Life-threatening complications of ascariasis in trauma patients:a review of the literature

BACKGROUND:Ascariasis is one of the most common human parasitic infections worldwide. In some rare cases,ascariasis may cause serious consequences even sudden death. This study was undertaken to review the life-threatening complications of ascariasis in trauma patients reported in the literature.DATA SOURCES:Relevant articles about ascariasis and trauma were searched from Pubmed,Google scholar,Scirus,and Wanfang databases.RESULTS:Twenty-four patients with ascariasis were collected from 21 articles searched. Most of these patients were from tropical and subtropical countries. Of the 24 patients,12 were children. Their major complications occurred in the airway passage and digestive tract. There were 3 fatal cases in these patients. Twelve of the 24 patients described in 10 articles were reported in the last 10 years.CONCLUSIONS:Early diagnosis and prompt intervention are essential to minimize the high morbidity and mortality of these serious complications in trauma patients. Physicians should be aware of the possibility of Ascaris infection in a trauma patient from endemic area of ascariasis. History of Ascaris infection and routine examination of feces for Ascaris eggs may be helpful to make a correct diagnosis.

Biliary ascariasis in a bile duct stones-removed female patient

Biliary ascariasis is a common problem in rural areas in China.The common presentations include biliary colic,acute cholangitis,obstructive jaundice,choledocholithiasis and acute cholecystitis.Here,we describe a case with biliary ascariasis two days after endoscopic sphincterotomy for choledocholithiasis.A living ascaris was successfully removed by endoscopic retrograde cholangiopancreatography.This case indicated that biliary ascariasis is not an uncommon complication of endoscopic sphincterotomy in some regions where ascariasis is epidemic.

Chemotherapy-based Control of Ascariasis and Hookworm in Highly Endemic Areas of China:Field Observations and a Modeling Analysis

Objective Our objective was to systematically evaluate chemotherapy-based control of ascariasis and hookworm infection and make predictions of the effectiveness of repeated mass treatment at different levels of coverage in highly endemic areas of China. Methods Field surveys were carried out to acquire the ascariasis and hookworm prevalence and intensity （mean worm burden） at baseline, one month and one year later. We calculated model parameters based on the survey data, then incorporated them into a quantitative framework to predict the prevalence and intensity one year later. Sensitivity analyses were performed to assess the influence of the chemotherapy measures on prevalence and intensity, and model simulations were performed to evaluate the feasibility of achieving the proposed transmission control criteria under different chemotherapy measures. Results The predicted prevalence and intensity one year from baseline were within the 95% confidence interval of actual values. As treatment frequency or coverage increased, the prevalence and intensity decreased. Model simulations show that many rounds of treatment are needed to maintain the prevalence at a low level in highly endemic areas of China. Conclusion We should select different combinations of treatment frequency, coverage and drug efficacy according to available resources and practical attainable conditions. Mathematical modeling could be used to help optimize the chemotherapeutic scheme aiming at specific parasitic species and areas, and to direct the establishment of soil-transmitted helminthiasis control criteria in China.

Endoscopic management of biliary ascariasis: A case report

BACKGROUND Biliary ascariasis is rare but remains the most common parasitic infection in remote areas and in people with poor medical conditions.Here,we reported a case of biliary ascariasis in order to raise awareness of possible parasitic infections.CASE SUMMARY A 68-year-old female was admitted to the emergency room of the Affiliated Hospital of Guizhou Medical University on 28 September 2017,with chief complaint of pain in the right upper abdomen.Ultrasonography of the abdomen showed that the upper segment of the common bile duct was slightly dilated with parallel tubular structures,indicative of biliary ascariasis.Endoscopic retrograde cholangiopancreatography was performed under general anesthesia on 29 September 2017,and an adult Ascaris lumbricoides worm was observed.After the worm was removed from the bile duct,the patient’s pain immediately subsided.The patient was successfully cured,without any complications.CONCLUSION This report emphasizes the need for physicians to consider biliary ascariasis as a possible cause when treating cases of biliary colic.

Loeffler's syndrome:unusual symptoms and signs of ascariasis:a case report

Ascariasis can be found in temperate and tropical areas but is more prevalent in most of the inter tropical zone due to local socio-economic conditions.Loeffler’s syndrome,also known as eosinophilic pulmonary syndrome is due to the trans-alveolar migration of ascaris larvae about 2 weeks after initial oral contamination.In this article, the case of a 10-year old child referred by his pediatrician for isolated eosinophilia,who was finally diagnosed with to have Loeffler’s syndrome is presented and discussed.

Role of endoscopic ultrasound in idiopathic pancreatitis

Recurrent acute pancreatitis(RAP) is defined based on the occurrence of two or more episodes of acute pancreatitis. The initial evaluation fails to detect the cause of RAP in 10%-30% of patients, whose condition is classified as idiopathic RAP(IRAP). Idiopathic acute pancreatitis(IAP) is a diagnostic challenge for gastroenterologists. In view of associated morbidity and mortality, it is important to determine the aetiology of pancreatitis to provide early treatment and prevent recurrence. Endoscopic ultrasound(EUS) is an investigation of choice for imaging of pancreas and biliary tract. In view of high diagnostic accuracy and safety of EUS, a EUS based management strategy appears to be a reasonable approach for evaluation of patients with a single/recurrent idiopathic pancreatitis. The most common diagnoses by EUS in IAP is biliary tract disease. The present review aims to discuss the role of EUS in the clinical management and diagnosis of patients with IAP. It elaborates the diagnostic approach to IAP in relation to EUS and other different modalities. Controversial issues in IAP like when to perform EUS, whether to perform after first episode or recurrent episodes, comparison among different investigations and the latest evidence significance are detailed.

Esophageal space-occupying lesion caused by Ascaris lumbricoides

Ascaris lumbricoides is the largest intestinal nematode parasite of man,which can lead to various complications because of its mobility.As the esophagus is not normal habitat of Ascaris,the report of esophageal ascariasis is rare.An old female presented with dysphagia after an intake of several red bean buns and haw jellies.The barium meal examination revealed a spherical defect in the lower esophagus.Esophageal bezoar or esophageal carcinoma was considered at the beginning.The patient fasted,and received fluid replacement treatment as well as some oral drugs such as proton pump inhibitor and sodium bicarbonate.Then upper gastrointestinal endoscopy was done to further confirm the diagnosis and found a live Ascaris lumbricoides in the gastric antrum and two in the duodenal bulb.The conclusive diagnosis was ascariasis.The esophageal space-occupying lesion might be the entangled worm bolus.Anthelmitnic treatment with mebendazole improved patient's clinical manifestations along with normalization of the radiological findings during a 2-wk follow-up.Authors report herein this rare case of Ascaris lumbricoides in the esophagus,emphasizing the importance of awareness of this parasitic infection as it often presents with different and unspecific symptoms.

Liver inflammatory pseudotumor or parasitic granuloma?

INTRODUCTION Liver pseudotumor is a very rare benign lesion.Since the first case reported by Pack and Baker in1953,only 40 cases had been reported up to 1996.The diagnostic challenge of hepatic inflammatorypseudotumor is emphasized by the fact that most ofthe reported cases were diagnosed by surgicalprocedures.Pathogenesis and etiology of

Comparison of the performance of MS enteroscope series and Japanese double-and single-balloon enteroscopes

BACKGROUND Small intestine disease endangers human health and is not easy to locate and diagnose.AIM To observe the effect of the MS series of small intestine endoscopes on the gastrointestinal tract,the changes in serum gastrin levels and intestinal tissue,and the time required for the examination.METHODS In vivo experiments in 20 Living pigs were conducted,Bowel preparation was routinely performed,Intravenous anesthesia with propofol and ketamine was applied,the condition of the small intestine was observed and the detection time of the MS series of small intestine endoscopes were recorded,The changes in intestinal tissue using the MS series of small intestine endoscopes observed and compared before and after the examination,Venous blood(3-5 mL)from pigs was collected before and after the experiment;changes in intestinal tissue after use of the MS series of small intestine endoscopes observed after examination.After completion of each type of small intestine endoscope experiment,the pigs were allowed to rest and the next type of small intestine endoscope experiment was performed after 15 days of normal feeding.The detection time data of the single-balloon small intestine endoscope and doubleballoon small intestine endoscope were collected from four hospitals.RESULTS One case of Ascarislumbricoides,one of suspected Crohn’s disease,one small intestinal diverticulum and one anesthesia accident were observed in pigs.The small intestine showed no differences in the MS series of small intestine endoscopes and there were no differences in serum gastrin between the groups(P>0.05).The time required for inspection was recorded,and the overall detection time for the Japanese small intestine endoscopes was approximately 1.68±0.16 h.CONCLUSION Intestinal ascariasis is a common disease in pigs.Some pigs have abnormal intestinal variation.After continuous upgrade and improvement,the MS-3 and MS-4 small intestine endoscope appear superior in terms of detection time.

Serum malondialdehyde level in patients infected with Ascaris lumbricoides

AIM:The aim of the study was to investigate the changes of serum malondialdehyde level, I.e; the oxidative stress hypothesis in patients infected with Ascaris lumbricoides.METHODS: Serum malondialdehyde activity was measured in 43 patients who were positive for intestinal parasite of Ascaris lumbricoides. Scores were obtained for the positives and their age-and sex-matched 60 Ascaris lumbricoides negative healthy controls.RESULTS: The difference between malondialdehyde levels of patients infected with Ascaris lumbricoides and control group was statistically significant both for females (P＜0.05)and for males (P＜0.05). In the patient and control groups,no correlation was found between age and malondialdehyde levels (P＞0.05) both in females and in males. In addition,no significant correlation could be found between malondialdehyde levels of both females and males for patients and control groups (P＞0.05).CONCLUSION: Malondialdehyde levels clearly increase in patients infected with Ascaris lumbricoides.

Ascaris-mimicking common bile duct stone: A case report

BACKGROUND In most cases,it is not difficult to differentiate common bile duct(CBD)stone from Ascaris infection because they are different disease entities and have different imaging findings.The two diseases usually demonstrate unique characteristic findings on computed tomography or magnetic resonance cholangiopancreatography.However,we report a rare case from our experience in which a CBD stone mimicked and was misdiagnosed as Ascaris.CASE SUMMARY A 72-year-old male presented with elevated serum liver enzymes.Computed tomography showed a hyper-attenuated,elongated lesion in the CBD lumen and associated biliary inflammation.Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography revealed a linear filling defect in the bile duct.Moreover,elongated echogenic material with a central hypoechogenic area was seen on endoscopic ultrasound.Although the imaging findings caused us to suspect infection with the nematode Ascaris,the lesion was revealed to be a dark-brown-colored CBD stone through endoscopic extraction.CONCLUSION We report a rare case of a CBD stone that mimicked Ascaris.We also review the literature for side-by-side comparisons of the imaging features of CBD stones and ascariasis.

ILLUSTRATIONS OF ACUTE SEVERE CASES TREATED WITH ACUPUNCTURE

Acupuncture treatment for certain acute severe cases has better clinical effect. It is also simple and easy to operate. Several cases are thus mentioned as a recollection of the clinical applicatign of acupuncture on the treatment of acute severe cases. Acute Infantile Convulsion One day in July 1961, a child of one