Eosinophilic synovial effusion is rarely observed in patients with inflammatory nature of synovial fluid, and the differential diagnosis includes parasitic arthritis. Toxocariasis is the one of the most common forms of helminthiasis worldwide and has been reported as a common cause of peripheral blood eosinophilia in Korea. However, joint involvement has been rarely reported in adults with toxocariasis in the English-language literature. Here, we report the first Korean case of a female presenting with acute monoarthritis with an increased number of eosinophils in the peripheral blood and synovial fluid, who was finally diagnosed with toxocariasis.
Adult ; Arthritis ; Diagnosis, Differential ; Eosinophilia ; Eosinophils* ; Female ; Helminthiasis ; Humans ; Joints ; Korea ; Synovial Fluid ; Toxocariasis*

In Korea, patterns of parasitic infections have notably changed during the past few decades. The soil-transmitted helminthiases and water-borne protozoan infections, which had been prevalent, became negligible, while parasitic zoonosis including pet-associated infections, food-borne helminthiases, and imported tropical endemic diseases have increasingly been detected. People who travel abroad and those who have immigrated from other countries might suffer from endemic tropical diseases. Except for a few entities, which invoked acute febrile illness (malaria) and diarrhea (giardiasis and amoebiasis), most helminthic and protozoan infections did not provoke acute symptoms. Those infections progress slowly, but can sometimes result in fatal clinical consequences. Diverse tropical endemic diseases are prevalent in several continents/countries according to different natural environments (climate and humidity), socioeconomic status, and traditional cultural background. Those diseases might be acquired through different routes of infection. Travelers who have returned to Korea from overseas and immigrants should undergo a careful differential diagnosis. Information on countries and duration of travel/residence, food habits, underlying medical history, prophylactics received, exposure to harmful environments (insect bites, contaminated food or water), and swimming in freshwater is valuable. This article briefly overviews the epidemiology, pathophysiology, clinical manifestations, diagnosis, and specific chemotherapeutics of the tropical endemic diseases that are important in Korea.
Diagnosis ; Diagnosis, Differential ; Diarrhea ; Emigrants and Immigrants ; Endemic Diseases ; Epidemiology ; Food Habits ; Fresh Water ; Helminthiasis ; Helminths ; Humans ; Korea ; Parasitic Diseases* ; Protozoan Infections ; Social Class ; Swimming

Nematomorpha, horsehair or Gordian worms, include about 300 freshwater species in 22 genera (Gordiida) and 5 marine species in 1 marine genus (Nectonema). They are parasitic in arthropods during their juvenile stage. In the present study, the used gordian worm was found in the feces of a dog (5-month old, male) in July 2014. Following the worm analysis using light and scanning electron microscopes, the morphological classification was re-evaluated with molecular analysis. The worm was determined to be a male worm having a bi-lobed tail and had male gonads in cross sections. It was identified as Gordius sp. (Nematomorpha: Gordiidae) based on the characteristic morphologies of cross sections and areole on the cuticle. DNA analysis on 18S rRNA partial sequence arrangements was also carried out, and the gordiid worm was assumed to be close to the genus Gordius based on a phylogenic tree analysis.
Animals ; Dog Diseases/diagnosis/*parasitology ; Dogs ; Feces/*parasitology ; Helminthiasis, Animal/diagnosis/*parasitology ; Helminths/classification/genetics/*isolation & purification ; Male ; Molecular Sequence Data ; Phylogeny

OBJECTIVETo study the value of MRI in the diagnosis of cerebral sparganosis in children.

METHODSThe MRI appearances of 17 children with cerebral sparganosis proven by pathology or serological test were retrospectively studied. The diagnostic accuracy rate of cerebral sparganosis was compared before and after knowing the imaging features of this disease.

RESULTSEnhanced MRI was performed in 12 cases, and all of them demonstrated abnormal enhancement. Peripheral ring-type, tortuous beaded shape or serpiginous tubular shape enhancement were found in 8 cases. After analysis of follow-up MRI for 7 cases, a change in location and shape of lesions was found in 2 cases. Typical MRI patterns of cerebral sparganosis included abnormal enhancement such as peripheral ring-type, tortuous beaded shape or serpiginous tubular shape enhancement, and changes in location and shape of lesions in the follow-up MRI. The diagnostic accuracy rate for the 17 cases of cerebral sparganosis at the first visit, after first imaging examination and after several follow-up MR examinations were 0%, 11.8% and 28.6%, respectively. The diagnostic accuracy rate of this disease increased to 64.7%, 70.6% and 85.7% respectively after the radiologists were trained in the imaging characteristics of the disease.

CONCLUSIONSMR findings in children with cerebral sparganosis are specific. Mastering correctly the typical imaging features of the disease can be very helpful in reducing the rate of clinical misdiagnosis.

Adolescent ; Central Nervous System Helminthiasis ; diagnosis ; pathology ; Child ; Child, Preschool ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Retrospective Studies ; Sparganosis ; diagnosis ; pathology

Fascioliasis is a zoonotic helminthiasis caused by Fasciola hepatica, the sheep liver fluke. Humans are accidental hosts in the life cycle of the parasite. They are infected by the ingestion of water or raw aquatic vegetables contaminated with the metacercaria. The diagnosis of fascioliasis is based on clinical symptoms, absolute eosinophilia, serologic test (ELISA), radiologic finding, and presence of eggs in the feces or duodenal fluid. Recently, some radiologists have been reporting specific findings of fascioliasis by MRI. We report a case of liver abscess associated with fascioliasis diagnosed by MRI.
Diagnosis ; Eating ; Eggs ; Eosinophilia ; Fasciola hepatica ; Fascioliasis* ; Feces ; Helminthiasis ; Humans ; Life Cycle Stages ; Liver Abscess* ; Liver* ; Magnetic Resonance Imaging* ; Ovum ; Parasites ; Serologic Tests ; Sheep ; Vegetables ; Water

It is clinically important to differentiate tissue-invading helminthiasis. The purpose of this study was to assess the specific immunoglobulin G (IgG) antibody positive rates for clonorchiasis, paragonimiasis, cysticercosis, and sparganosis 4 helminthiases from 1996 to 2006 using multi-antigen enzyme-linked immunosorbent assay (ELISA) in Korea. Results of 6,017 samples, which were referred to our institute for serodiagnosis, were analyzed. The subjects with positive serum IgG antibodies were 1,502 (25.0%) for any of the 4 helminthiases. The overall positive numbers for clonorchiasis, paragonimiasis, cysticercosis, and sparganosis were 728 (12.1%), 166 (2.8%), 729 (12.1%), and 263 (4.4%), respectively. The positive serologic reaction to multi-antigens was determined in 309 (20.6%) of the 1,502 total seropositive subjects. Those with multi-antigen positivity were regarded as positive for the antigen of strongest reaction but cross-reaction to others with weak positive reaction. Annual seropositive rates for those 4 tissue helminthiases ranged from 12.1% to 35.7%. The highest rate was observed in age from 60 to 69 years old and prevalence of men (27.4%; 1,030/3,763) was significantly higher than of women (19.1%; 332/1,741). Hospital records of 165 ELISA positive patients were reviewed to confirm correlation with their clinical diagnosis. Paragonimiasis was highly correlated as 81.8% (9/11), cysticercosis 29.9% (20/67), clonorchiasis 29.0% (20/69), and sparganosis 11.1% (2/18). In conclusion, the multi-antigen ELISA using 4 helminth antigens is useful to differentiate suspected tissue-invading helminthiases, especially ELISA diagnosis of paragonimiasis is reliable. The seropositivity is still high among suspected patients in Korea.
Antibodies ; Antigens, Helminth ; Clonorchiasis ; Cysticercosis ; Diagnosis ; Enzyme-Linked Immunosorbent Assay* ; Female ; Helminthiasis* ; Hospital Records ; Humans ; Immunoglobulin G ; Korea* ; Male ; Paragonimiasis ; Prevalence ; Serologic Tests ; Sparganosis

Plant root hairs are commonly found artifacts in parasitology specimens and may be confused with helminthes by an untrained eye. We report a case of brain tuberculoma where the tissue sample was contaminated with root hair derived from tap water; the presence of this root hair, which mimicked a larva, led to diagnostic confusion. Therefore, tap water should be considered a source of root hair and vegetable matter.
Animals ; Brain Diseases/*diagnosis/pathology ; *Diagnostic Errors ; Helminthiasis/diagnosis ; Helminths/growth & development ; Humans ; Larva/anatomy & histology ; Male ; Middle Aged ; Plant Roots/*anatomy & histology ; Tomography, X-Ray Computed ; Tuberculoma/*diagnosis/pathology ; Water

Modernized urban life style has changed patterns of parasitic infections in Korea. Parasitic diseases caused by soil-transmitted helminths and water-borne protozoans has significantly decreased, while imported parasitic diseases, zoonosis, and opportunistic infections are being increasingly recognized. Tissue-invading helminthiases also invoked formidable health problems, which had been neglected due to the difficult clinical diagnosis and slow progression. However, the diseases are associated with chronic morbidity and severe mortality. A variety of helminths invade the human tissue. With an exception of few entities (i.e., schistosomiasis, clonorchiasis, and paragonimiasis), most of tissue-invading helminths are associated with larvae/juveniles but not with adults. Larval infections might be more serious, since the larvae may migrate throughout the whole body, after which they lodge in critical foci in the brain, eye, liver, or elsewhere or may grow into large masses exerting space-occupying effects (i.e., cysticercosis, sparganosis, and hydatidosis). When the parasites invade the tissue, IgE levels are modulated by several effector molecules including interleukin (IL)-4, IL-6, interferon- and other cytokines secreted by different Th-cell subsets. Immediate-type hypersensitivity is related to huge production of Th2-type cytokines, mast cells, eosinophils, and IgE. These immune interactions elicit cellular responses, culminating in immunophysiological changes, which protect the host by surrounding the invasive parasite with granuloma. However, hyperactivation of the immune system may also be harmful to the host, resulting in immune-mediated diseases. This article briefly reviews the biology, clinical manifestations, diagnosis, and principle of the treatment of the tissue-invading helminthic infections, which are important in Korea.
Adult ; Biology ; Brain ; Cestoda ; Clonorchiasis ; Cysticercosis ; Cytokines ; Diagnosis ; Eosinophils ; Granuloma ; Helminthiasis ; Helminths* ; Humans ; Hypersensitivity ; Immune System ; Immunoglobulin E ; Interleukin-6 ; Interleukins ; Korea ; Larva ; Life Style ; Liver ; Mast Cells ; Mortality ; Opportunistic Infections ; Parasites ; Parasitic Diseases ; Schistosomiasis ; Sparganosis

The present study was performed to describe 2 human cases infected by the horsehair worm, Parachordodes sp., in Japan. Two gordiid worms were collected in the vomit and excreta of an 80-year-old woman in November 2009 in Kyoto city, and in the mouth of 1-year-old boy in December 2009 in Nara city, Japan, respectively. Both worms were males having bifurcated posterior ends and male gonads in cross sectional specimens. They were identified as Parachordodes sp. (Nematomorpha: Chordodidae) based on the characteristic morphologies of cross sections and areoles in the cuticle. DNA analysis on 18S rRNA partial sequence arrangements was also carried out and both worms were assumed to be close to the genus Paragordionus based on tree analysis, and far from Gordius sp. which has already been reported in humans in Japan. DNA sequencing of the Parachordodes worm does not appear on the database; therefore, more information on the gene sequences of the genus Parachordodes from humans, animals, or intermediates is required.
Aged, 80 and over ; Animals ; Cluster Analysis ; DNA, Helminth/chemistry/genetics ; DNA, Ribosomal/chemistry/genetics ; Female ; Helminthiasis/*diagnosis/*parasitology/pathology ; Helminths/anatomy & histology/classification/genetics/*isolation & purification ; Humans ; Infant ; Japan ; Male ; Microscopy ; Phylogeny ; RNA, Ribosomal, 18S/genetics ; Sequence Analysis, DNA

Integrated control strategies are important for sustainable control of schistosomiasis and soil-transmitted helminthiasis, despite their challenges for their effective implementation. With the support of Good Neighbors International in collaboration with National Institute of Medical Research, Mwanza, Tanzania, integrated control applying mass drug administration (MDA), health education using PHAST, and improved safe water supply has been implemented on Kome Island over 5 years for controlling schistosomiasis and soil-transmitted helminths (STHs). Baseline surveys for schistosomiasis and STHs was conducted before implementation of any integrated control strategies, followed by 4 cross-sectional follow-up surveys on randomly selected samples of schoolchildren and adults in 10 primary schools and 8 villages, respectively, on Kome islands. Those follow-up surveys were conducted for impact evaluation after introduction of control strategies interventions in the study area. Five rounds of MDA have been implemented from 2009 along with PHAST and improved water supply with pumped wells as other control strategies for complementing MDA. A remarkable steady decline of schistosomiasis and STHs was observed from 2009 to 2012 with significant trends in their prevalence decline, and thereafter infection rate has remained at a low sustainable control. By the third follow-up survey in 2012, Schistosoma mansoni infection prevalence was reduced by 90.5% and hookworm by 93.3% among schoolchildren while in adults the corresponding reduction was 83.2% and 56.9%, respectively. Integrated control strategies have successfully reduced S. mansoni and STH infection status to a lower level. This study further suggests that monitoring and evaluation is a crucial component of any large-scale STH and schistosomiasis intervention.
Adolescent ; Adult ; Animals ; Anthelmintics/*administration & dosage ; Child ; Child, Preschool ; Communicable Disease Control/*organization & administration ; Cross-Sectional Studies ; Female ; Follow-Up Studies ; Helminthiasis/*diagnosis/*drug therapy ; Humans ; Intestinal Diseases, Parasitic/*diagnosis/*drug therapy ; Islands ; Lakes ; Male ; Prevalence ; Schistosomiasis/*diagnosis/*drug therapy ; Tanzania ; Treatment Outcome