Page 184 - Medical Parasitology_ A Textbook ( PDFDrive )

14 Case Reports 177

duct, lancet-shaped worms were seen emerging from it, some of them were noted to
be swimming in the washing solution. No stones were found. Lancet-shaped adult
worms were also found in parts of the gallbladder. Forty-five adult worms were sent
to the diagnostic laboratory. The worms were identified as Clonorchis sinensis,
measuring an average of 18 mm long by 4 mm wide and appeared flat, transparent,
attenuated anteriorly, and rounded posteriorly. Branched testes was seen in the pos-
terior part of the body. The eggs retrieved from the ruptured uterus measured an
average of 28 μm long by 14.5 μm wide and were operculated. The histopathology
report showed no evidence of malignancy and histopathological findings of the gall-
bladder was consistent with acute-on-chronic cholecystitis and cholesterosis. On
further questioning, the patient gave a history of travelling to China and Hong Kong
1 month before admission and had consumed raw fish while visiting these places.
After the operation, the patient was treated with praziquantel 25 mg/kg t.i.d. for
2 consecutive days. He had an uneventful recovery.

Source: Rohela, M., J. Surin, I. Jamaiah, I. Init, and S. H. Lee. “Acute cholecys-
titis caused by Clonorchis sinensis.” Southeast Asian Journal of Tropical
Medicine and Public Health 37, no. 4 (2006): 648–51.

Learning Points
1. Clonorchiasis is commonly reported in the Far East and is acquired by ingestion
of raw/undercooked freshwater fish.
2. Clonorchiasis is known to be associated with cholangiocarcinoma.

Acknowledgement
We are grateful to Dr. Benedict Sim Lim Heng, Consultant Infectious Diseases
Physician, Hospital Sungai Buloh, Selangor, Malaysia for providing the learning
points.

Case 20: Visceral Leishmaniasis
Case report: A previously healthy 40-year-old gentleman was referred to the hos-
pital with 1-month history of fever with chills and rigors, significant weight loss and
non-productive cough. He received multiple courses of antibiotic (ampicillin/sul-
bactum, ceftriazone, piperacilin/tazobactam) but to no avail. On examination, he
was febrile (38.5 °C), blood pressure 110/70 mmHg, oxygen saturation of 99%. He
was pale but not jaundiced. There was non-tender hepatomegaly measuring 3 finger
breadth. The Traube’s space was dull. Auscultation of the lungs revealed bibasal
crepitations. Otherwise, jugular venous pressure was not raised and there was no
pitting ankle oedema. Blood investigations demonstrated pancytopenia (white blood
cells 3.2 × 10 /μL, haemoglobin 9.5 g/dL, platelets 39 × 10 /μL) and alkaline phos-
3
3
phatase 110 IU/L. Total bilirubin, alanine transaminase, and renal profile were nor-
mal. Blood cultures and blood film for malaria were repeatedly negative. HIV
serology was negative. A CT scan of chest and abdomen demonstrated hepatomeg-
aly with multiple calcifications in the spleen, pericardial effusion, and consolida-
tions in bilateral lung bases with minimal pleural effusion. Echocardiography