Prevalence of parasitic infections in surgically removed appendices: parasitological and histopathological studies

Abstract

Summary Intestinal parasites may cause symptoms similar to acute appendicitis. Moreover, the diagnosis of parasitic infections is only done by post-operative histopathological examination of the appendices. Therefore, our aims are to assess the prevalence of intestinal parasitic infections among patients who were be appendectomized at Tanta Hospitals, Egypt and to investigate the possible association between these parasitic infections and appendicitis. To achieve these objectives, we performed a cross-sectional study including 65 patients chosen randomly who had undergone appendectomy over a period of one year from Oct 2015 to Oct 2016. Demographic data were retrieved. Complete blood picture was done. Moreover, appendiceal faecolith were examined macroscopically then by direct smear examination, formol-ether concentration technique, modified Ziehl-Nelseen stain and rapid immunochromatographic test. Histopathological examination of resected appendices was done. We found that parasitic infections were detected in 24.6 % of examined cases. Most of parasitic infections were prevalent in patients belonging to the school age group. Different parasitic infections were detected in the faecolith specimens. Moreover, Enterobious vermicularis adult female and Schistosoma mansoni granuloma were detected in histopathological sections. Also, a spectrum of pathological changes in the appendices was found ranging from lymphoid hyperplasia to acute inflammation with peritonitis. In conclusion, intestinal parasites may cause clinical picture similar to that of acute appendicitis. Therefore, careful attention to clinical history, stool examination and high eosinophilia may aid diagnosis and avoid unnecessary appendectomy. Moreover, the presence of different parasitic stages in the narrow lumen of the appendix may have a role in the development of appendicitis and this needs further studies.