IPSID- a Neglected Cause of Chronic Diarrhea

Abstract

immunoproliferative small intestinal disease is considered as a rare condition and has endemicity inMediterranean countries and often associated with campylobacter jejuni infection. This conditionvaries in severity from benign to frankly malignant. Prolonged remission can be obtained with longterm antibiotic therapy but chemotherapy is required for those who have aggressive disease. Bangladeshidata on IPSID is sparse. Here our patient 21 years old male presented with chronic diarrhoea, occasionalvomiting, severe weakness and significant unintentional weight loss. He had cachectic body built,bipedal edema, easy bruising, glossitis with angular stomatitis. His upper GI endoscopy showed multiplenodular lesion in the duodenum. Biopsy was taken from nodular lesion and sent for histopathology,geneXpert and culture. Histopathology revealed IPSID. He was treated with tetracycline and improvedclinically. J MEDICINE 2022; 23: 84-86

N-acetylmuramoyl-L-alanine amidase : A competent vaccine candidate against IPSID

“…If left untreated can lead to higher grade of b-cell lymphomas, GI bleeding, malnutrition, morbidity and mortality. [1,2] Median diagnostic time is 10 months from the onset of earlier symptoms. Most of the people are successfully diagnosed for the disease when they develop the above-mentioned symptoms and report mild symptoms like diarrhea from the past several years.…”

“…Here, we were able to analyze PVC i.e., N-acetylmuramoyl-L-alanine amidase for development of vaccine against IPSID (Immuno proliferative small intestine disease) which was selected as a PVC by vaxign program [4], with the help of Vaxi-DL and VaxELAN [5,6] in terms of adhesion, secretory nature, trans-membrane helices, cleavage sites, MHC-I binding, CTL epitope prediction, essential genes, molecular weight, non-bacterial pathogen, non-homology with human genome, virulence factors, allergenicity, cellular localization and probability of being a PVC. IPSID is a disease emerging from the low socio-economic background areas such as in mediterranean regions and later spread as sporadic cases increased in European and American countries [1]. C. jejuni is the major and common pathogens found in studies amongst other groups of microbes found in the patients [2].…”

“…Later, in European and American countries the cases were seen due to migration [2]. People from low socio-economic classes majorly in developing areas having poor cleanliness and hygiene maintenance are certain to be invaded by C. jejuni [1]. C. jejuni can trigger a strong immune response, especially in the MALT (mucosal associated lymphocyte tissue).…”

“…The presence of IgA -alpha heavy chain (shortened) and devoid of light chain produced by plasma cells infiltrating the cells of intestine has been detected in the patients. Gastrointestinal endoscopy reveals nodules in distal duodenum and surface epithelium of lamina propria have been infiltrated by lymphocytes which suggests IPSID [1].…”