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Abstract Objective Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients. Data sources A PubMed search was conducted using the key terms "ascariasis complications" and "hepatobiliary ascariasis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023. Summary of findings Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed. Conclusion The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides.

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Parasitic infections continue to be a burden for developing countries-the lack of hygiene measures and clean water results in dangerous scenarios that can lead to challenging problems. Most Ascaris lumbricoides infections are usually mild; nonetheless, in rare cases in endemic regions, they can migrate to the bile duct and cause severe complications requiring surgery. We present the case of a 43-year-old woman who had severe cholangitis due to A. lumbricoides. The worm migrated from the bowel and obstructed the bile duct; after surgery, the patient fully recovered.

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OBJECTIVE: To evaluate the IgE reactivity of sera in patients suffering from type 1 diabetes (T1D), lupus nephritis (LN) and juvenile idiopathic arthritis (JIA) against a molecule constructed from T epitopes of A. lumbricoides allergens. METHODS: We designed and expressed a synthetic multi-epítope protein named MP1 from A. lumbricoides and house dust mites allergens. By indirect ELISA, we evaluated IgE-reactivity to MP1 and to the whole-body extract of Ascaris lumbricoides in 45 sera from Colombian Caribbean patients with lupus nephritis (LN; n=25), type 1 diabetes (T1D; n=10) and Juvenil idiopathic arthritis (JIA; n=10). Individuals with poly autoimmunity were excluded. All patients were referred to the study by their specialist doctor. RESULTS: IgE to whole-body extract of A. lumbricoides showed the following median concentrations.484.2 ng/ml (IQR: 203.4) in JIA patients, 325.6 ng/ml (IQR: 179.3) in individuals with LN, and 424.7 ng/ml (IQR: 80.1) in the T1D group. On the other hand, IgE-reactivity to MP1 was 126.4 ng/ml (IQR: 90.9) in JIA patients, 130.7 ng/ml (IQR: 94.8) in an individual with LN, and 148.8 ng/ml (IQR: 102.1) in the T1D group. Although no statistical differences were observed between patient groups, the IgE to MP1 in all patients (n: 45) (IgE median: 134.2 ng/ml; IQR: 100) were significantly less compared to Ascaris extract (IgE median: 380.7 ng/ml; IQR: 175.8); (W: 0.732; p-value: 1.034x10-7). CONCLUSIONS: These preliminary results suggest that MP1 showed antigenic properties with low IgE- reactivity, compared to Ascaris lumbricoides extracted in individuals with autoimmune diseases. Further studies are needed to understand better the immune response induced by this molecule.

OBJETIVO: Evaluar la reactividad IgE de sueros en pacientes que padecen diabetes tipo 1 (DT1), nefritis lúpica (NL) y artritis idiopática juvenil (AIJ) frente a una molécula construida a partir de epítopes T de alérgenos de A. lumbricoides. MÉTODOS: Se diseñó y expresó una proteína multi-epítopes sintética (MP1), a partir de alérgenos de A. lumbricoides y ácaros del polvo doméstico. Mediante ELISA indirecto, se evaluaron las reactividades IgE anti-MP1 y al extracto de cuerpo entero de Ascaris lumbricoides, en sueros de pacientes con nefritis lúpica (NL; n=25), diabetes tipo 1 (T1D; n=10) y artritis idiopática juvenil (AIJ; n=10), procedentes del Caribe colombiano. Se excluyeron los individuos con poliautoinmunidad. Todos los pacientes fueron remitidos al estudio por su médico especialista. RESULTADOS: La IgE frente al extracto de cuerpo completo de A. lumbricoides mostró concentraciones de 484,2 ng/ml (RIQ: 203,4) en pacientes con AIJ; 325,6 ng/ml (RIQ: 179,3) en individuos con NL; y 424,7 ng/ml (RIQ: 80,1) en el grupo con DT1. Por otra parte, la reactividad de IgE anti-MP1 fue de 126,4 ng/ml (RIQ: 90,9) en los pacientes con AIJ; 130,7 ng/ml (RIQ: 94,8) en los individuos con NL; y 148,8 ng/ml (RIQ: 102,1) en el grupo con DT1. Aunque no se observaron diferencias estadísticas entre los grupos de pacientes, la reactividad IgE anti- MP1 en todos los pacientes (n: 45) (mediana de IgE: 134,2 ng/ml; RIQ: 100), fue significativamente inferior en comparación con el extracto de Ascaris (mediana de IgE: 380,7 ng/ml; RIQ: 175,8); (W: 0,732; p-valor: 1,034x10-7). CONCLUSIONES: Estos resultados preliminares sugieren que MP1 mostró propiedades antigénicas con baja reactividad IgE, en comparación con el extracto de Ascaris lumbricoides en individuos con enfermedades autoinmunes. Se necesitan más estudios para comprender mejor la respuesta inmunitaria inducida por esta molécula.

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OBJECTIVE: The objective of the present study was to design a multi-epitope protein from A. lumbricoides and APD allergens and to evaluate its IgE reactivity preliminarily. METHODS: Using computational tools, a molecule containing multiple "T" epitopes of allergens derived from A. lumbricoides and APD was designed "in silico" This multi-epitope protein (MP1) was expressed using an E. coli system and purified by affinity chromatography using Ni-NTA agarose. Anti-MP1 and anti-HDM extract IgE reactivity was evaluated by Dot-Blot and indirect ELISA from sera of HDM-allergic patients and non-allergic individuals from Barranquilla-Colombia. Allergic individuals had a positive skin test to a standardized battery of inhaled allergens (EUROLINE - Ref: DP 3704-1601-1 E) and mite- specific IgE. RESULTS: Multi-epitope (MP1) protein was expressed and purified with high purity. Dot-Blot result showed that all sera from allergic patients showed lower IgE reactivity to MP1 compared to HDM extract. By ELISA, significantly lower concentrations of anti-MP1 IgE (Median: 270.86 ng/ml; IQR: 90.3) were observed in contrast to anti-HDM IgE levels (Median: 988.5 ng/ml; IQR: 1117.6) in sera of patients allergic to HDM. CONCLUSIONS: A protein composed of multiple epitopes of A. lumbricoides and HDM allergens was designed, expressed, and purified. Preliminary Dot-Blot results suggest that this molecule shows hypoallergenic properties with very low IgE reactivity compared to mite extract. Further functional studies are needed to understand better the immune response induced by this molecule.

OBJETIVO: Diseñar una proteína multiepítope a partir de alérgenos de A. lumbricoides y APD; y evaluar preliminarmente su reactividad IgE. MÉTODOS: Mediante herramientas computacionales se diseñó In Silico, una molécula que contiene múltiples epítopos T, de alérgenos derivados de A. lumbricoides y APD. Esta proteína multiepítope (MP1) se expresó utilizando un sistema de E. coli, y se purificó mediante cromatografía de afinidad, empleando agarosa Ni-NTA. La reactividad IgE anti-MP1 y anti-extracto de APD, se evaluó mediante Dot-Blot y ELISA indirecta, a partir de suero de pacientes alérgicos a APD, e individuos no alérgicos procedentes de Barranquilla, Colombia. Los individuos alérgicos contaron con prueba cutánea positiva a una batería estandarizada de alérgenos inhalados (EUROLINE - Ref: DP 3704-1601-1 E) e IgE específica para ácaros. RESULTADOS: La proteína multiepítope MP1 se expresó y purificó con alta pureza. El resultado del Dot-Blot, mostró que todos los sueros de pacientes alérgicos tuvieron una reactividad IgE menor a MP1 en comparación al extracto de APD. Por ELISA, se observaron concentraciones significativamente menores de IgE anti-MP1 (Mediana: 270,86 ng/ml; RIQ: 90,3), en contraste a los niveles de IgE anti-APD (Mediana: 988,5 ng/ml; RIQ: 1117,6), en suero de pacientes alérgicos a APD. CONCLUSIONES: Se diseñó, expresó y purificó una proteína compuesta por múltiples epítopes de alérgenos de A. lumbricoides y APD. Los resultados preliminares de Dot-Blot sugieren que esta molécula muestra propiedad hipoalergénica con una reactividad IgE muy baja, en comparación con el extracto de ácaros. Se necesita continuar con estudios funcionales para comprender mejor la respuesta inmune inducida por esta molécula.

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OBJECTIVE: To compare the relative frequencies of immune cell populations in the peripheral blood according to A. lumbricoides infection status. METHODS: Peripheral blood samples were collected from participants infected (n = 35) and uninfected with A. lumbricoides (n=27) residing in different rural municipalities of Bolívar. Infection was diagnosed using two coprological examinations and the Kato-Katz technique. Immunophenotyping was performed using two panels of markers and staining in fresh blood. The flow cytometry reading was performed on a spectral cytometer (Northern Lights, Cytek, USA). The populations identified in the first panel (Figure 1) were T lymphocytes (CD45+ CD3+), CD4+ or CD8+, B lymphocytes (CD45+ SSClow CD3- CD19+), neutrophils (CD45+ SSChi CD3- CD16+), and eosinophils (CD45+ SSChi CD3- CD16low). Monocytes were identified in another panel (Figure 2): classical (CD14++ CD16 -), intermediate (CD14++ CD16+), and non-classical (CD14+ CD16++). Dendritic cells, including CD123 + + CD303 + (plasmacytoid), HLA-DR + + CD1c + (myeloid CD1c +), and CD14-CD141 + + (myeloid CD141 +), were also identified. The study received approval from the Ethics Committee of the University of Cartagena, and participants provided informed consent. Funding was provided by the Colombian Sistema General de Regalías under BPIN2020000100405 - BPIN2020000100364. RESULTS: No significant differences were observed in age [mean cases: 35.69 (SD: 17.7) vs. controls: 37.04 (SD: 15.6) years] or sex (cases: 62.9% vs. controls: 74.1%) (Table 1). All infections were mild, with a median of 96 eggs (IQR, 48-216). A marginally significant difference was observed only in the percentage of neutrophils (45.37% in cases vs. 54.79% in controls, p=0.041) (Figure 3). Although the frequency of eosinophils was higher in the cases (8.1% vs. 6%), this difference was not significant (p=0.138) (Figure 3). No significant differences were observed in the populations of monocytes or dendritic cells between cases and controls (Figure 4). CONCLUSION: Mild A. lumbricoides infection appears to affect the number of neutrophils in peripheral blood. The low infection intensity in the studied samples may explain the lack of a significant impact on other cellular populations.

OBJETIVO: Comparar las frecuencias relativas de poblaciones de células inmunes en sangre periférica de acuerdo con el estado de infección por A. lumbricoides. MÉTODOS: Se recolectaron muestras de sangre periférica de participantes infectados (n=35) y no infectados con A. lumbricoides (n=27), residentes en distintos municipios rurales de Bolívar. La infección se diagnosticó por dos métodos coprológicos y la técnica de Kato-Katz. El inmunofenotipo se determinó con dos baterías de marcadores y tinciones en sangre fresca. La lectura fue realizada en un citómetro espectral (Northern Lights, Cytek, USA). Las poblaciones identificadas en la primera batería (Figura 1) fueron linfocitos T (CD45+ CD3+) CD4+ o CD8+, linfocitos B (CD45+ SSClow CD3- CD19+), neutrófilos (CD45+ SSChi CD3- CD16+), y eosinófilos (CD45+ SSChi CD3- CD16low). Los monocitos se identificaron en otra batería (Figura 2): clásicos (CD14++ CD16­), intermedios (CD14++ CD16+), y no clásicos (CD14+ CD16++). También se identificaron células dendríticas, tales como: CD123++ CD303+ (plasmocitoides), HLA-DR++ CD1c+ (mieloides CD1c+), y CD14- CD141++ (mieloides CD141+). El estudio recibió la aprobación del Comité de Ética de la Universidad de Cartagena, y los participantes otorgaron su consentimiento informado. La financiación fue proporcionada por el Sistema General de Regalías de Colombia, bajo el BPIN2020000100405 - BPIN2020000100364. RESULTADOS: No se observaron diferencias significativas en edad [media = casos: 35,69 (DE: 17,7) vs controles: 37,04 (DE: 15,6 años] o sexo (casos: 62,9% vs. controles: 74,1%). Todas las infecciones fueron leves con una mediana de huevos de 96 (RIC: 48 - 216). Solo se encontró diferencia significativa marginal en el porcentaje de neutrófilos (45,37% en los casos vs 54,79% en controles, p=0,041). Si bien la frecuencia de eosinófilos fue más alta en los casos (8,1% vs. 6%), esta diferencia no alcanzó la significancia (p=0,138). No se observaron diferencias significativas en las poblaciones de monocitos o células dendríticas entre casos y controles (Figura 4). CONCLUSIÓN: La infección leve por A. lumbricoides parece afectar el número de neutrófilos en sangre periférica. Es posible que por la baja intensidad de la infección en la muestra estudiada, no se detecte un impacto importante de la misma sobre el resto de las poblaciones celulares. Palabras claves: Helmintos; Ascaris lumbricoides; Citometría de flujo; Inmunofenotipado; Neutrófilos.

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OBJECTIVE: Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients. DATA SOURCES: A PubMed search was conducted using the key terms "ascariasis complications" and "hepatobiliary ascariasis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023. SUMMARY OF FINDINGS: Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed. CONCLUSION: The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides.

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Anti-Ascaris lumbricoides (Asc) IgE and IgG can immunomodulate the allergy; however, the influence of these isotypes has not been investigated in the giardiasis and allergy. Therefore, the frequency of respiratory allergy (RA) symptoms in Giardia lamblia-infected children, with or without anti-Asc IgE, IgG1, or IgG4 and Th1, Th2/Treg, and Th17 cytokine production, was evaluated. We performed a case-control study with children aged 2-10 years old selected by questionnaire and stool exams to form the groups: infected or uninfected with RA (G-RA, n = 55; nG-RA, n = 43); infected and uninfected without RA (G-nRA, n = 59; nG-nRA, n = 54). We performed blood leukocyte counts and in vitro culture. Cytokine levels in the supernatants (CBA), serum total IgE and anti-Asc IgE (ImmunoCAP), IgG1, IgG4, and total IgA (ELISA) were measured. Infection was not associated with allergy. Infected children showed increased levels of anti-Asc IgG1, IL-2, IFN-γ, IL-4, and IL-10. There was a lower frequency of allergy-related symptoms in anti-Asc IgG1-positive children than IgG1-negative (OR = 0.38; CI = 0.17-0.90, p = 0.027) and few eosinophils in G-RA than in G-nRA and more in G-nRA than in nG-nRA, whereas TNF-α levels were higher in the G-RA than in the nG-nRA group. For infected and positive anti-Asc IgG1, there was higher TNF-α and IL-10 production than G/-IgG1. IL-10 levels were lower in nG/ + IgG1 than in infected or non-infected, and both were negative for anti-Asc IgG1. Th1/Th2/IL-10 profiles were stimulated in the infected patients, and in those with circulating anti-Asc IgG1, the TNF-α production was strengthened with a lower risk for respiratory allergy symptoms.

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Resumen Introducción: la pancreatitis aguda es una de las entidades que afectan más normalmente el tracto gastrointestinal. Sus causas más frecuentes son la biliar y la alcohólica; sin embargo, no se deben descartar las causas infecciosas, entre ellas las parasitarias. Caso: se presenta un caso de un hombre de 35 años de edad procedente del área urbana de Bogotá que ingresó por un dolor torácico al servicio de urgencias del Hospital San Ignacio, posteriormente con migración hacia el abdomen y síntomas gastrointestinales asociados. Se diagnosticó pancreatitis aguda, se descartaron las causas biliar y alcohólica, y se evidenció en la escanografía un cuerpo extraño endoluminal gástrico hacia las asas intestinales, cuyo diagnóstico se confirmó de manera endoscópica (áscaris lumbricoides). Se extrajo el helminto en su totalidad y se continuó el manejo intrahospitalario. Como complicación presentó un compromiso necrotizante con colecciones asociadas en imágenes de control, sin compromiso multiorgánico. Finalmente, se dio egreso por una adecuada evolución clínica. Conclusión: la ascariasis es una causa infrecuente de pancreatitis aguda en adultos de zonas urbanas, incluso en países en vías de desarrollo como Colombia. Su diagnóstico y manejo terapéutico se realizan vía endoscópica con la extracción del helminto. Como en todos los casos de pancreatitis, debe realizarse un seguimiento clínico en busca de complicaciones asociadas y compromiso multiorgánico.

Abstract Introduction: Acute pancreatitis is one of the most common entities affecting the gastrointestinal tract. Its most frequent causes are biliary and alcoholic; however, infectious causes, including parasitic ones, should not be ruled out. Case: We present the case of a 35-year-old man from the urban area of Bogotá who was admitted to the emergency department of the San Ignacio Hospital due to chest pain, with subsequent migration to the abdomen and associated gastrointestinal symptoms. Acute pancreatitis was diagnosed, biliary and alcoholic causes were ruled out, and the scan revealed a gastric endoluminal foreign body towards the intestinal loops; the diagnosis was confirmed endoscopically (Ascaris lumbricoides). The helminth was entirely extracted, and the intrahospital management was continued. As a complication, he had necrosis with associated collections in control images without multi-organ involvement. Finally, he was discharged due to adequate clinical evolution. Conclusion: Ascariasis is a rare cause of acute pancreatitis in adults in urban areas, even in developing countries such as Colombia. Its diagnosis and therapeutic management are carried out endoscopically with the extraction of the helminth. As in all cases of pancreatitis, a clinical follow-up should be conducted in search of associated complications and multi-organ involvement.

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The World Health Organization indicates that more than 1.5 billion people are infected with geohelminths. Soil-transmitted helminths prevail mostly in tropical and subtropical regions, in areas with inadequate hygiene and sanitation conditions, and basic health education problems. Nematode eggs are structures of resistance and infection by fecal-oral transmission. When STH eggs are ingested, they can infect the potential host, causing abdominal pain, diarrhea, anemia, malnutrition, and physical-cognitive impacts in children. Taking advantage of the increasing employment of three-dimensional models of these structured based on light microscopy images to improve the research area and education could be an alternative to improve health education and spread scientific information on transmission and prevention. The objective of this work was to produce 3D printed models from bi-dimensional images of eggs based on their real morphological and morphometric characteristics. The virtual models were reconstructed from the acquisition and selection of images obtained using light microscopy. After selecting referential images, we constructed the models based on the vectorization of the egg structures. After vectorization, 3D modeling was performed and printed in PLA. 3D models have a high potential to contribute to the advanced morphological studies and teaching of parasitological sciences, enriching the teaching-learning process applicable in presential or remote teaching of basic education, undergraduate, and post-graduation classes.

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Soil-transmitted helminths, such as Ascaris lumbricoides, are the most prevalent parasites globally. Optimal anthelmintic treatment for A. lumbricoides in endemically infected communities is challenged by several host-related and environmental factors influencing infection acquisition. We assessed the risk of A. lumbricoides (re)infection after treatment in a Venezuelan rural community. Individual merthiolate-iodine-formaldehyde-fixed faecal samples were collected from 224 persons before a single-dose pyrantel treatment and at 1, 3, 6, 9 and 15 months after treatment. Effects of age, sex and socioeconomic status (SES) on A. lumbricoides prevalence, eggs/gram faeces (EPG) and infection (re)acquisition were assessed using both generalised linear mixed-effects models and survival analysis. Pre-treatment A. lumbricoides prevalence was 39.7%. Higher prevalence was associated with younger age and lower SES. Higher EPG values were observed among young children. Median time to A. lumbricoides infection was six months after treatment: at 1, 3, 6, 9 and 15 months post-treatment, cumulative incidence was 6.7%, 18.9%, 34.6%, 42.2%, and 52.6%, respectively. Younger age, lower SES, and pre-treatment A. lumbricoides infection status showed significantly elevated hazard ratios. Mass drug administration protocols would benefit from considering these factors in selective treatment strategies and possibly more than just annual or biannual treatments in the target population.

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Ascaris lumbricoides and Ascaris suum are described as helminths that infect humans and pigs, respectively. It is estimated that infection by A. lumbricoides affects about 447 million individuals living in tropical regions of developing countries. However, there is an increasing number of cases of human ascariasis in countries with no recent history of autochthonous infection by A. lumbricoides. In these places, pigs have been incriminated as the main source of human infection. Conventional parasitological diagnosis does not allow species-specific identification, and the real epidemiological scenario of human and swine ascariasis is still uncertain. Therefore, this work presents the application of a species-specific molecular diagnosis, based on the allele-specific PCR methodology (AS-PCR), using the Internal Transcript Space 1 (ITS-1) of the ribosomal DNA, as a target for differentiating between the two species, using DNA obtained from eggs. To validate the methodology, stool samples positive for Ascaris spp, were obtained from 68 humans from seven Brazilian states and from six pigs from the state of Minas Gerais. All samples obtained from humans were genotyped as A. lumbricoides and all samples obtained from swine were genotyped as A. suum. These results are in agreement with the literature, which demonstrates that in most endemic regions, transmission cycles are separate. Therefore, the execution of this work allowed the availability of a useful methodology for the differential diagnosis of the species, which may contribute to the characterization of the real epidemiological profile of human and swine ascariasis, and to the implementation of future control strategies.

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Introducción: Áscaris lumbricoides es el helminto más frecuente en el tracto gastrointestinal humano; la mayor prevalencia se registra en países en desarrollo, tropicales y subtropicales. En Cuba constituye una causa exótica de ictericia obstructiva con pocos casos reportados. Objetivo: Describir el manejo terapéutico exitoso de un caso de un hombre con ictericia obstructiva secundaria a ascariasis coledociana. Caso clínico: Paciente de 74 años operado en el Hospital Clínico Quirúrgico "Lucía Íñiguez Landín" de la provincia Holguín por ictericia obstructiva por ascariasis coledociana, con evolución clínico-quirúrgica satisfactoria. Conclusiones: En países en desarrollo debe tomarse en cuenta la ascariasis como causa de enfermedad obstructiva biliar o pancreática. El conocimiento del cuadro clínico y sus complicaciones, además, de las diferentes opciones en el tratamiento, debe ser del dominio de todo médico. La ictericia obstructiva por áscaris lumbricoides constituye en Cuba una causa exótica de esta infestación por parásitos(AU)

Introduction: Ascaris lumbricoides is the most frequent helminthiasis in the human gastrointestinal tract; the highest prevalence is recorded in developing, tropical and subtropical countries. In Cuba, it constitutes an exotic cause of obstructive jaundice with few reported cases. Objective: To describe the successful therapeutic management of a case of a man with obstructive jaundice secondary to choledochal ascariasis. Clinical case report: We report the case of a 74-year-old patient operated on at Lucía Íñiguez Landín Surgical Clinical Hospital, in Holguín province, for obstructive jaundice due to choledochal ascariasis, with satisfactory clinical-surgical evolution. Conclusions: In developing countries, ascariasis should be taken into account as a cause of biliary or pancreatic obstructive disease. Knowledge of the clinical condition and its complications, in addition to the different treatment options, should be the domain of every physician. Obstructive jaundice due to ascaris lumbricoides constitutes an exotic cause of this parasite infestation in Cuba(AU)

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Resumen La necrosis en la pancreatitis aguda muestra una mortalidad muy alta a pesar de los avances en cuidados críticos. Después de la etiología biliar y alcohólica, la tercera causa más común de pancreatitis es la idiopática, con un 10 % de los casos secundarios a parásitos, y el áscaris es el parásito más común implicado en la necrosis e inflamación del páncreas. Teniendo en cuenta la alta mortalidad que representa la pancreatitis necrotizante, se describe un reporte de caso por ascariasis, destacando su creciente epidemiología, sus causas, su diagnóstico clínico e imagenológico, y su tratamiento antiparasitario según la evidencia actual.

Abstract Necrosis in acute pancreatitis presents a high mortality rate despite advances in critical care. After biliary and alcoholic etiology, the third most common cause of pancreatitis is idiopathic etiology, with 10% of cases related to parasites, being Ascaris the most common parasite involved in pancreas necrosis and inflammation. Considering the high rates of mortality related to necrotizing pancreatitis, a case of ascariasis is analyzed, including its growing epidemiology, its causes, its clinical and imaging diagnosis, and its antiparasitic treatment based on current evidence.

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BACKGROUND: The systematics and taxonomy of Ascaris lumbricoides and Ascaris suum, two of the world's most widespread nematodes, still represent a highly debated scientific issue. Two different transmission scenarios have been described according to endemicity: separated host-specific transmission cycles in endemic regions, and a single pool of infection shared by humans and pigs in non-endemic regions. The swine roundworm A. suum is now recognized as an important cause of human ascariasis also in endemic areas such as China, where cross-infections and hybridization have also been reported, as well as in non-endemic regions like Italy. This study aimed to investigate the molecular epidemiology of human and pig ascariasis in three countries representing different epidemiological scenarios: Italy as a non-endemic country, Colombia as an endemic country, and Slovakia as a non-endemic country, but with a poor socio-economic context linked to some focal populations of Roma settlements. MATERIALS AND METHODS: A total of 237 nematodes were analysed: 46 from Colombia (13 from humans, 33 from pigs), 114 from Slovakia (20 from humans, 94 from pigs) and 77 from Italy (17 from humans and 60 from pigs). Genotyping by PCR-RFLP of nuclear (ITS) and sequencing of mitochondrial (cox1) target regions were performed. ITS genotypes were used to estimate the Hardy-Weinberg (HW) equilibrium according to hosts and country of origin. The partial cox1 sequences were used to analyse genetic polymorphisms according to hosts and country of origin, as well as to infer the network of haplotypes, their evolutionary relationships and geographical distribution. RESULTS: 110 quality cox1 sequences were obtained. Haplotype network revealed three main groups corresponding to clade A, B and C. Clade C included most of the human cases from Italy, while those from Slovakia and Colombia were grouped in clade B. Ascaris from Italian and Colombian pigs showed HW equilibrium at the ITS marker, while disequilibrium was found in A. lumbricoides from Slovak pigs, which suggest a high unexpected amount of roundworms of human origin circulating also in pigs. CONCLUSIONS: This study updates and extends the current understanding of Ascaris species and genotypes circulating in different epidemiological scenarios, with particular attention to the inclusion of human-derived Ascaris in the phylogenetic cluster C. Despite the evidence of HW equilibrium in the ITS in pig-derived Italian samples, the amount of genetic variation seems to support the existence of two closely related species.

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BACKGROUND: Most of the studies conducted in Brazil assessing the relationship between water, sanitation and hygiene (WASH) and Soil-transmitted helminth (STH) infections, have focused on cases, reflecting the reality of small areas and not of a countrywide situation. In order to fill this gap, the current paper presents an epidemiological study exploring the association between water and sanitation and STHs prevalence in students from 7 to 17 years old, in all 27 Brazilian Federation Units. METHODS: Three ecological studies were carried out considering the prevalence of ascariasis, trichuriasis, and hookworm as outcome variables. The sample consisted of 197,567 students aged 7-17 years old living in 521 Brazilian municipalities. Data were retrieved from the National Survey on the Prevalence of Schistosomiasis mansoni and Soil-transmitted helminth infections (2011-2015). The Generalized Linear Model with the negative binomial distribution was used to evaluate the statistical association between outcomes and explanatory variables. Univariate and Multivariate analyses were conducted with 25 and 5 % significance levels, respectively. Data were aggregated considering municipalities as the geographical unit for analysis. RESULTS: Protective association was found between access to filtered water and adequate sanitation in schools with ascariasis (RR 0.989, CI 95 % 0.983-0.996; RR 0.988, CI 95 % 0.977-0.998), access to filtered water in schools with trichuriasis (RR 0.986, CI 95 % 0.979-0.993) and adequate sanitation at home with hookworm ((RR 0.989, CI 95 % 0.982-0.996). The percentage of population served with Bolsa Família Program, used as a proxy for poverty, was the only significant variable common to all models. CONCLUSIONS: Our findings support that WASH, both in schools and homes, are essential to schoolchildren health with regard to STHs. However, sanitary interventions will not be fully effective in preventing STH infections without promoting access to quality public services, particularly for people living in poverty, the most vulnerable group.

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Background. The World Health Organization recommends biannual deworming with single-dose albendazole for all children over 1 year in regions where soil-transmitted helminths (STH) are endemic. There are limited data from the Dominican Republic (DR) on the effectiveness of deworming programs. Methods. Between January and June 2019, we enrolled 63 preschool-aged children at a community clinic in the DR. Participants received albendazole at enrollment. Stool samples were collected and examined for parasites at enrollment, 2 to 4 and 12 to 16 weeks post-albendazole. Caregivers were surveyed on home hygiene practices and children's symptoms. Findings. At enrollment, 1 or more parasites were noted in 89% of samples. Ascaris lumbricoides (68%) was the most common species, followed by Entamoeba histolytica (35%) and Giardia intestinalis (8%). Two-to-four weeks post-albendazole, fewer than half of those with A. lumbricoides infections at baseline had cleared the infection. STH symptoms significantly improved between enrollment and 2 to 4 weeks. By 12 to 16 weeks after treatment, A. lumbricoides infections were as high as baseline. Interpretation. Although limited by size and available technology, our study contributes data on STH in the DR. Single-dose deworming with albendazole did not reduce Ascaris lumbricoides infections in our sample. As STH are the most common neglected tropical diseases and negatively impact children's health globally, further studies on both effective deworming programs and interventions to prevent STH are needed.

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Genetic and epigenetic factors are considered to be critical for host-parasite interactions. There are limited data on the role of such factors during human infections with Ascaris lumbricoides. Here, we describe the potential role of genetic factors as determinants of the Th2 immune response to A. lumbricoides in Brazilian children. Stool samples were collected from the children to detect A. lumbricoides by microscopy and peripheral blood leukocytes (PBLs) were cultured in whole blood cultures for detection of cytokines (IL-5, IL-10, and IL-13) in vitro. Levels of anti-A. lumbricoides IgE and IgG4 were measured in plasma. DNA was extracted from PBLs and genotyped using Illumina 2.5 Human Omni Beadchip. Candidate genes associated with A. lumbricoides responses were identified and SNVs in these selected genes associated with the Th2 immune response to A. lumbricoides. Haplotype, gene expression, and epigenetic analyses were done to identify potential associations with Th2 immune responses. GWAS on samples from 1,189 children identified WSB1 as a candidate gene, and IL-21R was selected as a biologically relevant linked gene for further analysis. Variants in WSB1 and IL21R were associated with markers of Th2 immune responses: increased A. lumbricoides-specific IgE and IL-5/IL-13 by PBLs from infected compared to uninfected individuals. In infected children, WSB1 but not IL21R gene expression was suppressed and increased methylation was observed in the WSB1 promoter region. This is the first study to show an association between genetic variants in WSB1 and IL21R and Th2 immune responses during A. lumbricoides infections in children. WSB1/IL21R pathways could provide a potential target for the treatment of Th2-mediated diseases.

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OBJECTIVES: To determine spatial clustering and risk factors for occurrence and intensity of infection for soil-transmitted helminthiasis (STH), namely Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis and hookworms in a Venezuelan rural community. METHODS: MIF-fixed faecal samples were individually collected for STH testing. The Getis-Ord statistic was used to determine significant STH clustering within 25/50/100 m radiuses around houses. Individual- and house-level factors associated with STH occurrence and intensity of infection were determined using generalized estimating equations. RESULTS: Significant clusters of "wormy" houses for one or multiple parasites were found at distances of 25-50 m around 13 houses. Risk factors differed between occurrence and intensity of infection. Overcrowding in the house increased occurrence of S. stercoralis, T. trichiura and hookworm infections, while poor housing conditions increased A. lumbricoides infection risk. Overcrowding, poor faecal disposal system, economic dependency and lack of basic services differentially influenced the STHs. The "wormy" houses were mainly those built with waste materials, under economic dependency and lacking indoor water supply. CONCLUSIONS: STH distribution in a community is clustered, with significant hotspots of STH occurrence and intensity of infection and different associated risk factors. Targeting the "wormy" houses is expected to affect STH morbidity more efficiently.

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Se presenta el caso clínico de una paciente de 27 años de edad, con antecedentes de colecistectomía convencional desde hacía 10 meses por aparente colecistitis, quien acudió al Hospital Luis Vernaza de Guayaquil, Ecuador, por presentar ictericia y dolor abdominal. Teniendo en cuenta los hallazgos clínicos, de laboratorio e imagenológicos se le diagnosticó sepsis de foco abdominal, colangitis y coledocolitiasis. Durante la intervención quirúrgica se observó la presencia de 2 Ascaris lumbricoides y cálculo de colesterol en la vía biliar, por lo que se le realizó una derivación bilioentérica. Después de algunas complicaciones como insuficiencia respiratoria y descompensación hemodinámica, la paciente egresó de la institución a los 25 días de operada, con seguimiento por consulta externa durante 2 meses.

The case report of a 27 years patient is presented, with history of conventional cholecystectomy for 10 months due to apparent cholecystitis who went to Luis Vernaza Hospital in Guayaquil, Ecuador, presenting jaundice and abdominal pain. Taking into account the clinical, laboratory and imaging findings a sepsis of abdominal focus, cholangitis and choledocolithiasis was diagnosed. During the surgical intervention the presence of 2 Ascaris lumbricoides and cholesterol calculi in the bile duct was observed, reason why a bilioenteric bypass was carried out. After some complications such as breathing failure and hemodynamic upset, the patient was discharged from the institution 25 days after the surgery, with follow up in outpatient clinics during 2 months.

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Ascaris lumbricoides provoca una de las helmintiasis más frecuentes en los países tropicales, pudiendo producir efectos patológicos en cualquier parte del organismo, siendo los conductos biliales uno de los sitios recurrentes provocando una colecistitis aguda. La CA es una de las principales causas de ingreso al servicio de Emergencia, es una inflamación de la vesícula cuyo diagnóstico oportuno es de vital importancia para la prevención de complicaciones. Por tal razón, determinar la frecuencia de las variables clínicas, de laboratorio y ecográficas, su relación con las comorbilidades asociadas a las características demográficas de los pacientes y el nivel de severidad de la colecistitis aguda causada por la A. lumbricoides de las Guías de Tokio 2018 del Servicio de Emergencia del Hospital Alfredo Noboa Montenegro durante el periodo junio - diciembre 2018, para la elaboración de un esquema diagnóstico. La metodología de investigación fue cuantitativa descriptiva de corte transversal. Dentro de los principales hallazgos, el CA aparece con prevalencia en el género femenino en un 69,41%, promedio de edad de 32 a 45 años, el 10% de 170 pacientes presentaron en su ecografía una forma parasitaria compatible con A. Lumbricoides, los resultados clínicos arrojaron presencia de dolor (67,34%), fiebre (68,65%), náuseas (45,93%); en los laboratorio la Proteína C Reactiva estuvo aumenta en el 94,18% de los casos, en imagenología se refleja presencia de líquido pericolecistico en un 78,82% y un engrosamiento de pared vesicular en un 34,12%. El nivel de severidad registrado según los criterios de las guías de Tokio 2018 fue grado I 35,3%, grado II 47,1% y grado III 17,6%. Se recomienda la estructuración de un esquema diagnóstico oportuno de colecistitis aguda causada por A. Lumbricoides(AU)

Ascaris lumbricoides causes one of the most frequent helminthiases in tropical countries, being able to produce pathological effects in any part of the body, being the bile ducts one of the recurrent sites causing acute cholecystitis. AC is one of the main causes of admission to the Emergency service, it is an inflammation of the gallbladder whose timely diagnosis is of vital importance for the prevention of complications. signs and symptoms, the timely diagnosis is of vital importance for the prevention of complications. For this reason, determine the frequency of clinical, laboratory and ultrasound variables, their relationship with the comorbidities associated with the demographic characteristics of the patients and the level of severity of acute cholecystitis cause of A. lumbricoides of the Tokyo Guidelines 2018 of the Hospital Emergency Service Alfredo Noboa Montenegro during the period June - December 2018, for the elaboration of a diagnostic scheme. The research methodology was quantitative cross-sectional descriptive. Among the main findings that were prevailed in the female gender in 69,41%, average age from 32 to 45 years, 10% of 170 patients presented in their ultrasound a parasitic form compatible with A. lumbricoides, clinical results that prevailed was presence of pain (67.34%), fever (68.65%), nausea (45.93%); in the laboratory findings the C Reactive Protein was increased in 94,18% of cases, in imaging the presence of pericolecist fluid is reflected in 78,82% and a thickening of the vesicular wall in 34,12%. The severity level recorded according to the criteria of the Tokyo 2018 guidelines was grade I 43,53%, grade II 48,24% and grade III 8,24%. The structuring of a timely diagnostic scheme for acute cholecystitis cause of A. lumbricoides is recommended(AU)

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