A CLINICAL CASE OF AN ALLERGIC REACTION OF THE TYPE OF ACUTE URTICARIA AND ANGIOEDEMA IN A PATIENT WITH CHRONIC OPISTHORCHIASIS
Abstract
It is known that the invasion of Opisthorchis felineus can lead to the development of sensitization of the human body, which manifests itself in the form of symptoms of urticaria. However, the question of the effect of opisthorchis metabolites on the immune response remains open, depending on the duration of invasion, since information about these changes is only experimental. A patient suffering from opisthorchiasis for 4 years on the background of chronically occurring viral hepatitis C over the past 10 years has received complaints characterizing urticaria and angioedema. Examination revealed lymphadenopathy of the supraclavicular and axillary lymph nodes on the right, signs of inflammation: increased erythrocyte sedimentation rate and C-reactive protein concentration, leukocytosis and severe, persistent eosinophilia, signs of biliary stasis and diffuse liver damage, atrophic gastritis, restrictions in the movement of the left hip joint, which revealed signs of aseptic necrosis of the head of the left femoral bones. This clinical case also indicated the need for a more detailed study of the mechanisms of formation of the immune response in the presence of other diseases affecting the immune system, in this case we are talking about viral hepatitis C. Timely diagnosis of opisthorchiasis, as well as the doctor’s and the patient’s alertness to the risk of developing allergic syndrome may determine the timeliness, prevention and effectiveness of treatment, as well as influence the favorable prognosis of the patient’s condition in the future.
References
Fedorova O.S., Fedotova M.M., Zvonareva O.I. et al. Opisthorchis felineus infection, risks, and morbidity in rural Western Siberia, Russian Federation. PLoS Negl Trop Dis. 2020;14(6):e0008421. DOI: 10.1371/journal.pntd.0008421.
Zhao T.T., Feng Y.J., Doanh P.N., Sayasone S. et al. Model-based spatial-temporal mapping of opisthorchiasis in endemic countries of Southeast Asia. Elife. 2021;10:e59755. DOI: 10.7554/eLife.59755.
Petney T.N., Andrews R.H., Saijuntha W., Wenz-Mücke A. et al. The zoonotic, fish-borne liver flukes Clonorchis sinensis, Opisthorchis felineus and Opisthorchis viverrini. Int J Parasitol. 2013;43:1013–46. DOI: 10.1016/j.ijpara.2013.07.007.
Fedorova O.S., Kovshirina Y.V., Kovshirina A.E. et al. Opisthorchis felineus infection and cholangiocarcinoma in the Russian Federation: A review of medical statistics. Parasitol Int. 2017;66:365–71. 10.1016/j.parint.2016.07.010.
The State Report: Federal Center of Hygiene and Epidemiology of Federal Service for Supervision of Consumer Rights Protection and Human Welfare. Moscow; 2013:116–7.
Hering-Hagenbeck S., Schuster R. A focus of opisthorchiidosis in Germany. Appl Parasitol. 1996;37:260–265.
Ogorodova L.M., Fedorova O.S., Sripa B., Mordvinov V.A. et al. Opisthorchiasis: an overlooked danger. PLoS Negl Trop Dis. 2015;9:e0003563. DOI: 10.1371/journal.pntd.0003563.
Pakharukova M.Y., Mordvinov V.A. The liver fluke Opisthorchis felineus: Biology, epidemiology and carcinogenic potential. Trans R Soc Trop Med Hyg. 2015;110:28–36. DOI: 10.1093/trstmh/trv085.
Pozio E., Armignacco O., Ferri F., Gomez Morales M.A. Opisthorchis felineus, an emerging infection in Italy and its implication for the European Union. Acta Trop. 2013;126:54–62. DOI: 10.1016/j.actatropica.2013.01.
Skripova L.V., Romanenko N.A., Be’er S.A., Beznos T.V. et al. The detection of opisthorchiasis foci in Byelorussia. Med Parazitol (Mosk) n.d.:37–40.
Tselepatiotis E., Mantadakis E., Papoulis S., Vassalou E. et al. Case of Opisthorchis felineus Infestation in a Pilot from Greece. Infection. 2003;31:430–2. DOI: 10.1007/s15010-003-3225-z.
Бакштановская И.В., Степанова К.Б., Кальгина Г.А., Степанова Т.Ф. Взаимосвязи биохимических и иммунологических показателей у больных хроническим описторхозом. Медицинская паразитология и паразитарные болезни. 2018;17:13–19.
Fedorova O.S., Fedotova M.M., Sokolova T.S. et al. Opisthorchis felineus infection prevalence in Western Siberia: A review of Russian literature. Acta Trop 2018;178:196–204. DOI: 10.1016/j.actatropica.2017.11.018.
Mairiang E., Mairiang P. Clinical manifestation of opisthorchiasis and treatment. Acta Trop. 2003;88:221–227. DOI: 10.1016/j.actatropica.2003.03.001.
Fedorova O.S., Janse J.J., Ogorodova L.M. et al. Opisthorchis felineus negatively associates with skin test reactivity in Russia — EuroPrevall-International Cooperation study. Allergy Eur J Allergy Clin Immunol. 2017;72:1096–1104. DOI: 10.1111/all.13120.
Szymczyk A., Jaworski J., Podhorecka M. The challenge of diagnosing and classifying eosinophilia and eosinophil disorders: A review. Cent Eur J Immunol. 2024;49(1):60–69. DOI: 10.5114/ceji.2024.136512.
Zignego A.L., Ferri C., Monti M., LaCivita L., Giannini C., Careccia G., Giannelli F., Pasero G., Bombardieri S., Gentilini P. Hepatitis C virus as a lymphotropic agent: evidence and pathogenetic implications. Clin Exp Rheumatol. 1995;13:S33–7.
Курлаева Л.В., Степанова Т.Ф., Степанова К.Б. и др. Иммунологические показатели у больных хроническим описторхозом при наличии мутаций в генах, ассоциированных с предрасположенностью к остеопорозу. Инфекция и иммунитет. 2023;5:923–930. DOI: 10.15789/2220- 7619-IPI-8486.
Falchi L., Verstovsek S. Eosinophilia in hematologic disorders. Immunol Allergy Clin North. 2015;35:439–452.
Gotlib J. World Health Organization-defined Eosinophilic disorders: 2014 update on diagnosis, risk stratification, and management. Am J Hematol. 2014;89:325–337.
Brigden M., Graydon C. Eosinophilia detected by automated blood cell counting in ambulatory North American outpatients. Incidence and clinical significance. Arch Pathol Lab Med. 1997;121:963–967.
Tefferi A., Patnaik M.M., Pardanani A. Eosinophilia: Secondary, clonal and idiopathic. Br J Haematol. 2006;133:468–492.
Дрынов Г.И., Ушакова Д.В. Паразитарная аллергия. Инфекционные болезни: новости, мнения, обучение. 2014;1:28–32.
Allen J.E., Wynn T.A. Evolution of Th2 Immunity: A Rapid Repair Response to Tissue Destructive Pathogens. PLoS Pathog. 2011;7:e1002003. DOI: 10.1371/journal.ppat.1002003.
Сабитов А.У., Солдатов Д.А., Хаманова Ю.Б. Клинико-иммунологические особенности описторхозной инвазии. Казанский медицинский журнал. 2021;5:626–635. DOI: 10.17816/KMJ2021-626.
Peckruhn M., Elsner P., Tittelbach J. Eosinophilic dermatoses. J Dtsch Dermatol Ges. 2019;17(10):1039–1051. DOI: 10.1111/ddg.13943.
Little T.J. The Coevolution of Virulence: Tolerance in Perspective. PLoS Pathog. 2010;6:e1001006. DOI: 10.1371/journal.ppat.1001006.
Medzhitov R. Disease Tolerance as a Defense Strategy. Science. 2012;335:936–941. DOI: 10.1126/science.1214935.
McSorley H.J., Maizels R.M. Helminth Infections and Host Immune Regulation. Clin Microbiol Rev. 2012;25:585–608. DOI: 10.1128/CMR.05040-11.
Yazdanbakhsh M. Th2 responses without atopy: immunoregulation in chronic helminth infections and reduced allergic disease. Trends Immunol. 2001;22:372–377. DOI: 10.1016/s1471-4906(01)01958-5.
Jittimanee J. Protective immunization of hamsters against Opisthorchis viverrini infection is associated with the reduction of TGF-β expression. Acta Trop. 2012;122:189–195. DOI: 10.1016/j.actatropica.2012.01.010.
Sripa B., Kaewkes S. Relationship between parasite-specific antibody responses and intensity of Opisthorchis viverrini infection in hamsters. Parasite Immunol. 2000;22:139–145. DOI: 10.1046/j.1365-3024.2000.00286.x.
Wongratanacheewin S. Immunodepression in hamsters experimentally infected with Opisthorchis viverrini. J Helminthol. 1987;61:151–156. DOI: 10.1017/s0022149x00009913.
Magen E. Can worms defend our hearts? Chronic helminthic infections may attenuate the development of cardiovascular diseases. Med. Hypotheses. 2005;64:904–909. DOI: 10.1016/j.mehy.2004.09.028.
Magen E. Chronic Opisthorchis felineus infection attenuates atherosclerosis — An autopsy study. Int. J. Parasitol. 2013;43:819–824. DOI: 10.1016/j.ijpara.2013.04.008.
Chaidee A., Onsurathum S., Intuyod K. et al. Co-occurrence of opisthorchiasis and diabetes exacerbates morbidity of the hepatobiliary tract disease. PLoS Negl Trop Dis. 2018;12(6):e0006611. DOI: 10.1371/journal.pntd.0006611.
Bhamarapravati N., Thammavit W., Vajrasthira S. Liver changes in hamsters infected with a liver fluke of man. Am J Trop Med Hyg. 1978;27(4):787–794.
Charoensuk L., Pinlaor P., Laothong U. et al. Bile canalicular changes and defective bile secretion in Opisthorchis viverrini-infected hamsters. Folia Parasitol (Praha). 2014;61(6):512–522. DOI: 10.14411/fp.2014.063.
Lvova M.N., Tangkawattana S., Balthaisong S., Katokhin A.V. et al. Comparative histopathology of Opisthorchis felineus and Opisthorchis viverrini in a hamster model: an implication of high pathogenicity of the European liver fluke. Parasitol Int. 2012;61(1):167–172. DOI: 10.1016/j.parint.2011.08.005.
Sripa B., Kaewkes S. Localisation of parasite antigens and inflammatory responses in experimental opisthorchiasis. Int J Parasitol. 2000;30(6):735–740. DOI: 10.1016/S0020-7519(00)00054-0.
Белобородова Э.И., Святенко И.А., Белобородова Е.В. Течение гастроэзофагеальной рефлюксной болезни на фоне хронического описторхоза. Клинические перспективы в гастроэнтерологии, гепатологии. 2011;4:26–30.
Кривошеев А.Б., Хван Л.А. Хронический описторхоз и билиарная дисфункция. Поликлиника. 2017;3:28–30.
Кузнецова В.Г., Краснова Е.И., Патурина Н.Г. Описторхоз в клинической практике врача-инфекциониста. Леч. врач. 2013;6:74–78.
Kawraemruaen C., Sermswan R.W., Wongrata-nacheewin S. Induction of regulatory T cells by Opisthor-chis viverrini. Parasite Immunol. 2016;38(11):688–697. DOI: 10.1111/pim.12358.
Logan J., Navarro S., Loukas A., Giacomin P. Hel-minth-induced regulatory T cells and suppression of allergic responses. Curr Opin Immunol. 2018;54:1–6. DOI: 10.1016/j.coi.2018.05.007.
