Eosinophilic appendicitis due to Strongyloides stercoralis: a challenging differential diagnosis for clinicians

2021 ◽  
Vol 14 (6) ◽  
pp. e239685
Author(s):  
Javier Páramo-Zunzunegui ◽  
Laura Rubio-López ◽  
Silvia Benito-Barbero ◽  
Ángeles Muñoz-Fernández
Keyword(s):  
Inflammatory Diseases ◽  
Parasitic Infection ◽  
Strongyloides Stercoralis ◽  
Clinical Findings ◽  
The Past ◽  
Ultrasound Study ◽  
Therapeutic Choice ◽  
Inflammatory Bowel ◽  
Clinical Awareness ◽  
Initial Choice

A 45-year-old man presents with 48-hour status of high temperature, cough and dyspnoea. In the context of pandemic, the patient is initially diagnosed with COVID-19 syndrome. Later, the laboratory and ultrasound study supported acute appendicitis diagnosis. Appendicectomy was performed. The histopathology study confirmed eosinophilic appendicitis and that a parasitic infection was suspected. The stool sample was positive for Strongyloides stercoralis. The diagnosis of a S.stercoralis is a rare finding in Spain. S. stercoralis simulates clinical findings of inflammatory bowel disease or eosinophilic gastroenteritis, which may lead to the wrong therapeutic choice. Since in inflammatory diseases corticosteroid treatments are considered the initial choice in many cases, in the case of S. stercoralis infection, the administration of this therapy can be fatal. In Spain, the number of diagnoses is much lower than in the past decade, although it is highly probable that the infection has been underdiagnosed due to low clinical awareness among Spanish population.

Practical Guidelines for Managing Patients With Psoriasis on Biologics: An Update

2019 ◽  
Vol 23 (1_suppl) ◽  
pp. 3S-12S ◽  
Author(s):  
Susan M. Poelman ◽  
Christopher P. Keeling ◽  
Andrei I. Metelitsa
Keyword(s):  
Health Care Providers ◽  
Primary Care Physicians ◽  
Inflammatory Diseases ◽  
Biologic Agents ◽  
Targeted Therapeutics ◽  
Care Providers ◽  
The Past ◽  
Practical Guidelines ◽  
Inflammatory Bowel ◽  
Systemic Therapies

The paradigm for treating inflammatory diseases has shifted dramatically in the past 10 to 20 years with the discovery of targeted therapeutics or “biologic” agents. Patients with rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis, and psoriasis, among others, are reaping the benefits of decades of bench to bedside research, allowing them to live more productive lives with less side effects than traditional systemic therapies. Despite these advances, many physicians unfamiliar with biologics are left to care for the basic needs of these patients and may be unaware of the multisystem comorbidities associated with psoriasis and the screening, monitoring, and other special considerations required of biologics patients. This can be overwhelming to primary care physicians and inadvertently expose patients to undue risks. The aim of this review is to provide a practical approach for all health care providers caring for patients with psoriasis being treated with biologics to facilitate communication with their treating dermatologist and ultimately provide patients with more comprehensive care.

scholarly journals The hypoxia-adenosine link during inflammation

2017 ◽  
Vol 123 (5) ◽  
pp. 1303-1320 ◽  
Author(s):  
Jessica L. Bowser ◽  
Jae W. Lee ◽  
Xiaoyi Yuan ◽  
Holger K. Eltzschig
Keyword(s):  
Myocardial Injury ◽  
Inflammatory Diseases ◽  
Extracellular Adenosine ◽  
Tissue Integrity ◽  
The Past ◽  
Hypoxic Conditions ◽  
Inflammatory Conditions ◽  
Proinflammatory Responses ◽  
Inflammatory Bowel ◽  
The Relationship

Hypoxic tissue conditions occur during a number of inflammatory diseases and are associated with the breakdown of barriers and induction of proinflammatory responses. At the same time, hypoxia is also known to induce several adaptive and tissue-protective pathways that dampen inflammation and protect tissue integrity. Hypoxia-inducible factors (HIFs) that are stabilized during inflammatory or hypoxic conditions are at the center of mediating these responses. In the past decade, several genes regulating extracellular adenosine metabolism and signaling have been identified as being direct targets of HIFs. Here, we discuss the relationship between inflammation, hypoxia, and adenosine and that HIF-driven adenosine metabolism and signaling is essential in providing tissue protection during inflammatory conditions, including myocardial injury, inflammatory bowel disease, and acute lung injury. We also discuss how the hypoxia-adenosine link can be targeted therapeutically in patients as a future treatment approach for inflammatory diseases.

scholarly journals POS1236 IMPACT OF COVID-19 ON INITIATION AND RENEWAL OF BIOTHERAPIES AND TARGETED SYNTHETIC TREATMENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 901.1-901
Author(s):  
P. Richette ◽  
M. Allez ◽  
V. Descamps ◽  
L. Perra ◽  
S. Pilet ◽  
...  
Keyword(s):  
Inflammatory Bowel Diseases ◽  
Outpatient Care ◽  
Subcutaneous Injection ◽  
Inflammatory Diseases ◽  
Jak Inhibitors ◽  
Scientific Societies ◽  
The Past ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
The Impact

Background:During the epidemic’s peak of COVID-19, scientific societies published recommendations on biotherapy and targeted synthetic treatment (B/TST) use in patients with chronic articular inflammatory diseases, inflammatory bowel diseases, and psoriasis.Objectives:The objective was to evaluate the impact of COVID-19 in France on initiation and renewal of B/TST.Methods:LRx contains all anonymized medication dispenses prescribed in outpatient care in a representative panel of French retails pharmacies, including data of near 40 million patients. The impact of B/TST initiation and renewal were studied using 2019 as reference and dispense deliveries data of pharmacies with regular flew in order to perform the comparison. B/TST considered were abatacept, anti-TNF, anti-IL6, anti-IL17, anti-IL12/23 or anti-IL23, JAK inhibitors (JAKi) and other classes such as aprelimast, aminosalicylates (AS), hydroxychloroquine (HCQ), and methotrexate (MTX). A treatment initiated was defined as a treatment not delivered in the past 12 months, and conversely for a treatment renewal. Results were presented as raw one and expressed in percentage of patients having at least one B/TST delivery in each therapeutic classes of interest in 2020 compared to 2019 used as reference year (period from week 12 to week 19 considered and corresponding to the lockdown period in France).Results:During the lockdown period, a decrease in initiation was observed for patients treated with: abatacept (405 in 2019 vs 227 in 2020: -44%, p<0.001), anti-TNF (1156 vs 1058, -31%, p<0.001), anti-IL17 (415 vs 206, -50%, p<0.001), anti-IL12-23 (395 vs 339, -12%, p=0.16), JAKi (289 vs 174, -39%, p=0.006), contrasting with an increase for Tociliumab (117 vs 445, +152%, p=0,01). We found a decrease of 7% (2171 vs 2015, p=0,35), 44% (405 vs 227, p<0.001), 30% (3430 vs 2390, p p<0.001) of AS, aprelimast and MTX initiation, respectively, and an increase of 173% (1708 vs 4671, p=0.11) of HCQ initiation. No decrease for the renewal of B/TST was observedConclusion:During the epidemic’s peak, initiation of AS, MTX, biotherapies (except for tocilizumab), and JAKi dramatically decreased without impacting their renewal. Two treatments were mainly initiated, tocilizumab probably due to a switch from intravenous to subcutaneous injection and HCQ in relation to its presumably effect on COVID-19. Overall, recommendations from scientific societies have been followed.Disclosure of Interests:None declared

scholarly journals EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound

2019 ◽  
Vol 05 (01) ◽  
pp. E34-E51 ◽  
Author(s):  
Dieter Nuernberg ◽  
Adrian Saftoiu ◽  
Ana Barreiros ◽  
Eike Burmester ◽  
Elena Ivan ◽  
...  
Keyword(s):  
Inflammatory Diseases ◽  
Perineal Ultrasound ◽  
Therapy Planning ◽  
Contrast Enhanced Ultrasound ◽  
Rectal Tumors ◽  
Targeted Biopsy ◽  
Contrast Enhanced ◽  
Gastrointestinal Ultrasound ◽  
Examination Techniques ◽  
Inflammatory Bowel

AbstractThis article represents part 3 of the EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound (GIUS). It provides an overview of the examination techniques recommended by experts in the field of endorectal/endoanal ultrasound (ERUS/EAUS), as well as perineal ultrasound (PNUS). The most important indications are rectal tumors and inflammatory diseases like fistula and abscesses in patients with or without inflammatory bowel disease (IBD). PNUS sometimes is more flexible and convenient compared to ERUS. However, the technique of ERUS is quite well established, especially for the staging of rectal cancer. EAUS also gained ground in the evaluation of perianal diseases like fistulas, abscesses and incontinence. For the staging of perirectal tumors, the use of PNUS in addition to conventional ERUS could be recommended. For the staging of anal carcinomas, PNUS can be a good option because of the higher resolution. Both ERUS and PNUS are considered excellent guidance methods for invasive interventions, such as the drainage of fluids or targeted biopsy of tissue lesions. For abscess detection and evaluation, contrast-enhanced ultrasound (CEUS) also helps in therapy planning.

scholarly journals The Role of Enterobacteriaceae in Gut Microbiota Dysbiosis in Inflammatory Bowel Diseases

2021 ◽  
Vol 9 (4) ◽  
pp. 697
Author(s):  
Valerio Baldelli ◽  
Franco Scaldaferri ◽  
Lorenza Putignani ◽  
Federica Del Chierico
Keyword(s):  
Inflammatory Bowel Diseases ◽  
Inflammatory Diseases ◽  
Species Level ◽  
Unknown Etiology ◽  
Gut Dysbiosis ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Symbiotic Microbiota ◽  
Gut Microbiota Dysbiosis

Inflammatory bowel diseases (IBDs) are a group of chronic gastrointestinal inflammatory diseases with unknown etiology. There is a combination of well documented factors in their pathogenesis, including intestinal microbiota dysbiosis. The symbiotic microbiota plays important functions in the host, and the loss of beneficial microbes could favor the expansion of microbial pathobionts. In particular, the bloom of potentially harmful Proteobacteria, especially Enterobacteriaceae, has been described as enhancing the inflammatory response, as observed in IBDs. Herein, we seek to investigate the contribution of Enterobacteriaceae to IBD pathogenesis whilst considering the continuous expansion of the literature and data. Despite the mechanism of their expansion still remaining unclear, their expansion could be correlated with the increase in nitrate and oxygen levels in the inflamed gut and with the bile acid dysmetabolism described in IBD patients. Furthermore, in several Enterobacteriaceae studies conducted at a species level, it has been suggested that some adherent-invasive Escherichia coli (AIEC) play an important role in IBD pathogenesis. Overall, this review highlights the pivotal role played by Enterobacteriaceae in gut dysbiosis associated with IBD pathogenesis and progression.

scholarly journals The complex relationship between viruses and inflammatory bowel disease – review and practical advices for the daily clinical decision-making during the SARS-CoV-2 pandemic

2021 ◽  
Vol 14 ◽  
pp. 175628482098819
Author(s):  
Klaudia Farkas ◽  
Daniella Pigniczki ◽  
Mariann Rutka ◽  
Kata Judit Szántó ◽  
Tamás Resál ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Patient Management ◽  
Clinical Decision Making ◽  
Viral Infections ◽  
Clinical Decision ◽  
The Past ◽  
Rapid Changes ◽  
Inflammatory Bowel ◽  
Practical Recommendations

The coronavirus disease 2019 (COVID-19) outbreak emerged in December 2019 in China and rapidly spread worldwide. Inflammatory bowel disease (IBD) patients are likely to be more susceptible to viral infections, and this is significantly influenced by the type of therapy they receive. Thus, issues specifically concerning the medical treatment of IBD patients were shortly addressed at the beginning of the pandemic. However, recently available data on the occurrence and outcome of SARS-CoV-2 infection in IBD patients does not address the concerns raised at the beginning of the pandemic. Growing evidence and the rapid changes happening over the past few weeks have helped elucidate the current situation, contribute to our understanding of the disease, and many previously raised questions could now be answered. We hereby summarise available evidence regarding viral infections and IBD, focusing on SARS-CoV infections, and we provide practical recommendations related to patient management during the COVID-19 pandemic era.

scholarly journals The Economic Impact of Inflammatory Bowel Disease in Canada

2004 ◽  
Vol 18 (4) ◽  
pp. 255-257
Author(s):  
Robert Hilsden
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Labour Force ◽  
Incidence Rates ◽  
Age Group ◽  
Group Level ◽  
The Past ◽  
Inflammatory Bowel ◽  
Using Data ◽  
Very High

Longobardi and colleagues examined the effect of inflammatory bowel disease (IBD) on employment, using data from 10,891 respondents aged 20 to 64 years from the 1998 cycle of the Canadian National Population Health Survey (NPHS) (1). This sample included 187 (1.7%) subjects who self-reported IBD or a similar bowel disorder. A significantly greater proportion of IBD than non-IBD respondents reported that they were not in the labour force (28.9% versus 18.5%). Even after adjusting for other factors (age group, level of pain, etc), subjects with IBD had a 2.9% higher nonparticipation rate (21.4%). For example, among people not hospitalized within the past year and with no limitation of activities due to pain, IBD subjects were 1.2 times more likely to be unemployed than those without IBD. Subjects who reported high levels of pain had a very high probability of being out of the labour force. Based on Canadian annual compensation data for all employed persons in Canada, and age- and sex-specific prevalence, and incidence rates for IBD, the authors estimated that there are 119,980 IBD patients between the ages of 20 and 64 years in Canada and that this group includes 3479 people who are not in the labour force. This translates into lost wages of $104.2 million, or $868 per IBD patient

Clinical Comparison of 99Tcm-Hmpao Labelled Leucocytes and 99Tcm-Nanocolloid in the Detection of Inflammation

1989 ◽  
Vol 30 (6) ◽  
pp. 633-637 ◽  
Author(s):  
M. Vorne ◽  
T. Lantto ◽  
S. Paakkinen ◽  
S. Salo ◽  
I. Soini
Keyword(s):  
Soft Tissue ◽  
Inflammatory Bowel Diseases ◽  
Vascular Graft ◽  
Inflammatory Diseases ◽  
Reliable Information ◽  
Imaging Method ◽  
Joint Diseases ◽  
Labelled Leucocytes ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Forty-five patients with various inflammatory diseases were imaged with 99Tcm-HMPAO labelled leucocytes and 99Tcm-nanocolloid within 7 days. The overall sensitivity of 99Tcm-leucocytes was 97% and that of 99Tcm-nanocolloid 59% and both agents had a 100% specificity. The 99Tcm-leucocyte method showed reliable results in various inflammatory and infectious conditions, and seems suitable as a primary imaging method. On the contrary, 99Tcm-nanocolloid cannot be recommended for use in inflammatory bowel diseases, soft tissue abscesses or prosthetic vascular graft infections. However, 99Tcm-nanocolloid gave reliable information in inflammatory and infectious bone and joint diseases in which it had a 90% sensitivity and 100% specificity. In those lesions the 99Tcm-nanocolloid method may be useful, because it is simple, fast and cheap. Yet, further evaluation is needed.

Histopathology of Gastric and Duodenal Strongyloides stercoralis Locations in Fifteen Immunocompromised Subjects

2006 ◽  
Vol 130 (12) ◽  
pp. 1792-1798 ◽  
Author(s):  
Francesco Rivasi ◽  
Silvio Pampiglione ◽  
Renzo Boldorini ◽  
Loredana Cardinale
Keyword(s):  
Colorectal Adenocarcinoma ◽  
Parasitic Infection ◽  
Strongyloides Stercoralis ◽  
Duodenal Mucosa ◽  
Gastric Ulcers ◽  
Immunocompromised Patients ◽  
Histologic Diagnosis ◽  
Immunodeficiency Virus ◽  
Gastric Biopsies ◽  
Duodenal Biopsies

Abstract Context.—Strongyloidiasis is a worldwide parasitic infection affecting approximately 75 million people. In Italy, it was more prevalent in the past among rural populations of irrigated areas. Objective.—To determine the histopathologic alterations of the gastric and duodenal mucosa associated with the presence of Strongyloides stercoralis parasites. Design.—Fifteen cases of strongyloidiasis were observed in immunocompromised patients during a recent 6-year period in Italy. S stercoralis was found histologically in gastric biopsies (10 cases), in a gastrectomy (1 case), and in duodenal biopsies (9 cases). In 5 cases the parasite was present both in gastric and duodenal biopsies. Four patients were affected by lymphoma, 2 by multiple myeloma, 2 by gastric carcinoma, 1 by chronic myeloid leukemia, 1 by sideroblastic anemia, 1 by colorectal adenocarcinoma, 1 by chronic idiopathic myelofibrosis, 1 by chronic gastritis, 1 by gastric ulcers, and 1 by rheumatoid arthritis in corticosteroid therapy. No patient was affected by human immunodeficiency virus infection. Strongyloidiasis was not clinically diagnosed. Results.—Histologic examination revealed several sections of S stercoralis larvae, many eggs, and some adult forms. All the parasites were located in the gastric and/or the duodenal crypts. Eosinophils infiltrating into the lamina propria were found in all cases; their intensity was correlated with the intensity of the infection. Conclusions.—Histologic diagnosis of strongyloidiasis must be taken into consideration when examining both gastric and duodenal biopsies in immunocompromised patients, to avoid the development of an overwhelming infection of the parasite, which is dangerous for the life of the patient.

scholarly journals Prevalence of intestinal parasitic infection in five farms in Holambra, São Paulo, Brazil

1995 ◽  
Vol 37 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Jun Kobayashi ◽  
Hideo Hasegawa ◽  
Archimedes A. Forli ◽  
Nancy F. Nishimura ◽  
Ademar Yamanaka ◽  
...  
Keyword(s):  
Parasitic Infection ◽  
Strongyloides Stercoralis ◽  
Sao Paulo ◽  
São Paulo ◽  
Infection Rates ◽  
Blastocystis Hominis ◽  
Culture Methods ◽  
E Coli ◽  
Parasitological Survey ◽  
Protozoan Species

A parasitological survey was carried out on 222 inhabitants of five farms in Holambra, located 30 km north of Campinas, São Paulo, Brazil, on October 1992. Approximately 70% of the inhabitants were found to be infected with at least one species of intestinal parasite. The positive rates of 6 helminths and 7 protozoan species detected are as follows: 5.4% Ascaris lumbricoides; 8.6% Trichuris trichiura; 19.8% Necator americanus; 10.4% Strongyloides stercoralis; 14% Enterobius vermicularis; 0.9% Hymenolepis nana; 3.2% Entamoeba histolytica; 2.7% E. hartmanni; 9.9% E. coli; 14.0% Endolimax nana; 2.3% Iodamoeba butschlii; 10.4% Giardia lamblia; 37.8% Blastocystis hominis. The positive rates of helminth infection were generaly higher in the younger-group under 16 years-old than those in the elder group aged 16 or more, whereas the infection rates of protozoan species were higher in the elder group. The infection rate of Strongyloides was found to be 10.4% by a newly developed sensitive method (an agarplate culture methods).

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