Parasites-associated cholecystitis

Introduction and objectives: A wide variety of infectious agents has been associated withhepatobiliary diseases. The authors report cases of cholectystitis and cholangitis due toinfection with pathogenic parasites especially the coccidia.Material and Methods: Coccidiosis of the biliary tree was studied retrospectively in morethan three hundred patients with and without HIV/AIDS whom underwent cholecystectomy,at the Parasitology and Mycology Department of Shiraz Medical School, Iran. The diagnosiswas made by means of review histopathologic examination and imaging studies as well as thenested-PCR techniques on the residual paraffin-embedded biopsy tissues for confirmationusing specific primers of the coccidian protozoa.Results: Parasitic infections-related chronic acalculous cholecystitis was found in threepatients. Light microscopic examination of histopathological slides revealed the presence ofdevelopmental stages (schizogony, gametogony, oocysts and so on) of three coccidialparasites in three cases. The microscopic and molecular characteristics of thesemicroorganisms corresponded to Sarcocystis, Isospora belli, and Cryptosporidium. One caseof cholecystitis due to pressure an expanded hepatic cyst on a major bile duct also found.Investigations of histopathology, ultrasonography and computed scan reports showeddistended gallbladders with thickened walls and without calculi. Abdominal computed scanand ERCP of fifth case had been shown gallbladder sludge with no stones but dilation of thebile ducts. Acid-fast stain performed on fifth patient’s concentrated stool specimendemonstrated oocysts of Cyclospora cayetanensis.Discussion: To our knowledge, hepatobiliary diseases especially cholecystitis associated withcoccidian parasites have not been previously reported from Iran. When a patient withintermittent epigastric and right upper-quadrant pain recurred develops gallbladder or bileduct inflammation without stone, we propose that coccidiosis be included as a causativeagent.

کلیدواژه ها:

Cholecystitis ، cholangitis ، Cryptosporidium ، Isospora ، Sarcocystis ، Iran