About one-fourth of the global population is either overweight or obese, both of which increase the risk of insulin resistance, cardiovascular diseases, and infections. In obesity, both immune cells and adipocytes produce an excess of pro-inflammatory cytokines that may play a significant role in disease progression. In the recent coronavirus disease 2019 (COVID-19) pandemic, important pathological characteristics such as involvement of the renin-angiotensin-aldosterone system, endothelial injury, and pro-inflammatory cytokine release have been shown to be connected with obesity and associated sequelae such as insulin resistance/type 2 diabetes and hypertension. This pathological connection may explain the severity of COVID-19 in patients with metabolic disorders. Many studies have also reported an association between type 2 diabetes and persistent viral infections. Similarly, diabetes favors the growth of various microorganisms including protozoal pathogens as well as opportunistic bacteria and fungi. Furthermore, diabetes is a risk factor for a number of prion-like diseases. There is also an interesting relationship between helminths and type 2 diabetes; helminthiasis may reduce the pro-inflammatory state, but is also associated with type 2 diabetes or even neoplastic processes. Several studies have also documented altered circulating levels of neutrophils, lymphocytes, and monocytes in obesity, which likely modifies vaccine effectiveness. Timely monitoring of inflammatory markers (e.g., C-reactive protein) and energy homeostasis markers (e.g., leptin) could be helpful in preventing many obesity-related diseases.
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Larval nematodes belonging to genera Ancylostoma, Strongyloides, Rhabditis, Gnathostoma or microfilariae (Onchocerca volvulus)/adult filaria (Loa loa) can invade human skin, each making different lesion. In a 71-year old immunocompetent Koreanman with 23% eosinophilia and elevated serum IgG (2530 mg/dl), a skin biopsy was undertaken for a nodular lesion at abdominal wall. A longitudinal section of a larval nematode was recognized in mid-dermal tunnel surrounded by pseudolymphomatous diffuse lymphoreticular cell infiltration. The larval nematode, 15 um in maximum diameter, had outermost cuticular layer and pale intestinal cells. The nematode section was identified as a filariform larva of Strongyloides stercoralis mainly based on its maximum diameter. In Korea, this is the first description of a cutaneous larval nematode infection. This case did not show quick migration of lesion which is a typical manifestation of classical cutaneous larva migrans.
Ascariasis is probably the most common helminthic infestation of man, but it seldom causes severe illness.
Pathologic conditions of Ascaris may be caused by adult worms, eggs or larvae. We describe a case of Ascaris egg granulomas that were found incidentally on the surface of the liver in a 75-year-old woman who had undergone a segmentectomy for an intrahepatic stone. Grossly, there were several yellowish calcific nodules of 0.4 cm in diameter on the lateral surface of the left lobe of the liver.
Microscopically, the lesions were located in the hepatic capsule and consisted of fibrocalific nodules with many eggs. The eggs were round to oval, thick-shelled and measured 50~75x30~50 um. Most of the morphologically preserved eggs were fertilized eggs, but they had smooth shells without external protein coats. This case is of interest for the unusual location of the lesion, the presence of eggs without mammillation, and the association with the intrahepatic stone.
A 32-year-old housewife who resides in Taegu was admitted in Yeungman University Hospital due to right upper quadrant abdminal pain of 2 mounths'duration. An abdomical CT and ultrasonography revealed a relatively well demarcated low density mass in the right lobe of liver. Right hepatic lobectomy was performed on the clinical impression of hepatoma. On the light microscopic study, the lobulated liver mass showed extensive central necrosis and fibrosis, with large numbers of pseudotubercles therein. The pseudotubercles have distorted helminthic eggs frequently.
The submitted common bile duct lymph node also showed a few pseudotubercles. The eggs recovered from the tissue homogenate measured 140~152 micrometer by 75~85 micrometer in size and were unembryonated and light yellow to brown.
The eggs were determined as those of Fasciola species. We reported the present case as 11th one of human fascioliasis in korea.