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[Digestive localizations of sexually transmitted diseases in male homosexuals].

The common practice of sexual relations with many different and anonymous partners and the great variety of responsible micro-organisms account for the high incidence, growing complexity and uneasy prevention of sexually transmitted diseases of the digestive tract in male homosexuals. Syphilis, gonorrhoea, papillomas, chancroid, donovanosis, herpes virus or Chlamydia infections are known to be transmitted by anal coitus; amebiasis, giardiasis and shigellosis by oro-anal contact (faecal contamination). Still under discussion, however, are the predominant mode of transmission of Campylobacter jejuni, the true frequency in homosexuals of intestinal anguilluliasis, oxyuriasis and salmonellosis and the anorectal pathogenicity of Neisseria meningitidis, intestinal spirochetes, Mycoplasma homini, Ureaplasma urealyticum and Campylobacter-like organisms. Diagnosis is difficult since these infections are polymicrobial as a rule and often clinically asymptomatic or atypical and may be further modified by features of the acquired immunodeficiency syndrome, traumatic lesions or anorectal tumours. Microbiological examination is an essential prerequisite to rational treatment.

Acquired Immunodeficiency Syndrome↗

Epizootic of fatal amebiasis among exhibited snakes: epidemiologic, pathologic, and chemotherapeutic considerations.

An epizootic of reptilian amebiasis seems to have caused the death of 15 to 16 large and valuable captive snakes (boas, pythons, and anacondas) occupying one of 5 large display dioramas in the Steinhart Aquarium of the California Academy of Science, Golden Gate Park, San Francisco. Subsequent review of previous snake deaths in the colony indicated that of 464 snakes that had died since early 1969, 89 snakes had intestinal or hepatic lesions, and 80 of these snakes had pathologic features which involved severe intestinal ulceration, hemorrhage, and massive enteritis, with or without hepatic necrosis and destruction, condition compatible with Entamoeba invadens infection. The present epizootic began in November, 1972, with the death by acute enteritis of a red-tailed boa constrictor (Boa constrictor amarali) and was followed by the loss of 15 other large boids and pythonids. The affected snakes became immobile, refused to feed, and began to die 10 weeks after the death of the red-tailed boa. Seven boa constrictors, 4 pythons, and 4 anacondas from the same diorama died during the ensuing 10 weeks. Entamoeba invadens trophozoites were identified in the stool of the remaining living snake, a 3-m boa constrictor, and in the liver and the intestinal tissue of 1 of the dead boas examined microscopically. The parasite was also found in the stool of a giant Burmese python (Python molurus bivittatus) that died in the adjacent diorama and in the tissues of a blue-tongued skink (Tiliqua scincoides), separately housed, that died of enteritis during this period. Amebic cysts were recovered from turtle and alligator fecal samples taken from a central "swamp," or reservoir, draining the dioramas, water that is returned to the snake display areas after passage through a biological sand-gravel filter and ultraviolet radiation exposure. Cultures from these stools were positive and proved lethal to an experimentally infected boa constrictor. Treatment of the surviving snake in the affected diorama with metronidazole at the dose rate of 275 mg/kg proved rapidly effective; toxicosis was not observed. Other snakes and lizards suspected of having the infection were similarly treated and returned to normal behavior and feeding patterns. Epidemiologic considerations review the probable mode of introduction and spread of this highly lethal snake pathogen and recommendations are made for avoiding infection, prophylactic treatment, and handling of similar epizootics when they do occur among captive reptiles in aquariums, zoos, and research laboratories.

Amebiasis↗

Amoebiasis.

Amoebiasis is the second leading cause of death from parasitic disease worldwide. The causative protozoan parasite, Entamoeba histolytica, is a potent pathogen. Secreting proteinases that dissolve host tissues, killing host cells on contact, and engulfing red blood cells, E histolytica trophozoites invade the intestinal mucosa, causing amoebic colitis. In some cases amoebas breach the mucosal barrier and travel through the portal circulation to the liver, where they cause abscesses consisting of a few E histolytica trophozoites surrounding dead and dying hepatocytes and liquefied cellular debris. Amoebic liver abscesses grow inexorably and, at one time, were almost always fatal, but now even large abscesses can be cured by one dose of antibiotic. Evidence that what we thought was a single species based on morphology is, in fact, two genetically distinct species--now termed Entamoeba histolytica (the pathogen) and Entamoeba dispar (a commensal)--has turned conventional wisdom about the epidemiology and diagnosis of amoebiasis upside down. New models of disease have linked E histolytica induction of intestinal inflammation and hepatocyte programmed cell death to the pathogenesis of amoebic colitis and amoebic liver abscess.

Adult↗

Relationship between serum IgE levels and intestinal parasite load in African populations.

Serum IgE determinations and coproparasitological analyses were carried out on 161 individuals from two distinct ethnic groups (Hutus and Twas) from two regions in Rwanda (North and South). The cumulative parasitosis index (calculated for each individual as the sum of the scores for the four most frequent intestinal parasites) show a linear relation with IgE levels up to a plateau, with no clear pattern of correlation between the score for any given parasite and the IgE level. Such a direct quantitative (but not qualitative) relation reproposes the question on the role of IgE immunoglobulins in intestinal parasitoses.

Amebiasis↗

[Intestinal parasitoses in children of an Indian community of Bolivian altiplano].

A survey about motion parasitosis has been carried out on one hundred Indians (Quechua ethnic group) living in a hamlet called Amarete located in the Bolivian Altiplano. This community is living in a place difficult to reach (11,100 feet) where many pre-Colombian traditions are still alive. All children were parasitized, 75% of them were carrier of 3 to 5 parasites. Infestation with ascaris (91%) is the most frequent and the risks of getting amebic dysentery (Entamoeba histolytica 41%) and balantidial (Balantidium coli 8%) are high. Many other parasites (8 kinds of protozoa , 5 kinds of helminths) can be observed; more especially, we noticed that 20% of the pupils used to be carrier operculated eggs. Tenia embryophores (more probably Taenia solium found in 2 children) made us aware of possibilities of cysticercosis. An other problem lays on general hygiene and hygiene of the water since feces danger is responsible of important parasitologic loads. Results are compared with a fecal study carried out on a population from the Altiplano region but living now in the plain. Amazonian Indian population in previous or recent contact with occidental civilization show the same variations of parasitologic repartition between Amarete hamlet and the transplanted population of Altiplano region. The role played by the acculturation could be discussed.

Adolescent↗

Perforation of the colon in unsuspected amebic colitis: report of two cases.

Two cases of amebic colitis that resulted in perforation of the colon, an ominous complication, are presented. The first was diagnosed preoperatively as acute ulcerative colitis with toxic megacolon, and the second as peritonitis complicating acute cholecystitis. In both instances the correct diagnosis was made after operation. The first patient recovered after colectomy and antiamebic therapy, but the second patient died in the early postoperative period, in septic shock. Amebic colitis occurs infrequently in the United States, and the diagnosis is rarely considered. In most cases an initial diagnosis of ulcerative or granulomatous colitis is made and the true diagnosis is recognized only after operation for colonic perforation or hepatic abscess. It is suggested that amebic colitis should be considered more frequently in cases of patients who have diarrhea. Stool examination for ova and parasites is often negative in amebic colitis. The IHA is usually positive in emebiasis, and should be performed early in casesof patients who have bloody diarrhea or other clinical symptons when amebiasis is suspected. Rectal biopsy is also a useful diagnostic approach, but failed to reveal amebae in one of our cases. Finally, it is suggested that operation be performed urgently when fulminating amebic colitis is not reversed by antiamebic therapy, when peritonitis occurs even with antiamebic treatment in progess, and for colonic perforation or toxic megacolon even when antiamebic therapy has not been indicated.

Adult↗

The gay bowel syndrome: clinico-pathologic correlation in 260 cases.

The clinical and pathological findings in a group of 260 homosexual men comprising 10% of a private proctologic practice are reviewed. A clinical pattern of anorectal and colon diseases encountered with unusual frequency in these homosexual patients is termed the gay bowel syndrome. The clinical diagnoses in decreasing order of frequency include condyloma acuminata, hemorrhoids, nonspecific proctitis, anal fistula, perirectal abscess, anal fissure, amebiasis, benign polyps, viral hepatitis, gonorrhea, syphilis, anorectal trauma and foreign bodies, shigellosis, rectal ulcers and lymphogranuloma venereum. 60 anorectal and sigmoid biopsies from 51 patients failed to disclose evidence of specific infection other than condyloma acuminata. Of 21 patients with biopsy diagnosis of nonspecific proctitis, 8 had a specific infection which was detected by other means,--5 cases of shigellosis and one case each of gonorrheal proctitis, amebiasis and lymphogranuloma venereum. In evaluating proctologic problems in the gay male, all of the known sexually transmitted diseases should be considered. Shigellosis, amebiasis and viral hepatitis should be included. Microbiological evaluation is essential. Concurrent infections with 2 or more pathogens should be anticipated. Chlamydia trachomatis, an important cause of nonspecific urethritis in the general population, is high on the list of possible causes of the nonspecific proctitis present in 31 of the 260 patients.

Abscess↗