Unusual Hepatic Cyst (First Report Of human Apiosomaiasis) In Kurdistan/Iraq. Abdullah A. Hama 1. Kurdistan-Iraq

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1 Unusual Hepatic Cyst (First Report Of human Apiosomaiasis) In Kurdistan/Iraq. Abdullah A. Hama 1 1 Research center/ Technical College of Health / Sulaimani Polytechnic University- Correspondence: Abdullah A. Hama Abdullah.hama@spu.edu.iq Kurdistan-Iraq doi: /icasee Abstract: Protozoan parasites are an important group of pathogens responsible for the human and animal infection. To date, Balantidium coli is the only ciliated known to cause human disease. Apiosoma species are protozoan ciliates ectoparasite found on the gills and body of the aquatic organism primarily freshwater fish. The current study describes the first occurrence of human Apiosoma sp. infection. The patient complained of abdominal discomfort and gastric pain, physical examination, as well as computerized axial tomography scan (CAT scan) and ultrasound graph (U/S), revealed the presence of a cystic structure in the left lobe of the liver. Infection was initially thought to have been caused by Echinococcus granulosus Hydatid cyst (HC). The microscopic examination of the cyst fluid showed the presence of a huge number of Apiosoma sp and protoscolex was not detected. This report concludes that human can be the accidental host of Apiosoma sp. in particular condition. Keywords: Apiosoma sp, hydatid cyst, ciliate, protozoa 1. Introduction Apiosoma species are ectoparasite found on the gills and body of the aquatic organism primarily freshwater fish; this peritrichous ciliate belongs to the order sessilida (Kahl, 1933). Li et al. (2008) stated that the first species of genus Apiosoma was described by Kent (1882) with the name Spirochona tintinnabulum, after that the genus Apiosoma separated from Spirochona by Bütschli (1889) and renamed it Glossatella tintinnabulum. The term Glossatella was used for many years to describe new species of this genus until the priority of Apiosoma (Blanchard, 1885) was adopted by Lom (1966) and Corliss (1979) in their official work. The morphologically Apiosoma sp possess vase-shaped elongated bodies with small basal attachments, an oral ciliated ring, and a small triangular nucleus (Durborow, 2003). Ali and his colleagues (1989) firstly observed Apiosoma species in the Iraq from Babylon, and later from Al- Zaafaraniya in Baghdad (Sadek, 1999). Al-Marjan 114

2 and Abdullah (2008) and Al-nasri (2013) they have reported five species of Apiosoma; A. cylindriform, A. minuta, A. piscicola, A. poteriformis and A. amoebae from different regions of Iraq. These stalked ciliated parasites are known to attach to the skin, gills and buccal cavities of their fish hosts (Mhaisen, et al., 2012). The massive infection causes inflammation and ulceration of the skin and ultimate degeneration of the gills (Hoole et al., 2001). 2. Materials and methods Sampling: The cysts collected from 16 patients postoperatively in Sulaimani teaching hospital and Shorsh Hospital in Sulaimani Province the fluid and a germinal layer of each cyst separately preserved, kept in normal saline and transported to the laboratory for investigation, the cyst fluid washed three times until the supernatant looked clear. The sediments of each cyst microscopically examined for the presence of protoscoleces. The samples are separately divided into two parts, one part of each sample preserved in Ethanol with an equal volume (v/v) of 70% ethanol at 4 C and te other part retained in the formalin 10% for histopathological examination. (Bowles et al., 1992). Fertility and viability The cyst fluid examined by light microscope under (40x) for the presence of protoscoleces. The cysts which have no contain protoscoleces considered as nonfertile, and that contain protoscoleces regarded as a fertile cyst. The Eosin dye (vital stain) used for determination of viability of protoscolices the dead protoscoleces received eosin while the live protoscoleces remain unstained (Daryani et al., 2006). 3. Result and Case description A 43-year-old Kurdish male he was worked as farmer attended the surgical department of the Sulaimani Teaching Hospital in Kurdistan- Iraq, complaining of epigastric pain and abdominal discomfort that had lasted for over two months. The history of fever, jaundice, weight loss and abdominal trauma was not recorded. Also, a normal total white blood cell count, hematocrit, and platelet count were recorded. The physical investigation revealed hepatomegaly that was confirmed by ultrasonography and computed tomography that demonstrated the presence of a thin-layered multiloculated cystic lesion measuring 14 x 6 x 7 cm in the left lobe of the liver. Depending on sonographic and MRI the case was initially diagnosed to be a hydatid cyst due to metacestode stage of Echinococcus granulosus (Fig 1). However, no serological test was performed to confirm the infection. During surgical laparotomy, after aspiration of cyst fluid and partial removal of the cyst by mean of drainage the fluid and residual of the cyst stored at the coolbox and sent to a laboratory for examination. Microscopical examination of the cyst fluid using both direct wet mount and iodine wet mount did not reveal the presence of protoscoleces the larval stage of Echinococcus granulosus which was expected Further, histopathological examination of the cyst material demonstrated the absence of original hydatid cyst structures. Instead, a huge number of ciliated funnel shape organisms detected within the cyst fluid (Fig. 2 and 3), to identification and classification of our finding we adopted the morphological key of peritrichous (Bykhovskaya-Pavlovskaya, et al., 1962 and Hoffman, 1998) our finding morphologically was belong to Apiosoma sp. 115

3 4. Discussion The early stages of hydatid disease are asymptomatic and not detectable by radiology and sonography. While immunodiagnostic tests can be extremely sensitive (Zhang et al., 2007), due to the similarity of the cysts during early developmental stages accurate diagnosis remains difficult. In the present study, an unusual case was initially diagnosed as echinococcosis but was not confirmed by immunological assays. This work is the first record of human Apiosomiasis. The pathogenicity of this organism is unknown, Bauer et al. (1969) and Roberts (1978) stated that species of Apiosoma could be extremely pathogenic for fish. The Apiosoma is known to be potentially harmful; they may cause obstruction of the gills in fish and have the ability to infect the buccal cavity of their host (Mhaisen et al., 2012). However, infection in fish is not known to be fatal, although it may affect their productivity (Duijn, 1973). In heavy infections, Apiosoma sp. can cause inflammation, necrosis, and ulceration of the skin and degeneration of gill tissue and may lead to secondary infection (Hoole et al., 2001). The current study in agreement with Hoole et al.,(2001) and Mhaisen et al., (2012) they stated Apiosoma could be extremely pathogenic for fish and can cause ulceration of the skin and degeneration of gill tissue. In conclusion, we have shown that Apiosoma sp. have the potential to infect human tissues, especially liver cells. Further studies are needed to understand the criteria of infection, life cycle, transmission, pathogenesis, prevention, and control. Conflict of interest There are no conflicts of interest associated with this work. Acknowledgment The author appreciates Surgical Department of Sulaimani Teaching Hospital for his collaborate and facility. References Ali, N. M., Mhaisen, F. T., Abul-Eis, E. S. and Kadim, L. S Parasites of the silver carp Hypophthalmichthys matrix from Babylon Fish Farm, Hilla, Iraq. Riv. Idrobiol., 28 (1-2): AL-Marjan, K. S., and Abdullah S. M. A Some ecto parasite of the common carp (Cyprinus carpio) in Ainkawa Fish Hatchery, Erbil province, J. Duhok Univ. 12(1); Al-Nasri, F. S Protozoan parasites of five fish species from the Tigris River in Salah Al-deen, Province Iraq. J. Tikrit Univ. For Agri. Sci. 13 (1); Bauer, O.N., Musselius, V. A. and Strelkov, Yu. A Diseases of pond fish. Izdat. Kolos, Moscow: 220 pp. 116

4 Blanchard, R. (1885): Sur uninfusoire peritriche ectoparasite des poissonsd eaudouce. Bull Soc. Zool. 10: Bowles J, D. Blair, D.P. McManus Genetic variants within the genus Echinococcus identified by mitochondrial DNA sequencing, Molec. Biochem. Parasitol.1992, 54; pp Bykhovskaya-Pavlovskaya, I. E., A. V. Gusev, M. N. Dubinia, N. A. Izyumova, T. S. Smirnova, I. L. Sokolovskaya, G. A. Shtein, S. S. Shul'man, and V. M. Epshtein, (1962) Key to parasites of freshwater fish of the U. S. S. R, Akad. Nauk, S. S. S. R., Moscow. Corliss, J.O. (1979): The ciliated protozoa: Characterization, classification and guide to the literature, 2nd edition. Peragmon Press, pp 455. Daryani A.; Alaei, R.; Arab, R.; Sharif, M.; Deghahan, M. H., and Ziaei H. (2006).Prevalence of hydatid cyst in slaughtered animals in northwest Iran. J. Anim. and Vet. Adv., 5(4): Duijn, van C. Jnr Diseases of fishes, 3rd edn., Illife Books, London: 372 pp. Durborow, R. M Protozoan parasites. Southern regional aquaculture center. SRAC Publication No Hoffman, G. L Parasites of North American freshwater fishes, 2 edn. Cornell Univ. Press, London. Hoole, D., Bucke, D., Burgess, P. and Well by, I Diseases of Carp and other cyprinid fishes. Blackwell Science, London. doi: /s Kahl, A Ciliata Liberia et ectocommensalia. In: Grimpe G, Wagler E (eds) Die Tierwelt der Nord-und Ostsee. Life. 23 (Teil II, C3), Leipzig, p Kent,W.S. (1882): A manual of the infusoria I III. Bogue, London. Li, M.; Wang, J.; Zhu, D.; Gu., Z.; Zhang, J.; and Gong, X. (2008): Study of Apiosoma piscicola (Blanchard 1885) occurring on fry of freshwater fishes in Hongze, China with consideration of the genus Apiosoma. Parasitol. Res. 102: Lom, J. (1966): Sessiline peritrichs from the surface of some freshwater fishes. Folia Parasitol., (Praha). 18: Mhaisen, F. T., Al-Niaeem, K. S. and Al Zubaidy, Literature reviews on fish parasites of Al-Furat fish farm, Babylon Province, Iraq. Iraqi J. Aquaculture, 9 (1); S trebo, R. R.J Fish pathology. Second Edition. Bailliere Tindall, London. Sadek, A. A Ectoparasites of the juvenile of the common carp (Cyprinus Carpio) stacked in high density during winter and autumn. M. Sc. Thesis, Coll. Educ. (Ibn Al-Haitham), Univ. Baghdad. 100pp. Zhang, WB., Li. J., Li, Q. et al Identification of a diagnostic antibodybinding region on the immunogenic protein EpC1 from Echinococcus granulosus and its application in population screening for cystic echinococcosis. Clin Exp Immunol 149:

5 Figure (1): Liver multiloculated cyst (14 x 6 x 7 cm) Figure 2: Apiosoma sp. Stained with iodine, 40x Apiosoma Figure 3: camera lucida od 118

Protozoan parasites of five fish species from the Tigris River in Salah Al- Deen province, Iraq

Protozoan parasites of five fish species from the Tigris River in Salah Al- Deen province, Iraq Fatima S. Al-Nasiri Department of Biology, College of Science, Tikrit University (fshnasiri@yahoo.com) KeyWords: