1392
Correspondence
4. Le CT.Tick-borne relapsing fever in children. Pediatrics 1980;66:963-6. 5. Horton JM, Blaser MI. The spectrumof relapsing fever in the Rocky Mountains. Arch Intern Med 1985;145:871-5. 6. Felsenfeld O. Borrelia: strains, vectors, humanand animalborreliosis. St. Louis: Warren H. Green, 1971.
JlD 1991;163 (June)
7. ButlerT, Jones PK, Wallace CK. Borrelia recurrentis infection: singledoseantibiotic regimens and management of the Jarisch-Herxheimer reaction. J Infect Dis 1978;137:573-7.
Balantidium coli Infestation as a Cause of Acute Appendicitis
Reprints or correspondence: Dr. LeslieG. Dodd, Department of Pathology and Laboratory Medicine, UCLA Center for HealthSciences, 10833 Le Conte Ave., Los Angeles, CA 90024. The Journal of Infectious Diseases 1991;163:1392 © 1991 by The University of Chicago. All rights reserved. 0022-1899/91/6306-0044$01.00
Figure 1. Balantidium coli trophozite surrounded by inflammatory cells withintheappendix wall. Characteristic macronucleus andciliated cellmembrane are visible under high magnification (original x880).
manifesting as acuteappendicitis, suchas Strongyloides stercoralis [4, 5] and cryptosporidial infection [6]. B. coliis an exceedingly rare causeof acuteappendicitis. Appendicial involvement secondary to disseminated balantidial infection has been described once previously in a fatal case [7] but has not beenpreviously described as a primary infestation. B coliandother parasites are important to distinguish in appendectomy specimens because thecareofthepostsurgical patient may be altered significantly in an effort to eradicate the pathogen. Leslie G. Dodd UCLA Center for the Health Sciences, Los Angeles, California References 1. Gupta SC, Gupta AK, Keswani NK, Singh PA, Tripathi AK, Krishna
V. Pathology oftropicalappendicitis. J Clin PathoI1989;42:1169-72. 2. Hamadto HA, ArafaMS,AbdelWahab MA, et al. Relation between intestinal parasitosis and appendicitis. J Egypt Soc Parasitol 1986;16: 111-6. 3. Bredesen J, Lauritzen AF, Kristiansen VB, Sorensen C, Kjersgaard P. Appendicitis andenterobiasis in children. ActaChir Scand1988;154: 585-7. 4. NadlerS, Cappell NS, BhattB, MatanoS, Kure K. Appendiceal infection by Entamoeba histolytica and Strongyloides stereoralis presenting like acute appendicitis. Dig Dis Sci 1990;35:603-8. 5. ShakirAF,Youngberg G, Alvarez S. Strongyloides infestation as a cause of acute appendicitis. J Tenn Med Assoc 1986;79:543-4. 6. Ramsden K, FreethM. Cryptosporidial infection presenting as an acute appendicitis. Histopathology 1989;14:209-11. 7. Dorfman S, Rangel 0, Bravo LG. Balantidiasis: reportof a fatalcasewith appendicular andpulmonary involvement. TransR SocTropMedHyg 1984;78:833-4.
Downloaded from http://jid.oxfordjournals.org/ at New York University on May 27, 2015
COLLEAGUEs-Balantidium coli is a large, ciliated protozoa that normally inhabits theintestines ofinsects, fish, amphibians, andmammals. In humans, infestation is probably acquired by ingestion of cysts in contaminated food or water. Human infection is rare and usually asymptomatic. Occasionally the parasitewill produce disease in the humanhostwith symptoms attributable to invasion and inflammation of the distal large intestine. Primary involvement of the appendix with B. coli is distinctly rare and until now has not been recorded in the literature. This is the report of such a case. A l6-year-old hispanic boy presented with complaints of rightlower-quadrant abdominal pain for the preceding 18 h. Temperature was 38.5°C, anda complete bloodcountrevealed 18,500 white cells/mm'' with89% neutrophils, 6% lymphocytes, 3% monocytes, and 2% eosinophils. He was taken to surgery with a presumptive diagnosis of acuteappendicitis, anda gangrenous appendix was removed. Histopathologic examination of the appendix revealed severe inflammation, ulceration, and necrosis of the appendix wall. The predominant inflammatory cell type waspolymorphonuclear with occasional eosinophils. B. coli trophozoites werefound throughout the wallofthe appendix and adhering to the sloughed mucosal surface. The trophozoites were40-60 /Lm in diameter and showed the characteristic sausage-shaped macronucleus. Parasitic infection of the appendix is a well recognized causeof clinical acute appendicitis. In a large series of appendectomies reviewed fromIndia, an areawitha highprevalence of occultparasiticinfection, 2.5%of all removed appendices wereshown to contain unsuspected parasites [1]. Enterobius vermicularis was most frequent, present in 1.4% of the removed appendices. Entomoeba histolytica, Ascaris, Trichuris, and Taenia organisms were also identified, each in
Correspondence
4. Le CT.Tick-borne relapsing fever in children. Pediatrics 1980;66:963-6. 5. Horton JM, Blaser MI. The spectrumof relapsing fever in the Rocky Mountains. Arch Intern Med 1985;145:871-5. 6. Felsenfeld O. Borrelia: strains, vectors, humanand animalborreliosis. St. Louis: Warren H. Green, 1971.
JlD 1991;163 (June)
7. ButlerT, Jones PK, Wallace CK. Borrelia recurrentis infection: singledoseantibiotic regimens and management of the Jarisch-Herxheimer reaction. J Infect Dis 1978;137:573-7.
Balantidium coli Infestation as a Cause of Acute Appendicitis
Reprints or correspondence: Dr. LeslieG. Dodd, Department of Pathology and Laboratory Medicine, UCLA Center for HealthSciences, 10833 Le Conte Ave., Los Angeles, CA 90024. The Journal of Infectious Diseases 1991;163:1392 © 1991 by The University of Chicago. All rights reserved. 0022-1899/91/6306-0044$01.00
Figure 1. Balantidium coli trophozite surrounded by inflammatory cells withintheappendix wall. Characteristic macronucleus andciliated cellmembrane are visible under high magnification (original x880).
manifesting as acuteappendicitis, suchas Strongyloides stercoralis [4, 5] and cryptosporidial infection [6]. B. coliis an exceedingly rare causeof acuteappendicitis. Appendicial involvement secondary to disseminated balantidial infection has been described once previously in a fatal case [7] but has not beenpreviously described as a primary infestation. B coliandother parasites are important to distinguish in appendectomy specimens because thecareofthepostsurgical patient may be altered significantly in an effort to eradicate the pathogen. Leslie G. Dodd UCLA Center for the Health Sciences, Los Angeles, California References 1. Gupta SC, Gupta AK, Keswani NK, Singh PA, Tripathi AK, Krishna
V. Pathology oftropicalappendicitis. J Clin PathoI1989;42:1169-72. 2. Hamadto HA, ArafaMS,AbdelWahab MA, et al. Relation between intestinal parasitosis and appendicitis. J Egypt Soc Parasitol 1986;16: 111-6. 3. Bredesen J, Lauritzen AF, Kristiansen VB, Sorensen C, Kjersgaard P. Appendicitis andenterobiasis in children. ActaChir Scand1988;154: 585-7. 4. NadlerS, Cappell NS, BhattB, MatanoS, Kure K. Appendiceal infection by Entamoeba histolytica and Strongyloides stereoralis presenting like acute appendicitis. Dig Dis Sci 1990;35:603-8. 5. ShakirAF,Youngberg G, Alvarez S. Strongyloides infestation as a cause of acute appendicitis. J Tenn Med Assoc 1986;79:543-4. 6. Ramsden K, FreethM. Cryptosporidial infection presenting as an acute appendicitis. Histopathology 1989;14:209-11. 7. Dorfman S, Rangel 0, Bravo LG. Balantidiasis: reportof a fatalcasewith appendicular andpulmonary involvement. TransR SocTropMedHyg 1984;78:833-4.
Downloaded from http://jid.oxfordjournals.org/ at New York University on May 27, 2015
COLLEAGUEs-Balantidium coli is a large, ciliated protozoa that normally inhabits theintestines ofinsects, fish, amphibians, andmammals. In humans, infestation is probably acquired by ingestion of cysts in contaminated food or water. Human infection is rare and usually asymptomatic. Occasionally the parasitewill produce disease in the humanhostwith symptoms attributable to invasion and inflammation of the distal large intestine. Primary involvement of the appendix with B. coli is distinctly rare and until now has not been recorded in the literature. This is the report of such a case. A l6-year-old hispanic boy presented with complaints of rightlower-quadrant abdominal pain for the preceding 18 h. Temperature was 38.5°C, anda complete bloodcountrevealed 18,500 white cells/mm'' with89% neutrophils, 6% lymphocytes, 3% monocytes, and 2% eosinophils. He was taken to surgery with a presumptive diagnosis of acuteappendicitis, anda gangrenous appendix was removed. Histopathologic examination of the appendix revealed severe inflammation, ulceration, and necrosis of the appendix wall. The predominant inflammatory cell type waspolymorphonuclear with occasional eosinophils. B. coli trophozoites werefound throughout the wallofthe appendix and adhering to the sloughed mucosal surface. The trophozoites were40-60 /Lm in diameter and showed the characteristic sausage-shaped macronucleus. Parasitic infection of the appendix is a well recognized causeof clinical acute appendicitis. In a large series of appendectomies reviewed fromIndia, an areawitha highprevalence of occultparasiticinfection, 2.5%of all removed appendices wereshown to contain unsuspected parasites [1]. Enterobius vermicularis was most frequent, present in 1.4% of the removed appendices. Entomoeba histolytica, Ascaris, Trichuris, and Taenia organisms were also identified, each in
