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PubMed2002

Treatment failure in intestinal strongyloidiasis: an indicator of HTLV-I infection.

BACKGROUND: The association of severe strongyloides with HTLV-I is well known; however, the seroprevalence of HTLV-I in other groups with strongyloidiasis is still unknown. We conducted a prospective study in patients with intestinal strongyloidiasis without known immunodepression who failed to respond to standard therapy with ivermectin or thiabendazole (failure was defined as one positive stool examination at the post-therapy follow up). All these patients were tested for HTLV-I by ELISA and Western Blot. RESULTS: Forty seven patients were evaluated: 74.5% (35 out of 47) were HTLV-I positive, without significant difference between males (76%) and females (72.7%). CONCLUSIONS: We recommend that all patients with uncomplicated intestinal strongyloidiasis, who fail standard therapy, be studied for HTLV-I infection.

Adolescent↗

PubMed2003

Predictive markers for development of strongyloidiasis in patients infected with both Strongyloides stercoralis and HTLV-1.

Severe strongyloidiasis has often been reported to occur in some patients infected with both Strongyloides stercoralis (S. stercoralis) and human T-cell leukaemia virus type 1 (HTLV-1); however, there are few useful predictive markers for the risk of development of strongyloidiasis in these patients. To search for such predictive markers, we examined peripheral blood and stool samples of individuals infected with both S. stercoralis and HTLV-1 in Okinawa, Japan, an area in which both of these are endemic. The HTLV-1 proviral load and antibody titre were examined in relation to the S. stercoralis load as measured by the direct faecal smear method in patients infected with both S. stercoralis and HTLV-1. The Epstein-Barr virus (EBV)-associated nuclear antigen (EBNA) antibody titre was also measured in these patients in order to examine the relationship between host immunity and HTLV-1 proviral load or antibody titre. The direct faecal smear-positive group showed both a higher HTLV-1 proviral load and HTLV-1 antibody titre than the -negative group (P < 0.05). In contrast, inverse correlations of these parameters with the EBNA antibody titre were observed, especially for proviral load (rho = -0.387, P < 0.05). These results suggest that HTLV-1 proviral load and antibody titre influence the S. stercoralis load via disturbance of the host immunity, and that proviral load would be an especially useful predictive marker of the risk of development of strongyloidiasis in patients infected with both S. stercoralis and HTLV-1.

Adult↗

PubMed2001

The risk of Strongyloides stercoralis transmission from patients with disseminated strongyloidiasis to the medical staff.

To assess the risk of Strongyloides stercoralis transmission from two patients with disseminated strongyloidiasis to medical staff who had been in close contact with the patients, blood and stool specimens were obtained from medical staff two to three months after close contact with the patients. Antibodies to S. stercoralis were determined in blood. Stool specimens were tested for parasites with three different procedures.Forty-one medical staff were included. Culture and stool examination were negative in all subjects. Serology was negative in all subjects but one who had a borderline titer without signs or symptoms of strongyloidiasis. No evidence of transmission of S. stercoralis from patients with disseminated strongyloidiasis to medical staff was found.

Aged↗

PubMed1981

Comparison of larval antigens in an enzyme-linked immunosorbent assay for strongyloidiasis in humans.

An enzyme-linked immunosorbent assay for specific antibodies in patients with strongyloidiasis was developed using antigens extracted from the third-stage larvae of Strongyloides stercoralis and Strongyloides ratti. Sera from two groups of patients with strongyloidiasis proven by parasitologic methods, including one group of 29 coded positive sera, and from presumed normal subjects as controls were tested. Sera with optical density values greater than two standard deviations above the mean optical density value for the sera from control subjects were considered to be positive. Using this criterion 82%-84% of 51 positive patients had antibodies to S. stercoralis or S. ratti antigens. Immunosuppression and other factors that might influence antibody responses were associated with some patients who were negative for antibodies to Strongyloides. Antigen from an intestinal nematode of rats, Nippostrongylus brasiliensis, was also evaluated and found to be unsuitable for serodiagnosis of strongyloidiasis because of frequent false-positive as well as false-negative results.

Adult↗

PubMedDate not supplied

Case report: Antemortem diagnosis of central nervous system strongyloidiasis.

Strongyloidiasis is usually a benign illness confined to the gastrointestinal tract. However, dissemination (hyperinfection syndrome) may occur, particularly in patients with impaired cell-mediated immunity. The diagnosis of hyperinfection syndrome is often made postmortem, and mortality is high, even when the disease is recognized during life. Central nervous system involvement with Strongyloides stercoralis has previously been recognized in only a few cases at postmortem examination, and in one case antemortem. We describe a patient with disseminated strongyloidiasis in whom central nervous system involvement was diagnosed antemortem. This patient developed multiple bacterial and fungal systemic and central nervous system infections as a complication of disseminated strongyloidiasis. The natural history of the disease in man, factors predisposing to dissemination, immunologic aspects of helminthic infection, and treatment modalities are discussed.

Animals↗

PubMed1994

Case report: purpura in disseminated strongyloidiasis.

Purpuric lesions have been described previously in 10 patients with disseminated strongyloidiasis. We identified three additional patients in whom purpura developed as a manifestation of disseminated strongyloidiasis. Nine (69%) of the 13 patients were men, and the median age of patients was 61 years (range, 32-75 years). Six patients were from the southeastern United States. Six patients had underlying malignancy and four patients had chronic lung disease. All patients had received prior corticosteroids. The parasite was identified in 11 (92%) of 12 patients where stool or sputum examination was performed. Skin biopsies of purpuric lesions were obtained in 12 patients, in 10 (83%) of which larvae were found. Despite recommended treatment with thiabendazole in 12 of 13 patients, 11 (85%) of the patients died, and at least 6 died within 16 days of onset of purpura. Physicians, particularly those in the southeastern United States, should strongly consider the diagnosis of disseminated strongyloidiasis in patients receiving corticosteroids and in whom purpura and systemic toxicity develops.

Adrenal Cortex Hormones↗

PubMed1992

Seven years of recurrent severe strongyloidiasis in an HTLV-I-infected man who developed adult T-cell leukaemia.

OBJECTIVE: Human T-cell leukaemia/lymphoma virus type I (HTLV-I) is endemic in Japan, the Caribbean basin and Africa, where it has been aetiologically linked to certain chronic myelopathies and adult T-cell leukamia (ATL). We sought to investigate whether strongyloidiasis, a parasitic disease common in these areas, might be a cofactor in the pathogenesis of ATL, as some reports have suggested. PATIENTS, PARTICIPANTS: One 35-year-old HTLV-I-seropositive French West Indian man with a 7-year history of recurrent strongyloidiasis associated with episodic hyperinfestation presenting at the Centre Hospitalier Intercommunal, Villeneuve St Georges, France. INTERVENTIONS: Treatment with various chemotherapeutic agents and symptomatic therapy for hypercalcaemia and antiviral therapy (zidovudine and interferon). RESULTS: The patient developed ATL and died shortly after, despite chemotherapy. Immunological and virological studies performed during the last 15 months of his life showed an increase of the percentage of peripheral ATL cells, and progression from a polyclonal to a monoclonal integration of HTLV-I proviral DNA in the peripheral blood mononuclear and lymph-node cells. CONCLUSIONS: Recurrent strongyloidiasis appears to have been a possible cofactor associated with progression from healthy carrier state to ATL in our patient.

Adult↗

PubMed1998

Intestinal strongyloidiasis manifesting as eosinophilic pleural effusion.

Strongyloidiasis caused by the helminth Strongyloides stercoralis is usually asymptomatic or causes mild dermatologic or gastrointestinal symptoms. In immunocompromised hosts, hyperinfection and dissemination can occur. In this case, I describe a nonimmunocompromised Southeast Asian man who had an eosinophilic pleural effusion, peripheral eosinophilia, and rhabditiform larvae of S stercoralis in the stools. There was complete resolution of the pleural effusion after thiabendazole therapy, thus suggesting strongyloidiasis as the cause of the effusion. Helminthic infections like strongyloidiasis should be considered in the differential diagnosis of an eosinophilic pleural effusion, especially in individuals from endemic areas.

Adult↗

PubMed1986

Opportunistic strongyloidiasis in renal transplant recipients.

Eight patients with severe strongyloidiasis complicating renal transplantation are reported. Twenty-one additional cases from the English-language literature are reviewed. In this setting, systemic strongyloidiasis is an often baffling illness involving multiple organ systems that is frequently complicated by serious bacterial infection. Bacteremia, meningitis, urinary tract infection, and pneumonia resulting from enteric organisms are common. In order to make the diagnosis, larvae must be sought by direct microscopy of stool, upper intestinal fluid, sputum, urine, or biopsy specimens. Treatment with oral thiabendazole in prolonged or repeated courses is recommended. Effective parenteral therapy is not available. Following treatment, previously parasitized patients must be tested at regular intervals to detect therapeutic failure or reinfection. Screening of patients awaiting renal transplantation for chronic intestinal strongyloidiasis is suggested. Improvement of the observed 52% mortality will depend upon heightened awareness by physicians caring for renal transplant candidates, and upon improved therapeutic regimens.

Adult↗

PubMedDate not supplied

Disseminated strongyloidiasis in a child with lymphoblastic lymphoma.

PURPOSE: This report describes a case of disseminated strongyloidiasis in a child receiving chemotherapy for T-cell lymphoblastic lymphoma. PATIENT AND METHODS: A 10-year-old boy became severely ill with disseminated strongyloidiasis 4 weeks after starting chemotherapy for T-cell lymphoblastic lymphoma. He responded to treatment with supportive care, antibiotics, and albendazole but required ivermectin to eradicate the strongyloides infection. CONCLUSION: Disseminated strongyloidiasis is a severe, life-threatening complication of Strongyloides stercoralis infection that can occur in patients on immunosuppressive therapy, particularly when this therapy includes corticosteriods. In endemic areas, screening patients due to undergo immunosuppressive treatment and appropriate antistrongyloides treatment may be life saving. Ivermectin is the treatment of choice.

Child↗

PubMed1981

Severe strongyloidiasis associated with hypogammaglobulinaemia.

The association of severe strongyloidiasis and hypogammaglobulinaemia in one patient is described. Severe strongyloidiasis was observed twice (March 1971 and June 1974), and the Strongyloides stercoralis infestation probably lasted for at least 58 months (from March 1971 to December 1975), in spite of successive thiabendazole courses of treatment. Immunological studies performed disclosed severe, steady hypogammaglobulinaemia but no abnormality in cell-mediated immunity. The respiratory infections also seen during the follow-up were ascribable more to humoral immunity impairment than to cell-mediated immunity impairment. This is the first report of the association of hypogammaglobulinaemia and severe strongyloidiasis, and it suggests that humoral immunity plays a relevant role in the human defences against S. stercoralis infestation.

Adolescent↗

PubMed2006

Unsuspected strongyloidiasis in hospitalised elderly patients with and without eosinophilia.

The prevalence and associated factors of chronic uncomplicated strongyloidiasis were estimated among 200 consecutive elderly patients (aged >or= 60 years) admitted to a general hospital in northern Italy. One-hundred patients had a peripheral eosinophil concentration >or= 500 cells/microL (group A), and 100 were age- and gender-matched controls (group B). Measurements included serum IgG anti-Strongyloides antibody titre by an indirect immunofluorescence assay, combined with faecal culture for Strongyloides stercoralis. Anti-Strongyloides antibodies were detected in 28 patients (at high titre in 11 patients). Seropositivity was significantly more common among group A than among group B patients (OR 4.85). Strong seropositivity for anti-Strongyloides antibodies was associated with farm work (p < 0.001), but not with other patient characteristics or with signs and symptoms of strongyloidiasis. In conclusion, strongyloidiasis was relatively common among elderly in-patients; eosinophilia and a history of farm work were the most useful indications for this diagnosis.

Aged↗

PubMed1987

Demonstration and partial characterization of parasite-specific immunoglobulin A responses in human strongyloidiasis.

By using an enzyme-linked immunosorbent assay, serum immunoglobulin A (IgA) responses directed against Strongyloides stercoralis larvae antigens were measured in 104 presumably immunocompetent individuals with chronic uncomplicated strongyloidiasis and in 15 immunocompromised patients with S. stercoralis infection. Fifty healthy North American adults and 18 patients with other helminthic parasites served as controls. All 50 healthy controls were negative for antibody responses (mean absorbance +/- standard deviation = 0.0724 +/- 0.040). The mean absorbance of the 18 parasitized controls was 0.230 +/- 0.087; two individuals parasitized by Ascaris lumbricoides showed positive antibody responses. The mean absorbance of the immunocompetent patients with strongyloidiasis was 0.680 +/- 0.364, with 91 subjects (87.5%) having a positive value (greater than 0.300). Of the immunocompromised patients (mean absorbance +/- standard deviation = 0.735 +/- 0.538), 11 (73%) had a positive antibody response test. When the IgA responses of these two groups were compared, they were not significantly different. There was no correlation between the levels of total serum IgA and the concentration of specific IgA in the infected patients. Both IgA and IgG immunoreactive bands were detected on immunoblots of sodium dodecyl sulfate-polyacrylamide gel electrophoresis-separated larval antigen protein blots. Nineteen bands were recognized by IgG, and 13 were recognized by IgA from sera of infected patients. Several bands displayed specific IgG or IgA reactivity. The present work shows that most patients with strongyloidiasis mount specific IgA responses against filariform larval antigens. These responses are, for the most part, directed against antigens that are different from those recognized by IgG. The lack of correlation between the magnitude of the specific serum IgA responses and the clinical aspects of the infection suggests that these antibodies may not play a central role in the regulation of this parasitosis.

Antibody Specificity↗

PubMed1991

Small bowel bacterial overgrowth in strongyloidiasis.

Small bowel bacterial growth was studied in patients with strongyloidiasis, and the results were compared to controls. We concluded that in strongyloidiasis there is small bowel bacterial overgrowth, and so it should be considered in the pathogenesis of some of the gastrointestinal manifestations and complications of strongyloidiasis.

Adolescent↗

PubMed2004

Treatment strategies in controlling strongyloidiasis.

Strongyloidiasis is an intestinal parasite infection caused by Strongyloides stercoralis. Spontaneous cure cannot be expected due to the unique life cycle of the parasite, termed autoinfection. The disease occurs worldwide, but especially in tropical and subtropical regions. Serious clinical problems with complications and refractory strongyloidiasis are observed, especially in immunocompromised patients, such as those infected with human T cell leukaemia virus Type 1 (HTLV-1) or HIV, or corticosteroid-treated patients. Thiabendazole is effective against S. stercoralis infection; however, serious side effects have been reported. Recently, ivermectin, which has been introduced for the treatment of human onchocerciasis, has been reported to be effective against strongyloidiasis, without serious side effects. The interval of administration is important for treatment, because if autoinfective migrating larvae are not eradicated, S. stercoralis will resume its life cycle and multiply again. To evaluate the results of treatment of S. stercoralis, stool examinations and S. stercoralis-specific antibody titres should be examined for at least 1 or 2 years if possible. This article provides a review of treatments and methods of evaluation of patients infected with S. stercoralis.

Antinematodal Agents↗

PubMedDate not supplied

Total serum IgE and parasite-specific IgG and IgA antibodies in human strongyloidiasis.

Total serum IgE, and Strongyloides-specific IgG and IgA antibodies were studied in 27 patients with parasitologically proven strongyloidiasis. Clinical manifestations in this case series were investigated by a retrospective study of the patient's records. Total serum IgE levels were elevated (greater than 250 IU/ml) in 59% of the patients (mean concentration = 1364 IU/ml). Parasite-specific IgG and IgA antibodies were detected by ELISA in the serum of 23 (85.2%) and 21 (77.8%) patients, respectively. Elevated serum IgE and clinical manifestations were not useful indexes of the presence of strongyloidiasis. On the other hand, our results support the view that serologic tests, particularly ELISA for detecting Strongyloides-specific IgG antibodies, can be usefully exploited for diagnostic purposes in strongyloidiasis.

Animals↗

PubMedDate not supplied

[Strongyloidiasis in patients with pemphigus foliaceus].

In 30 patients with foliaceus pemphigus the frequency of strongyloidiasis was 40%, by three Baermann-Moraes examination. In the "Hospital do Pênfigo", for patients with pemphigus of Uberaba, the frequencies of strongyloidiasis in the employees (n = 14) and students (n = 47), of the annexed nursery, also were high, respectively 35.7% and 23.4%. In 7(58.3) of 12 samples from the soil of the hospital courtyard were found free-life forms of Strongyloides. The environmental factor and the susceptibility of the patients were associated with the high transmission of the strongyloidiasis.

Adolescent↗

PubMed2003

Strongyloides venezuelensis alkaline extract for the diagnosis of human strongyloidiasis by enzyme-linked immunosorbent assay.

The present study was conducted to detected IgG antibodies using Strongyloides venezuelensis alkaline extract for the diagnosis of human strongyloidiasis by the enzyme-linked immunosorbent assay (ELISA). Sera from 90 subjects were analyzed (30 with strongyloidiasis, 30 with other parasites and 30 healthy individuals). Results were expressed in antibody titers, which were considered as positive when titer was >80. Sensibility and specificity of the assay were 100% and 96.7%, respectively. It can be concluded that the heterologous alkaline extract could be employed in ELISA as a diagnostic aid in human strongyloidiasis, due to its advantages as easiness of obtaining, practicability in preparing, and high indexes of sensitivity and specificity.

Animals↗