Wang Meng, Liu Wei, Xiong Ziman, Li Zhen, Li Jiansha, Xu Xin, Zhang Meng, Xing Mingyou, Ning Qin, Wu Di, Qi Junying
Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
National Medical Center for Major Public Health Events, Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Front Med (Lausanne). 2022 May 11;9:881356. doi: 10.3389/fmed.2022.881356. eCollection 2022.
Parasitic co-infection is commonly observed in natural populations, yet rare in the laboratory. Multiparasitism can have negative effects on the host, ranging from the atypical manifestations to increased mortality, consequently, it may be misdiagnosed and treated with unsuitable anthelmintic medicines. Therefore, reliable diagnosis is critical for appropriate treatment of parasitic co-infection. Herein, we report a case of a 31-year-old woman with persistent eosinophilia and hypoechoic liver lesion on ultrasound. The microscopic examination of multiple stool specimens did not find any pathogens. The patient had serum specific anti- IgG antibody by Dot enzyme-linked immunosorbent assay (Dot-ELISA). After treatment with albendazole, contrast-enhanced magnetic resonance imaging (MRI) revealed more lesions in the liver. Subsequently, liver biopsy was performed in this patient and was identified using metagenomic next-generation sequencing (mNGS) as well as polymerase chain reaction. After treatment with triclabendazole, which is the only anthelmintic drug specifically available against this fluke, her eosinophil count returned normal, and the liver lesions were significantly regressed. This case highlights the diagnostic challenge posed by parasitic co-infection, which merits more in-depth evaluation to confirm the diagnosis.
寄生虫共感染在自然种群中普遍存在，但在实验室中却很少见。多重寄生虫感染可能会对宿主产生负面影响，从非典型表现到死亡率增加，因此，它可能会被误诊并用不合适的驱虫药物治疗。因此，可靠的诊断对于寄生虫共感染的恰当治疗至关重要。在此，我们报告一例31岁女性病例，该患者持续嗜酸性粒细胞增多，超声检查显示肝脏有低回声病变。多次粪便标本的显微镜检查未发现任何病原体。通过斑点酶联免疫吸附试验（Dot-ELISA）检测，患者血清中有特异性抗IgG抗体。使用阿苯达唑治疗后，对比增强磁共振成像（MRI）显示肝脏出现更多病变。随后，对该患者进行了肝活检，并通过宏基因组下一代测序（mNGS）以及聚合酶链反应进行鉴定。使用三氯苯达唑（唯一一种专门用于对抗这种吸虫的驱虫药物）治疗后，她的嗜酸性粒细胞计数恢复正常，肝脏病变明显消退。该病例突出了寄生虫共感染带来的诊断挑战，这值得进行更深入的评估以确诊。
