Unexpectedly High Prevalence of  Cystoisospora belli  Infection in Acalculous Gallbladders of Immunocompetent Patients

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Abstract

Objectives

Indications for cholecystectomy have changed dramatically over the past three decades. Cystoisospora belli has been reported in cholecystectomy specimens of immunocompetent patients. The present study was designed to determine the prevalence and clinical association of C belli in the gallbladder.

Methods

The study included retrospective review of cholecystectomy specimens (n = 401) removed for various indications, and a prospective cohort of cholecystectomy specimens (n = 22) entirely submitted for histologic evaluation. Correlations of presence of C belli with age, sex, clinical indication, and abnormalities of preoperative laboratory values were assessed by Fisher exact test.

Results

C belli was identified in 39/401 (9.7%) of the retrospective cohort, and 6/22 (27.3%) of the entirely submitted specimens. The presence of C belli showed no correlation with age, sex, clinical indication, or laboratory abnormalities.

Conclusions

C belli resides in a latent state in the gallbladder and may be best considered a commensal organism.

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Most cited references 35

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A prospective analysis of 1518 laparoscopic cholecystectomies. The Southern Surgeons Club.

WC Meyers, M. Farouk, GD Branum (1991)

The Southern Surgeons Club conducted a prospective study of 1518 patients who underwent laparoscopic cholecystectomy for treatment of gallbladder disease in order to evaluate the safety of this procedure. Seven hundred fifty-eight operations (49.9 percent) were performed at academic hospitals, and 760 (50.1 percent) at private hospitals. In 72 patients (4.7 percent) the operation was converted to conventional open cholecystectomy; the most common reason for the change was the inability to identify the anatomy of the gallbladder as a result of inflammation in the region of this organ. A total of 82 complications occurred in 78 (5.1 percent) of the patients; this is comparable with the rates of 6 to 21 percent that have been reported for conventional cholecystectomy. Overall, the most common complication was superficial infection of the site of insertion of the umbilical trocar. A total of seven injuries to the common bile duct or the hepatic duct occurred during the operation, for a rate of 0.5 percent. Four of the seven injuries were simple lacerations, which were repaired after conversion to conventional cholecystectomy. The incidence of bile-duct injury in the first 13 patients operated on by each surgical group was 2.2 percent, as compared with 0.1 percent for subsequent patients. No complications were attributed directly to either cautery or laser-surgical technique, and similar numbers of complications occurred in academic and private hospitals. The mean hospital stay for the entire group was 1.2 days (range, 6 hours to 30 days). The results of laparoscopic cholecystectomy compare favorably with those of conventional cholecystectomy with respect to mortality, complications, and length of hospital stay. A slightly higher incidence of biliary injury with the laparoscopic procedure is probably offset by the low incidence of other complications.

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Bile duct injuries during laparoscopic cholecystectomy. Factors that influence the results of treatment.

L. Stewart, L W Way (1995)

To analyze the treatment of bile duct injuries during laparoscopic cholecystectomy to discern the factors affecting outcome. An analysis of the treatment of 88 patients with laparoscopic bile duct injuries. A university hospital. Eighty-eight patients with major bile duct injuries following laparoscopic cholecystectomy. Success of treatment, morbidity rate, mortality rate, and length of illness. Operations to repair bile duct injuries were unsuccessful in 27 (96%) of 28 procedures when cholangiograms were not obtained preoperatively, and they were unsuccessful in 69% when cholangiographic data were incomplete. In some cases, lack of complete cholangiographic information led to an inappropriate and harmful operation. When cholangiographic data were complete, the first repair was successful in 16 (84%) of 19 patients. A primary end-to-end repair over a T tube (13 patients) was unsuccessful in every case in which the duct had been divided. Direct closure of a partial defect in the duct was successful in four of seven patients. Fifty-four (63%) of 84 Roux-en-Y hepaticojejunostomies were successful. Factors responsible for the unsuccessful outcomes were the following: incomplete excision of the scarred duct, use of nonabsorbable suture material, use of two-layer anastomosis, and failure to eradicate subhepatic infection before the attempted repair. Dilatation and stenting was uniformly unsuccessful as primary treatment (three patients) and was unsuccessful in only seven of 26 patients following a previous operative repair. Patients first treated by the primary surgeon had an average length of illness of 222 days (P < .01). Only 17% of primary repair attempts and no secondary repair attempts performed by the laparoscopic surgeon were successful. Patients whose first repair was performed by tertiary care biliary surgeons had a length of illness of 78 days (P < .01), and 45 (94%) of 48 repairs by tertiary care biliary surgeons were successful. Surgeons who specialize in the repair of bile duct injuries achieve much better results than those with less experience. The worse results of other surgeons could be attributed in many instances to specific correctable errors. Nonsurgical treatment was usually unsuccessful and substantially increased the duration of disability.

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SAGES expert Delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy.

Rajesh Aggarwal, Horacio Asbun, L Brunt … (2015)

Although it has been 25 years since the introduction of laparoscopy to cholecystectomy, outcomes remain largely unchanged, with rates of bile duct injury higher in the modern age than in the era of open surgery. The SAGES Safe Cholecystectomy Task Force (SCTF) initiative seeks to encourage a culture of safety in laparoscopic cholecystectomy (LC) and reduce biliary injury. An expert consensus study was conducted to identify interventions thought to be most effective in pursuit of this goal.

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Author and article information

Journal

Journal ID (nlm-ta): Am J Clin Pathol

Journal ID (iso-abbrev): Am. J. Clin. Pathol

Journal ID (publisher-id): ajcp

Title: American Journal of Clinical Pathology

Publisher: Oxford University Press (US )

ISSN (Print): 0002-9173

ISSN (Electronic): 1943-7722

Publication date (Print): January 2019

Publication date (Electronic): 04 October 2018

Publication date PMC-release: 04 October 2018

Volume: 151

Issue: 1

Pages: 100-107

Affiliations

[1 ]Department of Pathology, University of Rochester Medical Center, Rochester, NY

[2 ]Department of Pediatrics, University of Rochester Medical Center, Rochester, NY

[3 ]Department of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY

[4 ]Department of Pathology, University of Michigan, Ann Arbor

Author notes

Corresponding author: Michael G. Drage MD, PhD; Michael_Drage@ 123456URMC.rochester.edu .

H.D.N. and K.S. are undergraduate students from other institutions who performed their contribution to the project while participating in the PathIT program at University of Rochester Medical Center.

Author information

Michael G Drage http://orcid.org/0000-0003-2593-8268

Article

Publisher ID: aqy122

DOI: 10.1093/ajcp/aqy122

PMC ID: 6287653

PubMed ID: 30285068

SO-VID: 84a152fa-32ea-442e-a5b0-08e3f86cfec5

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Page count

Pages: 8

Funding

Funded by: University of Rochester Medical Center 10.13039/100009750

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Unexpectedly High Prevalence of Cystoisospora belli Infection in Acalculous Gallbladders of Immunocompetent Patients

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Abstract

Objectives

Methods

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Conclusions

Related collections

Decoding Infection and Transmission

Most cited references 35

A prospective analysis of 1518 laparoscopic cholecystectomies. The Southern Surgeons Club.

Bile duct injuries during laparoscopic cholecystectomy. Factors that influence the results of treatment.

SAGES expert Delphi consensus: critical factors for safe surgical practice in laparoscopic cholecystectomy.

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