Catheter Ablation ; Humans ; Liver Diseases, Parasitic ; diagnosis ; pathology ; surgery ; Male ; Middle Aged ; Paragonimiasis ; diagnosis ; pathology ; surgery

No abstract available.
Adult ; Animals ; *Capillaria ; Diagnostic Errors ; Dirofilariasis/*diagnosis ; Enoplida Infections/*diagnosis ; Humans ; Korea ; Liver/*parasitology ; Liver Diseases, Parasitic/*diagnosis ; Male

Most of human dirofilariasis are pulmonary or subcutaneous infections, but there have been a few reports of human dirofilariasis in unusual sites, such as large vessels, mesentery, peritoneal cavity, and spermatic cord. We present the first case of human hepatic dirofilariasis, which was surgically diagnosed. A 39-yr-old man without any evidence of systemic symptom was found incidentally to have a hepatic nodule during routine physical check-up. The histologic findings of the resected lesion showed a granulomatous lesion with central necrosis containing up to 35 transverse sections of a nematode, ranging 30-80 micrometer in diameter. Thin (1.5-5 micrometer) cuticle with transverse striations surrounded polymyarian and muscle bundles occupied a sixth of both sides of outer body cavity. Central portion of the body cavity was occupied with an intestine-like tubular structure and a larger reproductive tube. These microscopic findings were consistent with degenerated Dirofilaria immitis. Antibody test by enzyme-linked immunosorbent assay for patient serum reacted positively against adult D. immitis antigen.
Adult ; Animals ; Dirofilaria immitis/anatomy & histology/isolation & purification ; Dirofilariasis/*diagnosis/parasitology ; Humans ; Liver Diseases, Parasitic/*diagnosis/parasitology ; Male

Abdominal Neoplasms ; diagnosis ; secondary ; Adult ; Animals ; Female ; Humans ; Liver Diseases, Parasitic ; diagnosis ; Liver Neoplasms ; diagnosis ; parasitology ; pathology ; Neoplasm Metastasis ; Paragonimiasis ; diagnosis

Human fascioliasis is a zoonosis caused by Fasciola hepatica, and this is a trematode that infests cattle and sheep. Humans are accidental hosts in the life cycle of this parasite. People are infected by ingestion of the water or the raw aquatic vegetables that are contaminated with the metacercaria. This fluke's worldwide distribution occurs in areas where sheep, cattle and goats are raised, and there is a life-cycle niche for this fluke in lymnaeid snails. However, it is a rare disease in Korea. We experienced four human fascioliasis which were difficult to differentiate from hepatic malignancy in three patients, and this was misdiagnosed as common hepatic duct tumor in one patient. The patients manifested only vague abdominal symptoms. Intrahepatic fascioliasis showed multiple ill-defined hypoattenuating lesions and filling defects of the lesion lumens on radiologic study. A striking eosinophilia from the patients' blood was identified and a positive finding of a serum enzyme linked immunosorbent assay for the Fasciola hepatica was also noted in three of four patients. The therapeutic trial with triclabendazole and praziquantel was not successful.
Adult ; Bile Duct Neoplasms/*diagnosis ; *Bile Ducts, Intrahepatic ; Cholangiocarcinoma/*diagnosis ; Diagnostic Errors ; English Abstract ; Fascioliasis/*diagnosis ; Female ; Humans ; Liver Diseases, Parasitic/*diagnosis ; Middle Aged

Paragonimiasis is a parasitic disease caused by Paragnonimus species. The primary site of infection is the lung, and extrapulmonary involvement is also reported. When infected with Paragonimus westermani, which is the dominant species in Korea, the central nervous system is frequently involved along with the liver, intestine, peritoneal cavity, retroperitoneum, and abdominal wall. Ectopic paragonimiasis raises diagnostic challenge since it is uncommon and may be confused with malignancy or other inflammatory diseases. Here, we report an ectopic paragonimiasis case initially presented with recurrent abdominal pain. The patient developed abdominal pain 3 times for the previous 3 years and the computed tomography (CT) of the abdomen revealed fluid collection with wall enhancement. Recurrent diverticulitis was initially suspected and part of the ascending colon was resected. However, the specimen showed intact colon wall without evidence of diverticulitis and multiple parasite eggs and granulomas were found instead. The size of about 70 μm, the presence of an operculum and relatively thick egg shell suggested eggs of Paragonimus species. With appropriate exposure history and a positive antibody test, the definitive diagnosis was made as peritoneal paragonimiasis.
Abdomen ; Abdominal Abscess* ; Abdominal Pain ; Abdominal Wall ; Abscess ; Animals ; Central Nervous System ; Colon ; Colon, Ascending ; Diagnosis ; Diverticulitis* ; Egg Shell ; Eggs ; Granuloma ; Humans ; Intestines ; Korea ; Liver ; Lung ; Ovum ; Paragonimiasis* ; Paragonimus ; Paragonimus westermani ; Parasites ; Parasitic Diseases ; Peritoneal Cavity

Fascioliasis is a foodborne zoonotic parasitic disease. We report 4 cases occurring in the same family, in whom diagnosis of acute fascioliasis was established after series of tests. One case was hospitalized with fever, eosinophilia, and hepatic lesions. MRI showed hypodense changes in both liver lobes. The remaining 3 cases presented with the symptom of stomachache only. Stool analysis was positive for Fasciola eggs in 2 adult patients. The immunological test and molecular identification of eggs were confirmed at the National Institute of Parasitic Diseases, Chinese Center for Disease Control and Prevention, Shanghai, China. The results of serological detection were positive in all the 4 patients. DNA sequencing of PCR products of the eggs demonstrated 100% homology with ITS and cox1 of Fasciola hepatica. The conditions of the patients were not improved by broad-spectrum anti-parasitic drugs until administration of triclabendazole.
Adult ; Asian Continental Ancestry Group ; Centers for Disease Control and Prevention (U.S.) ; China* ; Diagnosis ; Eggs ; Eosinophilia ; Fasciola ; Fasciola hepatica ; Fascioliasis* ; Fever ; Humans* ; Immunologic Tests ; Liver ; Magnetic Resonance Imaging ; Ovum ; Parasitic Diseases ; Polymerase Chain Reaction ; Sequence Analysis, DNA

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

Cholangiocarcinoma (CCA) is an aggressive cancer arising from epithelial cells of the bile duct. Most patients with CCA have an unresectable tumor at the time of diagnosis. In Western countries, the risk of CCA increases in patients with primary sclerosing cholangitis, whereas liver fluke infection appears to be the major risk factor for CCA in Asian countries. A diagnosis of liver fluke infection often relies on stool samples, including microscopic examination, polymerase chain reaction-based assays, and fluke antigen detection. Tests of serum, saliva and urine samples are also potentially diagnostic. The presence of liver fluke along with exogenous carcinogens magnifies the risk of CCA in people living in endemic areas. The “liver fluke-cholangiocarcinoma” carcinogenesis pathways consist of mechanical damage to the bile duct epithelium, immunopathologic and cellular reactions to the liver fluke's antigens and excretory/secretory products, liver fluke-induced changes in the biliary tract microbiome and the effects of repeated treatment for liver fluke. A vaccine and novel biomarkers are needed for the primary and secondary prevention of CCA in endemic areas. Importantly, climate change exerts an effect on vector-borne parasitic diseases, and awareness of liver fluke should be enhanced in potentially migrated habitat areas.
Asian Continental Ancestry Group ; Bile Ducts ; Biliary Tract Neoplasms* ; Biliary Tract* ; Biomarkers ; Carcinogenesis ; Carcinogens ; Cholangiocarcinoma ; Cholangitis, Sclerosing ; Climate Change ; Clonorchiasis ; Diagnosis ; Ecosystem ; Epithelial Cells ; Epithelium ; Fasciola hepatica ; Humans ; Liver* ; Microbiota ; Opisthorchiasis ; Parasitic Diseases ; Risk Factors ; Saliva ; Secondary Prevention ; Trematoda

Schistosomiasis is one of the important neglected tropical diseases (NTDs) in Tanzania, particularly in Lake Victoria zone. This baseline survey was a part of the main study of integrated control of schistosomiasis and soil-transmitted helminths (STHs) aimed at describing morbidity patterns due to intestinal schistosomiasis among adults living on Kome Island, Sengerema District, Tanzania. Total 388 adults from Kome Islands (about 50 people from each village) aged between 12 and 85 years, were examined by abdominal ultrasound according to the Niamey protocol. Liver image patterns (LIPs) A and B were considered normal, and C-F as distinct periportal fibrosis (PPF). The overall prevalence of PPF was 42.2%; much higher in males than in females (47.0% in male vs 34.4% in females, P=0.007). Abnormal increase of segmental branch wall thickness (SBWT) and dilated portal vein diameter (PVD) were also more common in males than in females. Hepatosplenomegaly was frequently encountered; 68.1% had left liver lobe hepatomegaly and 55.2% had splenomegaly. Schistosoma mansoni-related morbidity is quite high among adults in this community justifying the implementation of integrated control strategies through mass drug administration, improved water supply (pumped wells), and health education that had already started in the study area.
Abdomen/ultrasonography ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Animals ; Child ; Cross-Sectional Studies ; Female ; Humans ; Islands ; Lakes ; Liver Diseases, Parasitic/diagnosis/*epidemiology/*pathology ; Male ; Middle Aged ; Prevalence ; Schistosomiasis mansoni/diagnosis/*epidemiology/*pathology ; Sex Factors ; Splenic Diseases/diagnosis/*epidemiology/parasitology/*pathology ; Tanzania/epidemiology ; Young Adult