An Unusual Case of Campylobacter jejuni Gastroenteritis Presenting with Acute Reversible Encephalopathy in an Immunocompetent Host

Campylobacter jejuni gastroenteritis is the most frequent organism associated with acute infectious diarrhea worldwide. (e clinical presentation involves fever, diarrhea, rigors, and myalgias. Other extraintestinal symptoms that have been described involve delirium and other neurological complications, and the most well-known is Guillain-Barr´e, where there is cross-reactivity between the gastrointestinal tract and the brain. Despite previously described multiple neurological complications, there is a lack of clinical data on the association of Campylobacter-related gastroenteritis with acute encephalopathy in immunocompetent patients. (e type of population, immunocompetent stage, and unfamiliarity with the clinical presentation makes this a challenging diagnosis for clinicians. We report a case of Campylobacter gastroenteritis associated with acute encephalopathy in an immunocompetent patient

Tyrannobdella rex N. Gen. N. Sp. and the Evolutionary Origins of Mucosal Leech Infestations

BACKGROUND: Leeches have gained a fearsome reputation by feeding externally on blood, often from human hosts. Orificial hirudiniasis is a condition in which a leech enters a body orifice, most often the nasopharyngeal region, but there are many cases of leeches infesting the eyes, urethra, vagina, or rectum. Several leech species particularly in Africa and Asia are well-known for their propensity to afflict humans. Because there has not previously been any data suggesting a close relationship for such geographically disparate species, this unnerving tendency to be invasive has been regarded only as a loathsome oddity and not a unifying character for a group of related organisms. PRINCIPAL FINDINGS: A new genus and species of leech from Perú was found feeding from the nasopharynx of humans. Unlike any other leech previously described, this new taxon has but a single jaw with very large teeth. Phylogenetic analyses of nuclear and mitochondrial genes using parsimony and Bayesian inference demonstrate that the new species belongs among a larger, global clade of leeches, all of which feed from the mucosal surfaces of mammals. CONCLUSIONS: This new species, found feeding from the upper respiratory tract of humans in Perú, clarifies an expansion of the family Praobdellidae to include the new species Tyrannobdella rex n. gen. n. sp., along with others in the genera Dinobdella, Myxobdella, Praobdella and Pintobdella. Moreover, the results clarify a single evolutionary origin of a group of leeches that specializes on mucous membranes, thus, posing a distinct threat to human health

Comparative internal and external anatomy of <i>Tyrannobdella rex.</i>

<p>(A) Whole body ventral view illustrating annulation, relative size of the caudal sucker and relative position of gonopores. (B) Eyespot arrangement illustrated dorsally. (C) Male and female median reproductive anatomy.</p

Genes and primer sequences used in phylogenetic analyses.

<p>Genes and primer sequences used in phylogenetic analyses.</p

Taxa used for the phylogenetic analyses, collection localities, and GenBank accession numbers.

<p>Type species of genera are indicated with an asterisk.</p

Comparative jaw morphology of <i>Tyrannobdella rex</i>.

<p>(A) Stereomicrograph of the single dorsal jaw of <i>T. rex</i> with large teeth. Scale bar is 100 µm. (B) <i>Tyrannobdella rex</i> anterior sucker exhibiting velar mouth and longitudinal slit through which the dorsal jaw protrudes when feeding. Scale bar is 1 mm. (C) Compound micrograph in lateral view of eight large teeth of <i>T. rex</i>. Scale bar is 100 µm. (D) Lateral view of jaw of <i>Limnatis paluda</i> illustrating typical size of hirudinoid teeth. Scale bar is 100 µm.</p

Mucosally invasive hirudinoid leeches.

<p>Known from a wide variety of anatomical sites including eyes (A) as in this case involving <i>Dinobdella ferox</i> (B), mucosal leech species, as in a case involving <i>Myxobdella annandalei</i> (C), more frequently feed from the nasopharyngeal surfaces of mammals (D).</p

Single most parsimonious tree based on combined 18S rDNA, 28s rDNA, 12s rDNA, and COI datasets.

<p>The family Praobdellidae formed a well-supported monophyletic group of leeches that exhibits a predilection for mammalian mucosa. All groups received 100 percent bootstrap support and posterior probabilities of 1.00 except as noted on the tree. Branches are drawn proportional to amount of change.</p