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PubMed2006

Minimal change nephrotic syndrome in association with strongyloidiasis.

Although parasitic infections have been known to be associated with immune complex-mediated glomerular lesions, strongyloidiasis-related glomerulopathy has not been well documented. We report a patient with delayed-recognized disseminated strongyloidiasis who developed nephrotic syndrome 3 months after the beginning of the manifestations related to strongyloidiasis. A kidney biopsy showed minimal change disease. We treated strongyloidiasis and hesitated to give steroid therapy for the treatment of minimal change nephrotic syndrome (MCNS) because of the risk of aggravation of Strongyloides stercoralis infection. Surprisingly, resolution of heavy proteinuria occurred after anthelmintic therapy with ivermectin. This case suggests a possible causal relationship between S. stercoralis infection and MCNS. In addition, a review of another 4 cases previously reported in the literature demonstrates the importance of detecting underlying S. stercoralis infection in patients with nephrotic syndrome since steroid therapy can cause hyperinfection or disseminated strongyloidiasis, and which may lead to fatal outcome.

Aged↗

PubMed2000

Pulmonary strongyloidiasis--case report of 2 cases.

Strongyloidiasis is a benign gastrointestinal infection. It can pass through the lungs and induce pulmonary strongyloidiasis. The suspicion of pulmonary involvement begins with clinical and chest radiographic features in the patients at risk. They are as follows: chronic lung diseases, age was 65 years, altered cellular immunity, and use of corticosteroids. Definitive diagnosis is made by identification of strongyloides in the secretion or tissue of the respiratory tract. We present 2 patients with pulmonary strongyloidiasis in this research. These 2 cases were patients with chronic obstructive pulmonary disease; both patients were more than 65 years old. They had the risk factors for severe strongyloides infection (advanced age, use of corticosteroids, an high serum cortisol level), worsening of pulmonary symptoms (e.g., dyspnea, cough, sputum production) and abnormal radiographic findings. Strongyloides stercoralis was found in the sputum and stool, and pulmonary strongyloidiasis was diagnosed. Mebendazole 100 mg twice daily was used and this eliminated the parasite from the stool in case 1, and from the sputum in case 2. Unfortunately, there was a relapse of parasite infection in case 1 and it also induced pulmonary strongyloidiasis. Finally, he died of respiratory failure. Since this disorder has a high relapse rate (15%), serial follow-up of stool and sputum is very important.

Aged↗

PubMed1989

[Comparative study of thiabendazole and mebendazole in strongyloidiasis].

Taking into consideration some statements about better efficacy and good tolerability of mebendazole and since thiabendazole has not been produced in our country the past few years we have conducted a study evaluating mebendazole, in comparison with thiabendazole in the treatment of patients with strongyloidiasis. Strongyloidiasis is a disease that should be treated with an effective and active drug since it can rapidly progress and be fatal in patients with disturbed immunocompetence. One hundred and ten patients with strongyloidiasis were treated with oral thiabendazole in a dosage of 50 mg/kg daily for two days; the other group of 41 patients was given mebendazole in a dosage of 10 mg/kg/day orally for five days. Clinical evaluations, parasitologic and hematologic tests were performed within three months after the therapy. Patients were considered to have been cured if parasitologic findings were negative and abnormal blood eosinophilia decreased below 0.09 (733/microliters). According to these criteria thiabendazole was effective in 96.4% of patients and mebendazole in 44% of patients only. We conclude that thiabendazole has still to be regarded the drug of choice in treating patients with strongyloidiasis. Mebendazole is far less effective in patients with this helminthiasis and very probably only suppresses the infection. The reports of other studies on the effect of some of the newer benzimidazole antihelmintics as cambendazole, albendazole and flubendazole have shown that they are toxic or less effective in the treatment of strongyloidiasis.

Humans↗

PubMedDate not supplied

Clinical, immunological and epidemiological aspects of strongyloidiasis in an endemic area of Brazil.

Eighty-eight residents of Curitiba, Brazil, with parasitologically proven Strongyloides stercoralis infection were assessed clinically and evaluated for their specific and non-specific responses to the parasite. A control group of 73 patients with other intestinal parasites, but with negative stools for S. stercoralis were also evaluated. Abdominal symptoms and/or weight loss were present in 24% of the patients with strongyloidiasis and in 25% of the patients with other parasites only. Elevated peripheral eosinophilia (greater than 5%) was present in 68% of the patients with strongyloidiasis (mean = 10.6%) and in 73% of the individuals with other parasites only (mean = 8.8%). Total serum IgE were elevated (greater than IU/ml) in 84% of the patients with strongyloidiasis (mean = 2872 IU/ml), and in 79% of the patients with other parasites only. Over 90% of the patients with proven strongyloidiasis had detectable levels of parasite specific IgG and IgE antibodies, as detected by the ELISA and the RAST, respectively. These antibodies were present in 23% of the individuals in whom fecal examinations had failed to reveal S. stercoralis. We conclude that in an endemic area, gastrointestinal manifestations and non-specific indicators of parasitic infections, such as elevated peripheral eosinophilia and total IgE, are not useful indexes of the presence of strongyloidiasis. Immunoserologic tests, such as the ELISA and the RAST may represent sensitive and specific tools for the screening of candidates for immunosuppression and for gathering needed epidemiological information about this increasingly important opportunistic nematode.

Adolescent↗

PubMed2004

Strongyloides serology--useful for diagnosis and management of strongyloidiasis in rural Indigenous populations, but important gaps in knowledge remain.

General practitioners who care for Aboriginal patients in rural and remote communities from tropical Australia must be aware of strongyloidiasis. The prevalence of this parasitic infection is high and occasional cases can have a fatal outcome. Other groups in Australia at high risk of strongyloidiasis are immigrants from endemic countries, particularly from Southeast Asia, and military personnel who have served overseas in endemic areas. Elimination programs for enteric parasites in rural Australian Indigenous communities are so important that a nationally coordinated approach has been advocated. Wisely used, cost-effective diagnostic tests are a critical component of an elimination program. Strongyloidiasis must be confirmed by laboratory diagnosis and the strongyloides ELISA, although not ideal, is a useful test that can be used to diagnose strongyloidiasis and to monitor cure. In this article the value of the current strongyloides ELISA is discussed and a cost-benefit analysis is conducted using direct costs only. In a typical rural Aboriginal community in tropical Australia with prevalence of strongyloidiasis at 20% each true positive case detected by the strongyloides ELISA is estimated to cost approximately AU590 dollars to diagnose and manage until cure, proven by negative serology.

Journal Article↗

PubMed1993

The efficacy of two electron transport inhibitors (720C80 and 993C76) on murine strongyloidiasis: a comparison with albendazole.

The clinical efficacy of albendazole (ABZ) in the treatment of chronic uncomplicated strongyloidiasis has been reported to be highly variable. In our murine model of strongyloidiasis a single oral dose of 5 and 10 mg kg-1 ABZ reduced (at day 4 post infection) the faecal larval count (FLC) by 54.2 +/- 12.5% and 81.5 +/- 10.2%, respectively. 100 mg kg-1 ABZ reduced the FLC by 100%. Two inhibitors of protozoan and filarial electron transport (720C80 and 993C76) inhibited the endogenous O2 consumption of intact infective (L3) larvae of S. ratti by > 50% at 2 x 10(-5) M in vitro, and reduced the FLC by 72 +/- 9.3% and 62.0 +/- 10.3% respectively in vivo, at a dose of 70 mg kg-1. These results suggest that compounds designed as selective inhibitors of protozoan electron transport have significant efficacy against murine strongyloidiasis and may prove useful in the management of human strongyloidiasis.

Albendazole↗

PubMed1976

A fatal case of strongyloidiasis with Strongyloides larvae in the meninges.

A case of fatal strongyloidiasis associated with pyogenic meningitis in an adult male African is reported. Strongyloides larvae were present in the purulent exudate in the the meninges, an observation not, to the authors knowledge, hitherto reported in man. Fatal strongyloidiasis due to autoinfection has been reported by several authors and De Paula (1962) reviewed the literature in 40 cases and added 10 others which he had studied. In Uganda fatal cases have been reported by Craven et al. (1971) and Poltera (1974). Although in some cases of fatal strongyloidiasis there was associated pyogenic meningitis (BROWN & PERNA, 1958; WILSON & THOMPSON, 1964; BASSAN-TREMINGER & EL-LANSHAR, 1968) we have not found in the literature any case in which Strongyloides stercoralis larvae or adult worms were found in the brain or meninges. We are, therefore, now reporting a case of fatal strongyloidiasis with pyogenic meningitis in which S. stercoralis larvae were present in the subarachnoid space.

Humans↗

PubMed1981

Serodiagnosis of human strongyloidiasis by an enzyme-linked immunosorbent assay.

The sensitivity specificity of an enzyme-linked immunosorbent assay (ELISA) for the serodiagnosis of strongyloidiasis has been investigated. 45 men with long-standing strongyloidiasis were compared with the same number of age- and sex-matched control subjects. The ELISA detected antibody in 84% of patients with parasitologically proven strongyloidiasis. When the technique was compared with an indirect immunofluorescent assay (IFA), a high correlation coefficient was obtained. Specificity was demonstrated by observing a marked fall in optical density of pooled positive serum after prior incubation with Strongyloides ratti soluble antigen but not after incubation with antigens derived from Ascaris suum or Dirofilaria immitis. The test is simple and offers a useful method for the diagnosis of strongyloidiasis. In these patients it was more reliable than a single parasitological examination of faeces or duodenal contents.

Antibody Specificity↗

PubMed2000

High circulating proviral load with oligoclonal expansion of HTLV-1 bearing T cells in HTLV-1 carriers with strongyloidiasis.

Adult T cell leukemia (ATLL) develops in 3 - 5% of HTLV-1 carriers after a long period of latency during which a persistent polyclonal expansion of HTLV-1 infected lymphocytes is observed in all individuals. This incubation period is significantly shortened in HTLV-1 carrier with Strongyloides stercoralis (Ss) infection, suggesting that Ss could be a cofactor of ATLL. As an increased T cell proliferation at the asymptomatic stage of HTLV-1 infection could increase the risk of malignant transformation, the effect of Ss infection on infected T lymphocytes was assessed in vivo in HTLV-1 asymptomatic carriers. After real-time quantitative PCR, the mean circulating HTLV-1 proviral load was more than five times higher in HTLV-1 carriers with strongyloidiasis than in HTLV-1+ individuals without Ss infection (P<0.009). This increased proviral load was found to result from the extensive proliferation of a restricted number of infected clones, i.e. from oligoclonal expansion, as evidenced by the semiquantitative amplification of HTLV-1 flanking sequences. The positive effect of Ss on clonal expansion was reversible under effective treatment of strongyloidiasis in one patient with parasitological cure whereas no significant modification of the HTLV-1 replication pattern was observed in an additional case with strongyloidiasis treatment failure. Therefore, Ss stimulates the oligoclonal proliferation of HTLV-1 infected cells in HTLV-1 asymptomatic carriers in vivo. This is thought to account for the shortened period of latency observed in ATLL patients with strongyloidiasis. Oncogene (2000) 19, 4954 - 4960

Adult↗

PubMed2003

Hyperinfection syndrome in strongyloidiasis: report of two cases.

Hyperinfection in strongyloidiasis has been associated with corticosteroid treatment. Other immunodepressive conditions also seem to facilitate the state of hyperinfection. The etiologic diagnosis of this parasitosis can be difficult to reach and a positive urine microscopy is unusual. We report two patients under corticosteroid therapy with disseminated strongyloidiasis; both had eosinophilia. The first patient, followed for 8 years for autoimmune hemolytic anemia, recently developed abdominal symptoms. A colonoscopy was performed 1 month before admission and the biopsy was thought to show nonspecific changes. At admission, few larvae of Strongyloides stercoralis were disclosed by urine microscopy, and a review of the colonic biopsy uncovered a few larvae of Strongyloides. The patient received anti-helmintic therapy with a dramatic improvement. The second patient, under treatment for lupus erythematosus for 3 years, was admitted with pulmonary symptoms and during admission developed massive gastrointestinal bleeding. Disseminated strongyloidiasis was discovered only at autopsy. The low suspicion index for strongyloidiasis resulted in delaying the etiologic diagnosis in one patient and in failing to diagnose the disease in the other. The morphologic features of the parasite in the two cases are presented with emphasis on the difficulties of recognizing the larvae in the intestinal biopsy.

Adrenal Cortex Hormones↗

PubMed2000

Severe strongyloidiasis during interferon plus ribavirin therapy for chronic HCV infection.

Ribavirin is a nucleoside analogue, recently introduced in hepatitis C virus (HCV) therapy, that has postulated immunomodulatory and immunosuppressive action. Strongyloidiasis is an helmintic infection caused by Strongyloides stercoralis, endemic in tropical countries. Severe strongyloidiasis has been demonstrated after immunosuppression by corticosteroids evolving some fatal cases. Here, we describe two cases of severe strongyloidiasis coincident with ribavirin plus interferon therapy for treating HCV infection. The review of our monotherapy protocol with interferon did not disclose any case of symptomatic strongyloidiasis pointing to a possible role of ribavirin in modifying immune response to S. stercoralis. We propose a careful screening for S. stercoralis before initiating ribavirin therapy or even empiric antihelmintic treatment.

Adult↗

PubMed2005

Strongyloidiasis: a review of the evidence for Australian practitioners.

OBJECTIVE: To summarise the available evidence concerning the prevalence, clinical manifestations, diagnosis and management of strongyloidiasis in Northern Australia. METHODS: We searched Medline, Clinical Evidence and the Cochrane Library using MeSH terms and text words 'strongyloides OR strongyloidiasis'. For Australian studies we included text words '(parasite* OR parasitic OR helminth*) AND Australia*'. We examined references contained in retrieved studies or identified from direct contact with researchers. Studies consistent with our objective that described their methods were eligible for inclusion. RESULTS: The prevalence in some tropical Aboriginal communities is high. Infection can be asymptomatic, cause a range of clinical syndromes or death. It may become chronic. Infected patients are at risk of developing severe disseminated disease particularly with immune compromise. There is little information about the relative frequency of different clinical outcomes. Available diagnostic tools are imperfect. Stool examination has a low sensitivity. Serology may have a low specificity in high prevalence populations and has not been evaluated in Aboriginal populations. Antihelmintic drugs are relatively safe and effective. Community programs based on treatment of stool-positive cases have been associated with a reduced prevalence of strongyloidiasis. We found no studies examining alternative public health interventions. CONCLUSION: There is a high prevalence in many Aboriginal communities. Strongyloides infection should be excluded prior to commencing immunosuppressive therapies in patients from endemic areas. Further studies examining the public health impact of strongyloidiasis, the role of the enzyme-linked immuno-sorbent assay serological test and population-based approaches to management of the disease in endemically infected Australian populations are needed.

Albendazole↗

PubMed2005

Comparative assessment of the gelatin particle agglutination test and an enzyme-linked immunosorbent assay for diagnosis of strongyloidiasis.

The performances of the gelatin particle agglutination test (GPAT) and enzyme-linked immunosorbent assay (ELISA) for the diagnosis of strongyloidiasis with reference to the results of the agar plate culture technique (APCT) were evaluated with samples from 459 individuals from communities in northeast Thailand where strongyloidiasis is endemic. The prevalence of strongyloidiasis in five sample groups determined by GPAT varied between 29.3 and 61.5% (mean, 38.8%). ELISA and APCT, employed concurrently, gave lower prevalence rates of 27.5% (range, 21.6 to 42.1%) and 22.7% (range, 12.7 to 53.8%), respectively. By using APCT as the standard method, the sensitivity of GPAT was generally higher than that of ELISA (81 versus 73%). The specificity of GPAT was slightly lower than that of ELISA (74 versus 86%). The resulting GPAT titers exhibited positive linear relationships with the ELISA values (optical density at 490 nm) (P < 0.05), which suggests that the GPAT titer also reflects the levels of specific antibody comparable to those reflected by the ELISA values. Based on the relative ease and simplicity of use of the technique as well as the acceptable rates of sensitivity and specificity of the test, GPAT is more practical for screening for strongyloidiasis than the conventional ELISA.

Agar↗

PubMed1991

Strongyloidiasis influences the elevation of adult T-cell leukemia-associated antigen antibody titer.

We have carried out a seroepidemiological study on the infectious situation of adult T-cell leukemia and strongyloidiasis in Okinawa and in the south-western islands of Japan. The mean titer of adult T-cell leukemia virus-associated antigen (ATLA) antibody of human T-lymphotropic virus type-1 (HTLV-1) carriers with strongyloidiasis was significantly higher than that of HTLV-1 carriers without strongyloidiasis. This suggests the possibility that strongyloidiasis is also associated with an elevation of the ATLA antibody titer.

Antigens, Viral, Tumor↗

PubMed1996

Expression of CD23, CD32, Mac-1 and other adhesion molecules in eosinophils in strongyloidiasis and HTLV-I-positive patients.

The relationship between human T-lymphotropic virus I (HTLV-I) infection and strongyloidiasis has recently become an important problem. This study compared the expression of CD23, CD32, Mac-1 and other adhesion molecules in eosinophils of patients with strongyloidiasis positive for anti-(HTLV-I) antibodies and in those negative for the antibodies. The expression of CD23, Mac-1 and intercellular adhesion molecule-1 (ICAM-1) on eosinophils of patients with strongyloidiasis was augmented in comparison with normal subjects and HTLV-I carriers. There were no significant differences, however, in the expression of CD23, CD32, Mac-1 and adhesion molecules (ICAM-1, leukocyte function-associated antigen-1 alpha (LFA-1 alpha), LFA-1 beta, very late antigen-4) on eosinophils of patients with strongyloidiasis positive for anti-HTLV-I antibodies in comparison with those negative for these antibodies.

Adult↗

PubMed2004

Efficacy and safety of ivermectin and thiabendazole in the treatment of strongyloidiasis.

Treatment of strongyloidiasis has been traditionally based on thiabendazole, despite its frequent gastrointestinal side effects and failure to achieve eradication of the parasite from faeces in approximately 30% of cases. Ivermectin has been shown to be more effective for treating chronic uncomplicated strongyloidiasis. The efficacy and tolerability of these drugs in a series of patients treated from 1999 to 2002 at the Oliva Health Centre, Valencia, Spain, are reported. A total of 88 patients diagnosed of strongyloidiasis were treated using the following regimens: thiabendazole 25 mg/kg/12 h for 3 consecutive days in 31 patients; ivermectin 200 mug/kg as a single dose in 22 patients; and ivermectin 200 mug/kg for 2 consecutive days in 35 patients. The efficacy and side effects were recorded. A total of 65 patients were male, and 23 female. The mean age was 64 +/- 12 years. Of the patients, 44 had worked barefoot in rice fields. Among the 31 patients treated with thiabendazole, 25 (78%) met the criteria for cure (the absence of parasite in faeces after examination of three samples collected on alternate days), and 5 (16%) experienced side effects (asthenia, epigastralgia and disorientation). Of the 22 patients treated with ivermectin on a single day, 17 (77%) met the criteria for cure, and 2 (9%) reported side effects (dizziness, dyspepsia). Among the 35 patients treated with ivermectin on 2 consecutive days, 100% met the criteria for cure, and 0% experienced side effects. In chronic uncomplicated strongyloidiasis, a treatment regimen consisting of ivermectin 200 mug/kg for 2 consecutive days provided the best results with regard to efficacy and tolerability. When the eosinophilia continued after treatment, we observed a high percentage of not-cure rate (7 of 9 patients, 77%).

Animals↗

PubMed2003

[Clinical and immunological consequences of the association between HTLV-1 and strongyloidiasis].

Strongyloidiasis is one of most important forms of helminthiasis in tropical countries and epidemiologic studies have shown the association of this parasitic disease with HTLV. It has been observed in regions where both these agents are endemic and coinfection may result in an increase in the disseminated forms of strongyloidiasis as well as recurrent strongyloidiasis. While HTLV-1 is related to a high production of IFN-gamma; and deviation of the immune response towards a Th1 response, the protection against helminths is associated with Th2 like immune response. Individuals infected with HTLV and S. stercoralis have a reduction in the production of IL-4, IL-5, IL-13 and parasitic IgE response, all of which are factors participating in the defense mechanism against S. stercoralis. These abnormalities are the basis for the occurrence of an increase in the severe forms of strongyloidiasis among patients infected with HTLV-1.

Animals↗

PubMed2003

Western blotting using Strongyloides ratti antigen for the detection of IgG antibodies as confirmatory test in human strongyloidiasis.

The present study was conducted to evaluate the frequency of antigenic components recognized by serum IgG antibodies in Western blotting (WB) using a Strongyloides ratti larval extract for the diagnosis of human strongyloidiasis. In addition, the WB results were compared to the enzyme-linked immunosorbent assay (ELISA) and the indirect immunofluorescence antibody test (IFAT) results. Serum samples of 180 individuals were analyzed (80 with strongyloidiasis, 60 with other intestinal parasitoses, and 40 healthy individuals). S. ratti was obtained from fecal culture of experimentally infected Rattus rattus. For IFAT, S. ratti larvae were used as antigen and S. ratti larval antigenic extracts were employed in WB and ELISA. Eleven S. ratti antigenic components were predominantly recognized by IgG antibodies in sera of patients with strongyloidiasis. There was a positive concordance for the three tests in 87.5% of the cases of strongyloidiasis. The negative concordance in the three tests was 94% and 97.5%, in patients with other intestinal parasitoses and healthy individuals, respectively. In cases of positive ELISA and negative IFAT results, diagnosis could be confirmed by WB. ELISA, IFAT, and WB using S. ratti antigens showed a high rate of sensitivity and specificity. In conclusion, WB using S. ratti larval extract was able to recognize 11 immunodominant antigenic components, showing to be a useful tool to define the diagnosis in cases of equivocal serology.

Adolescent↗