce literature is reviewed. All patients presented with colonic obstruction and in all three the condition was diagnosed at laparotomy, as CT-scanning is not an available option in either of the two institutions. The transverse colon had not become gangrenous but was resected after detorsion for redundancy. The postoperative course was complicated and relaparotomy had to be performed for reobstruction in all cases. Only if the 'reverse' bean sign is recognized on the preoperative plain abdominal radiograph this rare diagnosis can be suspected.
Yao-Chun; Hsu; Chin-Lin; Perng; Jai-Jen; Tsai; Hwai-Jeng; Lin
AIM:To investigate clinical outcomes of patients with chronic gastric volvulus(GV)who were managed conservatively over a 5-year period.METHODS:A total of 44 consecutive patients with chronic GV,as diagnosed by barium study between October 2002 and July 2008 were investigated.All of these patients received conservative management initially without anatomical correction.Their clinical manifestations,diagnostic work-ups,and clinical outcomes were analyzed.We sought to identify independent risk factors for poor...
李海风; 李世宽; 周岩冰; 彭新刚; 李元博; 赵东升
目的:乙状结肠扭转既往主要依靠腹部平片进行诊断,但腹部平片具有局限性,容易误诊、漏诊,CT可以弥补腹平片不足.探讨乙状结肠扭转的CT征象,以提高其术前诊断水平.方法:回顾性分析手术中证实为乙状结肠扭转的23例患者,分析其腹部CT扫描图和横断面扫描特征,最后总结乙状结肠扭转的CT影像学特征.结果:在CT定位像上,最敏感的表现是扩张的乙状结肠倒U征(21/23,91％),不成比例乙状结肠扩张(19/23,83％),其次为咖啡豆征(17/23,74％),Y征(12/23,52％).在横断面扫描上,最敏感的是不成比例的乙状结肠扩张(21/23,91％)和圆腹征(20/23,87％),其次为近端结肠扩张(15/23,65％),漩涡征(15/23,65％),鸟嘴征(13/23,57％).在CT定位像和横断面扫描上,典型的乙状结肠扭转影像表现分别占57％(13/23)和83％(19/23).在定位像上,咖啡豆征与Y征在显著相关(p＜0.05).横断面扫描上肠管损害的CT征象与临床肠管损害显著相关(P＜0.05).结论:在定位像上,乙状结肠扭转的主要影像学表现为倒U征,特征性表现为Y征；在横断面扫描上,主要影像学表现为不成比例的乙状结肠扩张,特征性表现为漩涡征和鸟嘴征.多排螺旋CT是诊断乙状结肠扭转的可靠检查方法,具有重要的临床应用价值.%Objective:Previous imaging diagnosis of Sigmoid volvulus mainly depended on abdominal X-ray plain film,but it have many disadvanteges such as limitations,easily misdiagnosed and misdiagnosis.And CT can make up for these drawbacks.To discuss the imaging characteristics of sigmoid volvulus on Multi-detector CT to improve the preoperative diagnostic accuracy of CT in patients with sigmoid volvulus.Methods:We retrospectively reviewed 23 cases of sigmoid volvulus confirmed at surgery,and then analyzed the signs of abdominal CT scanograms and cross-sectional images.Finally,we summarized CT images characteristics of sigmoid volvulus
Full Text Available Introduction. Gallbladder volvulus is a rare, potentially fatal condition unless diagnosed and treated early. Choledochal cysts are rare congenital malformations of the biliary tree predisposing to different pathologies and posing the risk of degradation into cholangiocarcinoma and gallbladder cancer. Dealing with both diseases at once has not been published yet in the literature. Presentation of Case. We report a case of gallbladder volvulus in an elderly female who happened to have a concomitant type I choledochal cyst. Treatment was achieved with a cholecystectomy and observation and follow-up of the choledochal cyst. Discussion. Prompt diagnosis and surgical management of gallbladder volvulus is important to avoid the morbidity and mortality of gangrenous cholecystitis and biliary peritonitis in a frail old population of patients. Precise clinical diagnosis, supplemented with specific imaging clues, helps in the diagnosis. Management of choledochal cysts is also surgical; however the timing of surgery is still a matter of debate. Conclusion. We describe in this report the first case of gallbladder volvulus in a patient with a choledochal cyst and propose a management algorithm of a very rare biliary tree pathology combination.
Belandria, Gerardo A.; Pavletic, Michael M.; Boulay, James P.; Penninck, Dominique G.; Schwarz, Leslie A.
Surgical stapling equipment was used to create a gastropexy in 20 dogs undergoing emergency surgery for gastric dilatation and volvulus (GDV). The technique involved creation of a tunnel between the seromuscular layer and the submucosa of the pyloric antrum, and a matching tunnel beneath the right m. transversus abdominis. The arms of a gastrointestinal anastomosis stapling device were ...
Full Text Available nce. 52 3e-04 2 AW355195 |AW355195.1 PFOvAFCB597K Onchocerca volvulus adult female cDNA following ivermect...in (SAW98PF-OvAF) Onchocerca volvulus cDNA clone PFOvAFCB597 5', mRNA sequence. 52
Full Text Available rmectin (SAW98PF-OvAF) Onchocerca volvulus cDNA clone PFOvAFCB597 5', mRNA sequence...sequence. 52 3e-04 2 AW355195 |AW355195.1 PFOvAFCB597K Onchocerca volvulus adult female cDNA following ive
Full Text Available rmectin (SAW98PF-OvAF) Onchocerca volvulus cDNA clone PFOvAFCB597 5', mRNA sequence...ne SWOv3MCAM56B08 5', mRNA sequence. 52 3e-04 2 AW355195 |AW355195.1 PFOvAFCB597K Onchocerca volvulus adult female cDNA following ive
Full Text Available Ov3MCAM56B08 5', mRNA sequence. 54 3e-04 2 AW355195 |AW355195.1 PFOvAFCB597K Onchocerca volvulus adult female cDNA following ivermect...in (SAW98PF-OvAF) Onchocerca volvulus cDNA clone PFOvAFCB597 5', mRNA sequence. 54
Full Text Available CBRC-LAFR-01-0937 ref|NP_008375.1|ND1_13186 NADH dehydrogenase subunit 1 [Onchocerca volvulus...] gb|AAC61617.1| NADH dehydrogenase subunit 1 [Onchocerca volvulus] NP_008375.1 0.010 25% ...
Full Text Available CBRC-DSIM-03-0045 ref|NP_008379.1|ND5_13186 NADH dehydrogenase subunit 5 [Onchocerca volvulus...] gb|AAC61621.1| NADH dehydrogenase subunit 5 [Onchocerca volvulus] NP_008379.1 1.6 26% ...
Full Text Available CBRC-OLAT-26-0096 ref|NP_008368.1|ND2_13186 NADH dehydrogenase subunit 2 [Onchocerca volvulus...] gb|AAC61610.1| NADH dehydrogenase subunit 2 [Onchocerca volvulus] NP_008368.1 2e-08 28% ...
Full Text Available CBRC-CPOR-01-1960 ref|NP_008369.1|ND4_13186 NADH dehydrogenase subunit 4 [Onchocerca volvulus...] gb|AAC61611.1| NADH dehydrogenase subunit 4 [Onchocerca volvulus] NP_008369.1 0.070 28% ...
Full Text Available CBRC-BTAU-01-2609 ref|NP_008379.1|ND5_13186 NADH dehydrogenase subunit 5 [Onchocerca volvulus...] gb|AAC61621.1| NADH dehydrogenase subunit 5 [Onchocerca volvulus] NP_008379.1 1e-05 29% ...
Full Text Available CBRC-DNOV-01-2555 ref|NP_008368.1|ND2_13186 NADH dehydrogenase subunit 2 [Onchocerca volvulus...] gb|AAC61610.1| NADH dehydrogenase subunit 2 [Onchocerca volvulus] NP_008368.1 0.071 24% ...
Full Text Available CBRC-BTAU-01-2345 ref|NP_008369.1|ND4_13186 NADH dehydrogenase subunit 4 [Onchocerca volvulus...] gb|AAC61611.1| NADH dehydrogenase subunit 4 [Onchocerca volvulus] NP_008369.1 0.003 24% ...
Full Text Available CBRC-TTRU-01-0341 ref|NP_008369.1|ND4_13186 NADH dehydrogenase subunit 4 [Onchocerca volvulus...] gb|AAC61611.1| NADH dehydrogenase subunit 4 [Onchocerca volvulus] NP_008369.1 7e-04 25% ...
Full Text Available CBRC-DSIM-01-0068 ref|NP_008379.1|ND5_13186 NADH dehydrogenase subunit 5 [Onchocerca volvulus...] gb|AAC61621.1| NADH dehydrogenase subunit 5 [Onchocerca volvulus] NP_008379.1 2.6 38% ...
Full Text Available CBRC-TTRU-01-0223 ref|NP_008379.1|ND5_13186 NADH dehydrogenase subunit 5 [Onchocerca volvulus...] gb|AAC61621.1| NADH dehydrogenase subunit 5 [Onchocerca volvulus] NP_008379.1 0.60 26% ...
Full Text Available CBRC-RMAC-20-0011 ref|NP_008379.1|ND5_13186 NADH dehydrogenase subunit 5 [Onchocerca volvulus...] gb|AAC61621.1| NADH dehydrogenase subunit 5 [Onchocerca volvulus] NP_008379.1 0.45 25% ...
Full Text Available CBRC-RNOR-10-0249 ref|NP_008379.1|ND5_13186 NADH dehydrogenase subunit 5 [Onchocerca volvulus...] gb|AAC61621.1| NADH dehydrogenase subunit 5 [Onchocerca volvulus] NP_008379.1 4e-11 29% ...
Full Text Available CBRC-TTRU-01-0495 ref|NP_008369.1|ND4_13186 NADH dehydrogenase subunit 4 [Onchocerca volvulus...] gb|AAC61611.1| NADH dehydrogenase subunit 4 [Onchocerca volvulus] NP_008369.1 0.003 23% ...
Full Text Available CBRC-LAFR-01-1805 ref|NP_008379.1|ND5_13186 NADH dehydrogenase subunit 5 [Onchocerca volvulus...] gb|AAC61621.1| NADH dehydrogenase subunit 5 [Onchocerca volvulus] NP_008379.1 0.014 23% ...
Full Text Available CBRC-ETEL-01-1246 ref|NP_008379.1|ND5_13186 NADH dehydrogenase subunit 5 [Onchocerca volvulus...] gb|AAC61621.1| NADH dehydrogenase subunit 5 [Onchocerca volvulus] NP_008379.1 0.008 24% ...
Full Text Available CBRC-MMUS-14-0080 ref|NP_008379.1|ND5_13186 NADH dehydrogenase subunit 5 [Onchocerca volvulus...] gb|AAC61621.1| NADH dehydrogenase subunit 5 [Onchocerca volvulus] NP_008379.1 0.008 23% ...
Full Text Available CBRC-CINT-01-0047 ref|NP_008379.1|ND5_13186 NADH dehydrogenase subunit 5 [Onchocerca volvulus...] gb|AAC61621.1| NADH dehydrogenase subunit 5 [Onchocerca volvulus] NP_008379.1 7e-11 27% ...
Full Text Available CBRC-TTRU-01-0181 ref|NP_008379.1|ND5_13186 NADH dehydrogenase subunit 5 [Onchocerca volvulus...] gb|AAC61621.1| NADH dehydrogenase subunit 5 [Onchocerca volvulus] NP_008379.1 0.004 25% ...
Full Text Available CBRC-DNOV-01-1062 ref|NP_008368.1|ND2_13186 NADH dehydrogenase subunit 2 [Onchocerca volvulus...] gb|AAC61610.1| NADH dehydrogenase subunit 2 [Onchocerca volvulus] NP_008368.1 0.001 27% ...
Hyung Hun Kim
Full Text Available Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial torsion in the chest due to either concomitant enlargement of the hiatus or a diaphragmatic hernia. Iatrogenic diaphragmatic hernia can occur after hiatal hernia repair and other surgical procedures, such as nephrectomy, esophagogastrectomy and splenopancreatectomy. We describe a 49-year-old woman who presented to our emergency department with acute moderate epigastric soreness and vomiting. She had undergone extensive gynecologic surgery including splenectomy 1 year before. The chest radiograph obtained in the emergency department demonstrated an elevated gastric air-fluid level in the left lower lung field. An urgent gastroscopy showed twisted structural abnormality of the stomach body. A computed tomography scan demonstrated the distended stomach, located in the left lower hemithorax through a left diaphragmatic defect. Emergent transthoracic repair was performed. Postoperative recovery was uneventful, and the patient did not experience any pain or difficulty with eating.
Amstrup, Steven C.; Nielsen, Carol A.
A large, adult male polar bear (Ursus maritimus) was found dead on a barrier island north of Prudhoe Bay, Alaska (USA), in June 1987. There were no external signs of trauma. A twisted distended stomach, distinctive parenchymal and fascial congestion, and significant difficulty in repositioning the anterior abdominal organs, indicated that gastric dilatation-volvulus (GDV) was the proximate cause of death. Polar bears frequently consume large quantities of food at one time and have large stomachs that are well adapted to periodic gorging. The scarcity of food in winter and early spring, combined with voluntary fasting and protracted vigorous activity during the breeding season in late spring may have predisposed this bear to GDV. The relationship between GDV and postprandial exercise emphasizes the need for a better understanding of how the present human invasion of arctic habitats may influence polar bear activities.
Full Text Available Tubular duplication of the colon is very rare especially in adulthood, because it is frequently symptomatic earlier in newborn life, so only few cases are reported in literature. Several theories are proposed to explain the onset and the evolution of gut malformations as the aberrant lumen recanalization or the diverticular theory, the alteration of the lateral closure of the embryonal disk or finally the dorsal protrusion of the yolk-sac for herniation or adhesion to the ectoderm for an abnormality of the longitudinal line, but none clarifies the exact genesis of duplication [1–3]. U Shaped transverse colonic duplication with volvulus has never been reported before and very rare in condition in gastrointestinal duplication.
Atamanalp, Sabri Selcuk; Atamanalp, Refik Selim
Sigmoid volvulus (SV) is a rare form of acute intestinal obstruction in which the sigmoid colon wraps around itself. The disease generally presents as a mechanical bowel obstruction with clinical features that are not pathognomonic. Similarly, X-ray films are not diagnostic in most cases. It is difficult to establish the correct preoperative diagnosis when CT and MRI are not used. The principal strategy in the treatment of SV in uncomplicated patients is emergency endoscopic detorsion followed by elective surgery; emergent surgery is required in patients with bowel gangrene, bowel perforation, peritonitis, or unsuccessful endoscopic treatment. In this review, we have discussed the role of sigmoidoscopy in the diagnosis and treatment of SV. Additionally, we have retrospectively and prospectively evaluated our 49-year, 987-patient clinical experience, the largest single-center SV series ever reported.
Justin L, Regner, E-mail: Justin.Regner@BSWHealth.org; Angela, Lomas [Department of Surgery, Baylor Scott and White Health and Texas A& M Health Science Center College of Medicine, Temple, TX (United States)
An 86 year-old woman with a past medical history significant for abdominal hernia and Alzheimer dementia presented to the Emergency Department with a 24 hour history of acute right upper quadrant pain associated with nausea and non-bilious emesis. Physical exam revealed right sided abdominal tenderness with associated mass. All laboratory values were within normal ranges. Both abdominal ultrasound and computed tomography of the abdomen/pelvis revealed a large distended gallbladder with wall thickening and gallstones. Based on presentation and radiologic findings, the emergency general surgery service was consulted for suspected acute cholecystitis. The patient was then admitted for intravenous antibiotics and scheduled for laparoscopic cholecystectomy the following day. Intra-operative findings revealed volvulus with acute necrosis of the entire gallbladder. The gallbladder had a long pedunculated cystic duct and artery that was detorsed before proceeding with resection. Postoperatively, the patient did well and was discharged a few days later tolerating a regular diet.
Olczak, Mieszko; Skrzypek, Ewa
An 8-year boy was admitted to the ER of one of Warsaw's pediatric hospitals with a history of having bloody vomiting the day before. During admission the boy collapsed and lost consciousness. CPR was unsuccessful. On medico-legal autopsy, two foreign objects (small magnetic spheres--0.5 cm in diameter) were found in two different places in the small and large intestines and were notably attracted magnetically one to another. A loop of approximately 1-m length with features of small intestinal hemorrhagic necrosis and small intestinal mechanical obstruction was found. The cause of death was intestinal volvulus and small intestinal mechanical obstruction caused by ingestion of foreign objects (two neodymium magnets). Most likely these small magnetic spheres were part of a popular toy, the safety of which, lately, has been widely discussed.
@@ 小儿急性肠扭转除一般急性机械性肠梗阻临床表现外,发病急,易发生大量渗出、失血、肠坏死、穿孔、腹膜炎和中毒性休克,故预后极差.如能在肠坏死发生前早期确诊及时复位,对提高治愈率具有重要意义.本文总结我院儿外科自1970年5月到1981年12月间治疗之小儿肠扭转72例,就早期诊断和治疗进行讨论.%72 children,50 boys and 22 girls, were admitted for acute volvulus of the intestine from May,1970 to Dec.,1981.The cure rate was 80.5%,with mortality of 19.5%. This paper gives a discussion on its etiology which includes congenital malformation, intestinal malformation, and defective attachment of the mesentery. Besides, occlusion in the intestinal lumen from ascariasis and other factors can also induce its onset. These anatomical factors as well as pathological lesions would soon cause distension of the caecum, which, in turn, would make the mesentery over stretched or narrowed that twist, or volvulus, would result. The authors point out:(1)almost every case had causative factors, such as violent exercise after meal, heavy meals, diarrhea, ascariasis with intestinal occlusion and inadequate administration of ascaricides,(2)symptoms suggestive of the condition are sudden onset of severe colic pain around the umbilicus and repeated vomiting and(3)X-ray examination reveals signs of intestinal obstruction. It is emphasized that correct diagnosis and active explorative laparotomy should be done without delay. The authors also point out that toxic shock is often responsible for death.
Adeleke, Monsuru Adebayo; Sam-Wobo, Sammy Olufemi; Akinwale, Olaoluwa Pheabian; Olatunde, Ganiyu Olatunji; Mafiana, Chiedu Felix
The biting preference of Simulium vectors has been known to influence the distribution of Onchocerca nodules and microfilariae in human body. There is, however, variation in biting pattern of Simulium flies in different geographical locations. This study investigates the biting pattern on human parts by Simulium vectors along Osun river system where Simulium soubrense Beffa form has been implicated as the dominant vector and its possible implication on the distribution of Onchocerca nodules on human body along the river. Flies were collected by consented fly capturers on exposed human parts namely head/neck region, arms, upper limb and lower limb in Osun Eleja and Osun Budepo along Osun river in the wet season (August-September) and the dry season (November-December) in 2008. The residents of the communities were also screened for palpable Onchocerca nodules. The results showed that number of flies collected below the ankle region was significantly higher than the number collected on other exposed parts (p parts coupled with the presence of nodules at the head and upper trunk regions showed that Simulium vectors could obtain microfilariae from any part of the body, thus increasing the risk of onchocerciasis transmission.
Full Text Available A Bochdalek hernia is a posterior congenital defect of the diaphragm, usually on the left hemidiaphragm, caused by a lack of closure of the pleuroperitoneal canal between the eighth and tenth week of fetal life during the embryonic development. It typically presents in the neonatal period with severe respiratory failure. Here we present a 28 year old man with history of episodes of severe dyspnea, pain in epigastric region who arrived to the emergency room, having tachypnoea with oxygen saturation 80% on room air. During his medical work-up we incidentally found gastric volvulus with diaphragmatic hernia. It was managed with reduction of the herniated and rotated stomach and spleen back to the peritoneal cavity and closed the defect by open approach. This type of hernia is uncommon in adults. In this age group, there are two different clinical presentations: asymptomatic patients who are diagnosed incidentally when abdominal organs are found in the thorax in a chest X-ray, and symptomatic patients due to side effects of incarceration, strangulation, hemorrhage and visceral perforation in the chest cavity. [Int J Res Med Sci 2016; 4(5.000: 1749-1751
... Does My Child Need? How to Safely Give Acetaminophen Is It a Cold or the Flu? Is the Flu Vaccine a Good Idea for Your Family? Too Late for the Flu Vaccine? Common Childhood Infections Can Chronic Ear Infections Cause Long-Term Hearing Loss? Chickenpox Cold Sores Common Cold Diarrhea Fever and ...
O'Neill, D G; Case, J; Boag, A K; Church, D B; McGreevy, P D; Thomson, P C; Brodbelt, D C
To report prevalence, risk factors and clinical outcomes for presumptive gastric dilation-volvulus diagnosed among an emergency-care population of UK dogs. The study used a cross-sectional design using emergency-care veterinary clinical records from the VetCompass Programme spanning September 1, 2012 to February 28, 2014 and risk factor analysis using multivariable logistic regression modelling. The study population comprised 77,088 dogs attending 50 Vets Now clinics. Overall, 492 dogs had presumptive gastric dilation-volvulus diagnoses, giving a prevalence of 0·64% (95% Confidence interval: 0·58 to 0·70%). Compared with cross-bred dogs, breeds with the highest odds ratios for the diagnosis of presumptive gastric dilation-volvulus were the great Dane (odds ratio: 114·3, 95% Confidence interval 55·1 to 237·1, P<0·001), akita (odds ratio: 84·4, 95% Confidence interval 33·6 to 211·9, P<0·001) and dogue de Bordeaux (odds ratio: 82·9, 95% Confidence interval 39·0 to 176·3, P<0·001). Odds increased as dogs aged up to 12 years and neutered male dogs had 1·3 (95% Confidence interval 1·0 to 1·8, P=0·041) times the odds compared with entire females. Of the cases that were presented alive, 49·7% survived to discharge overall, but 79·3% of surgical cases survived to discharge. Approximately 80% of surgically managed cases survived to discharge. Certain large breeds were highly predisposed. © 2017 British Small Animal Veterinary Association.
Full Text Available Hypermagnesemia is an uncommon but a potentially serious clinical condition. Over-the-counter magnesium containing products are widely used as antacids or laxatives. Although generally well tolerated in patients with normal renal function, their unsupervised use in the elderly can result in severe symptomatic hypermagnesemia, especially in those patients with concomitant renal failure and bowel disorders. We report a case of severe symptomatic hypermagnesemia associated with over-the-counter laxatives in a 70-year-old male patient with renal failure and sigmoid volvulus, who was successfully treated with hemodialysis.
Full Text Available BACKGROUND Volvulus of wandering spleen is a rare clinical occurrence with fewer than 500 cases reported and an incidence of less than 0.2%. We present a case of a 27-year-old man, who complained of a short history of severe abdominal pain with the background of recurrent abdominal pain. Ultrasound revealed wandering spleen with splenic vein thrombosis. An abdominal contrast enhanced computerized tomography scan revealed a torted wandering spleen with splenic vein thrombosis with infarction. This required a splenectomy due to splenic infarction. This report highlights the investigations including USG and CECT necessary for a patient who presents with an ischaemic torted wandering spleen.
Khairi, Talal; Amer, Syed; Spitalewitz, Samuel; Alasadi, Lutfi
Hypermagnesemia is an uncommon but a potentially serious clinical condition. Over-the-counter magnesium containing products are widely used as antacids or laxatives. Although generally well tolerated in patients with normal renal function, their unsupervised use in the elderly can result in severe symptomatic hypermagnesemia, especially in those patients with concomitant renal failure and bowel disorders. We report a case of severe symptomatic hypermagnesemia associated with over-the-counter laxatives in a 70-year-old male patient with renal failure and sigmoid volvulus, who was successfully treated with hemodialysis.
Usui, Akihito; Kawasumi, Yusuke; Hosokai, Yoshiyuki; Ishizuka, Yuya; Ikeda, Tomoya; Saito, Haruo; Funayama, Masato
This report describes the case of a man who developed fatal sigmoid volvulus that was identified on postmortem radiography before forensic autopsy. Postmortem radiography is useful for visualizing the body prior to autopsy. We discuss postmortem multidetector computed tomography that was tailored for optimum image quality to allow reconstruction of the fatal findings in multiple axes and in three dimensions, helping to pinpoint the anatomical sites of interest. This involves techniques such as manipulation of the scanning beam pitch and overlapping CT section acquisition. These techniques are best performed by personnel with CT technology training.
Full Text Available Morgagni hernia is a rare disorder in adulthood, and most of the cases are asymptomatic. Symptomatic cases are extremely rare and present with life-threatening complications. Early diagnosis and surgery are lifesaving. We hereby present an adult case of symptomatic Morgagni hernia. Diaphragmatic herniation of the stomach and mesenteroaxial rotation led to intrathoracic gastric volvulus in this case. A right-sided air bubble on a chest radiogram was the only finding leading to the suspicion of diaphragmatic hernia. Computed tomography in the diagnosis of diaphragmatic hernias is of great importance.
Christina A Bulman
Full Text Available Two major human diseases caused by filariid nematodes are onchocerciasis, or river blindness, and lymphatic filariasis, which can lead to elephantiasis. The drugs ivermectin, diethylcarbamazine (DEC, and albendazole are used in control programs for these diseases, but are mainly effective against the microfilarial stage and have minimal or no effect on adult worms. Adult Onchocerca volvulus and Brugia malayi worms (macrofilariae can live for up to 15 years, reproducing and allowing the infection to persist in a population. Therefore, to support control or elimination of these two diseases, effective macrofilaricidal drugs are necessary, in addition to current drugs. In an effort to identify macrofilaricidal drugs, we screened an FDA-approved library with adult worms of Brugia spp. and Onchocerca ochengi, third-stage larvae (L3s of Onchocerca volvulus, and the microfilariae of both O. ochengi and Loa loa. We found that auranofin, a gold-containing drug used for rheumatoid arthritis, was effective in vitro in killing both Brugia spp. and O. ochengi adult worms and in inhibiting the molting of L3s of O. volvulus with IC50 values in the low micromolar to nanomolar range. Auranofin had an approximately 43-fold higher IC50 against the microfilariae of L. loa compared with the IC50 for adult female O. ochengi, which may be beneficial if used in areas where Onchocerca and Brugia are co-endemic with L. loa, to prevent severe adverse reactions to the drug-induced death of L. loa microfilariae. Further testing indicated that auranofin is also effective in reducing Brugia adult worm burden in infected gerbils and that auranofin may be targeting the thioredoxin reductase in this nematode.
Tomita, Ryouichi; Sugitou, Kiminobu; Sakurai, Kenichi; Fujisaki, Shigeru; Ikeda, Taro; Koshinaga, Tsugumichi
To clarify the physiologic function of the enteric nervous system (ENS) in the elongated sigmoid colon (ESC) of patients with sigmoid volvulus (SV), we examined the enteric nerve responses in lesional and normal longitudinal muscle strips (LMS) derived from patients with ESC and patients who underwent colon resection for colonic cancers. Thirty preparations of LMS were taken from the lesional sigmoid colons of 10 ESC patients with SV (8 men and 2 women, aged 53 to 80 years, mean 66.2 years). Forty preparations of LMS were taken from the normal sigmoid colons (NSC) of 20 patients with colonic cancer (12 men and 8 women, aged 55 to 76 years, mean 62.3 years). A mechanographic technique was used to evaluate in vitro muscle responses to electrical field stimulation (EFS) before and after treatment with various autonomic nerve blockers. Response to EFS before blockade of the adrenergic and cholinergic nerves was as follows: NSC and ESC significantly demonstrated relaxation reaction rather than contraction reaction (P = 0.0253, P < 0.0001, respectively). ESC showed relaxation reaction more than NSC (P = 0.1138). Response to EFS after blockade of the adrenergic and cholinergic nerves was as follows: NSC and ESC significantly demonstrated relaxation reaction via nonadrenergic noncholinergic (NANC) inhibitory nerves rather than contraction reaction via NANC excitatory nerves (P < 0.0001, P < 0.0001, respectively). ESC with SV significantly showed relaxation reaction more than NSC (P = 0.0092). An increased response of relaxation mediated NANC inhibitory nerves may play a role in impaired motility in the ESC of patients with SV.
Kotobi, H; Tan, V; Lefèvre, J; Duramé, F; Audry, G; Parc, Y
Total small-intestinal volvulus with malrotation (TSIVM) classically presents in the neonatal period; it occurs much less frequently in the adult and is often misdiagnosed. Prognosis is directly related to the degree and duration of intestinal ischemia. Our goal is to describe our experience with TSIVM in the adult, to identify any specific findings and to discuss its management. Eleven patients who had undergone surgery for TSIVM at three centers between 1992 and 2012 were included. Surgery was performed as an emergency for five patients and surgery was elective for six. Mean follow-up was 63 months (range: 12-270). Six patients had had previous abdominal surgery. In nine cases, the diagnosis of TSIVM was made preoperatively, mainly by CT scan in eight cases. Seven patients had associated congenital failure of retroperitoneal fixation of the right colon and all of these underwent a Ladd procedure. The mortality rate was zero. Of the five patients who underwent emergency surgery, three required intestinal resections, one of whom developed a short bowel syndrome. The six patients who underwent surgery electively had no surgical complications. TSIVM is a very unusual finding in adult patients. The diagnosis can be made by CT scan with IV and oral contrast, but it often comes to light only at the time of surgery, even though the patients have often had recurrent episodes of abdominal symptomatology that dated back to childhood. The Ladd procedure, consisting of division of Ladd's bands, widening of the mesentery, and incidental appendectomy, remains the standard surgical repair. Digestive surgeons who care for adults should be familiar with this procedure, and it should be performed, as often as possible, with the assistance of a pediatric surgeon. Copyright © 2016. Published by Elsevier Masson SAS.
Full Text Available Se reporta el caso de una paciente femenina de 62 años de edad que se presenta con cuadro de abdomen agudo de pocas horas de evolución. Se realizó TC, observándose lesión infraumbilical oblonga, de contenido líquido, de paredes de 3-5 mm, con imágenes de aspecto cálcico. La imagen fue interpretada como vólvulo intestinal o tumor quístico peritoneal. El diagnóstico quirúrgico fue vólvulo vesicular, entidad infrecuente de difícil diagnóstico preoperatorio.We report on a 62-year-old female patient who presented with an acute abdomen developed shortly before her visit. CT scan revealed infraumbilical oblong mass, fluid content and thick walls (3-5 mm, with calcium images. The image was interpreted as intestinal volvulus or peritoneal cystic tumor. The surgical diagnosis was gallbladder volvulus, an uncommon entity, which is difficult to diagnose preoperatively.
Ueda, Masami; Onishi, Tadashi; Hata, Taishi; Nishida, Kentaro; Yanagawa, Takehiro; Fujita, Shoichiro; Fujita, Junya; Yoshida, Tetsuya; Tono, Takeshi; Monden, Takushi; Imaoka, Shingi; Mori, Masaki
A therapeutic guideline for sigmoid volvulus (SV) has not been established, and the most recommended surgical procedure for SV has not been determined. Our objective is to assess the usability of elective laparoscopic sigmoidectomy and the feasibility of single-incision laparoscopic surgery for SV following endoscopic reduction. SV typically affects the elderly and accounts for 1% to 7% of intestinal obstructions in Western countries. We report on 3 patients with SV who underwent elective laparoscopic sigmoidectomy following endoscopic reduction, and we first describe single-port surgery for SV. We discuss the 3 patients (a 79-year-old male, an 88-year-old female, and a 67-year-old female) with SV who underwent elective laparoscopic sigmoidectomy following endoscopic reduction. All 3 patients underwent laparoscopic sigmoidectomy, and 2 patients underwent single-port laparoscopic surgery without complications. Recurrence of volvulus was not seen during the course of 12 to 24 months. In experienced hands, elective laparoscopic sigmoidectomy after colonoscopic detorsion is a valuable alternative, and single-port surgery is also feasible.
Tubby, Kurtis G.
Postmortem examination of a 7-year-old German shepherd dog which had gastric dilatation/volvulus and splenectomy 2 months earlier revealed that the right middle and quadrate liver lobes were diffusely congested and torsed. The gall bladder was grossly distended and torsed along its long axis and there was evidence of bile peritonitis.
Virginia Vanzzini Zago
Full Text Available This is a retrospective, and descriptive study about the support that the laboratory of microbiology aids can provide in the diagnosis of ocular infections in patients whom were attended a tertiary-care hospital in México City in a 10-year-time period. We describe the microbiological diagnosis in palpebral mycose; in keratitis caused by Fusarium, Aspergillus, Candida, and melanized fungi; endophthalmitis; one Histoplasma scleritis and one mucormycosis. Nowadays, ocular fungal infections are more often diagnosed, because there is more clinical suspicion and there are easy laboratory confirmations. Correct diagnosis is important because an early medical treatment gives a better prognosis for visual acuity. In some cases, fungal infections are misdiagnosed and the antifungal treatment is delayed.
Carlos Eduardo Jacob
Full Text Available BACKGROUND: Gastric volvulus is frequently an asymptomatic disease, and it is usually diagnosed during radiographic examination of the superior digestive tract. The acute form, however, can spawn serious and lethal clinical consequences. This disease is defined by the anomalous rotation of the stomach over itself, and it can be classified according to type, extension, direction, etiology, and clinical presentation. AIM: To review the records from 38 patients with gastric volvulus diagnosed in the Hospital das Clínicas of University of São Paulo between 1968 and 2001. METHODS: This is retrospective analysis of 38 patient records. It was collected from each patient: name, age of first symptom appearance, gender, main clinical findings and complementary exams, volvulus type, extension, direction, etiology, and clinical presentation, therapeutic procedures, type of surgery performed, eventual recurrence, and long-term evolution. RESULTS: It was observed that occurrences of gastric volvulus are mainly secondary (75.8%. For the majority of patients (n=33, surgery was chosen as the treatment option: chronic disease in 29 cases and acute in four. Conservative treatment was reserved only for patients with no clinical conditions to surgical treatment. Anterior gastropexy was associated to high recurrence rates. Suturing the low gastric curve to the hepatic capsule and the transverse colon to the left subphrenic space (Tanner´s operation seemed to be the technical treatment of choice for primary gastric volvulus. CONCLUSION: Treatment of gastric volvolus must be tailored according the etiology of the disease.RACIONAL: O volvo gástrico é frequentemente condição assintomática e diagnosticado em exame radiológico feito por outras causas. A forma aguda, no entanto, pode ter consequências graves e letais. Ele é definido como rotação anômala do estômago nele próprio e classificado de acordo com o tipo, extensão, direção, causa e apresenta
Georg G. Duscher
The role of wild ungulates, especially ruminants, as reservoirs for zoonotic disease on the other hand seems to be negligible, although the deer filaroid Onchocerca jakutensis has been described to infect humans. Deer may also harbour certain Anaplasma phagocytophilum strains with so far unclear potential to infect humans. The major role of deer as reservoirs is for ticks, mainly adults, thus maintaining the life cycle of these vectors and their distribution. Wild boar seem to be an exception among the ungulates as, in their interaction with the fox, they can introduce food-borne zoonotic agents such as Trichinella britovi and Alaria alata into the human food chain.
Interactions between biofilms and the environment. FEMS Microbiol Rev. 1997;20:291–303. 4. Webb LX, Wagner W, Carroll D, et al. Osteomyelitis and...treatment of osteomyelitis . Biomed Mater. 2008;3: 034114. 6. Gristina AG. Biomaterial-centered infection: microbial adhesion versus tissue integration...vertebral osteomyelitis . Spine. 2007;32: 2996–3006. 15. Beckham JD, Tuttle K, Tyler KL. Reovirus activates transforming growth factor ß and bone
Nyuwi, Kuotho T; Singh, Chabungbam Gyan; Sangtam, Ty Apila; Varte, Lalhruaitluanga
Enteric Duplication Cysts (EDC) is a rare congenital malformation, usually found in mesenteric side of Gastrointestinal (GI) tract. Generally patients present with non-specific symptoms depending on size and location of the cyst in GI tract. EDC presenting as small bowel volvulus is a rare clinical entity. Herein, we are reporting a 16-year-old adolescent girl who presented to Emergency Department (ED) with the features of acute bowel obstruction with septicemia. Patient underwent exploratory laparotomy which revealed dilated, twisted, gangrenous bowel due to a cystic lesion adjacent to the mesenteric side. Resection of the cystic lesion along with the affected gangrenous segment of bowel with an end to end anastomosis performed. PMID:28208934
Patel Pranav H
Full Text Available Abstract Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.
Glickman, L T; Glickman, N W; Schellenberg, D B; Simpson, K; Lantz, G C
A study was conducted of 101 dogs (i.e., case dogs) that had acute episodes of gastric dilatation-volvulus (GDV) and 101 dogs (i.e., control dogs) with nonGDV-related problems. The control dogs were matched individually to case dogs by breed or size, and age. Predisposing factors that significantly (p less than 0.10) increased a dog's risk of GDV were male gender, being underweight, eating one meal daily, eating rapidly, and a fearful temperament. Predisposing factors that decreased the risk of GDV significantly were a "happy" temperament and inclusion of table foods in a usual diet consisting primarily of dry dog food. The only factor that appeared to precipitate an acute episode of GDV was stress.
Iso, Yukihiro; Tagaya, Nobumi; Nemoto, Takehiko; Kita, Junji; Sawada, Tokihiko; Kubota, Keiichi
An 86-year-old woman was admitted to the hospital to undergo an examination for tarry stools. Laboratory tests showed hypoproteinemia and renal dysfunction. Upper gastrointestinal endoscopy demonstrated a type 5 tumor located in the upper body of the stomach. An upper gastrointestinal series and computed tomography revealed an organoaxial gastric volvulus and the dislocation of the proximal stomach through an esophageal hiatal hernia. The preoperative diagnosis was the incarceration of a gastric carcinoma arising from the proximal stomach with an organoaxial gastric volvulus through an esophageal hiatal hernia. A total gastrectomy and hernia repair were performed. A microscopic examination of the surgical specimen revealed a gastric large cell neuroendocrine carcinoma (GLCNEC). The patient was discharged 22 days after the surgery. Although the prognosis of GLCNEC is significantly worse than that of a conventional adenocarcinoma, the patient was doing well without recurrence at 15 months after surgery. The details of this case are reported with some bibliographical comments.
Bregani, Enrico Rino; Balzarini, Laura; Mbaïdoum, Narassem; Rovellini, Angelo
Filarial parasites infect an estimated 140 million people worldwide. Wuchereria bancrofti, Onchocerca volvulus, Loa loa and Mansonella perstans are responsible for most filarial infections in sub-Saharan Africa. We describe the prevalence and the clinical characteristics of filariasis in symptomatic patients in Goundi Sanitary district:167 patients were enrolled (99 men, 68 women). M. perstans microfilariae were isolated in peripheral blood in 164 cases, while Loa loa and Wuchereria bancrofti filariasis were diagnosed in only six and three cases, respectively. The most frequent filariasis observed in our study were due to M. perstans and L. loa, while the few cases of W. bancrofti filariasis seem to have been acquired abroad. No cases of O. volvulus were observed. Microfilarial burden was not related to symptoms, but a correlation between eosinophilia and pruritus was evident. No relationship was observed between eosinophils and symptoms. The prevalence observed in symptomatic patients could reflect the real prevalence of filariasis.
Sigmoid volvulus is a rare surgical complication occurring in pregnancy and puerperium. Only 84 cases of sigmoid volvulus in pregnancy have been reported in the English literature so far. We have reviewed the available literature on this subject and present another case recently managed at our institution. The available literature suggests that over the years, there has been an improvement in the maternal and fetal outcome for this critical condition, but delay in presentation and a further delay in diagnosis remain a challenge for the treating physicians. Our patient was a 30-week pregnant lady, who presented late with 6 days history of abdominal pain, distension and absolute constipation. She had evidence of multi-organ dysfunction at presentation due to complicated sigmoid volvulus. She was resuscitated and surgical exploration revealed gangrenous large bowel. Bowel resection with diverting ileostomy was performed, but she succumbed to the septic shock due to late presentation. Acute surgical pathology may be overlooked in pregnant patients due to reluctance in radiological workup and a high index of suspicion is essential for enhanced outcome. There is a need to increase the awareness amongst the obstetricians and general practitioners. Early diagnosis and referral and timely surgical intervention could significantly improve the outcome of this surgical and obstetric catastrophe. PMID:22551246
Khan Muhammad R
Full Text Available Abstract Sigmoid volvulus is a rare surgical complication occurring in pregnancy and puerperium. Only 84 cases of sigmoid volvulus in pregnancy have been reported in the English literature so far. We have reviewed the available literature on this subject and present another case recently managed at our institution. The available literature suggests that over the years, there has been an improvement in the maternal and fetal outcome for this critical condition, but delay in presentation and a further delay in diagnosis remain a challenge for the treating physicians. Our patient was a 30-week pregnant lady, who presented late with 6 days history of abdominal pain, distension and absolute constipation. She had evidence of multi-organ dysfunction at presentation due to complicated sigmoid volvulus. She was resuscitated and surgical exploration revealed gangrenous large bowel. Bowel resection with diverting ileostomy was performed, but she succumbed to the septic shock due to late presentation. Acute surgical pathology may be overlooked in pregnant patients due to reluctance in radiological workup and a high index of suspicion is essential for enhanced outcome. There is a need to increase the awareness amongst the obstetricians and general practitioners. Early diagnosis and referral and timely surgical intervention could significantly improve the outcome of this surgical and obstetric catastrophe.
孟世平; 刘地水; 谢斯
目的回顾性分析肠套叠与肠扭转的64层螺旋CT鉴别诊断价值。方法应用siemens definition AS64螺旋CT行全腹部薄层扫描，结合MPR、CPR、容积再现(VR)等重建图像进行综合分析。结果肠套叠34例，肠扭转3例，术前诊断符合率100%。结论 MSCT结合MPR、CPR等方法对肠套叠与肠扭转的术前鉴别诊断具有重要价值。%Objective To Retrospectively analysis The differential diagnostic value of intussusception and volvulus in MSCT. Methods To apply Siemens definition AS64 CT in the whole abdominal lamellar scanning, comprehensive analysis the reconstructive image of MPR、CPR、VR. Results The rate of preoperative diagnosis coincidence is 100% in 34 cases of intussusception and 3 cases of volvulus. Conclusion It is valuable in preoperative differential diagnosis of intussusception and volvulus that MSCT integrates with MPR, CPR.
Radwan, A. M.; Ahmed, N. E.; Elakabawy, L. M.; Ramadan, M. Y.; Elmadawy, R. S.
Aim: The primary objective of the present study is to determine the commonness of filarial parasites in donkeys in Egypt, identification of the filarial species tainting them and the delivered pathogenic impact connected with the infestation. Materials and Methods: A total of 188 donkeys were examined for filarial infection. The blood samples and scraping of the cutaneous bleeding lesions were collected, stained, and inspected for microfilariae all through the period from March 2011 to October 2013. The adult worms were perceived in tissue samples acquired from skin scraping, testes, eyes, tendons, peritoneal and pleural cavities, and the ligamentum nuchae. Results: On the basis of morphological identification, 163 of 188 donkeys (86.70%) were infected with Onchocerca cervicalis (82.98%), Setaria equina (31.11%), Parafilaria multipapillosa (5.32%), and Onchocerca reticulata (4.26%). There was no significant effect of the sex on the incidence of all the encounteredfilarial worms except for S. equina, where the infection rate prevailed in males versus females (40.82% vs. 35.90%). In addition, age group of 5-15 years old exhibited a fundamentally higher predominance (p15 years old. Conclusion: The preliminary results add to our comprehension of filarial species infecting donkeys in Egypt, their impact on animal execution and production. Accentuation must be taken for avoidance, control of filarial disease, and improvement of the management system of donkeys. PMID:27651679
Kevin L Winthrop
Full Text Available For decades, onchocerciasis (or river blindness was one of the most common infectious causes of blindness in the world. Primarily an infection of Africa, with limited distribution in the new world, disease due to the nematode Onchocerca volvulus is rapidly diminishing as a result of large public health campaigns targeting at risk populations in Africa and the Americas. Existing and newly-developed treatment strategies offer the chance to eliminate onchocercal ocular morbidity in some parts of the world. This article reviews these treatment strategies, current clinical and epidemiologic aspects of onchocerciasis, and the next steps toward elimination.
Verocai Guilherme G
Full Text Available Abstract Background Onchocerca cervipedis is a filarioid nematode of cervids reported from Central America to boreal regions of North America. It is found primarily in subcutaneous tissues of the legs, and is more commonly known as ‘legworm’. Blackflies are intermediate hosts and transmit larvae to ungulates when they blood-feed. In this article we report the first records of O. cervipedis from high latitudes of North America and its occurrence in previously unrecognized host subspecies including the Yukon-Alaska moose (Alces americanus gigas and the Grant’s caribou (Rangifer tarandus granti. Methods We examined the subcutaneous connective tissues of the metacarpi and/or metatarsi of 34 moose and one caribou for parasitic lesions. Samples were collected from animals killed by subsistence hunters or animals found dead in the Northwest Territories (NT, Canada and Alaska (AK, USA from 2005 to 2012. Genomic DNA lysate was prepared from nematode fragments collected from two moose. The nd5 region of the mitochondrial DNA was amplified by PCR and sequenced. Results Subcutaneous nodules were found in 12 moose from the NT and AK, and one caribou from AK. Nematodes dissected from the lesions were identified as Onchocerca cervipedis based on morphology of female and male specimens. Histopathological findings in moose included cavitating lesions with multifocal granulomatous cellulitis containing intralesional microfilariae and adults, often necrotic and partially mineralized. Lesions in the caribou included periosteitis with chronic cellulitis, eosinophilic and lymphoplasmacytic infiltrate, and abundant granulation associated with intralesional adult nematodes and larvae. Sequences of the nd5 region (471bp, the first generated for this species, were deposited with Genbank (JN580791 and JN580792. Representative voucher specimens were deposited in the archives of the United States National Parasite Collection. Conclusions The geographic range of O
Gustavo H. Peniche González
Full Text Available The duplication of the vermiform appendix is a rare anatomical variant. Most of the cases reported with symptomatology of appendicitis and the finding of a duplication of vermiform appendix. A seven year old female, with abdominal septic shock, plain abdominal radiography with distended transverse intestinal loop with air-fluid levels and absence of air in distal colon and rectal ampula. Emergency laparotomy was performed finding a blind loop with secondary necrosis volvulus, with the torsion being at the base of the duplication, connected at the middle portion of the vermiform appendix; desvolvulus and resection was performed in a block fashion with Parker-Kerr technique using a 4-0 polyglactin suture. There are 100 cases of duplication of appendix reported worldwide. In our case, a duplication of the vermiform appendix type A was presented, shown by the surgical findings and corroborated by pathology samples of intestinal tissue featuring smooth muscle tissue and transmural necrosis and fibrinopurulent exudate in serous.
Moore George E
Full Text Available Abstract Background Gastric dilatation-volvulus (GDV is a life-threatening condition of mammals, with increased risk in large breed dogs. The study of its etiological factors is difficult due to the variety of possible living conditions. The association between meteorological events and the occurrence of GDV has been postulated but remains unclear. This study introduces the binary time series approach to the investigation of the possible meteorological risk factors for GDV. The data collected in a population of high-risk working dogs in Texas was used. Results Minimum and maximum daily atmospheric pressure on the day of GDV event and the maximum daily atmospheric pressure on the day before the GDV event were positively associated with the probability of GDV. All of the odds/multiplicative factors of a day being GDV day were interpreted conditionally on the past GDV occurrences. There was minimal difference between the binary and Poisson general linear models. Conclusion Time series modeling provided a novel method for evaluating the association between meteorological variables and GDV in a large population of dogs. Appropriate application of this method was enhanced by a common environment for the dogs and availability of meteorological data. The potential interaction between weather changes and patient risk factors for GDV deserves further investigation.
ABSTRACT Midgut volvulus is a highly life-threatening condition that carries a high risk of short gut syndrome. We report a case of catastrophic neonatal midgut volvulus in which second-look laparotomy revealed apparently non-viable remnant small intestine but with a moderate blood supply. Full-thickness small intestine necrosis was distributed in a patchy fashion, with non-viable and necrotic areas distributed so widely that no portion of the intestine could be resected. A section of full-th...
Marcelo Wilson Rocha Almeida
Full Text Available INTRODUÇÃO: Este estudo tem como objetivo relatar um caso de Síndrome de Chilaiditi associada a volvo de cólon sigmóide. RELATO DE CASO: Paciente masculino, branco, 51 anos, admitido no Pronto-Socorro de Pelotas queixando parada da eliminação de gases e fezes, dor abdominal difusa com distensão e inapetência, aceitando somente líquido. Tem diagnóstico de retardo mental e constipação intestinal crônica. Foi realizado Rx de abdome agudo, sendo evidenciada distensão difusa de cólon, e sinais sugestivos de volvo de sigmóide com imagem de cólon transverso entre o fígado e o diafragma. O paciente foi submetido a laparotomia exploradora, sendo constatado volvo de sigmóide, megacólon difuso e interposição do cólon transverso entre o fígado e o diafragma. Procedeu-se a colectomia subtotal, com colostomia terminal em cólon ascendente e fechamento do reto remanescente, recebendo alta no 9º dia. DISCUSSÃO: A interposição do cólon entre o fígado e a cúpula diafragmática (síndrome de Chilaiditi, associada a volvo de cólon sigmóide, constitui causa rara de abdome agudo obstrutivo, embora o volvo de sigmóide seja uma das principais causas de obstrução intestinal mecânica no Brasil. Geralmente o tratamento é clínico, porém se associado a complicações o tratamento é cirúrgico.INTRODUCTION: This study aims at reporting a case of Chilaiditi Syndrome associated to sigmoid colon volvulus. CASE REPORT: Male patient, white, 51 years old, arrives at an emergency hospital in Pelotas with complaints of stoping the elimination of gases, diffuse abdominal pain, increase of abdominal volume, gradual and progressive inappetence, accepting only liquid. He is diagnosed with mental retardation and a situation of intestinal constipation. An acute abdomen Rx highlighted a diffuse colon distension, suggestive of sigmoid volvulus with tranversum colon image between the liver and the diaphragm. The patient was submitted to exploratory
Ottesen, E A
It is not clear what role immediate hypersensitivity immune responses have in the pathogenesis of human onchocerciasis, but it is certain that these responses are prominent both in the course of natural infection and during the Mazzotti reactions that follow treatment with diethylcarbamazine. In humans, the levels of total serum IgE associated with onchocerciasis are as high or higher than those associated with almost any helminth infection, although specific IgE antibodies to Onchocerca volvulus appear to be a small and still poorly characterized fraction of the total serum IgE. Evidence about the relationship of these prominent IgE responses in patients with onchocerciasis to the onchocercal skin disease that manifests as pruritus and papular eruptions is conflicting, but in a guinea pig model of ocular pathology induced by onchocerca microfilariae evidence for the pathogenetic importance of IgE and immediate hypersensitivity is much less equivocal. The suggestive findings from this model make it imperative to carry out similar studies of Onchocerca-affected human eyes to determine whether immediate hypersensitivity responses play a similar critical role in the pathogenesis of the ocular lesions in humans.
Greene, B M; Taylor, H R; Brown, E J; Humphrey, R L; Lawley, T J
Diethylcarbamazine (DEC) therapy for Onchocerca volvulus infection results in frequent ocular and systemic complications, but the pathogenesis of these complications is unclear. Twenty men with O. volvulus infection were treated over a period of six months with DEC given daily for one week and weekly thereafter. Major systemic and ocular complications included proteinuria, severe pruritus, visual field constriction, optic nerve pallor, chorioretinitis, anterior uveitis, and punctate keratitis. Levels of circulating immune complexes (CICs) were increased (greater than 11% [125I]C1q binding) in 14 of the 20 men prior to treatment. Persons with pretreatment C1q binding activity of greater than 30% were at increased risk to develop constriction of visual fields (P less than 0.05) and proteinuria (P less than 0.015). Linear regression analysis revealed a striking correlation between pretreatment levels of CICs and the total number of both systemic and ocular complications (P less than 0.001) and ocular complications alone (P less than 0.005). These results suggest that CICs may be important in the pathogenesis of the delayed systemic and ocular complications following DEC therapy for O. volvulus infection.
刘勃; 张增俊; 施伟栋; 杜毛绳; 黄明侠; 张雅; 白慧萍
目的 评价CT对肠旋转不良伴中肠扭转(volvulus in intestinal malrotation, VIM)的诊断价值.方法 对12例术前CT明确诊断并经手术证实的VIM患者的临床CT资料进行回顾性分析.结果肠系膜根部"漩涡征"12例,"鸟喙征"9例,"靶环征"3例,3例合并肠管淤张积液、肠系膜水肿及腹水.结论 VIM具有特异性CT征象,CT检查对诊断VIM具有重要价值.
Annette C. Kuesel
Full Text Available Onchocerciasis is a parasitic, vector borne disease caused by the filarial nematode Onchocerca volvulus. More than 99% of the population at risk of infection live in Africa. Onchocerciasis control was initiated in West Africa in 1974 with vector control, later complemented by ivermectin mass drug administration and in the other African endemic countries in 1995 with annual community directed treatment with ivermectin (CDTI. This has significantly reduced infection prevalence. Together with proof-of-concept for onchocerciasis elimination with annual CDTI from foci in Senegal and Mali, this has resulted in targeting onchocerciasis elimination in selected African countries by 2020 and in 80% of African countries by 2025. The challenges for meeting these targets include the number of endemic countries where conflict has delayed or interrupted control programmes, cross-border foci, potential emergence of parasite strains with low susceptibility to ivermectin and co-endemicity of loiasis, another parasitic vector borne disease, which slows down or prohibits CDTI implementation. Some of these challenges could be addressed with new drugs or drug combinations with a higher effect on Onchocerca volvulus than ivermectin. This paper reviews the path from discovery of new compounds to their qualification for large scale use and the support regulatory authorities provide for development of drugs for neglected tropical diseases. The status of research for new drugs or treatment regimens for onchocerciasis along the path to regulatory approval and qualification for large scale use is reviewed. This research includes new regimens and combinations of ivermectin and albendazole, antibiotics targeting the O. volvulus endosymbiont Wolbachia, flubendazole, moxidectin and emodepside and discovery of new compounds.
Kuesel, Annette C
Onchocerciasis is a parasitic, vector borne disease caused by the filarial nematode Onchocerca volvulus. More than 99% of the population at risk of infection live in Africa. Onchocerciasis control was initiated in West Africa in 1974 with vector control, later complemented by ivermectin mass drug administration and in the other African endemic countries in 1995 with annual community directed treatment with ivermectin (CDTI.) This has significantly reduced infection prevalence. Together with proof-of-concept for onchocerciasis elimination with annual CDTI from foci in Senegal and Mali, this has resulted in targeting onchocerciasis elimination in selected African countries by 2020 and in 80% of African countries by 2025. The challenges for meeting these targets include the number of endemic countries where conflict has delayed or interrupted control programmes, cross-border foci, potential emergence of parasite strains with low susceptibility to ivermectin and co-endemicity of loiasis, another parasitic vector borne disease, which slows down or prohibits CDTI implementation. Some of these challenges could be addressed with new drugs or drug combinations with a higher effect on Onchocerca volvulus than ivermectin. This paper reviews the path from discovery of new compounds to their qualification for large scale use and the support regulatory authorities provide for development of drugs for neglected tropical diseases. The status of research for new drugs or treatment regimens for onchocerciasis along the path to regulatory approval and qualification for large scale use is reviewed. This research includes new regimens and combinations of ivermectin and albendazole, antibiotics targeting the O. volvulus endosymbiont Wolbachia, flubendazole, moxidectin and emodepside and discovery of new compounds.
Amano, Hizuru; Uchida, Hiroo; Kawashima, Hiroshi; Tanaka, Yujiro; Kishimoto, Hiroshi
Midgut volvulus is a highly life-threatening condition that carries a high risk of short gut syndrome. We report a case of catastrophic neonatal midgut volvulus in which second-look laparotomy revealed apparently non-viable remnant small intestine but with a moderate blood supply. Full-thickness small intestine necrosis was distributed in a patchy fashion, with non-viable and necrotic areas distributed so widely that no portion of the intestine could be resected. A section of full-thickness necrotic intestine preserved at surgery was able to regenerate, and normal function was restored over a period of 1 month. This case indicated that intestinal resumption may be dependent on blood flow. Even when intestinal viability is questionable, preservation enables the chance of regeneration if moderate blood flow is present.
uterus pushing the pelvic colon into the abdomen (3). Presenting symptoms and signs are .... consequent displacement of abdominal organs cause complications of ... However, prolapse seems to be more prevalent in those reported and its ...
Objective To explore the imaging experience of small intestine volvulus in order to improve realization of the disease. Methods 2 cases of small intestine volvulus comfirmed by operation were analyzed retrospectively. Results The sign of "whirlpool" were found in both 2 cases, "beak" in 1 case. Jejunum, ileum artery heterotopia and sign of whirlpool were seen in a DSA. Conclusion CT is of important value in diagnosing small intestine volvulus, with "whirlpool" and "beak" as the specific signs of the disease.%目的 探讨小肠扭转的影像表现,提高对本病的认识.方法 回顾性分析2例经手术确诊的小肠扭转患者的KUB、CT、DSA影像表现.结果 1例KUB示磨玻璃样阳性稀少征,2例CT均显示漩涡征,1例显示鸟嘴征,1例DSA示空回肠动脉异位及漩涡征.结论 CT对小肠扭转的诊断有重要价值,漩涡征、鸟嘴征为其特征性影像表现.
钟晖; 秦旭惠; 王莹
Objective ::To explore the diagnostic value of 16-slice spiral CT conventional scan and its multi-planar reformation(MPR) in sigmoid colon volvulus.. Methods:retrospectively analysed the outcome of 12 case of sigmoid colon Volvulus patients who were diagnosed by 16-slice spiral CT conventional scan and its MPR and proved by clinical operations . Results: Multi-slice CT(MSCT) features of 12 case. including:volvulus with intestinal expanded 、fluid and pneumotosis、 with shapes of U-shaped or capsule strips 12 cases. Whirl pool of intestine and mesenteric whirlpool sign 9 cases 、 Cross sign 7 cases 、Beak sign 12 cases. Abdominal fluid 6 cases. Conclusion:: MSCT conventional scan can quickly show the location degree lesion morphological characterstic of intestinal volvulus ,with or without hemody namic images impairment of bouel wal. 16-slice spiral CT conventional scan and its (MPR) have important value to diagnose sigmoid colon volvulus .% 目的探讨16层螺旋CT在乙状结肠扭转中的诊断价值。方法对经16层螺旋CT平扫及多平面重组(MPR)诊断的12例乙状结肠扭转患者，结合其临床和手术结果进行回顾性分析。结果 CT主要表现有：扭转的肠袢扩张积液积气，呈马蹄形或囊袋状形12例；肠管及系膜漩涡征9例；交叉征7例；鸟喙征12例；腹水6例。结论多层螺旋CT平扫结合MPR能快速显示乙状结肠扭转的部位、程度、形态特征、有无血运障碍等，是诊断乙状结肠扭转非常有价值的检查方法。
Lariviere, M; Vingtain, P; Aziz, M; Beauvais, B; Weimann, D; Derouin, F; Ginoux, J; Schulz-Key, H; Gaxotte, P; Basset, D
In a randomised double-blind study, ivermectin was compared with diethylcarbamazine (DEC) and placebo in the treatment of onchocerciasis in 30 male patients from Mali with moderate to heavy Onchocerca volvulus infections and ocular involvement. 10 patients received a single oral dose of ivermectin, 12 mg, 10 received DEC daily for eight days (total dose 1.3 g), and 10 received matching placebo. Patients were examined periodically for twelve months. Punctate keratitis disappeared in 6 of 7 ivermectin patients but increased in DEC patients. Numbers of O volvulus microfilariae (mf) in the anterior chamber decreased slowly and eventually disappeared in most ivermectin patients during the six months following treatment; anterior chamber mf disappeared more rapidly in some patients after DEC, but reappeared within six months of stopping treatment. Both ivermectin and DEC caused a prompt decrease in mean skin mf density; density then increased in both groups over the twelve month observation period, reaching 9% of pretreatment values in ivermectin patients and 45% in the DEC group. Analysis of adult O volvulus from nodules excised at three and twelve months post treatment showed no effect of either drug on viability; however, there was evidence of degeneration of intra-uterine developing mf in the ivermectin group. Side-effects were less frequent and less severe in ivermectin patients than in DEC patients. Ivermectin as a single oral dose appears to be a more effective microfilaricidal drug than DEC in onchocerciasis.
Roger Chen Zhu
Full Text Available Arrest in the embryologic intestinal rotation around the superior mesenteric artery prevents proper mesenteric attachment and subjects the gut to volvulus and ischemia which may lead to bowel resection. The length of non-viable resected bowel has been shown by Teitelbaum et al. to be an independent predictor of survival in patients with postoperative short bowel syndrome (RR = 5.74, P = .003. Non-occlusive mesenteric ischemia (NOMI is a feed-forward loop of vasoconstriction that aggravates the primary ischemic injury. It is an initially reversible process and a potential point of intervention for preservation of viable bowel. The Boley et al. algorithm for management of adult NOMI utilizes intravascular papaverine infusion to increase intracellular cAMP, decreasing calcium concentration and halting vasospasm. We present a modified version of this approach using topical papaverine in the setting of neonatal post-ischemic NOMI, with the goal of minimizing bowel resection.
Sérgio Santalucia Ramos da Silva
Full Text Available A síndrome da dilatação volvo gástrica (DVG é uma condição grave, de caráter agudo, que confere alto índice de óbito em pequenos animais. A etiologia não está completamente estabelecida e, em contrapartida, diversas possibilidades de tratamento são descritas. A DVG causa grave redução na perfusão tecidual, afetando vários órgãos, incluindo os sistemas respiratório e cardiovascular. Este estudo tem como objetivo realizar uma revisão de literatura sobre a patogenia desta síndrome e seu tratamento.The syndrome of gastric dilatation volvulus (GDV is a severe condition of acute character, which gives a high rate of death in small animals. The etiology is not fully established, however, several treatment options have been described. The DVG causes severe reduction in tissue perfusion, affecting many organs, including the respiratory and cardiovascular systems. This study aims to conduct a comprehensive literature review of the pathogenesis of this syndrome as well as its treatment.
Adami, Yara Leite; Rodrigues, Gabriel; Alves, Marilene Costa; Moraes, Mario Augusto Pinto; Banic, Dalma Maria; Maia-Herzog, Marilza
Mansonella ozzardi infections are common in the riverside communities along the Solimões, Negro and Purus Rivers in the state of Amazonas (AM). However, little is known about the presence of this parasite in communities located in regions bordering AM and the state of Acre. The prevalence rate of M. ozzardi infections was determined in blood samples from volunteers according to the Knott method. A total of 355 volunteers from six riverine communities were enrolled in the study and 65 (18.3%) were found to be infected with M. ozzardi. As expected, most of the infections (25%) occurred in individuals involved in agriculture, cattle rearing and fishing and an age/sex group analysis revealed that the prevalence increased beginning in the 40-50-years-of-age group and reached 33% in both sexes in individuals over 50 years of age. Based on the described symptomatology, articular pain and headache were found to be significantly higher among infected individuals (56 and 65% prevalence, respectively, p < 0.05). Sera from volunteers were subjected to ELISA using a cocktail of recombinant proteins from Onchocerca volvulus to evaluate the specificity of the test in an endemic M. ozzardi region. No cross-reactions between M. ozzardi-infected individuals and recombinant O. volvulus proteins were detected, thus providing information on the secure use of this particular cocktail in areas where these parasites are sympatric.
Yara Leite Adami
Full Text Available Mansonella ozzardi infections are common in the riverside communities along the Solimões, Negro and Purus Rivers in the state of Amazonas (AM. However, little is known about the presence of this parasite in communities located in regions bordering AM and the state of Acre. The prevalence rate of M. ozzardi infections was determined in blood samples from volunteers according to the Knott method. A total of 355 volunteers from six riverine communities were enrolled in the study and 65 (18.3% were found to be infected with M. ozzardi. As expected, most of the infections (25% occurred in individuals involved in agriculture, cattle rearing and fishing and an age/sex group analysis revealed that the prevalence increased beginning in the 40-50-years-of-age group and reached 33% in both sexes in individuals over 50 years of age. Based on the described symptomatology, articular pain and headache were found to be significantly higher among infected individuals (56 and 65% prevalence, respectively, p < 0.05. Sera from volunteers were subjected to ELISA using a cocktail of recombinant proteins from Onchocerca volvulus to evaluate the specificity of the test in an endemic M. ozzardi region. No cross-reactions between M. ozzardi-infected individuals and recombinant O. volvulus proteins were detected, thus providing information on the secure use of this particular cocktail in areas where these parasites are sympatric.
Full Text Available Ivermectin-based mass drug administration (MDA programs have achieved remarkable success towards the elimination of onchocerciasis and lymphatic filariasis. However, their full implementation has been hindered in Central Africa by the occurrence of ivermectin-related severe adverse events (SAEs in a subset of individuals with high circulating levels of Loa loa microfilariae. Extending MDA to areas with coincident L. loa infection is problematic, and inexpensive point-of-care tests for L. loa are acutely needed. Herein, we present a lateral flow assay (LFA to identify subjects with a serological response to Ll-SXP-1, a specific and validated marker of L. loa. The test was evaluated on serum samples from patients infected with L. loa (n = 109 and other helminths (n = 204, as well as on uninfected controls (n = 77. When read with the naked eye, the test was 94% sensitive for L. loa infection and was 100% specific when sera from healthy endemic and non-endemic controls or from those with S. stercoralis infections were used as the comparators. When sera of patients with O. volvulus, W. bancrofti, or M. perstans were used as the comparators, the specificity of the LFA was 82%, 87%, and 88%, respectively. A companion smartphone reader allowed measurement of the test line intensities and establishment of cutoff values. With a cutoff of 600 Units, the assay sensitivity decreased to 71%, but the specificity increased to 96% for O. volvulus, 100% for W. bancrofti, and 100% for M. perstans-infected individuals. The LFA may find applications in refining the current maps of L. loa prevalence, which are needed to eliminate onchocerciasis and lymphatic filariasis from the African continent.
Prajna Gayen; Sudipta Maitra; Sutapa Datta; Santi P Sinha Babu
Wolbachia are symbiotic endobacteria that infect the majority of filarial nematodes, including Wuchereria bancrofti, Brugia malayi and Onchocerca volvulus. Recent studies have suggested that Wolbachia are necessary for the reproduction and survival of filarial nematodes and have highlighted the use of antibiotic therapy such as tetracycline/doxycycline as a novel method of treatment for infections caused by these organisms. Before such therapy is conceived and implemented on a large scale, it is necessary to assess the prevalence of the endosymbiont in W. bancrofti from different geographical locations. We present data from molecular and electron microscopic studies to provide evidence for Wolbachia symbiosis in W. bancrofti microfilariae collected from two districts (Bankura and Birbhum) of West Bengal, India.
Fendt, J; Hamm, D M; Banla, M; Schulz-Key, H; Wolf, H; Helling-Giese, G; Heuschkel, C; Soboslay, P T
Ivermectin treatment will effectively diminish microfilariae (Mf) of Onchocerca volvulus in the skin of patients, but therapy is associated with adverse host inflammatory responses. To investigate the association of proinflammatory chemokines with the intensity of infection and clinical adverse reactions, chemokine serum levels were measured in patients following ivermectin treatment (100 microg/kg, 150 microg/kg or 200 microg/kg) or placebo. The density of O. volvulus Mf per mg skin decreased by 85%, 97%, 97% and 90% at day 3, at month 3, month 6 and at 1 year post-ivermectin. The cutaneous T cell-attracting chemokine (CTACK/CCL27) was found highly elevated in onchocerciasis patients compared to infection-free European controls (P = 0.0004) and it did not change following ivermectin or placebo to 1 year post-therapy. The chemokine RANTES/CCL5 (regulated on activated and normally T cell-expressed) was similarly high in onchocerciasis patients and infection-free European controls; the RANTES/CCL5 levels did not change following treatment until 6 months post-therapy but were slightly elevated at 1 year post-therapy (P ivermectin (P ivermectin treatment, but following clearance of microfilariae of O. volvulus their levels increased from 6 months post-therapy onwards (for both at 12 months post-therapy, P dose of ivermectin or with the serum levels of MIP-1alpha/CCL3, MIP-1beta/CCL4, TARC/CCL17, MDC/CCL22 and CTACK/CCL27. Our observations suggest that following ivermectin, macrophages as well as memory Th2-type lymphocytes and B cells, attracted and activated by MDC/CCL22, TARC/CCL17 and CTACK/CCL27, may contribute to dermal immune responses and O. volvulus Mf killing and clearance. The transient changes of TARC/CCL17 and MDC/CCL22 were not associated with clinical adverse responses, and the later rise of MIP-1alpha/CCL3 and MIP-1beta/CCL4 showed a reactivation of Type 1 immune responses associated with persistent low levels of O. volvulus microfilariae and an expiring
Full Text Available Background: This study was carried out in Opi-Agu a tropical semi-urban autonomous community comprising of three villages in Enugu State, Nigeria, between the months of April and June 2010. It was designed to determine the prevalence of Onchocerca volvulus infection and assess the perception of the disease among the inhabitants of this community.Methods: A total number of 305 individuals comprising of 148 males and 157 females were examined for various manifestations of onchocerciasis symptoms using rapid epidemiological assessment (REA method.Results: Out of this number, 119 (39.02% individuals were infected. Prevalence of infection among age groups and villages varied. Age group 41 yr and above had the highest (31.00% prevalence, while among the villages, Ogbozalla village ranked higher (45.71% than the other villages. Overall the prevalence of infection among the sexes revealed that males were more infected (43.24% than the females (35.03%. Lichenified onchodermatitis (LOD was the most prevalent (35.29% onchocerciasis symptom among others identified in the area, while leopard skin (LS had the lowest (20.17% occurrence and blindness (0.00% which is the most devastating effect of O. volvulus infection was not observed. Questionnaire responses from 410 individuals revealed that 34.8% respondent from Idi village and 28.1% from Ibeku village believed that O. volvulus infection occurs through poor personal hygiene. Bite of blackfly ranked least (10.6% among the respondent’s knowledge of the causes of onchocerciasis in Opi-Agu community.Conclusion: Opi-Agu community members had poor knowledge of onchocerciasis, the vector and of its etiologic organism. There is need for integration of community health education with mass chemotherapy
Gloeckner, Christian; Garner, Amanda L; Mersha, Fana; Oksov, Yelena; Tricoche, Nancy; Eubanks, Lisa M; Lustigman, Sara; Kaufmann, Gunnar F; Janda, Kim D
Onchocerciasis, or river blindness, is a neglected tropical disease caused by the filarial nematode Onchocerca volvulus that affects more than 37 million people, mainly in third world countries. Currently, the only approved drug available for mass treatment is ivermectin, however, drug resistance is beginning to emerge, thus, new therapeutic targets and agents are desperately needed to treat and cure this devastating disease. Chitin metabolism plays a central role in invertebrate biology due to the critical structural function of chitin for the organism. Taken together with its absence in mammals, targeting chitin is an appealing therapeutic avenue. Importantly, the chitinase OvCHT1 from O. volvulus was recently discovered, however, its exact role in the worm's metabolism remains unknown. A screening effort against OvCHT1 was conducted using the Johns Hopkins Clinical Compound Library that contains over 1,500 existing drugs. Closantel, a veterinary anthelmintic with known proton ionophore activities, was identified as a potent and specific inhibitor of filarial chitinases, an activity not previously reported for this compound. Notably, closantel was found also to completely inhibit molting of O. volvulus infective L3 stage larvae. Closantel appears to target two important biochemical processes essential to filarial parasites. To begin to unravel closantel's effects, a retro-fragment-based study was used to define structural elements critical for closantel's chitinase inhibitor function. As resources towards the development of new agents that target neglected tropical diseases are scant, the finding of an existing drug with impact against O. volvulus provides promise in the hunt for new therapies against river blindness.
Duvic, C; Nedelec, G; Debord, T; Herody, M; Didelot, F
Renal involvement in parasitic infections are polymorphic. Plasmodium malariae often leads to membranoproliferative glomerulonephritis whereas acute tubular necrosis or post-infectious acute glomerulonephritis are observed with Plasmodium falciparum. Urogenital taxis of Schistosoma haematobium is responsible for frequency of chronic tubular and interstitial nephritis. Without specific treatment, the renal function progressively deteriorates and urological complications appear. Schistosoma mansoni mainly leads to mesangial and membranoproliferative glomerulonephritis. Membranoproliferative and membranous glomerulonephritis are reported with loasis. Onchocerca volvulus also leads to membranoproliferative glomerulonephritis and lipoid nephrosis. Renal involvement with Wuchereria bancrofti is rare. With leishmaniosis, it is often mild but more serious observations are described: acute glomerulonephritis, nephrotic syndrome or acute interstitial nephritis. Renal hydatic cysts are diagnosed in two or three per cent of cases. Surgery is the only treatment. Immunosuppressive or antimalarial treatments seem to be ineffective in the outcome of chronic glomerulonephritis.
Taylor, H R; Greene, B M
Twenty men with moderate infection of Onchocerca volvulus were studied in a double-masked, controlled clinical trial to compare the safety and efficacy of oral diethylcarbamazine (DEC) with topical DEC lotion. Visual acuity and colour vision did not alter during the 6 months of observation, although 2 patients receiving DEC lotion and 3 patients receiving oral DEC developed either visual field constriction or optic atrophy. Fluffy corneal opacities were common in both groups. Intraocular microfilariae also appeared in both groups but to a greater extent in those receiving DEC lotion. New chorioretinal changes developed in 4 men receiving lotion and in only 1 receiving tablets. It is concluded that DEC lotion offers no advantage over tablets in the treatment of ocular onchocerciasis and in fact may be associated with more ocular complications than the conventional oral treatment.
Taylor, H R
Ivermectin, a recently developed macrocyclic lactone with broad antiparasitic activity, has been shown by a series of clinical trials to be safe and effective in the treatment of human infection with Onchocerca volvulus. Although it is rapidly microfilaricidal, it does not cause a severe reaction as is seen with diethylcarbamazine treatment. In patients with onchocerciasis, a single oral dose of ivermectin (150 micrograms/Kg) repeated once a year leads to a marked reduction in skin microfilaria counts and ocular involvement, although ivermectin has no known long-lasting effects on the adult worms. With treatment there is no significant exacerbation of either anterior or posterior segment eye disease even in those with severe ocular disease. Treatment leads to a marked and prolonged improvement in ocular status. Because of its safety and efficacy, ivermectin can be used on a mass scale and promises to revolutionize the treatment of onchocerciasis.
Taylor, H R; Greene, B M
Ivermectin is a macrocyclic lactone that has widespread antiparasitic activity. Numerous clinical trials have shown that ivermectin is safe and effective in the treatment of human infection with Onchocerca volvulus. Although it is rapidly microfilaricidal, it does not cause a severe reaction, as is seen with diethylcarbamazine treatment. The drug temporarily interrupts production of microfilaria but has not known long-lasting effects on the adult worms. In patients with onchocerciasis, a single oral dose of ivermectin (150 micrograms/kg) repeated once a year leads to a marked reduction in skin microfilaria counts and ocular involvement. At this dose, ivermectin causes minimal side effects and is sufficiently free of severe reactions to be used on a mass scale. It promises to revolutionize the treatment of onchocerciasis.
Taylor, H R
Ivermectin is a recently developed macrocyclic lactone that has widespread antiparasitic activity. A series of clinical trials has shown that ivermectin is safe and effective in the treatment of human infection with Onchocerca volvulus. Although it is rapidly microfilaricidal, it does not cause a severe reaction as is seen with diethylcarbamazine treatment. The drug also temporarily interrupts production of microfilaria but has no known long-lasting effects on the adult worms. In patients with onchocerciasis, a single oral dose of ivermectin (150 micrograms/kg) repeated once a year leads to a marked reduction in skin microfilaria counts and ocular involvement. At this dose, ivermectin causes minimal side effects and appears to be sufficiently free of severe adverse reactions to be used on a mass scale. Its use promises to revolutionise the treatment of onchocerciasis.
Miller, M J
Levamisole is a drug of choice for treatment of ascariasis. With recommended dosages, it is virtually free of side effects. Single doses of 50 to 150mg will eliminate all parasites in 90 to 100% of ascariasis patients irrespective of worm burden. Activity against hookworms has been demonstrated for levamisole but the most effective treatment regimen has not been determined. Further drug trials are needed for better assessment of efficacy. Levamisole has little or no curative action on infections with whipworms and pinworms. It may have some activity against strongyloides but confirmatory studies are needed. It has been shown that levamisole has significant activity against microfilariae of Wuchereria bancrofti and Brugia malayi. It is not, however, as effective as diethylcarbamazine ('Hetrazan'), and side reactions are greater. In tolerated doses, levamisole does not have significant action on adult forms or microfilariae of Onchoceea volvulus. The drug applied topically, however, may find a place in treatment of ocular onchocerciasis. Limited trials with levamisole for toxoplasmosis and chronic cutaneous leishmaniasis have given promising results, and further studies are indicated.
Cupp, E W; Cupp, M S
When blood-feeding, black flies introduce secretions into the feeding lesion that act in a coordinated manner on the 3 arms of the vertebrate hemostatic system (platelet aggregation, coagulation, and vasoconstriction). Apyrase activity inhibits platelet aggregation and is ubiquitous in the saliva of black flies, although activity per gland varies by species and has a positive association with anthropophagy. Anticoagulants target components in the final common pathway of the coagulation cascade, including factors V, Xa, and II (thrombin). The antithrombin salivary protein may exert a redundant effect by inhibiting the role of thrombin in platelet aggregation. Antithrombin presence and activity also varies among black fly species, and exhibits a positive correlation with zoophagy. Vasodilation of capillaries to increase blood supply to the feeding wound appears to be an important requirement for Simulium spp., because substantial erythema-inducing activity, has been demonstrated in salivary glands of all New World species examined. Salivary glands of Simulium ochraceum (Walker), a highly anthropophilic vector of Onchocerca volvulus (Leuckhart), contain greater vasodilator activity than several other species, including S. metallicum Bellardi, a secondary zoophagic vector of human onchocerciasis. Simulium vittatum Zetterstedt saliva affects immune cell responses and cytokine production. The ability of the saliva to modulate components of the host immune system provides an opportunity for enhancing transmission of pathogens during bloodfeeding. Thus, the likely possibility that effective pathogen transmission relies on vector saliva may complement present efforts aimed at target epitopes of O. volvulus or identify additional molecules to be investigated as part of a "river blindness" vaccine cocktail. Components in saliva also may enhance the transmission of other microbial agents either by a cofeeding process similar to that observed in ixodid ticks or through rupture
... infection; Central venous catheter - infection; CVC - infection; Central venous device - infection; Infection control - central line infection; Nosocomial infection - central line infection; Hospital acquired ...
Hookworm disease; Ground itch; Ancylostoma duodenale infection; Necator americanus infection; Parasitic infection - hookworm ... The infection is caused by infestation with any of the following ... Ancylostoma duodenale Ancylostoma ceylanicum Ancylostoma ...
... X-ray called a voiding cystourethrogram. Antibiotics for kidney infections Antibiotics are the first line of treatment ... the infection is completely eliminated. Hospitalization for severe kidney infections For a severe kidney infection, your doctor ...
... Old Feeding Your 1- to 2-Year-Old Shigella Infections KidsHealth > For Parents > Shigella Infections Print A ... the Doctor en español Infecciones por Shigella About Shigella Shigella are bacteria that can infect the digestive ...
... infections may occur following surgery or spontaneously in patients with certain risk factors. Risk factors for spinal infections include poor nutrition, immune suppression, human immunodeficiency virus (HIV) infection, cancer, diabetes and obesity. Surgical risk factors ...
Full Text Available Abstract Background Anti-Wolbachia treatment with doxycycline is effective in sterilising and killing adult Onchocerca volvulus nematodes, proving superior to ivermectin and of great potential as an alternative approach for the treatment and control of onchocerciasis, particularly in areas of Loa loa co-endemicity. Nevertheless, the length of the required treatment poses potential logistical problems and risk of poor compliance, raising a barrier to the use of doxycycline in Mass Drug Administration (MDA strategies. In 2007 and 2008 a feasibility trial of community-directed treatment with doxycycline was carried out in two health districts in Cameroon, co-endemic for O. volvulus and L. loa. With 17,519 eligible subjects, the therapeutic coverage was 73.8% with 97.5% compliance, encouraging the feasibility of using doxycycline community-directed delivery in restricted populations of this size. The current study evaluated the effectiveness of this community-directed delivery of doxycycline four years after delivery. Findings Infection with O. volvulus was evaluated by skin biopsy and nodule palpation. Of the 507 subjects recruited, 375 had completed the treatment with doxycycline followed by one or two rounds of annual ivermectin MDA and 132 received one or two rounds of annual ivermectin MDA alone. Statistically significant lower microfilarial prevalence (17.0% [doxycycline plus ivermectin group], 27.0% [ivermectin only group], p = 0.014 and load (p = 0.012 were found in people that had received doxycycline followed by ivermectin compared to those who received ivermectin only. Conclusions This study demonstrates the long-term effectiveness of doxycycline treatment delivered with a community-directed strategy even when evaluated four years after delivery in an area of ongoing transmission. This finding shows that a multi-week course of treatment is not a barrier to community-delivery of MDA in restricted populations of this size and supports its
Diallo, S; Aziz, M A; Lariviere, M; Diallo, J S; Diop-Mar, I; N'Dir, O; Badiane, S; Py, D; Schulz-Key, H; Gaxotte, P
Ivermectin (MK-933) has been compared with diethylcarbamazine (DEC) and placebo in a double-blind study in 30 adult male Senegalese patients with Onchocerca volvulus infection. 10 patients were randomly assigned to each treatment group. Ivermectin was administered as a single oral dose of 12 mg and DEC as 50 mg daily for two days and 100 mg twice daily for the following six days, total 1.3 g in eight days. Skin O. volvulus microfilaria densities remained near pre-study values in the placebo patients, but decreased rapidly with both active drugs to mean values about 2% of pretreatment (Day 8) and then increased slowly, reaching in 12 months about 4% of pre-treatment (ivermectin) and 18% (DEC). This difference is statistically significant. Clinical adverse reactions were recorded in four ivermectin, ten DEC and three placebo patients. One ivermectin and six DEC patients received steroid treatment for relief of these reactions. Serious adverse ocular changes were not seen in any patients, possibly because of the steroid therapy in the DEC patients. Adult O. volvulus from onchocercal nodules one and six months after treatment showed no effect of either drug on viability. Intra-uterine developing forms of the microfilariae appeared normal in all three treatment groups at the one month examination but deformed and degenerated forms were evident at six months in the ivermectin group but not in the DEC and placebo patients. Ivermectin as a single oral dose appears to be a safer and more effective microfilaricidal drug in human onchocerciasis than DEC in the standard multi-dose regimen.
... Artery Disease Venous Thromboembolism Aortic Aneurysm More Infective Endocarditis Updated:Oct 10,2016 View an illustration of endocarditis Infective endocarditis (IE), also called bacterial endocarditis (BE), ...
... a skin infection that can cause skin redness, warmth, and pain. People with cellulitis may have a ... cause the skin around the nail to be red, swollen, and tender. If the infection is treated ...
... Culture Household Safety: Preventing Cuts Dealing With Cuts Osteomyelitis Tetanus First Aid: Skin Infections Toxic Shock Syndrome ... Abscess Paronychia Dealing With Cuts and Wounds Cellulitis Osteomyelitis Impetigo Staph Infections MRSA Cuts, Scratches, and Scrapes ...
... red rash on the body. Impetigo - a skin infection Toxic shock syndrome Cellulitis and necrotizing fasciitis (flesh-eating disease) Group B strep can cause blood infections, pneumonia and meningitis in newborns. A screening test ...
Diseases and Conditions Tapeworm infection By Mayo Clinic Staff Tapeworm infection is caused by ingesting food or water contaminated with tapeworm eggs or larvae. If you ingest certain tapeworm eggs, they can migrate outside ...
... lives are lost because of the spread of infections in hospitals. Health care workers can take steps ... of infectious diseases. These steps are part of infection control. Proper hand washing is the most effective ...
... The skin may become itchy and red, with blisters and cracking of the skin. The infection may ... my sheets and towels every day? ResourcesDiagnosis and Management of Common Tinea Infections by SL Noble, Pharm. ...
Campylobacter infection is a common foodborne illness. You get it from eating raw or undercooked poultry. You ... whether you need to take antibiotics. To prevent campylobacter infection, cook poultry thoroughly. Use a separate cutting ...
Tay, Bobby K-B; Deckey, Jeffrey; Hu, Serena S
Spinal infections can occur in a variety of clinical situations. Their presentation ranges from the infant with diskitis who is unwilling to crawl or walk to the adult who develops an infection after a spinal procedure. The most common types of spinal infections are hematogenous bacterial or fungal infections, pediatric diskitis, epidural abscess, and postoperative infections. Prompt and accurate diagnosis of spinal infections, the cornerstone of treatment, requires a high index of suspicion in at-risk patients and the appropriate evaluation to identify the organism and determine the extent of infection. Neurologic function and spinal stability also should be carefully evaluated. The goals of therapy should include eradicating the infection, relieving pain, preserving or restoring neurologic function, improving nutrition, and maintaining spinal stability.
... on the face and neck, sometimes after a dental infection or procedure such as a tooth extraction or ... adults of all ages. The most common are dental infections, inflammation of the abdominal lining (peritonitis), and abscesses ...
... but deadly viral infection. It is spread by mice and rats. They shed the virus in their ... breathe infected air or come into contact with rodents or their urine or droppings. You cannot catch ...
Rotavirus is a virus that causes gastroenteritis. Symptoms include severe diarrhea, vomiting, fever, and dehydration. Almost all ... the U.S. are likely to be infected with rotavirus before their 5th birthday. Infections happen most often ...
Full Text Available The evolution and persistence of ocular pathology was assessed in a cohort of Onchocerca volvulus infected patients treated annually with ivermectin for 23 years. Patients were resident in rural Central and Kara Region of Togo and ocular examinations included testing of visual acuity, slit lamp examination of the anterior eye segment and the eye fundus by ophthalmoscopy. Before ivermectin treatment, vivid O.volvulus microfilariae (MF were observed in the right and left anterior eye chamber in 52% and 42% of patients (n = 82, and dead MF were seen in the right and left cornea in 24% and 15% of cases, respectively. At 23 years post initial treatment (PIT, none of the patients (n = 82 presented with MF in the anterior chamber and cornea. A complete resolution of punctate keratitis (PK lesions without observable corneal scars was present at 23 years PIT (p<0.0001, and sclerosing keratitits (SK lessened by half, but mainly in patients with lesions at early stage of evolution. Early-stage iridocyclitis diminished from 42%(rE and 40%(lE to 13% (rE+lE(p<0.0001, but advanced iridocyclitis augmented (p<0.001 at 23 years PIT compared to before ivermectin. Advanced-stage papillitis and chorioretinitis did not regress, while early-stage papillitis present in 28%(rE and 27%(lE of patients at before ivermectin regressed to 17%(rE and 18%(lE, and early-stage chorioretinitis present in 51%(rE+lE of cases at before ivermectin was observed in 12%(rE and 13%(lE at 23 years PIT (p<0.0001. Thus, regular annual ivermectin treatment eliminated and prevented the migration of O. volvulus microfilariae into the anterior eye chamber and cornea; keratitis punctata lesions resolved completely and early-stage sclerosing keratitits and iridocyclitis regressed, whilst advanced lesions of the anterior and posterior eye segment remained progressive. In conclusion, annual ivermectin treatments may prevent the emergence of ocular pathology in those populations still exposed
Full Text Available Achievements obtained by the onchocerciasis control programmes should not lead to a relaxation in the biological research on Onchocerca volvulus. Issues such as the Loa loa-related postivermectin serious adverse events, the uncertainties as to whether onchocerciasis can be eliminated by ivermectin treatments, and the possible emergence of ivermectin-resistant O. volvulus populations should be addressed proactively. Doxycycline, moxidectin and emodepside appear to be promising as alternative drugs against onchocerciasis but support to researches in immunology and genomics should also be increased to develop new control tools, including both vaccines and macrofilaricidal drugs.
cooked meat of infected animals, especially sheep and pigs. Toxoplasma infects one-third to one-half of normal humans by age 40, but causes...Toxoplasma in the first trimester, 30-50 per cent deliver an obviously affected infant. Congenital infection is associated with hydrocephalus...chorioretinitis, hepatosplenomegaly, and rash. In survivors, mental retardation, deaf- ness, and cardiac malformations may be noted. Chorioretinitis may also
Schiele, Philippe; Le Nen, Dominique
Superficial and deep hand infections are frequent in general medical practice. Clinical examination is a crucial step for an adapted provided care. Most of the time, surgery is the only way to heal infections. However, in some cases (like bites), empiric antibiotherapy is first indicated to limit infection. Staphyloccocus aureus as well as Group Beta Streptococcus are the most frequently pathogenes associated with hand infections. Methicillin resistant S. Aureus must always be considered in the diagnoses. Whatever treatment is provided, clinical assessement must be repeated within two days. An early adaquated treatment prevent functional complications and in some cases death of the patients.
... Genitals and Urinary Tract Glands & Growth Head Neck & Nervous System Heart Infections Learning Disabilities Obesity Orthopedic Prevention Sexually Transmitted Skin Tobacco Treatments Injuries & ...
... Genitals and Urinary Tract Glands & Growth Head Neck & Nervous System Heart Infections Learning Disabilities Obesity Orthopedic Prevention Sexually Transmitted Skin Tobacco Treatments Injuries & ...
... Genitals and Urinary Tract Glands & Growth Head Neck & Nervous System Heart Infections Learning Disabilities Obesity Orthopedic Prevention Sexually Transmitted Skin Tobacco Treatments Injuries & ...
... ill or the area spreads and gets very red or and hot — it's a good idea to see a doctor. Wound infections generally show up 2 or more days after the injury or surgery. The signs of a wound infection (redness, pain, swelling, and warmth) are similar to those found in cellulitis. A ...
... you should be familiar with include the following: Cellulitis is a bacterial skin infection that first affects the outer layers of the ... skin. Although other types of bacteria can cause cellulitis, Saureus ... may diagnose the infection by examining the area. The doctor may take ...
... Old Feeding Your 8- to 12-Month-Old Feeding Your 1- to 2-Year-Old First Aid: Skin ... (bacterial infection of the deeper layers of the skin and tissues beneath) are typical childhood skin infections. The usual bacterial culprits in skin ...
Turner, Hugo C.; Churcher, Thomas S.; Martin Walker; Osei-Atweneboana, Mike Y.; Prichard, Roger K.; María-Gloria Basáñez
BACKGROUND: Recent studies in Mali, Nigeria, and Senegal have indicated that annual (or biannual) ivermectin distribution may lead to local elimination of human onchocerciasis in certain African foci. Modelling-based projections have been used to estimate the required duration of ivermectin distribution to reach elimination. A crucial assumption has been that microfilarial production by Onchocerca volvulus is reduced irreversibly by 30-35% with each (annual) ivermectin round. However, other m...
Frempong, Kwadwo K.; Walker, Martin; Cheke, Robert A.; Tetevi, Edward Jenner; Gyan, Ernest Tawiah; Owusu, Ebenezer O.; Wilson, Michael D.; Boakye, Daniel A.; Taylor, Mark J.; Biritwum, Nana-Kwadwo; Osei-Atweneboana, Mike; Basáñez, María-Gloria
Background. Several African countries have adopted a biannual ivermectin distribution strategy in some foci to control and eliminate onchocerciasis. In 2010, the Ghana Health Service started biannual distribution to combat transmission hotspots and suboptimal responses to treatment. We assessed the epidemiological impact of the first 3 years of this strategy and quantified responses to ivermectin over 2 consecutive rounds of treatment in 10 sentinel communities. Methods. We evaluated Onchocerca volvulus community microfilarial intensity and prevalence in persons aged ≥20 years before the first, second, and fifth (or sixth) biannual treatment rounds using skin snip data from 956 participants. We used longitudinal regression modeling to estimate rates of microfilarial repopulation of the skin in a cohort of 217 participants who were followed up over the first 2 rounds of biannual treatment. Results. Biannual treatment has had a positive impact, with substantial reductions in infection intensity after 4 or 5 rounds in most communities. We identified 3 communities—all having been previously recognized as responding suboptimally to ivermectin—with statistically significantly high microfilarial repopulation rates. We did not find any clear association between microfilarial repopulation rate and the number of years of prior intervention, coverage, or the community level of infection. Conclusions. The strategy of biannual ivermectin treatment in Ghana has reduced O. volvulus microfilarial intensity and prevalence, but suboptimal responses to treatment remain evident in a number of previously and consistently implicated communities. Whether increasing the frequency of treatment will be sufficient to meet the World Health Organization's 2020 elimination goals remains uncertain. PMID:27001801
Department of Veterinary Pathology, University of Ibadan, Ibadan, Nigeria. Summary: The ... Keywords: Pneumonia, West African Dwarf goats,Lung morphometry, Infection. ... high incidence of infectious diseases with pneumonia being an ...
... as careful care and monitoring in the hospital. Listeriosis What is it? Infection with Listeria monocytogenes bacteria ... properly cleaned, pasteurized, or cooked may give someone listeriosis . Babies can acquire bacteria from their mothers if ...
... in the small intestine from a bacteria called Campylobacter jejuni . It is a type of food poisoning. Causes ... testing for white blood cells Stool culture for Campylobacter jejuni Treatment The infection almost always goes away on ...
... body will learn to resist them causing antibiotic resistance. Later, you could get or spread an infection that those antibiotics cannot cure. NIH: National Institute of Allergy and Infectious Diseases
... You can get chlamydia during oral, vaginal, or anal sex with someone who has the infection. A woman ... to prevent chlamydia is to not have vaginal, anal, or oral sex. Correct usage of latex condoms greatly reduces, but ...
... children, use an oral rehydration solution, such as Pedialyte, unless your doctor advises otherwise. Salmonella infection can ... can use an oral rehydration solution, such as Pedialyte, unless your doctor advises otherwise. The U.S. Department ...
... don't have symptoms. Symptoms mainly occur in children, and range from mild to severe. A severe infection may cause: Bloody diarrhea Iron-deficiency anemia Fecal incontinence (during sleep) Rectal prolapse (the ...
Bjarnsholt, Thomas; Jensen, Peter Østrup; Moser, Claus Ernst
A still increasing interest and emphasis on the sessile bacterial lifestyle biofilms has been seen since it was realized that the vast majority of the total microbial biomass exists as biofilms. Aggregation of bacteria was first described by Leeuwenhoek in 1677, but only recently recognized...... as being important in chronic infection. In 1993 the American Society for Microbiology (ASM) recognized that the biofilm mode of growth was relevant to microbiology. This book covers both the evidence for biofilms in many chronic bacterial infections as well as the problems facing these infections...... such as diagnostics, pathogenesis, treatment regimes and in vitro and in vivo models for studying biofilms. This is the first scientific book on biofilm infections, chapters written by the world leading scientist and clinicians. The intended audience of this book is scientists, teachers at university level as well...
2008050 The establishment of a rat model of chronic pulmonary infection of Pseudomonas aeruginosa. WANG Weifang(王炜芳), et al. Dept Respir, PLA General Hosp, Beijing 100853. Natl Med J China 2008;88(1):46-50. Objective To establish a rat model of chronic pulmonary infection by inoculating two different Pseudomonas aeruginosa embedded in minute seaweed algiante beads made by an ejection set with an acuminate hole to
Middle ear infection - chronic; Otitis media - chronic; Chronic otitis media; Chronic ear infection ... up. When this happens, infection can occur. A chronic ear infection develops when fluid or an infection ...
... Home » Health Info » Hearing, Ear Infections, and Deafness Ear Infections in Children On this page: What is ... additional information about ear infections? What is an ear infection? An ear infection is an inflammation of ...
Karampekios, Spyros [University of Crete, Department of Radiology, Heraklion, Crete (Greece); Hesselink, John [UCSD, Department of Radiology, San Diego, CA (United States)
Despite the development of many effective antibiotic therapies and the general improvement in hygiene and health care systems all over the world, the incidence of central nervous system (CNS) infection has increased significantly in the past 15 years. This can be attributed primarily to the acquired immunodeficiency syndrome (AIDS) epidemic and its devastating effect on the immune system and secondarily to various immunosuppressive agents that are being used in aggressive cancer treatment and in organ transplantations. The brain particularly is protected from infection by the calvarium, meninges and blood brain barrier. However, different types of pathogens, including bacteria, viruses, fungi and parasites, can reach the brain hematogenously or, less likely, by direct extension from an adjacent infected focus. The early detection and specific diagnosis of infection are of great importance, since brain infections are potentially treatable diseases. Imaging studies play a crucial role in the diagnostic process, along with the history (exposure to infectious agents), host factors (open head trauma, CSF leak, sinusitis, otitis, immune status), physical examination and laboratory analysis of CSF. (orig.)
Full Text Available Active and passive mouth opening exercises are a very common practice in oral and maxillofacial surgery especially for various conditions causing limited mouth opening like space infections, trauma, and ankylosis. But most of the practitioners do not follow basic principles while advocating these active mouth opening exercises and also take it for granted that it would benefit the patient in the long run. Because of this, the mouth opening physiotherapy by itself can at times lead to unwanted complications. We report a case wherein due to active physiotherapy, the patient had complications leading to persistent temporal space infection which required surgical intervention and hospitalization. This could have been because of hematoma formation during physiotherapy which got infected due to anchoretic infection of unknown etiology and resulted in temporal space infection. Hence, our conclusion is that whenever mouth opening exercises are initiated, it should be done gradually under good antibiotic coverage to avoid any untoward complications and for optimum results. According to the current English literature, such a complication has not been documented before.
Tali, E. Turgut E-mail: email@example.com
Spinal infections can be thought of as a spectrum of disease comprising spondylitis, discitis, spondylodiscitis, pyogenic facet arthropathy, epidural infections, meningitis, polyradiculopathy and myelitis. Radiological evaluations have gained importance in the diagnosis, treatment planning, treatment and treatment monitoring of the spinal infections. Conventional radiographs are usually the initial imaging study. The sensitivity and specificity of the plain radiographs are very low. The sensitivity of CT is higher while it lacks of specificity. Conventional CT has played minor role for the diagnosis of early spondylitis and disc space infection and for follow-up, researches are going on the value of MDCT. MRI is as sensitive, specific and accurate as combined nuclear medicine studies and the method of choice for the spondylitis. Low signal areas of the vertebral body, loss of definition of the end plates and interruption of the cortical continuity, destruction of the cortical margins are typical on T1WI whereas high signal of affected areas of the vertebral body and disc is typical on T2WI. Contrast is mandatory and increases conspicuity, specificity, and observer confidence in the diagnosis and facilitates the treatment planning. Contrast enhancement is the earliest sign and pathognomonic in the acute inflammatory episode and even in the subtle infection then persists to a varying degree for several weeks or months. The outcome of the treatment is influenced by the type of infection and by the degree of neurologic compromise before treatment. There is an increasing move away from surgical intervention towards conservative therapy, percutaneous drainage of abscess or both. It is therefore critical to monitor treatment response, particularly in the immuno-deficient population.
Full Text Available Background & objectives: Onchocerciasis is endemic in some parts of Akwa Ibom State, Nigeria. This study describes the entomological parameters of transmission in three rural communities of Akwa Ibom State, prior to ivermectin intervention in 2004. Methods: Blackflies were caught using human bait and 90% of the flies were dissected for parity. All parous flies were further dissected for the presence of filaria larvae. Monthly and annual biting rate, and transmission potential were calculated using standard methods.Results: A total of 4296 adult Simulium damnosum were caught on human bait, 4119 were dissected of which 208 (5.1% were infected with Onchocerca volvulus larvae. Transmission parameters varied significantly (p < 0.05 in the three villages. Annual biting rates, ranged from 9490 to 11,218 bites per person per year. The annual transmission potential ranged from 131 to 189 infective larvae per person per year, monthly biting rate and monthly transmission potential varied significantly (p < 0.05 in the three villages. Transmission was highly seasonal occurring during the peak of rainy season from August to October. There was no transmission during the dry periods — November to March, and the early rainy periods — April to May. The diurnal biting activity of the fly exhibited a bimodal pattern with a morning peak (0900–1000 hrs and a more marked evening peak (1600–1700 hrs. Interpretation & conclusion: The results indicate that there is a temporal and spatial variation in the transmission dynamics of S. damnosum in the study area.
Goa, K L; McTavish, D; Clissold, S P
Ivermectin, a derivative of avermectin B, is an orally effective microfilaricidal agent. It is the current drug of choice for treating patients infected with the nematode Onchocerca volvulus, which is a major cause of blindness in inhabitants of some tropical areas. Ivermectin is administered orally as a single dose of 150 micrograms/kg given annually. Skin and ocular microfilarial counts are dramatically reduced after the first dose, with some evidence for a resulting decrease in transmission of infection by the blackfly vector. With the exception of rare serious reactions such as severe systemic postural hypotension, ivermectin is generally well tolerated. The drug has the clear advantages of ease of administration and better tolerability compared with diethylcarbamazine and suramin, agents previously used to treat onchocerciasis. Thus, ivermectin is suitable for inclusion in mass treatment programmes and is the best therapeutic option presently available to combat onchocerciasis. As such it provides hope for many thousands of people at risk of becoming blind, and represents a major contribution to tropical medicine.
This podcast will educate health care providers on diagnosing baylisascariasis and on providing patients at risk of Baylisascaris infection with prevention messages. Created: 8/27/2012 by Center for Global Health, Division of Parasitic Diseases and Malaria. Date Released: 8/28/2012.
THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE. 28 ... micronutrients and herbal concoctions have been advocated.4 But none has provided the survival benefit, freedom from ... trimoxazole (CTX) use in patients with advanced HIV infection became .... A further Zambian study noted birth outcomes in pregnant.
... fecal matter from an infected person (especially a child in diapers). Household pets can carry and transmit the bacteria to their ... by the person with diarrhea. Also, if a pet dog or cat has diarrhea, wash your hands often and check ... lab tests also might be needed, especially if your child has blood in the stool. If your doctor ...
Muhammed, Maged; Anagnostou, Theodora; Desalermos, Athanasios; Kourkoumpetis, Themistoklis K.; Carneiro, Herman A.; Glavis-Bloom, Justin; Coleman, Jeffrey J.
Abstract Fusarium species is a ubiquitous fungus that causes opportunistic infections. We present 26 cases of invasive fusariosis categorized according to the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria of fungal infections. All cases (20 proven and 6 probable) were treated from January 2000 until January 2010. We also review 97 cases reported since 2000. The most important risk factors for invasive fusariosis in our patients were compromised immune system, specifically lung transplantation (n = 6) and hematologic malignancies (n = 5), and burns (n = 7 patients with skin fusariosis), while the most commonly infected site was the skin in 11 of 26 patients. The mortality rates among our patients with disseminated, skin, and pulmonary fusariosis were 50%, 40%, and 37.5%, respectively. Fusarium solani was the most frequent species, isolated from 49% of literature cases. Blood cultures were positive in 82% of both current study and literature patients with disseminated fusariosis, while the remaining 16% had 2 noncontiguous sites of infection but negative blood cultures. Surgical removal of focal lesions was effective in both current study and literature cases. Skin lesions in immunocompromised patients should raise the suspicion for skin or disseminated fusariosis. The combination of medical monotherapy with voriconazole or amphotericin B and surgery in such cases is highly suggested. PMID:24145697
Full Text Available Seasonal and daily biting activity patterns, and natural filarial infections of adult black flies attracted to human bait were investigated at Ban Pang Faen, a rural area in Chiang Mai Province in northern Thailand. Collections were carried out twice a month from 06-00 to 18-00 hours from January 2005 to February 2006. Among ten Simulium species collected, S. nodosum and S. asakoae were predominant occupying 57.3% and 37.2% of the total 16, 553 females, respectively. These two predominant species showed different patterns in seasonal abundance: majority of S. nodosum (86.7% were collected in hot season (from mid February to mid May, while most of S. asakoae (74.5% were collected in rainy season (from mid May to mid October. For the daily biting activity, S. nodosum had two patterns: the main one was unimodal with a peak from 17-00 to 18-00, and the other was bimodal and had the major peak from 16-00 to 18-00 and the minor one from 07-00 to 09-00. The pattern of S. asakoae was mostly unimodal with a peak from 06-00 to 10-00. The filarial larvae found in S. nodosum and S. asakoae were morphologically different from each other. The short and thick infective larvae found in S. asakoae differed from all known filarial larvae; it is suggested that they might be a bird parasite, Splendidofilariinae or Lemdaninae. The infection of the mammophilic S. nodosum with large Onchocerca type infective larvae was confirmed in this area. Natural filarial infections were found in each month (except December in either S. nodosum or S. asakoae or in both. Monthly infection rates with all stages of larvae were 0.6-5.0% for S. nodosum, and 1.0-4.0% for S. asakoae. It is suggested that people in this village are exposed to the risk of infection with zoonotic filariae throughout the year.
Nails - fungal infection; Onychomycosis; Infection - fungal - nails; Tinea unguium ... hair, nails, and outer skin layers. Common fungal infections include: Athlete's foot Jock itch Ringworm on the ...
Francisco de Salles Collet e Silva
Full Text Available O volvo de colo direito é uma rara causa de obstrução intestinal em nosso meio e apresenta uma mortalidade elevada. Apresentam-se dois casos de volvo de cola direito associado ao megacolo adquirido, que apresentaram boa evolução. Discute-se a etiologia, o tratamento e as complicações.
Sweeney, Daniel A.; Hicks, Caitlin W.; Cui, Xizhong; Li, Yan
Bacillus anthracis infection is rare in developed countries. However, recent outbreaks in the United States and Europe and the potential use of the bacteria for bioterrorism have focused interest on it. Furthermore, although anthrax was known to typically occur as one of three syndromes related to entry site of (i.e., cutaneous, gastrointestinal, or inhalational), a fourth syndrome including severe soft tissue infection in injectional drug users is emerging. Although shock has been described with cutaneous anthrax, it appears much more common with gastrointestinal, inhalational (5 of 11 patients in the 2001 outbreak in the United States), and injectional anthrax. Based in part on case series, the estimated mortalities of cutaneous, gastrointestinal, inhalational, and injectional anthrax are 1%, 25 to 60%, 46%, and 33%, respectively. Nonspecific early symptomatology makes initial identification of anthrax cases difficult. Clues to anthrax infection include history of exposure to herbivore animal products, heroin use, or clustering of patients with similar respiratory symptoms concerning for a bioterrorist event. Once anthrax is suspected, the diagnosis can usually be made with Gram stain and culture from blood or surgical specimens followed by confirmatory testing (e.g., PCR or immunohistochemistry). Although antibiotic therapy (largely quinolone-based) is the mainstay of anthrax treatment, the use of adjunctive therapies such as anthrax toxin antagonists is a consideration. PMID:21852539
Urinary tract infection (UTI) Overview By Mayo Clinic Staff A urinary tract infection (UTI) is an infection in any part of ... UTI spreads to your kidneys. Doctors typically treat urinary tract infections with antibiotics. But you can take steps to ...
Fish tapeworm infection is an intestinal infection with the tapeworm parasite found in fish. ... The fish tapeworm ( Diphyllobothrium latum ) is the largest parasite that infects humans. Humans become infected when they eat raw ...
Awadzi, K; Dadzie, K Y; Shulz-Key, H; Haddock, D R; Gilles, H M; Aziz, M A
Nineteen patients from an area of vector control in the savanna region of Northern Ghana, all with moderate to heavy infections with Onchocerca volvulus and some with ocular involvement, were treated with 50, 100, 150 or 200 micrograms kg-1 of ivermectin. Detailed monitoring of clinical and ocular reactions and of alterations in skin microfilarial counts and laboratory indices were carried out during the first 28 days. Microfilarial counts in skin snips and detailed ocular examinations were then repeated at intervals over a period of nine months. Ivermectin slowly eliminated microfilariae from the skin and eye without serious adverse clinical or ocular reactions in all treated groups. There was little difference in efficacy between doses of 100, 150 and 200 micrograms kg-1, and these were more effective than the 50 micrograms kg-1 dose. Very low levels of skin microfilariae were maintained for nine months. Microfilariae were not eliminated from the eye for at least three months. The drug was neither macrofilaricidal nor embryotoxic. However, it produced a dose-dependent stimulation of embryogenesis manifest at one month and succeeded by a suppression of embryogenesis at three months after therapy. In areas where transmission of onchocerciasis has been interrupted, ivermectin may need not be given more often than once a year. The efficacy of the drug on single dosage and the mild adverse reactions produced, if confirmed in subsequent controlled studies, would greatly simplify the treatment of onchocerciasis and would reintroduce new concepts of the role of chemotherapy in the control of onchocerciasis.
Dadzie, K Y; Bird, A C; Awadzi, K; Schulz-Key, H; Gilles, H M; Aziz, M A
The effect of ivermectin, a new microfilaricide, was assessed in a double blind trial against diethylcarbamazine citrate (DEC) and placebo. Fifty-nine adult males with moderate to heavy infection with Onchocerca volvulus and with eye involvement were recruited from an area under Onchocerciasis Control Programme (OCP) vector control in Northern Ghana. They were randomly assigned to an eight-day treatment with ivermectin as a single dose of 12 mg on day 1 followed by placebo for the remaining seven days, or DEC, total dose 1.3 g, or placebo, and ophthalmological review was undertaken over a period of one year. DEC acted quickly to eliminate microfilariae from the eye and was associated with reactive ocular changes and in a few cases functional deficit. Ivermectin eliminated microfilariae slowly from the anterior chamber of the eye over a period of six months. The ocular inflammatory reaction was minimal and no functional deficit occurred. It is postulated that the observed slow action of ivermectin on the eye may be attributed in part to its instability to cross the blood-aqueous humour barrier because of its molecular size as a macrocyclic lactone causing microfilariae to leave the eye gradually along a newly created gradient. Ivermectin is an effective microfilaricide with minimal ocular adverse effect and could therefore be suitable for widespread application without strict supervision. PMID:3548811
Chemotherapy against onchocerciasis and lymphatic filariasis has been discussed mainly within the framework of mass drug administration with diethylcarbamazine, ivermectin and albendazole. Although strong reductions in infection prevalence were achieved, the regimes for these drugs do not fully cover needs of individual patients who seek treatment because of symptoms. Chemotherapy against filarial Wolbachia endosymbionts with doxycycline showed higher antiparasitic efficacy in onchocerciasis and lymphatic filariasis and also improved disease. This review details the recent indications for this new treatment, focussing on regimes for individual drug administration. A regimen of 6-week/100 mg doxycycline per day sterilized adult female Onchocerca volvulus. Two hundred milligrams doxycycline per day for 4 or 6 weeks revealed 50 and 60% macrofilaricidal effects, respectively. Reduction of 80-90% of adult worms was observed in bancroftian filariasis with 200 mg/day doxycycline for 4 or 6 weeks. The latter regimen showed reduction of lymph vessel dilation and of hydrocele. Lymphoedema progression was halted and reversed in early stages. Different options for antiwolbachial individual drug administration are summarized here. With improving health systems in endemic countries, individuals will demand best-possible treatment and accelerate a shift from mass drug administration-only approaches to integrated approaches combining both mass drug administration and individual drug administration. Treatment may be further improved by new antibiotics detected in high-throughput settings.
Full Text Available Abstract The majority of filarial nematodes harbour Wolbachia endobacteria, including the major pathogenic species in humans, Onchocerca volvulus, Brugia malayi and Wuchereria bancrofti. These obligate endosymbionts have never been demonstrated unequivocally in any non-filariid nematode. However, a recent report described the detection by PCR of Wolbachia in the metastrongylid nematode, Angiostrongylus cantonensis (rat lungworm, a leading cause of eosinophilic meningitis in humans. To address the intriguing possibility of Wolbachia infection in nematode species distinct from the Family Onchocercidae, we used both PCR and immunohistochemistry to screen samples of A. cantonensis and A. costaricensis for the presence of this endosymbiont. We were unable to detect Wolbachia in either species using these methodologies. In addition, bioinformatic and phylogenetic analyses of the Wolbachia gene sequences reported previously from A. cantonensis indicate that they most likely result from contamination with DNA from arthropods and filarial nematodes. This study demonstrates the need for caution in relying solely on PCR for identification of new endosymbiont strains from invertebrate DNA samples.
Mahalakshmi, N; Aparnaa, R; Kaliraj, P
Filariasis caused by infectious parasitic nematodes has been identified as the second leading source of permanent and long-term disability in Sub-Saharan Africa, Asia and Latin America. Several vaccine candidates were identified from infective third-stage larvae (L3) which involves in the critical transition from arthropod to human. Hitherto studies of these antigens in combination with alum adjuvant have shown to elicit its characteristic Th2 responses. Inulin is a safe, non-toxic adjuvant that principally stimulates the innate immune response through the alternative complement pathway. In the present study, the immune response elicited by inulin and alum as adjuvants were compared with filarial antigens from different aetiological agents: secreted larval acidic protein 1 (SLAP1) from Onchocerca volvulus and venom allergen homologue (VAH) from Brugia malayi as single or as cocktail vaccines in mice model. The study revealed that inulin can induce better humoral response against these antigens than alum adjuvant. Antibody isotyping disclosed inulin's ability to elevate the levels of IgG2a and IgG3 antibodies which mediates in complement-dependent cytotoxicity and antibody-dependent cell-mediated cytotoxicity (ADCC), respectively, in mice. Splenocyte analysis showed that T cells prestimulated with inulin have higher stimulation index (P inulin formulation had induced higher cytotoxicity with filarial antigens (as single P inulin to deplete the levels of Treg and brought a balance in Th1/Th2 arms against filarial antigens in mice.
Irina Clara Delgado Varela
Full Text Available Background: Toxoplasmosis is the most widespread zoonosis worldwide. Its prevalence can double in rural populations in relation to urban populations, and it is different in persons of different races within the same community. Objective: To determine the characteristics of toxoplasmosis infection in Charavalle community, Bermúdez municipality, Sucre State, Venezuelan Republic. Methods: A descriptive, cross-sectional study was developed between April and September 2006. Through observation and interview the primary data on the 343 patients selected through simple sampling was obtained. The studied population was classified according to socio-demographic variables, the serum presence of IgG antibodies anti-Toxoplasma gondii was determine through indirect hemagglutination and the main risk factors l inked to toxoplasmosis infection were identified. Results: There was a prevalence of the age group between 16 and 30 years, mainly females in the Stratum III of socioeconomic level. Serological prevalence rate of antibodies IgG anti-Toxoplasma gondii was 63, 56/100 inhabitants and the most significant risk factors were: cohabitation with dogs and cats, raw vegetables and fruit intake, and no drinkable water intake. Conclusions: Results largely agree with other researches on the same subject.
Full Text Available Of 168 patients with chronic hepatitis B virus (HBV infection-related liver disease, 20 patients who had received 100 mg of lamivudine plus 10 mg/day of adefovir dipivoxil (ADV (ADV group and 124 patients who had received 0.5 mg/day of entecavir or 100 mg/day of lamivudine (non-ADV group for >1 year were enrolled. For comparative analyses, 19 well-matched pairs were obtained from the groups by propensity scores. At the time of enrollment, serum creatinine and phosphate concentrations were similar between the ADV and non-ADV groups; however, urinary phosphate ( and serum bone-specific alkaline phosphatase (BAP ( concentrations were significantly higher in the ADV group than in the non-ADV group. Serum BAP was significantly higher at the time of enrollment than before ADV administration in the ADV group (, although there was no significant change in serum BAP concentration in the non-ADV group. There was a significant positive correlation between the period of ADV therapy and ΔBAP (, . Serum BAP concentration increased before increase in serum creatinine concentration and was useful for early detection of adverse events and for developing adequate measures for continuing ADV for chronic HBV infection-related liver disease.
Papa M. Drame
Full Text Available Immunoassays are currently needed to quantify Loa loa microfilariae (mf. To address this need, we have conducted proteomic and bioinformatic analyses of proteins present in the urine of a Loa mf-infected patient and used this information to identify putative biomarkers produced by L. loa mf. In total, 70 of the 15,444 described putative L. loa proteins were identified. Of these 70, 18 were L. loa mf specific, and 2 of these 18 (LOAG_16297 and LOAG_17808 were biologically immunogenic. We developed novel reverse luciferase immunoprecipitation system (LIPS immunoassays to quantify these 2 proteins in individual plasma samples. Levels of these 2 proteins in microfilaremic L. loa-infected patients were positively correlated to mf densities in the corresponding blood samples (r = 0.71 and P < 0.0001 for LOAG_16297 and r = 0.61 and P = 0.0002 for LOAG_17808. For LOAG_16297, the levels in plasma were significantly higher in Loa-infected (geometric mean [GM], 0.045 µg/ml than in uninfected (P < 0.0001, Wuchereria bancrofti-infected (P = 0.0005, and Onchocerca volvulus-infected (P < 0.0001 individuals, whereas for LOAG_17808 protein, they were not significantly different between Loa-infected (GM, 0.123 µg/ml and uninfected (P = 0.06 and W. bancrofti-infected (P = 0.32 individuals. Moreover, only LOAG_16297 showed clear discriminative ability between L. loa and the other potentially coendemic filariae. Indeed, the specificity of the LOAG_16297 reverse LIPS assay was 96% (with a sensitivity of 77%. Thus, LOAG_16297 is a very promising biomarker that will be exploited in a quantitative point-of-care immunoassay for determination of L. loa mf densities.
930120 A clinical study of 50 cases of legion-naires disease.WANG Baofa(王保法),et al.Dept Intern Med,2nd Affili Hosp,Hehei MedColl,Shijiazhuang,050000.Chin J Tuberc &Respir Dis 1992;15(5):266-268.The clinical features and X-ray manifesta-tions of 50 cases of legionnaires disease wereanalysed.8 cases might be due to nosocomial in-fection through breathing in flying particles ofthe saliva or phlegm.According to the mainclinical features,this disease could be dividedinto common pneumonia type,acute gastroen-teritis type,encephalopathy type,shock type,and acute renal insufficiency type.The differen-
Full Text Available Lymphatic filariasis affects nearly 120 million people worldwide and mass preventive chemotherapy is currently used as a strategy to control this infection. This has substantially reduced the incidence of the infection in several parts of the world. However, a prophylactic vaccine would be more effective in preventing future infections and will supplement the mass chemotherapy efforts. Unfortunately, there is no licensed vaccine available currently to prevent this infection. Molecules expressed on the surface of the parasite are potential candidates for vaccine development as they are exposed to the host immune system. In this study we show that the large extracellular loop of tetraspanin (TSP LEL, a protein expressed on the cuticle of Brugia malayi and Wuchereria bancrofti is a potential vaccine candidate. Our results showed that BmTSP LEL is expressed on the surface of B. malayi infective third stage larvae (L3 and sera from human subjects who are putatively immune to lymphatic filariasis carry high titer of IgG1 and IgG3 antibodies against BmTSP LEL and WbTSP LEL. We also showed that these antibodies in the sera of human subjects can participate in the killing of B. malayi L3 in an antibody dependent cell-mediated cytotoxicity mechanism. Vaccination trials in mice showed that close to 64% protection were achieved against challenge infections with B. malayi L3. Immunized animals showed high titer of anti-WbTSP LEL IgG1, IgG2a and IgG2b antibodies in the sera and IFN-γ secreting cells in the spleen. Onchocerca volvulus another filarial parasite also expresses TSP LEL. Cross-reactivity studies showed that IgG1 antibody in the sera of endemic normal subjects, recognize OvTSP LEL. Similarly, anti-OvTSP LEL antibodies in the sera of subjects who are immune to O. volvulus were also shown to cross-react with rWbTSP LEL and rBmTSP LEL. These findings thus suggested that rTSP LEL can be developed as a potential vaccine candidate against multiple
... Old Feeding Your 1- to 2-Year-Old Listeria Infections KidsHealth > For Parents > Listeria Infections A A ... to Call the Doctor en español Listeriosis About Listeria Listeria infections (known as listeriosis ) are rare. When ...
... Old Feeding Your 1- to 2-Year-Old Listeria Infections KidsHealth > For Parents > Listeria Infections Print A A ... your risk of getting this infection. continue Treating Listeriosis Listeriosis is usually treated with antibiotics in the ...
Listeria infection Overview By Mayo Clinic Staff Listeria infection is a foodborne bacterial illness that can be very serious for pregnant women and people with impaired immune systems. Listeria infection is most ...
Ear infection (middle ear) Overview By Mayo Clinic Staff An ear infection (acute otitis media) is most often a bacterial or viral infection that affects the middle ear, the air-filled space behind the eardrum that ...
Strady, C; Jaussaud, R; Remy, G; Penalba, C
Hantaviruses are cosmopolite anthropozoonosis considered as an emerging disease. Four pathogenic types for humans and part of the Bunyaviridae species are hosted by rodents and have been isolated: the Sin nombre virus responsible for the severe American respiratory form; the Hantaan and Seoul viruses responsible for hemorrhagic fevers with renal syndrome (HFRS) of severe to moderate expression in Asia and also in the Balkans; the Puumala virus responsible for HFRS of moderate expression or the socalled nephropathia epidemica in Europe. The Puumala virus is responsible for a minor form of the disease that is observed in areas of the Occidental sector of the ex-URSS, in Scandinavia and in the rest of Europe, notably in the North-East of France. The epidemic episodes occur every three years. They follow the proliferation of rodents, notably russet voles, the reservoir hosts, and their degree of infection. The concept of an occupation at risk in 20 to 49 year-old men (working in forests, agriculture, living near a forest, contact with wood) in an endemic area has not always been found. Its clinical form can vary greatly in its presentation. Basically it is a severe algic influenza syndrome accompanied by acute myopia in 38% of cases, but is nearly pathognomonic in the context. Respiratory involvement is frequent but benign. The initial syndrome can suggest an abdominal or urological surgical emergency, which is source of diagnostic and therapeutic errors. Early biological examination reveals thrombopenia and proteinuria. Then more or less severe acute kidney failure appears in slightly more than 50% of cases. Although it usually regresses with symptomatic treatment, after effects remain in some patients. The environmental changes, the geographical distribution depending on the biotope, the dynamics and behaviour of rodents and the viral circulation between them and its transmission to human beings and its risk factors must continue to be studied in order to gain
ANSWERS by heart Cardiovascular Conditions What Is Infective Endocarditis? Infective (bacterial) endocarditis (IE) is an infection of either the heart’s inner lining (endocardium) or the heart valves. Infective endocarditis is a serious — and sometimes fatal — illness. Two ...
Chau, C.L.F. [Department of Radiology, North District Hospital, NTEC, Fanling, NT, Hong Kong (China)]. E-mail: firstname.lastname@example.org; Griffith, J.F. [Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, NTEC, Shatin, NT, Hong Kong (China)
Musculoskeletal infections are commonly encountered in clinical practice. This review will discuss the ultrasound appearances of a variety of musculoskeletal infections such as cellulitis, infective tenosynovitis, pyomyositis, soft-tissue abscesses, septic arthritis, acute and chronic osteomyelitis, and post-operative infection. The peculiar sonographic features of less common musculoskeletal infections, such as necrotizing fasciitis, and rice body formation in atypical mycobacterial tenosynovitis, and bursitis will also be presented.
Constant, Jonathan; Chernev, Ivan; Gomez, Eric
Shewanella putrefaciens rarely causes infection in humans. In the last few decades a growing number of cases have been described. The following report outlines the case of a 40-year-old immunocompetent white man with S. putrefaciens infective endocarditis. This is the first known case of infective endocarditis due to an apparently monomicrobial S. putrefaciens infection, and the second known case of S. putrefaciens-related infective endocarditis worldwide. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.
Full Text Available Shewanella putrefaciens rarely causes infection in humans. In the last few decades a growing number of cases have been described. The following report outlines the case of a 40-year- old immunocompetent white man with S. putrefaciens infective endocarditis. This is the first known case of infective endocarditis due to an apparently monomicrobial S. putrefaciens infection, and the second known case of S. putrefaciens-related infective endocarditis worldwide.
Taramasso, Lucia; Tatarelli, Paola; Di Biagio, Antonio
In the combined antiretroviral therapy era, HIV-infected patients remain a vulnerable population for the onset of bloodstream infections (BSI). Worldwide, nontyphoid salmonellae, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus and coagulase negative staphylococci are the most important pathogens. Intravenous catheter associated infection, skin-soft tissue infection and endocarditis are associated with Gram-positive bacteremia. Among the Gram-negative, nontyphoidal Salmonella have been previously correlated to sepsis. Other causes of BSI in HIV-infected patients are mycobacteria and fungi. Mycobacteria constitute a major cause of BSI in limited resource countries. Fungal BSI are not frequent and among them Cryptococcus neoformans is the most common life-threatening infection. The degree of immunosuppression remains the key prognostic factor leading to the development of BSI.
Takaoka, H; Bain, O; Uni, S; Korenaga, M; Kozek, W J; Shirasaka, C; Aoki, C; Otsuka, Y; Fukuda, M; Eshita, Y; Daa, T
Histological examination of a nodule removed from the back of the hand of a 58-year-old woman from Oita, Kyushu, Japan showed an Onchocerca female sectioned through the posterior region of the worm (ovaries identifiable) and young (thin cuticle). Six Onchocerca species are enzootic in that area: O. gutturosa and O. lienalis in cattle, O. suzukii in serows (Capricornis crispus), O. skrjabini and an Onchocerca sp. in Cervus nippon nippon, and O. dewittei japonica in wild boar (Sus scrofa leucomystax). Diagnostic characters of female Onchocerca species, such as the cuticle and its ridges, change along the body length. Tables of the histologic morphology of the mid- and posterior body-regions of the local species are presented. In addition, it was observed that transverse ridges arose and thickened during the adult stage (examination of fourth stage and juvenile females of O. volvulus). The specimen described in this report, with its prominent and widely spaced ridges, was identified as O. d. japonica. Four of the 10 zoonotic cases of onchocerciasis reported worldwide were from Oita, three of them being caused by O. d. japonica, the prevalence of which in local wild boar was 22 of 24 (92%).
Full Text Available Histological examination of a nodule removed from the back of the hand of a 58-year-old woman from Oita, Kyushu, Japan showed an Onchocerca female sectioned through the posterior region of the worm (ovaries identifiable and young (thin cuticle. Six Onchocerca species are enzootic in that area: O. gutturosa and O. lienalis in cattle, O. suzukii in serows (Capricornis crispus, O. skrjabini and an Onchocerca sp. in Cervus nippon nippon, and O. dewittei japonica in wild boar (Sus scrofa leucomystax. Diagnostic charactets of female Onchocerca species, such as the cuticle and its ridges, change along the body length. Tables of the histologic morphology of the mid- and posterior body-regions of the local species are presented. In addition, it was observed that transverse ridges arose and thickened during the adult stage (examination of fourth stage and juvenile females of O. volvulus. The specimen described in this report, with its prominent and widely spaced ridges, was identified as O. d. japonica. Four of the 10 zoonotic cases of onchocerciasis reported worldwide were from Oita, three of them being caused by O. d. japonica, the prevalence of which in local wild boar was 22 of 24 (92 %.
... Radiation - preventing infection; Bone marrow transplant - preventing infection; Cancer treatment - immunosuppression ... this is a short-lived side effect of cancer treatment. Your provider may give you medicines to help ...
... vestibule. Nasal furuncles may develop into a spreading infection under the skin (cellulitis) at the tip of the nose. A doctor becomes concerned about infections in this part of the face because veins ...
... an ENT Doctor Near You Ear Infection and Vaccines Ear Infection and Vaccines Patient Health Information News ... or may need reinsertion over time. What about vaccines? A vaccine is a preparation administered to stimulate ...
... medlineplus.gov/ency/patientinstructions/000449.htm Staph infections - hospital To use the sharing features on this page, ... one person to another. Staph Infections in the Hospital Staph germs are mostly spread by skin-to- ...
... Listen Español Text Size Email Print Share Middle Ear Infections Page Content Article Body What are the ... illness. What if a child with a middle ear infection is in great pain and discomfort? The ...
... by 1 of 2 species of tapeworm: Hymenolepis nana or Hymenolepis diminuta . The disease is also called ... bowel, so infection can last for years. Hymenolepis nana infections are much more common than Hymenolepis diminuta ...
... for most infections in humans is carried by chickens, cows, pigs, and reptiles (such as turtles, lizards, ... groups, most doctors will treat an infection with antibiotics to prevent it from spreading to other parts ...
Dahl, Anders; Bruun, Niels Eske
Enterococcus faecalis infective endocarditis (IE) is a disease of increasing importance, with more patients infected, increasing frequency of health-care associated infections and increasing incidence of antimicrobial resistances. The typical clinical presentation is a subacute course with fever...... or ceftriaxone. E. faecalis infective endocarditis continues to be a very serious disease with considerable percentages of high-level gentamicin resistant strains and in-hospital mortality around 20%. Strategies to prevent E. faecalis IE, improve diagnostics, optimize treatment and reduce morbidity...
Fischer, Thea Kølsen; Harvala, Heli; Midgley, Sofie
Infections with human parechoviruses (HPeV) are highly prevalent, particularly in neonates, where they may cause substantial morbidity and mortality. The clinical presentation of HPeV infection is often indistinguishable from that of enterovirus (EV) infection and may vary from mild disease invol...
... Old Feeding Your 1- to 2-Year-Old Salmonella Infections KidsHealth > For Parents > Salmonella Infections A A A What's in this article? Salmonella ... contaminated food (usually meat, poultry, eggs, or milk). Salmonella infections affect the intestines and cause vomiting, fever, and ...
Dahl, Anders; Rasmussen, Rasmus V; Bundgaard, Henning;
Because of the nephrotoxic effects of aminoglycosides, the Danish guidelines on infective endocarditis were changed in January 2007, reducing gentamicin treatment in enterococcal infective endocarditis from 4 to 6 weeks to only 2 weeks. In this pilot study, we compare outcomes in patients with En...... with Enterococcus faecalis infective endocarditis treated in the years before and after endorsement of these new recommendations....
Full Text Available The purpose of this study was to assess the possible correlation between Brucella and HIV infections. Iran is a country where HIV infection is expanding and Brucellosis is prevalent. In the present study, 184 HIV infected patients were assigned and for all of them HIV infection was confirmed by western blot test. In order to identify the prevalence rate of Brucella infection and systemic brucellosis in these subjects, sera samples were obtained and Brucella specific serological tests were performed to reveal antibody titers. Detailed history was taken and physical examination was carried out for all of patients. 11 (6% subjects had high titers but only 3 of them were symptomatic. Most of these subjects were injection drug user (IDU men and one was a rural woman. Considering both prevalence rates of Brucella infection (3% and symptomatic brucellosis (0.1% in Iran, our HIV positive patients show higher rates of Brucella infection and systemic brucellosis. Preserved cellular immunity of participants and retention of granulocytes activity may explain this poor association; whereas other explanations such as immunological state difference and non-overlapping geographical distribution of the 2 pathogens have been mentioned by various authors.
Cardiovascular Diseases; Coronary Disease; Cerebrovascular Accident; Myocardial Infarction; Venous Thromboembolism; Heart Diseases; Infection; Chlamydia Infections; Cytomegalovirus Infections; Helicobacter Infections; Herpesviridae Infections; Inflammation
Gemechu, Fassil W; Seemant, Fnu; Curley, Catherine A
Diabetic foot infection, defined as soft tissue or bone infection below the malleoli, is the most common complication of diabetes mellitus leading to hospitalization and the most frequent cause of nontraumatic lower extremity amputation. Diabetic foot infections are diagnosed clinically based on the presence of at least two classic findings of inflammation or purulence. Infections are classified as mild, moderate, or severe. Most diabetic foot infections are polymicrobial. The most common pathogens are aerobic gram-positive cocci, mainly Staphylococcus species. Osteomyelitis is a serious complication of diabetic foot infection that increases the likelihood of surgical intervention. Treatment is based on the extent and severity of the infection and comorbid conditions. Mild infections are treated with oral antibiotics, wound care, and pressure off-loading in the outpatient setting. Selected patients with moderate infections and all patients with severe infections should be hospitalized, given intravenous antibiotics, and evaluated for possible surgical intervention. Peripheral arterial disease is present in up to 40% of patients with diabetic foot infections, making evaluation of the vascular supply critical. All patients with diabetes should undergo a systematic foot examination at least once a year, and more frequently if risk factors for diabetic foot ulcers exist. Preventive measures include patient education on proper foot care, glycemic and blood pressure control, smoking cessation, use of prescription footwear, intensive care from a podiatrist, and evaluation for surgical interventions as indicated.
Duke, B O
The general characteristics of Onchocerca volvulus infection and its transmission are outlined in this overview of human onchocerciasis. The pathogenic role of the microfilariae, producing lesions of the skin, lymphatic system, eye and deep organs, are described, along with the main clinical manifestations of the disease. The global prevalence and distribution of onchocerciasis are given. Best estimates in 1985 gave 86 million persons at risk, 17.8 million infected, 336,400 blind and a like number suffering from severe visual impairment. The vast majority was in Africa. The impact of onchocerciasis on communities in the Sudano-Guinean savanna zone of Africa is outlined, emphasizing the very high blindness rates and the increased mortality among the blind. Communities so affected cannot remain economically viable. They are forced to desert their villages and the fertile land near rivers. The background to the establishment of the Onchocerciasis Control Programme in West Africa (OCP) is given and the successful 10-year results of this campaign, which is based on prolonged, regular Simulium larviciding, are outlined. In the context of the future of the OCP and of the control of onchocerciasis elsewhere in the world, the need for improved chemotherapy is discussed. The prospects for large-scale suppressive therapy have greatly improved following the registration of ivermectin in 1988 for use in human onchocerciasis. The potential and possible uses of this drug, as a single-dose, non-toxic microfilaricide, which excites very little Mazzotti reaction and has a prolonged microfilarial suppressant action, are discussed. It is considered that an effective non-toxic macrofilaricide is still a prime need for onchocerciasis control.
Mario A Rodríguez-Pérez
Full Text Available Mexico is one of the six countries formerly endemic for onchocerciasis in Latin America. Transmission has been interrupted in the three endemic foci of that country and mass drug distribution has ceased. Three years after mass drug distribution ended, post-treatment surveillance (PTS surveys were undertaken which employed entomological indicators to check for transmission recrudescence.In-depth entomologic assessments were performed in 18 communities in the three endemic foci of Mexico. None of the 108,212 Simulium ochraceum s.l. collected from the three foci were found to contain parasite DNA when tested by polymerase chain reaction-enzyme-linked immunosorbent assay (PCR-ELISA, resulting in a maximum upper bound of the 95% confidence interval (95%-ULCI of the infective rate in the vectors of 0.035/2,000 flies examined. This is an order of magnitude below the threshold of a 95%-ULCI of less than one infective fly per 2,000 flies tested, the current entomological criterion for interruption of transmission developed by the international community. The point estimate of seasonal transmission potential (STP was zero, and the upper bound of the 95% confidence interval for the STP ranged from 1.2 to 1.7 L3/person/season in the different foci. This value is below all previous estimates for the minimum transmission potential required to maintain the parasite population.The results from the in-depth entomological post treatment surveillance surveys strongly suggest that transmission has not resumed in the three foci of Mexico during the three years since the last distribution of ivermectin occurred; it was concluded that transmission remains undetectable without intervention, and Onchocerca volvulus has been eliminated from Mexico.
Laura Moya Alonso
Full Text Available Background: Onchocerciasis or river blindness is a chronic parasitic disease caused by the filarial nematode Onchocerca Volvulus. It occurs in 38 countries in the world, including Africa, Latin America and the Arabian Peninsula. The infection predominantly causes visual impairment and blindness and skin disease. Objectives: The aim of this project is to review the literature on the psycho-social and economic consequences of onchocerciasis in endemic areas. Economic evaluation studies on onchocerciasis and its control programmes were also reviewed. Methods: Electronic searches of PUBMED and Google were made. In addition, the Cochrane Library and WHO website were searched. Different types of economic analysis were reviewed to quantify the relationship between the programme costs and impacts. Results: Eighty papers were identified from different sources, most of which are quantitative studies or literature reviews, and only two were clinical trials. Onchocerciasis has severe socio-economic and psychological consequences. The stigma associated with the disease may reduce marital prospects among affected individuals, disrupt social relationships and cause loss of self-confidence. Also among agricultural workers onchocerciasis has been associated with increased time away from work and reduced productivity, leading to lower income. Discussion: Most of the papers analysed were cross-sectional studies based on data collection through questionnaires. Although there is an increasing number of published papers about the importance of the psycho-social and economic perspective of onchocerciasis, further research is still necessary to quantify and control its consequences. Conclusion: Onchocerciasis is still a serious problem in poor countries. Infected people face physical disability and social stigma that can dramatically reduce the quality of life and land productivity. Control programmes, though costly, have been very successful and cost
Fischer, P; Bonow, I; Supali, T; Rückert, P; Rahmah, N
The establishment of simple, sensitive and specific tools for the diagnosis of brugian lymphatic filariasis is a prerequisite for a successful intervention to control the disease. In the simple and rapid Brugia Rapid (BR) test, an immunochromatographic dipstick is used to detect IgG(4) antibodies that are reactive with a recombinant Brugia malayi antigen. When sera from 109 individuals with Brugia microfilaraemias (12 with B. malayi and 97 with B. timori) were investigated using the BR test, all were found positive. In contrast, all of the 150 sera from individuals with Onchocerca volvulus or Mansonella infections investigated were found negative in BR tests. Some unwelcome cross-reactions were observed, however, with sera from individuals infected with Wuchereria bancrofti (three of 12 test-positive) and Dirofilaria (one of nine test-positive). In an attempt to facilitate sample collection and detect any cross-reactions, the BR dipstick was used to screen blood spots, that had been allowed to dry on filter paper, for B. timori microfilariae, before the dipstick-positive samples were tested with a PCR-based assay. Of the 66 individuals so tested, 37 (56%) were found positive by the BR test used on dry blood spots and eight (22%) by the filtration of fresh blood samples. Only nine of the 37 dipstick-positive samples were found PCR-positive. The combined use of BR tests and PCR-based assays, for testing blood spots in areas where brugian filariasis is endemic, appears to be a promising method not only for post-treatment monitoring but also for the certification activities planned within the framework of the Global Programme to Eliminate Lymphatic Filariasis.
Doyle, D.J. [Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Canada)]. E-mail: email@example.com; Hanbidge, A.E. [Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Canada); O' Malley, M.E. [Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, Ont. (Canada)
Imaging plays a significant role in the detection, characterization and treatment of hepatic infections. Infectious diseases of the liver include pyogenic and amoebic abscesses and parasitic, fungal, viral and granulomatous infections. With increases in worldwide travel, immunosuppression and changing population demographics, identification of cases of hepatic infection is becoming more common in daily practice. Knowledge of the imaging features seen with hepatic infections can assist in early diagnosis and timely initiation of appropriate therapy. This review presents the imaging appearances of hepatic infections, emphasizing specific features that may contribute to the diagnosis. Examples of the imaging findings seen with pyogenic and amoebic abscesses, infection with Echinococcus granulosus (Hydatid), schistosomiasis, candidiasis and tuberculosis (TB) are presented.
Full Text Available Tarig B Higazi,1 Timothy G Geary,2 Charles D Mackenzie3,41Department of Biological Sciences, Ohio University Zanesville, Zanesville, OH, USA; 2Institute of Parasitology, McGill University, Montreal, QC, Canada; 3Center for Neglected Tropical Diseases, Liverpool School of Tropical Medicine, Liverpool, UK; 4Department of Pathobiology & Diagnostic Investigation, Michigan State University, East Lansing, MI, USAAbstract: Onchocerciasis treatment is one of the most positive stories in tropical medicine although major challenges remain to reaching the ultimate goal of disease elimination. Such challenges are to be expected when the therapeutic goal is to kill and safely remove a large multistage, efficient, metazoan infectious agent such as Onchocerca volvulus that has an exceptionally complicated relationship with its host. Successful control of onchocerciasis has often been hampered by host reactions following chemotherapy, that can sometimes cause significant tissue pathology. Presence of other filariae, particularly Loa loa, in endemic onchocerciasis-treatment areas also poses severe problems due to adverse reactions caused by drug-induced death of the coincident microfilariae of this usually clinically benign species. Although ivermectin has been very successful, there is a need to enhance the progress toward elimination of onchocerciasis; new drugs and their efficient use are keys to this. The permanent absence of Onchocerca microfilaridermia, defined as the lack of resurgence of skin microfilarial loads after treatment, is the ultimate characteristic of a useful new chemotherapeutic agent. Several drugs are under investigation to achieve this, including the reassessment of currently available and previously tested agents, such as the antibiotic, doxycycline, which targets the adult parasites through its anti-Wolbachia endosymbiont activity. Flubendazole, a benzimidazole derivative approved for treatment of human gastrointestinal nematodes, is
Bjerklund Johansen, Truls E.; Naber, Kurt G.
Urinary tract infections (UTI) are among the most frequently acquired infections in the community, but also in hospitals and other health care institutions, causing a huge amount of antibiotic consumption. During the last decade we have seen significant changes in the field of urinary tract infections regarding causative pathogens and antibiotic treatment calling for an update of current trends. The worldwide increase of uropathogens resistant to former first line antibiotics, such as cotrim...
Periprosthetic infection is one of the most challenging and difficult complications in orthopaedics. It can result in significant patient distress and disability, with repeated surgeries, increased cost and utilization of medical resources, and in rare cases even mortality. The biggest challenge to date is the correct diagnosis of periprosthetic infection and implementation of effective treatment regimens capable of eradicating the organism. This article reviews the various modalities used in the imaging of periprosthetic and post-arthroplasty infection.
Stephen A. Geller
Full Text Available Clostridium difficile infection (CDI is a significant and increasing medical problem, surpassing methicillin-resistant Staphylococcus aureus as the most common hospital-onset or facility-associated infection, and a key element in the challenging battle against hospital-acquired infections. This Gram-positive, anaerobic, spore-forming colonizes the intestinal tract after antibiotics have altered the normal intestinal flora.
Nazarian Mobin, Sheila S; Keyes, Geoffrey R; Singer, Robert; Yates, James; Thompson, Dennis
In the plastic surgery patient population, outpatient surgery is cost effective and will continue to grow as the preferred arena for performing surgery in healthy patients. Although there is a widespread myth that outpatient surgery centers may suffer from increased infection rates due to lax infection control, the data presented from American Association for Accreditation of Ambulatory Surgery Facilities-accredited facilities prove the contrary. There is a lack of data investigating infection prevention in the perioperative period in plastic surgery patients. As data collection becomes more refined, tracking the postoperative care environment should offer additional opportunities to lower the incidence of postoperative infections.
Holt, MS; Andersen, SS; Andersen, Ove
patients with only local symptoms of infection. The microorganisms isolated from the tips of the epidural catheters were coagulase-negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and others (10%). The Gram-negative bacilli and S. aureus caused serious infections more......Seventy-eight patients with culture-positive epidural catheters, were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence...
This review summarizes the knowledge of the scientific community for Zika-virus infection. It became popular because of severe congenital damage causes of CNS in newborns whose mothers are infected during pregnancy, as well as the risk of pandemic distribution. Discusses the peculiarities of the biology and ecology of vectors--blood-sucking mosquitoes Aedes; stages in the spread of infection and practical problems which caused during pregnancy. Attention is paid to the recommendations that allow leading national and international medical organizations to deal with the threat Zika-virus infection.
Full Text Available Partial laparoscopic splenectomy is performed commonly in hereditary spherocytosis. Vaccination against capsulatedbacteria is essential before undergoing splenectomy. Hand-assisted laparoscopic splenectomy is known to be effectiveand convenient in the removal of a spleen larger than 20 cm in size. Laparoscopic splenectomy provides less hemorrhage,reduced surgical trauma and pain, shorter duration of hospital stay, and early recovery. Laparoscopic approachwas particularly effective in reducing the infectious complication rate compared with the open surgery. Infectious complicationsof splenectomy were observed to be wound infection, subphrenic abscess, and sometimes pulmonary infection.J Microbiol Infect Dis 2013; 3(1: 1-2Key words: Laparoscopy, splenectomy, infection
Dennis J. Baumgardner
Full Text Available Fungal infections as a result of freshwater exposure or trauma are fortunately rare. Etiologic agents are varied, but commonly include filamentous fungi and Candida. This narrative review describes various sources of potential freshwater fungal exposure and the diseases that may result, including fungal keratitis, acute otitis externa and tinea pedis, as well as rare deep soft tissue or bone infections and pulmonary or central nervous system infections following traumatic freshwater exposure during natural disasters or near-drowning episodes. Fungal etiology should be suspected in appropriate scenarios when bacterial cultures or molecular tests are normal or when the infection worsens or fails to resolve with appropriate antibacterial therapy.
Holt, MS; Andersen, SS; Andersen, Ove
Seventy-eight patients with culture-positive epidural catheters, were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence of cen...... frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and suggest a proposal for prophylactic and diagnostic guidelines for epidural catheter-related infections. Comment in: J Hosp Infect. 1997 Mar;35(3):245....
Rzewnicki, Ireneusz; Olszewska, Ewa; Rogowska-Szadkowska, Dorota
Summary HIV (human immunodeficiency virus) infection may produce no clinical symptoms for 10 years on average. However, after many years of infection most people develop symptoms that indicate progression of the disease. There are no regular characteristic symptoms or early stage, and no logical sequence of AIDS indicator disorders has been observed. People who are not aware of the infection are referred to physicians of various specializations, including otolaryngologists. It is on their knowledge about HIV infections, among other factors, that early diagnosis of the disease depends. Appropriate and quick introduction of anti-retroviral drugs may let a person with HIV live decades longer. PMID:22367140
The review specifies 25 Bartonella species known so far and describes epidemiology and pathogenesis of Bartonella infections which are classified using patient symptomatology including culture-negative endocarditis. Microbiological diagnosis and significant principles of antibiotic therapy of Bartonella infections are also stated.
Holt, MS; Andersen, SS; Andersen, Ove
patients with only local symptoms of infection. The microorganisms isolated from the tips of the epidural catheters were coagulase-negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and others (10%). The Gram-negative bacilli and S. aureus caused serious infections more...
... effective means of preventing pinworm infection. This includes washing hands with soap and warm water after using the toilet, changing diapers, and before handling food. Keep fingernails clean and short, avoid ... of washing hands to prevent infection. Daily morning bathing and ...
SBA National Resource Center: 800-621-3141 Pediatric Urinary Tract Infections and Catheterization in Children with Neurogenic Bladder and ... To protect the kidneys from damage – By preventing urinary tract infections (UTI) – By identifying and treating vesicoureteral remux (VUR). ...
The emergence and re-emergence of viral infections is an ongoing process. Large-scale vaccination programmes led to the eradication or control of some viral infections in the last century, but new viruses are always emerging. Increased travel is leading to a rise in the importation of exotic infecti
Nosocomial infections develop within a hospital or are produced by microorganisms acquired during hospitalization. They may involve not only patients (2 to 10 percent) but also hospital personnel. They arise from complex interactions of multiple causal factors. Patients risk factors are these that reduce the patient's capacity for resisting the injurious effects of the microorganisms and impair natural host defense mechanisms: patients with malignant disorders or immunosuppressive therapy, poor nutritional status, extensive burn wounds ... The young and the elderly are generally more susceptible to infection. Other infections are preventable. Disease causation is often multifactorial. Nosocomial urinary tract infections had the highest rate, followed by lower respiratory tract infections, surgical infections and bacteremias. The emergence of other nosocomial infections, caused by bacteria (tuberculosis), virus (HIV, hepatitis B and C virus, cytomegalovirus...), Aspergillus species or Pneumocystis carinii appears to be recent in origin and is of importance to immunocompromised hosts, other patients and hospital personnel. Nosocomial infections and their social and economic impacts require for their prevention vigorous organized hospital-wide surveillance and control programs.
Vuong, Cuong; Otto, Michael
The opportunistic human pathogen Staphylococcus epidermidis has become the most important cause of nosocomial infections in recent years. Its pathogenicity is mainly due to the ability to form biofilms on indwelling medical devices. In a biofilm, S. epidermidis is protected against attacks from the immune system and against antibiotic treatment, making S. epidermidis infections difficult to eradicate.
Beer, W. Nicholas
Outdoor recreationists are at risk for developing giardia infection from drinking contaminated stream water. Giardia is the most common human parasite found in contaminated water that causes gastrointestinal illness. Describes medical treatment and ways of preventing infection through water treatment, including heat, filtration, and chemical…
Diepeningen, van A.D.; Brankovics, Balázs; Iltes, Jearidienne; Lee, van der T.A.J.; Waalwijk, Cees
Infections caused by the genus Fusarium have emerged over the past decades and range from onychomycosis and keratitis in healthy individuals to deep and disseminated infections with high mortality rates in immune-compromised patients. As antifungal susceptibility can differ between the different
Wormser, G P; Nadelman, R B; Nowakowski, J; Schwartz, I
Little is known about the natural history of asymptomatic Borrelia burgdorferi infection. Our analysis of the asymptomatic infections diagnosed serologically in a recent OspA vaccine trial conducted in the United States (N Engl J Med 1998;339: 209-215), suggests that the natural history of this event is more benign than that reported for untreated patients with erythema migrans (Ann Intern Med 1987;107: 725-731). We hypothesize that this is due either to incorrect diagnosis since the specificity of the serologic criteria used to diagnose asymptomatic infection in the vaccine study is unknown, or to infection with non-pathogenic strains of B. burgdorferi. Increasing evidence indicates that the invasive potential of strains of B. burgdorferi varies according to the specific subtype. Theoretically, a serologic testing method could be devised which would distinguish infection with invasive versus non-invasive strains of B. burgdorferi, and allow testing of the second hypothesis.
Butreau-Lemaire, M; Botto, H
The concept of nosocomial urinary tract infection now corresponds to a precise definition. It is generally related to bladder catheterization, constitutes the most frequent form of nosocomial infection (30 to 50% of infections), and represents the third most frequent portal of entry of bacteraemia. The organism most frequently isolated is Escherichia coli; but the flora is changing and the ecological distribution is continually modified. Despite their usually benign nature, these nosocomial infections can nevertheless influence hospital mortality; they increase the hospital stay by an average of 2.5 days and their treatment represents a large share of the antibiotic budget. Prevention of these infections is therefore essential, with particular emphasis on simple and universally accessible measures: very precise indications for vesical catheterization, use of closed circuit drainage, maximal asepsis when handling catheters, after washing the hands.
Yu. V. Lobzin
Full Text Available The key questions to solve the problem of congenital infection in the Russian Federation are: using in national practice over world accepted terminology adapted to the recommendations of the World Health Organization; representation of the modern concepts of an infectious process in the classification of congenital infections; scientific development and introducing in clinical practice the «standard case definitions», applied to different congenital infections; optimization of protocols and clinical guidelines for diagnosis, treatment and prevention of congenital infections; improvement a knowledge in the infectious disease for all pecialists involved in the risk assessment of congenital infections, manage pregnancy and children. Based on our experience and analysis of publications, the authors suggest possible solutions.
Egger, M; Muhlemann, K; Aebi, C; Taüber, M G
Infections in pregnancy may complicate its course and harm the fetus or newborn after vertical transmission. Treatment of asymptomatic bacteriuria is mandatory in pregnant women given the high risk of secondary pyelonephritis. Intraamniotic infection usually arises by the ascending route and is associated with premature rupture of membranes. Vaginal infections promote preterm labour or premature rupture of membranes and may be transmitted to the child during labour. They must therefore be treated although they often cause little discomfort to the pregnant woman. Systemic infections due to viral, protozoal and bacterial pathogens may be transmitted transplacentally and cause embryopathies, fetopathies or neonatal infections. Depending on the responsible agent the negative impact on the course of pregnancy and on the fetus' or neonate's health can be prevented or reduced by prophylactic or therapeutic interventions.
... It Works Urologic Diseases A-Z Bladder Infection (Urinary Tract Infection—UTI) in Adults View or Print All Sections ... Bladder infections are the most common type of urinary tract infection (UTI), but any part of your urinary tract ...
Stephen; T; Abedon
Phages are credited with having been first described in what we now, officially, are commemorating as the 100 th anniversary of their discovery. Those one-hundred years of phage history have not been lacking in excitement, controversy, and occasional convolution. One such complication is the concept of secondary infection, which can take on multiple forms with myriad consequences. The terms secondary infection and secondary adsorption, for example, can be used almost synonymously to describe virion interaction with already phage-infected bacteria, and which can result in what are described as superinfection exclusion or superinfection immunity. The phrase secondary infection also may be used equivalently to superinfection or coinfection, with each of these terms borrowed from medical microbiology, and can result in genetic exchange between phages, phage-on-phage parasitism, and various partial reductions in phage productivity that have been termed mutual exclusion, partial exclusion, or the depressor effect. Alternatively, and drawing from epidemiology, secondary infection has been used to describe phage population growth as that can occur during active phage therapy as well as upon phage contamination of industrial ferments. Here primary infections represent initial bacterial population exposure to phages while consequent phage replication can lead to additional, that is, secondary infections of what otherwise are not yet phage-infected bacteria. Here I explore the varying meanings and resultant ambiguity that has been associated with the term secondary infection. I suggest in particular that secondary infection, as distinctly different phenomena, can in multiple ways influence the success of phage-mediated biocontrol of bacteria, also known as, phage therapy.
... These types of infections are called healthcare-associated infections (HAIs). Hospital staff and healthcare providers do everything they can ... IV tube) can increase your risk for fungal infection. During your hospital stay you may need a central venous catheter, ...
... Feeding Your 1- to 2-Year-Old Middle Ear Infections KidsHealth > For Parents > Middle Ear Infections Print ... 3 years old. A Close Look at the Ear To understand how ear infections develop, let's review ...
Full Text Available Paragonimiasis (human infections with the lung fluke Paragonimus westermani is an important public health problem in parts of Africa. This study was aimed at assessing the prevalence of Paragonimus infection in Ebonyi State. Deep sputum samples from 3600 individuals and stool samples from 900 individuals in nine Local Government Areas in Ebonyi State, Nigeria were examined for Paragonimus ova using concentration technique. The overall prevalence of pulmonary Paragonimus infection in the area was 16.30%. Six foci of the infection were identified in Ebonyi North and Ebonyi Central but none in Ebonyi South. The intensity of the infection was generally moderate. Of the 720 individuals examined, 16 (12.12% had less than 40 ova of Paragonimus in 5 mL sputum and 114 (86.36% had between 40 and 79 ova of Paragonimus in 5 mL sputum. While 2 individuals (1.52% had over 79 ova of Paragonimus in 5 mL Sputum. Furthermore, there was higher prevalence of paragonimiasis in rainy season than in dry season. The results of this study indicated the growing public health threat posed by paragonimiasis in Ebonyi North and Ebonyi Central. A combination of chemotherapy, to bring relief to persons already infected by the disease and public health education related to paragonimiasis transmission to increase awareness of the infection in the areas is recommended.
Joel M. Palefsky
Full Text Available While much is known about the natural history of cervical human papillomavirus (HPV infection and its consequences, including cervical intraepithelial neoplasia and cervical cancer, relatively little is known about the natural history of anogenital HPV infection and diseases in men. In part this reflects difficulties in penile sampling and visual assessment of penile lesions. Anal HPV infection and disease also remain poorly understood. Although HPV is transmitted sexually and infects the genitals of both sexes, the cervix remains biologically more vulnerable to malignant transformation than does the penis or anus in men. An understanding of male HPV infection is therefore important in terms of reducing transmission of HPV to women and improving women's health. However, it is also important due to the burden of disease in men, who may develop both penile and anal cancer, particularly among HIV-positive men who have sex with men. Improved sampling techniques of the male genitalia and cohort studies in progress should provide important information on the natural history of anogenital HPV infection and disease in men, including risk factors for HPV acquisition and transmission. The impact of HPV vaccination in women on male anogenital HPV infection will also need to be assessed.
Full Text Available Toxoplasmosis is an infectious disease caused by a protozoa named Toxoplasma gondii. It is a very important disease because it is related to fetal anomalies and poor perinatal outcomes like abortus and stillbirth. It spreads via uncooked meat and contaminated food. Timely and appropriate treatment and management of this infection prenatally reduces the risk of serious neurological sequelae. Therefore it is crucial that clinician who takes care of pregnant women know this infection deeply. In this review we aimed to summarize the prenatal diagnosis, complications and treatment of toxoplasma infection. [Archives Medical Review Journal 2016; 25(4.000: 457-466
Ozábalová, Eva; Krejčí, Jan; Hude, Petr; Godava, Julius; Honek, Tomáš; Špinarová, Lenka; Pavlík, Petr; Bedáňová, Helena; Němec, Petr
Heart transplantation (HTx) is a method of treatment for patients with end-stage heart failure with severe symptoms despite complex therapy. Post-transplant difficulties include acute rejection and infectious complications, which are the most common reason of morbidity and mortality in the first year after heart transplant. It requires the patient to remain on immunosuppressive medication to avoid the possibility of graft rejection. Therefore the range of infection is much larger. The diagnosis and treatment of viral, bacterial and fungal infections is often difficult.Key words: heart transplantation - immunosuppression - infection.
Beuy; Joob; Viroj; Wiwanitkit
<正>To the editor,The report on Toxocara infection in gardener is very interesting.Esquivel et al.concluded that"gardeners do not have a higher risk for Toxocara infection than subjects of the general population in Durango City,Mexico".In fact,considering the source of infection of Toxocara,it can be at risk for anyone who contacts it.As an occupation,gardener might have a chance to contact soil.In fact,everyone has to contact soil and the gardener does not live all day but part of
Emmanuel Uttah & Dominic C. Ibeh
Full Text Available Background & objectives: The study was aimed at determining the pattern of co-occurrence of species ofmicrofilaraemia between onchocerciasis endemic and sporadic populations.Methods: From every consenting person of one year and above, 50 μl of day and night blood samples werecollected and processed respectively with Haemotoxylin and Giemsa as vital stains. Two skin snips (one eachfrom the waist and the shoulder were also taken from these individuals and processed.Results: Results showed single species microfilaraemia (86.4 and 82.3%, double species microfilaraemia (12.2and 16.9% and triple species microfilaraemia (1.4 and 0.7% for endemic and sporadic populations respectively.All the species had single species microfilaraemia mostly, but Mansonella perstans and Loa loa showed greatestt endency towa rds doubl e and t r ipl e spe c i e s mi c rof i l a r a emi a . The pr eva l enc e of Wuche re r ia banc rof t imicrofilaraemia among those positive for Onchocerca volvulus was significantly lower than the overall prevalenceof Wuchereria bancrofti. Wuchereria bancrofti microfilaraemia was most common among those who had L. loamicrofilaraemia. Wuchereria bancrofti microfilarial intensity was higher among those with M. perstansmicrofilaraemia than among those positive for any of the other filarial species. Similarly, the intensity of M.perstans microfilaraemia among those positive for W. bancrofti exceeded the overall intensity of M. perstans.Conclusion: It is concluded that there was no definite pattern in mf densities discernible from co-occurrenceinfections either in the onchocerciasis endemic or sporadic population. There could be varied outcomes ofonchocerciasis infection attributable to positive or negative regulatory effects of other pathogens harbored bythe victims.
U.S. Department of Health & Human Services — TheÂ Healthcare-Associated Infections (HAI)Â measures - state data. These measures are developed byÂ Centers for Disease Control and Prevention (CDC)Â and collected...
Marschang, Rachel E
A large number of viruses have been described in many different reptiles. These viruses include arboviruses that primarily infect mammals or birds as well as viruses that are specific for reptiles. Interest in arboviruses infecting reptiles has mainly focused on the role reptiles may play in the epidemiology of these viruses, especially over winter. Interest in reptile specific viruses has concentrated on both their importance for reptile medicine as well as virus taxonomy and evolution. The impact of many viral infections on reptile health is not known. Koch's postulates have only been fulfilled for a limited number of reptilian viruses. As diagnostic testing becomes more sensitive, multiple infections with various viruses and other infectious agents are also being detected. In most cases the interactions between these different agents are not known. This review provides an update on viruses described in reptiles, the animal species in which they have been detected, and what is known about their taxonomic positions.
Nuermberger, Eric; Bishai, William R; Grosset, Jacques H
Latent tuberculosis infection (LTBI) is a clinical condition characterized by a positive tuberculin skin test in the absence of clinical or radiological signs of active tuberculosis disease. It has been estimated that one third of the world's population is latently infected with Mycobacterium tuberculosis and serves as an enormous reservoir for future cases of active tuberculosis. The detection and treatment of individuals with LTBI and a high risk of progression to active tuberculosis are effective means to control the spread of tuberculosis. Furthermore, a better understanding of the host-pathogen interactions that result in latent infection could provide important insights for future drug or vaccine development. This chapter reviews recent developments in the molecular genetics, natural history, diagnosis, and treatment of LTBI within its historical context, including the impact of human immunodeficiency virus infection. Current treatment recommendations are also summarized.
was known about HIV infection and AIDS in the country. However, the health authorities were aware of the report ... natal, family planning and sexually transmitted diseases ..... Francis DP, Chin J. The prevention of acquired immunodeficiency.
... sex. The giardia parasite is a very common intestinal parasite. Although anyone can pick up giardia parasites, some ... Disease Control and Prevention. http://www.cdc.gov/parasites/giardia/. Accessed Sept. ... infections and trichomoniasis. In: Harrison's Principles of Internal ...
... discharge to thick, white, and chunky (like cottage cheese). Itching and burning of the vagina and labia ... a wet mount and KOH test. Sometimes, a culture is taken when the infection does not get ...
Mathew, Ashish Jacob; Ravindran, Vinod
Bacteria, viruses, fungi, and parasites can all cause arthritis of either acute or chronic nature, which can be divided into infective/septic, reactive, or inflammatory. Considerable advances have occurred in diagnostic techniques in the recent decades resulting in better treatment outcomes in patients with infective arthritis. Detection of emerging arthritogenic viruses has changed the epidemiology of infection-related arthritis. The role of viruses in the pathogenesis of chronic inflammatory arthritides such as rheumatoid arthritis is increasingly being recognized. We discuss the various causative agents of infective arthritis and emphasize on the approach to each type of arthritis, highlighting the diagnostic tests, along with their statistical accuracy. Various investigations including newer methods such as nucleic acid amplification using polymerase chain reaction are discussed along with the pitfalls in interpreting the tests.
Parize, P; Mainardi, J-L
Infective endocarditis has continuously evolved since its first clinical description by William Osler in the late 19th century. The epidemiological and microbiological profile of the disease has changed as the result of the progress of the medical care and demographic mutation in industrialized countries. Furthermore, advances in anti-infective therapy and in cardiovascular surgery have contributed to an improvement in the management and the prognosis of this severe infectious disease. During the past decade, the recommendations on antibiotic prophylaxis against infective endocarditis have changed dramatically. Guidelines on management of infective endocarditis and state-of-the-art articles have been published recently and this work aims to outline current recommendations about this evolving disease.
... Dockrell H, Zuckerman M, et al. Hospital infection, sterilization and disinfection. In: Goering R, Dockrell H, Zuckerman M, et al., eds. Mims' Medical Microbiology . 5th ed. Philadelphia, PA: Elsevier Saunders; 2013:chap ...
Blastocystis hominis infection Overview By Mayo Clinic Staff Blastocystis hominis is a microscopic organism that may be ... people who aren't having any digestive symptoms. Blastocystis hominis is also sometimes found in the stools ...
Full Text Available Abstract Urticaria is a group of diseases that share a distinct skin reaction pattern. Triggering of urticaria by infections has been discussed for many years but the exact role and pathogenesis of mast cell activation by infectious processes is unclear. In spontaneous acute urticaria there is no doubt for a causal relationship to infections and all chronic urticaria must have started as acute. Whereas in physical or distinct urticaria subtypes the evidence for infections is sparse, remission of annoying spontaneous chronic urticaria has been reported after successful treatment of persistent infections. Current summarizing available studies that evaluated the course of the chronic urticaria after proven Helicobacter eradication demonstrate a statistically significant benefit compared to untreated patients or Helicobacter-negative controls without urticaria (p
... tight or made of materials like nylon that trap heat and moisture might make yeast infections more ... Nemours Foundation, iStock, Getty Images, Corbis, Veer, Science Photo Library, Science Source Images, Shutterstock, and Clipart.com
Sips, Gregorius J.; Wilschut, Jan; Smit, Jolanda M.
Flaviviruses, including Dengue, West Nile, Japanese encephalitis, and Tick-borne encephalitis virus, are major emerging human pathogens, affecting millions of individuals worldwide. Many clinically important flaviviruses elicit CNS diseases in infected hosts, including traditional "hemorrhagic"
... bacteria begins to grow and release harmful substances (toxins) that kill tissue and affect blood flow to ... pressure ( hyperbaric oxygen therapy ) for certain types of bacterial infections Outlook (Prognosis) How well you do depends ...
Sips, Gregorius J.; Wilschut, Jan; Smit, Jolanda M.
Flaviviruses, including Dengue, West Nile, Japanese encephalitis, and Tick-borne encephalitis virus, are major emerging human pathogens, affecting millions of individuals worldwide. Many clinically important flaviviruses elicit CNS diseases in infected hosts, including traditional "hemorrhagic" viru
... Treatment & Outcomes Statistics More Resources Fungal Nail Infections Histoplasmosis Definition Symptoms People at Risk & Prevention Sources Diagnosis & ... CDC at Work Global Fungal Diseases Cryptococcal Meningitis Histoplasmosis ... Resistance Resources Laboratory Submission Information Reportable Fungal ...
Fuchs, Wolfgang; Brockmeyer, Norbert H
In no other medical field former rare infections of the 1980(th) and 1990(th) occur again as this is seen in the field of venerology which is as well based on the mobility of the population. Increasing rates of infections in Europe, and increasing bacteriological resistances face health professionals with new challenges. The WHO estimates more than 340 million cases of illnesses worldwide every year. Diseases caused by sexually transmitted infections (STI) in a strict sense are syphilis, gonorrhea, lymphogranuloma venereum, granuloma inguinale, and chancroid. In a wider sense, all illnesses are included which can mainly be transmitted through sexual contact. The term "sexual contact" has to be seen widely, from close physical contact to all variants of sexual behavior. This CME article is an overview of the most common occurring sexually transmitted infections in clinical practice. Both, basic knowledge as well as recent developments are discussed below.
Campbell, Lee Ann; Rosenfeld, Michael E.
Atherosclerosis is a chronic disease hallmarked by chronic inflammation, endothelial dysfunction and lipid accumulation in the vasculature. Although lipid modification and deposition are thought to be a major source of the continuous inflammatory stimulus, a large body of evidence suggests that infectious agents may contribute to atherosclerotic processes. This could occur by either direct effects through infection of vascular cells and/or through indirect effects by induction of cytokine and acute phase reactant proteins by infection at other sites. Multiple bacterial and viral pathogens have been associated with atherosclerosis by seroepidemiological studies, identification of the infectious agent in human atherosclerotic tissue, and experimental studies demonstrating an acceleration of atherosclerosis following infection in animal models of atherosclerosis. This review will focus on those infectious agents for which biological plausibility has been demonstrated in animal models and on the challenges of proving a role of infection in human atherosclerotic disease. PMID:26004263
... Alternative Names Cervicitis - chlamydia; STI - chlamydia; STD - chlamydia; Sexually transmitted - chlamydia; ... for Disease Control and Prevention. Chlamydial infections in adolescents and adults. Updated June 4, 2015. www.cdc. ...
and mortality as well as significant financial implications. Worldwide it has ... common nosocomial infection amongst surgical patients with up to 38% .... antibiotics as soon as the sensitivity results are available. ... Breast surgery. Staph Aureus/ ...
... of food poisoning, are frequently found in raw chicken or eggs. Shigella bacteria are highly contagious and ... bacterial intestinal illness may need to take prescription antibiotics to prevent the infection from spreading throughout the ...
Pergam, Steven A
The number of patients undergoing hematopoietic cell and solid organ transplantation are increasing every year, as are the number of centers both transplanting and caring for these patients. Improvements in transplant procedures, immunosuppressive regimens, and prevention of transplant-associated complications have led to marked improvements in survival in both populations. Infections remain one of the most important sources of excess morbidity and mortality in transplant, and therefore, infection prevention strategies are a critical element for avoiding these complications in centers caring for high-risk patients. This manuscript aims to provide an update of recent data on prevention of major healthcare-associated infections unique to transplantation, reviews the emergence of antimicrobial resistant infections, and discusses updated strategies to both identify and prevent transmission of these pathogens in transplant recipients.
AJRH Managing Editor
treatment practices of sexually transmitted infections among brothel based female sex workers Three hundred and twenty three consenting ... five top diseases for which Nigerians seek medical ... in other countries have also revealed a high.
Müllegger, Robert R; Häring, Nina S; Glatz, Martin
A wide array of infectious diseases can occur in pregnancy. Their acquisition, clinical presentation, and course during gestation may be altered due to an impairment of the maternal cellular immunity. Some infectious diseases can lead to serious consequences for the mother or the offspring, including congenital malformations. This review describes in detail the clinical presentation, course, management, and associated maternal and fetal risks of selected viral (varicella-zoster virus infections, condylomata acuminata), fungal (candida vulvovaginitis), bacterial (Lyme borreliosis), and parasitic (scabies) infections. The treatment options are critically reviewed. First-line therapies include acyclovir and varicella-zoster virus immunoglobulin for varicella-zoster virus infections, surgical modalities for genital warts, topical clotrimazole and oral fluconazole for Candida vulvovaginitis, amoxicillin and cefuroxime for Lyme borreliosis, and permethrin for scabies. A synopsis of maternal and fetal risks of other important infections is also included. Copyright © 2016 Elsevier Inc. All rights reserved.
Sips, Gregorius J.; Wilschut, Jan; Smit, Jolanda M.
Flaviviruses, including Dengue, West Nile, Japanese encephalitis, and Tick-borne encephalitis virus, are major emerging human pathogens, affecting millions of individuals worldwide. Many clinically important flaviviruses elicit CNS diseases in infected hosts, including traditional "hemorrhagic" viru
Nordholm, Anne Christine; Søborg, Bolette; Andersson, Mikael
BACKGROUND: Indigenous Arctic people suffer from high rates of infectious diseases. However, the burden of central nervous system (CNS) infections is poorly documented. This study aimed to estimate incidence rates and mortality of CNS infections among Inuits and non-Inuits in Greenland...... and in Denmark. METHODS: We conducted a nationwide cohort study using the populations of Greenland and Denmark 1990-2012. Information on CNS infection hospitalizations and pathogens was retrieved from national registries and laboratories. Incidence rates were estimated as cases per 100,000 person......-years. Incidence rate ratios were calculated using log-linear Poisson-regression. Mortality was estimated using Kaplan-Meier curves and Log Rank test. RESULTS: The incidence rate of CNS infections was twice as high in Greenland (35.6 per 100,000 person years) as in Denmark (17.7 per 100,000 person years...
Rybtke, Morten; Hultqvist, Louise Dahl; Givskov, Michael
Studies of biopsies from infectious sites, explanted tissue and medical devises have provided evidence that biofilms are the underlying cause of a variety of tissue-associated and implant-associated recalcitrant human infections. With a need for novel anti-biofilm treatment strategies, research...... in biofilm infection microbiology, biofilm formation mechanisms and biofilm-associated antimicrobial tolerance has become an important area in microbiology. Substantial knowledge about biofilm formation mechanisms, biofilm-associated antimicrobial tolerance and immune evasion mechanisms has been obtained...... through work with biofilms grown in in vitro experimental setups, and the relevance of this information in the context of chronic infections is being investigated by the use of animal models of infection. Because our current in vitro experimental setups and animal models have limitations, new advanced...
U.S. Department of Health & Human Services — TheÂ Healthcare-Associated Infection (HAI)Â measures - provider data. These measures are developed byÂ Centers for Disease Control and Prevention (CDC)Â and...
U.S. Department of Health & Human Services — TheÂ Healthcare-Associated Infections (HAI)Â measures - national data. These measures are developed byÂ Centers for Disease Control and Prevention (CDC)Â and...
Lamb, Tracey J
... be manipulated to develop therapeutic interventions against parasitic infection. For easy reference, the most commonly studied parasites are examined in individual chapters written by investigators at the forefront of their field...
Bove, J M
Plants can be infected by two types of wall-less procaryotes, spiroplasmas and mycoplasma-like organisms (MLO), both located intracellularly in the phloem tissues of affected plants. Spiroplasmas have been cultured, characterized and shown to be true members of the class Mollicutes. MLO have not yet been cultured or characterized; they are thought to be mycoplasma-like on the basis of their ultrastructure as seen in situ, their sensitivity to tetracycline and resistance to penicillin. Mycoplasmas can also be found on the surface of plants. These extracellularly located organisms are members of the following genera: Spiroplasma. Mycoplasma and Acholeplasma. The presence of such surface mycoplasmas must not be overlooked when attempts to culture MLO from affected plants are undertaken. Sensitive serological techniques such as the enzyme-linked immunosorbent assay (ELISA) can successfully be used to compare the MLO located in the phloem of affected plants with those eventually cultured from the same plants. In California and Morocco periwinkles naturally infected with both Spiroplasma citri and MLO have been reported. With such doubly infected plants, the symptom expression has been that characteristic of the MLO disease (phyllody or stolbur), not that given by S. citri. Only S. citri can be cultured from such plants, but this does not indicate that S. citri is the causal agent of the disease expressed by the plant. In California many nonrutaceous plants have been found to be infected with S. citri. Stubborn affected citrus trees represent an important reservoir of S. citri, and Circulifer tenellus is an active leafhopper vector of S. citri. Hence, it is not surprising that in California MLO-infected fruit trees could also become infected with S. citri but it would not mean that S. citri is the causal agent of the disease. Criteria are discussed that are helpful in distinguishing between MLO infections and S. citri infections.
Lindsay M Lawson
Full Text Available The authors describe a 43-year-old patient who had a mediastinal mass that became infected after a transbronchial needle aspirate biopsy. A paraspinal, extrapleural window with a saline-lidocaine mixture was created that allowed the placement of a percutaneous drainage catheter into the infected lesion. This procedure resulted in an excellent clinical outcome, and obviated the need for a thoracotomy and more invasive surgical management.
Ceviz, M; Becit, N; Kocak, H.
A 24 year old woman presented with chest pain and palpitation. The presence of a semisolid mass—an echinococcal cyst or tumour—in the left ventricular apex was diagnosed by echocardiography, computed tomography, and magnetic resonance imaging. The infected cyst was seen at surgery. The cyst was removed successfully by using cardiopulmonary bypass with cross clamp. Keywords: cardiac hydatid cyst; infected cardiac hydatid cyst
Fingolimod is the first approved drug with oral availability for the treatment of relapsing multiple sclerosis. To review the mechanism of action of fingolimod and its relationship with the development of infections. To propose preventive measures for those patients who are receiving the drug or will initiate a new treatment. In addition, the role of fingolimod in the development of progressive multifocal leukoencephalopathy on the basis of recent knowledge of its pathophysiology will be discussed. The mechanism of action of fingolimod is based on an antagonic effect on the sphingosine 1-phospate receptors that will generate an inhibition of the egress of naive and central memory lymphocytes into the bloodstream, allowing the free recirculation of memory effectors T lymphocytes. This effect will produce lymphopenia. Fingolimod-associated lymphopenia is a consequence of lymphocyte redistribution, and it is selective and reversible. There is no evidence of higher number of opportunistic and non-opportunistic infections in comparison to placebo or interferon beta-1a in patients receiving fingolimod. However, two patients developed severe herpetic infections under fingolimod. Fingolimod induce a selective and reversible lymphopenia that, taking into account the most recent available data, does not seem to be associated with higher risk of opportunistic infections due to a preservation of immuno-surveillance. The risk of herpesvirus infection should be taken into consideration and more studies are warranted to confirm if an association of these infections with the use of fingolimod exists.
Evangelisti, Gisberto; Andreani, Lorenzo; Girardi, Federico; Darren, Lebl; Sama, Andrew; Lisanti, Michele
Postoperative spinal wound infection is a potentially devastating complication after operative spinal procedures. Despite the utilization of perioperative prophylactic antibiotics in recent years and improvements in surgical technique and postoperative care, wound infection continues to compromise patients’ outcome after spinal surgery. In the modern era of pending health care reform with increasing financial constraints, the financial burden of post-operative spinal infections also deserves consideration. The aim of our work is to give to the reader an updated review of the latest achievements in prevention, risk factors, diagnosis, microbiology and treatment of postoperative spinal wound infections. A review of the scientific literature was carried out using electronic medical databases Pubmed, Google Scholar, Web of Science and Scopus for the years 1973-2012 to obtain access to all publications involving the incidence, risk factors, prevention, diagnosis, treatment of postoperative spinal wound infections. We initially identified 119 studies; of these 60 were selected. Despite all the measures intended to reduce the incidence of surgical site infections in spine surgery, these remain a common and potentially dangerous complication. PMID:26605028
Full Text Available Sexually transmitted infections (STIs other than HIV have reappeared as an important public health problem in developed countries (1. In the late 1970s and early 1980s, research and treatment of the 'classic' STIs - gonorrhea, syphilis and chlamydia - were a major focus of infectious diseases practice and research. There were large outbreaks of syphilis in parts of Canada (2, penicillin-resistant Neisseria gonorrhoeae was a concern (3, and high rates of Chlamydia trachomatis infection with complications of pelvic inflammatory disease and ectopic pregnancy were being reported (4,5. Then, HIV infection emerged, with its spectre of a wasting, early death. There was no effective treatment, and safe sexual practices were embraced and adhered to by high-risk populations as the only effective way to avoid infection. These practices effectively prevented other STIs; rates of syphilis, gonorrhea and chlamydia infection plummeted in developed countries (5. For at least a decade, it appeared that HIV might be an end to all STIs, at least for some parts of the world. STIs continued unabated in developing countries, as many epidemiological and therapeutic studies explored the association of STIs with HIV infection.
Hagedorn Henry H
Full Text Available Abstract Background Oocyte development was studied in the autogenous black fly, Simulium vittatum (Diptera, Nematocera, a vector of Onchocerca volvulus, the causative agent of onchocerciasis. Results Oocyte growth was nearly linear between adult eclosion and was complete by 72 hours at 21°C. The oocyte became opaque at 14 hours after eclosion indicating the initiation of protein yolk deposition. The accumulation of vitellogenin was measured using SDS-PAGE. The density of the yolk protein bands at about 200 and 65 kDa increased during the first and second days after eclosion. The amount of protein in the 200 kDa band of vitellogenin, determined using densitometry, rapidly increased between 12 and 25 hours after eclosion. Ecdysteroid levels were measured using a competitive ELISA. Ecdysteroid levels increased rapidly and subsequently declined during the first day after eclosion. Conclusion These data show a correlation between the appearance of vitellogenin in the oocyte, and the rise in ecdysteroids. A possible relationship to molting of the nematode, Onchocerca volvulus, is discussed.
A. J. Shelley
Full Text Available Factors that affect the propensity of a simuliid species to act as a host to Onchocerca volvulus and to naturally transmit this filarial worm in nature are discussed. Presence or absence of a cibarial armature is believed to be a major factor that has been previously overlooked and this is considered in relation to the choice of control methods currently advocated for onchocerciasis. The current epidemiological studies, transmission dynamics and relevant control measures are discussed for each onchocerciasis focus in Latin America.Neste trabalho são discutidos os fatores que interferem na suscetibilidade de espécies de simulídeos atuarem como hospedeiros do Onchocerca volvulus e de transmitir a filária em condições naturais. Acredita-se que a presença ou não da armadura do cibário pode ser um fator central, que anteriormente foi subestimado. Este aspecto é discutido em relação às opções em voga de métodos de controle na oncocercose. São também discutidos os estudos epidemiológicos correntes, a dinâmica de transmissão e principais medidas de controle para cada foco de oncocercose na América Latina.
Full Text Available BACKGROUND: Mass treatment with ivermectin is a proven strategy for controlling onchocerciasis as a public health problem, but it is not known if it can also interrupt transmission and eliminate the parasite in endemic foci in Africa where vectors are highly efficient. A longitudinal study was undertaken in three hyperendemic foci in Mali and Senegal with 15 to 17 years of annual or six-monthly ivermectin treatment in order to assess residual levels of infection and transmission and test whether ivermectin treatment could be safely stopped in the study areas. METHODOLOGY/PRINCIPAL FINDINGS: Skin snip surveys were undertaken in 126 villages, and 17,801 people were examined. The prevalence of microfilaridermia was <1% in all three foci. A total of 157,500 blackflies were collected and analyzed for the presence of Onchocerca volvulus larvae using a specific DNA probe, and vector infectivity rates were all below 0.5 infective flies per 1,000 flies. Except for a subsection of one focus, all infection and transmission indicators were below postulated thresholds for elimination. Treatment was therefore stopped in test areas of 5 to 8 villages in each focus. Evaluations 16 to 22 months after the last treatment in the test areas involved examination of 2,283 people using the skin snip method and a DEC patch test, and analysis of 123,000 black flies. No infected persons and no infected blackflies were detected in the test areas, and vector infectivity rates in other catching points were <0.2 infective flies per 1,000. CONCLUSION/SIGNIFICANCE: This study has provided the first empirical evidence that elimination of onchocerciasis with ivermectin treatment is feasible in some endemic foci in Africa. Although further studies are needed to determine to what extent these findings can be extrapolated to other endemic areas in Africa, the principle of elimination has been established. The African Programme for Onchocerciasis Control has adopted an additional