Extraurogenital Trichomoniasis, Pancreas Pathology and Diabetes: Causation rather than casual association
Krvavac, S., MD
Public Health Center Stari Grad, Sarajevo
Bosnia and Herzegovina
Trichomonads (Ts) clearing from cervix uteri during (sub)acute pancreatitis occured in 3 women with chronic T infection.Personal observation of fibrocystic mastopathy infedted by Ts (Krvavac:Med Arh;1998) and genito-pulmonary translocation of T infection (EFIS Meeting, Edinburgh 1990), suggested to this author the detection of the protozoa in pancreas secretion during their clinical examination.Aflagellary Ts was found in wet mounts of all 3 women and additionaly in pancreatic pseudocyst fluid of a 5 years old male child.Culture was +(pos.) in 1 woman only,which agrees with the fact that Ts from atypical locations hardly grow in commercial culture media.T hominis was identified on the basis of shape.
Contrarily to T vag.,T tenax and T hominis consider as saprophytes although they obligatory sensitize the host. J.Jirovec observed competition of infections by distinct T species in distant organs.This occurence could be today explained by the interspecies cross-immunity. However, the evoked immunity rarely clears Ts but the established focus stimulates immunisation,which by immunocompetent hosts prevents extrafocal T superinfection.Wide spectrum of T antigens, 20-230 kD, can elicite releasing various immunoglobulins. Great intraspecies antigenic differences were proved, so enabling monospecific but polystrain sensitization.If the focus settles in airway then the spontaneously swallowed in mucus wrapped aflagellary Ts can cause various nonspecific disorders in digestive tract of sensitized host.
Drinking of lerge amounts of beverages in gastric phase of food digestion enables Ts to pass the acid barrier,especially if drink uptake is combined with simultaneous pressure from outside on the stomach, which all can push, in mucus enveloped protozoa, into P duct. Experimentally recogniuzed avidity of Ts to P. tissue, combined with enzymatic P autodigestion can cause wide spectrum of pathologic pictures, particularly in immune hyperreactors.
Chronic Ts/P interaction leads to reactive fibrosis which is evident by all parasitoses and is confirmed in experimental animals (BM Honigberg, J. Kulda).
The extreme cold of P,due to drinking of very cool liquid in empty stomach, increased release of proteinases from parasites because of their hypothermic stress and, if combined with trauma, immunodepression, alcoholism and emotional stress, altogether can cause the fall of local mucous resistance of P. drains and subsequent submucous T invasion.
Frequent association, if not even causation, of chronic T infection and precancerous lesions of cervix uteri suggests similar relation between intraductal presence of virulent T strains and neoplastic P processes. Presence of Ts near beta, insulin releasing cells can cause their functional disorder with (sub)clinical and laboratory parameters and apoptosis by thight contact, which in chronic cases could trigger mechanism of diabetes mellitus.
Metronidazole therapy,Hyppocratic hygiene of upper parts of digestive/respiratory tracts or Yogic Shatkarma (cleaning holow digestive/respiratory organs), lactovegetable diet and gravitational facilitation of drainage of P ducts, by right side lying (Yoga posture), in pancreatic digestion phase can clean Ts from P drains.