Human babesiosis is a tick-borne disease induced by the genus Babesia and has been significantly reported in the Republic of Korea. This report shows the cases of 2 patients with human babesiosis who traveled to the USA in 2019. The 2 patients experienced fever and had travel histories to babesiosis-endemic regions. The diagnoses of both cases were verified by the identification of Babesia-infected red blood cells on blood smears. One patient was found to be infected with Babesia microti using polymerase chain reaction (PCR) for 18S rRNA, which discovered the phylogenetic link to the B. microti strain endemic in the USA. The 2 patients recovered from fever with subsequent hemoparasite clearance. Babesiosis could be diagnosed in anyone with histories of travel to babesiosis-endemic countries and tick bites. Furthermore, Babesia-specific PCR is required for determining geno-and phenotypic characteristics.
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The prevalence of human taeniasis has decreased in Korea. The stool egg positive proportion decreased from 1.9% in 1971 to 0% in 2004 in nationwide surveys. The neurocysticercosis (NCC) is also presumed to decrease. However, detailed information regarding the recent status of NCC in Korea is lacking. We retrospectively reviewed NCC cases from 1990 to 2016 at Asan Medical Center, a 2700-bed tertiary referral hospital in Korea. We identified patients based on clinical symptoms, brain imaging, pathology and serological assay. The cases were classified as parenchymal, extraparenchymal, and mixed NCC. Eighty-one patients were included in the analysis. The mean age was 54.5 years, and 79.0% were male. The number of NCC cases was highest from 1995 to 1999, and continuously decreased thereafter. Forty (49.4%) patients had parenchymal NCC, while 25 (30.9%) patients had extraparenchymal NCC, and 16 (19.8%) patients had mixed NCC. The seizure and headache were most common symptom of parenchymal NCC and extraparenchymal NCC respectively. Hydrocephalus was more common in extraparenchymal NCC, and patients with extraparenchymal NCC were more likely to require a ventriculoperitoneal shunt. Cases of NCC are decreasing accordingly with human taeniasis and lesion location was the most important determinant of clinical presentation and outcome of NCC in Korea.
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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.
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Toxoplasma gondii infection induces alteration of the host cell cycle and cell proliferation. These changes are not only seen in directly invaded host cells but also in neighboring cells. We tried to identify whether this alteration can be mediated by exosomes secreted by T. gondii-infected host cells. L6 cells, a rat myoblast cell line, and RH strain of T. gondii were selected for this study. L6 cells were infected with or without T. gondii to isolate exosomes. The cellular growth patterns were identified by cell counting with trypan blue under confocal microscopy, and cell cycle changes were investigated by flow cytometry. L6 cells infected with T. gondii showed decreased proliferation compared to uninfected L6 cells and revealed a tendency to stay at S or G2/M cell phase. The treatment of exosomes isolated from T. gondii-infected cells showed attenuation of cell proliferation and slight enhancement of S phase in L6 cells. The cell cycle alteration was not as obvious as reduction of the cell proliferation by the exosome treatment. These changes were transient and disappeared at 48 hr after the exosome treatment. Microarray analysis and web-based tools indicated that various exosomal miRNAs were crucial for the regulation of target genes related to cell proliferation. Collectively, our study demonstrated that the exosomes originating from T. gondii could change the host cell proliferation and alter the host cell cycle.
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Exosomes in Pathogen Infections: A Bridge to Deliver Molecules and Link Functions Wenchao Zhang, Xiaofeng Jiang, Jinghui Bao, Yi Wang, Huixing Liu, Lijun Tang Frontiers in Immunology.2018;[Epub] CrossRef
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A new landscape of host–protozoa interactions involving the extracellular vesicles world Bruno Gavinho, Izadora Volpato Rossi, Ingrid Evans-Osses, Jameel Inal, Marcel I. Ramirez Parasitology.2018; 145(12): 1521. CrossRef
Extracellular vesicles isolated from Toxoplasma gondii induce host immune response Valeria Oliveira Silva, Marta Marques Maia, Ana Claudia Torrecilhas, Noemi Nosomi Taniwaki, Gislene Mitsue Namiyama, Katia Cristina Oliveira, Kleber Silva Ribeiro, Maytê dos Santos Toledo, Patricia Xander, Vera Lucia Pereira‐Chioccola Parasite Immunology.2018;[Epub] CrossRef
Chronic diarrhea with a 35 kg weight loss (75 kg to 40 kg) occurred during 2 years in an alcoholic patient was diagnosed with Isospora belli infection in the Republic of Korea. The patient, a 70-year old Korean male, had been a heavy drinker for more than 30 years. He was admitted to the Seoul National University Hospital because of long-standing diarrhea and severe weight loss. He had an increased white blood cell (WBC) count with high peripheral blood eosinophilia (36.8-39.9%) and lowered protein and albumin levels but without any evidence of immunosuppression. A parasitic infection was suspected and fecal examination was repeated 3 times with negative results. Peroral endoscopy with mural biopsy was performed in the upper jejunum. The biopsy specimens revealed villous atrophy with loss of villi together with various life cycle stages of I. belli, including trophozoites, schizonts, merozoites, macrogamonts, and microgamonts. The patient was treated successfully with oral doses of trimethoprim 160-320 mg and sulfamethoxazole 800-1,600 mg daily for 4 weeks. A follow-up evaluation at 2.5 years later revealed marked improvement of body weight (68 kg), increased protein and albumin levels, and normal WBC count with low eosinophils (3.1%). This is the first clinical case of isoporiasis with demonstration of various parasitic stages in the Republic of Korea.
A Case of Cystoisospora (Isospora) belli Infection With Multiple Life Stages Identified on Endoscopic Small Bowel Biopsies Daniel J. Rowan, Samar Said, Audrey N. Schuetz, Bobbi S. Pritt International Journal of Surgical Pathology.2020; 28(8): 884. CrossRef
Endogenous development of Cystoisospora belli in intestinal and biliary epithelium of humans J. P. Dubey, Kimberley J. Evason, Zenta Walther Parasitology.2019; 146(07): 865. CrossRef
Cystoisospora belliinfections in humans: the past 100 years J. P. Dubey, S. Almeria Parasitology.2019; 146(12): 1490. CrossRef
Uncommon and fatal case of cystoisosporiasis in a non HIV-immunosuppressed patient from a non-endemic country Lucie Post, Cécile Garnaud, Danièle Maubon, Hervé Pelloux, Catherine Mansard, Annick Bosseray, Céline Dard Parasitology International.2018; 67(1): 1. CrossRef
Intestinal isosporiasis in patients with acquired immunodeficiency syndrome (AIDS). Pathologic diagnosis in small intestinal mucosal biopsies David Oddó, Gonzalo P. Méndez, Yasmina Retamal, Aarón Oddó Annals of Diagnostic Pathology.2018; 33: 17. CrossRef
Unexpectedly High Prevalence of Cystoisospora belli Infection in Acalculous Gallbladders of Immunocompetent Patients Mushal Noor, Philip J Katzman, Aaron R Huber, Jennifer J Findeis-Hosey, Christa Whitney-Miller, Raul S Gonzalez, Zhongren Zhou, Henriette D N’kodia, Kathryn Skonick, Rebecca L Abell, Lawrence J Saubermann, Laura W Lamps, Michael G Drage American Journal of Clinical Pathology.2018;[Epub] CrossRef
A Road Less Travelled: Clinical Comparison of HIV Seropositive and Seronegative Patients with Cystoisosporiasis – An 11-Year Experience from a Tertiary Care Centre in Northern India Ujjala Ghoshal, Vidhi Jain, Nidhi Tejan, Sonali Khanduja Kalra, Prabhat Ranjan, Richa Sinha, Dinesh Gangwar, Uday C. Ghoshal Indian Journal of Medical Microbiology.2018; 36(4): 508. CrossRef
Intestinal coccidian parasites as an underestimated cause of travellers’ diarrhoea in Polish immunocompetent patients Matylda Kłudkowska, Łukasz Pielok, Krystyna Frąckowiak, Małgorzata Paul Acta Parasitologica.2017;[Epub] CrossRef
Chronic Cystoisospora belli infection in an immunocompetent Myanmar refugee – microscopy is not sensitive enough Sze-Ann Woon, Rongchang Yang, Una Ryan, Peter Boan, David Prentice BMC Infectious Diseases.2016;[Epub] CrossRef
Eosinophils in Gastrointestinal Disorders Pooja Mehta, Glenn T. Furuta Immunology and Allergy Clinics of North America.2015; 35(3): 413. CrossRef
An Up-To-Date Review of Piglet Isosporosis Vasiliki Boulaki, Dimitrios Vlachakis, Smaragda Sotiraki, Sophia Kossida International Journal of Systems Biology and Biomedical Technologies.2013; 2(4): 49. CrossRef
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