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PubMed2001

Intestinal permeability in strongyloidiasis.

The objective of the present study was to assess intestinal permeability in patients with infection caused by Strongyloides stercoralis. Twenty-six patients (16 women and 10 men), mean age 45.9, with a diagnosis of strongyloidiasis were evaluated. For comparison, 25 healthy volunteers (18 women and 7 men), mean age 44.9, without digestive disorders or intestinal parasites served as normal controls. Intestinal permeability was measured on the basis of urinary radioactivity levels during the 24 h following oral administration of chromium-labeled ethylenediaminetetraacetic acid ((51)Cr-EDTA) expressed as percentage of the ingested dose. The urinary excretion of (51)Cr-EDTA was significantly reduced in patients with strongyloidiasis compared to controls (1.60 +/- 0.74 and 3.10 +/- 1.40, respectively, P = 0.0001). Intestinal permeability is diminished in strongyloidiasis. Abnormalities in mucus secretion and intestinal motility and loss of macromolecules could explain the impaired intestinal permeability.

Adult↗

PubMed2000

Strongyloidiasis--progress in diagnosis and treatment.

Strongyloidiasis is an intestinal parasitic disease caused by Strongyloides stercoralis. Basically, detecting larvae of S. stercoralis in feces makes definitive diagnosis. The ordinary agar plate culture method developed at our department is much simpler to handle and much more sensitive than the conventional filter paper culture method. It is considered to be the most useful method in the diagnosis of strongyloidiasis and in evaluation of the eradicating effect. Among chemotherapeutic agents, thiabendazole representing the benzimidazole compounds is most effective. However, it has a problem in safety, since its adverse effects and liver dysfunction occur with a high incidence, and it can be severe. Regarding the effects of mebendazole, albendazole and ivermectin, a study was conducted which included many patients. A high incidence of liver dysfunction was observed with mebendazole, and eradicating effect was not sufficient with albendazole. Ivermectin is different from benzimidazole compounds in a pharmacokinetic profile. However, ivermectin showed a strong anthelmintic effect with the least toxicity. We therefore consider ivermectin is the most useful drug for the treatment of strongyloidiasis.

Antiprotozoal Agents↗

PubMedDate not supplied

Fatal disseminated strongyloidiasis in patients on immunosuppressive therapy: report of two cases.

Disseminated strongyloidiasis is a rare manifestation in patients on immunosuppressive drugs. We report two cases of fatal disseminated Strongyloides stercoralis infestation. The first was in a patient of pemphigus vulgaris who developed an exacerbation of symptoms, one year after diagnosis and was given intravenous dexamethasone and azathioprine and in the third week of hospitalization developed features of septicemia, respiratory failure and petechial hemorrhages which were proven to be due to disseminated strongyloidiasis. The second patient was diagnosed to have stage IV diffuse large cell type of non-Hodgkin lymphoma and after the second cycle of chemotherapy, developed generalized symptoms of septicemia, respiratory failure, purpuric macules and patches. This was also proven to be disseminated strongyloidiasis.

Animals↗

PubMed2001

Influence of human T-cell lymphocytotropic virus type 1 infection on serologic and skin tests for strongyloidiasis.

The aim of this study was to determine whether human T-cell lymphocytotropic virus type 1 (HTLV-1) infection may affect the levels of parasite-specific immunoglobulin (Ig) G and IgE and the positivity of the skin test for strongyloidiasis. Participants included 67 patients with strongyloidiasis (40 without HTLV-1 infection and 27 coinfected with HTLV-1). We determined IgG and IgE levels by enzyme-linked immunosorbent assay, and the immediate hypersensitivity skin test was performed with the metabolic Strongyloides stercoralis antigen. Specific IgE levels and the size of skin reactions in patients without HTLV-1 were higher (P < 0.01) than those observed in patients coinfected with HTLV-1. Additionally, 89% of patients without HTLV-1 had specific IgE and 92.5% had positive skin tests; however, these values were significantly reduced (P < 0.01) in patients coinfected with HTLV-1 (44% and 59%, respectively). These data show that HTLV-1 infection decreases the sensitivity of detection of S. stercoralis-specific IgE, the size of the immediate hypersensitivity reaction, and the sensitivity of these tests in the diagnosis of strongyloidiasis.

Adult↗

PubMed2001

[Disseminated strongyloidiasis].

ENDEMIC ZONES: Strongyloidiasis is an intestinal parasitosis which is frequently found in tropical and subtropical regions. RISK: The "autoinfection" cycle during this helminthiasis explains why the infection can be perpetuated without further exposure to exogenous, infective larvae. Hyperinfection may occur by dissemination of Strongyloides stercoralis in immuno-compromised patients, particularly those under corticotherapy. DISSEMINATATED STRONGYLOIDIASIS: Disseminated strongyloidiasis is characterized by severe gastrointestinal and respiratory tract involvement, meningitis, skin rash, or Gram-negative bacteremia. Since disseminated stronglyoidiasis is fatal in 80% of cases it is imperative to diagnose and treat this condition before long-term corticotherapy. Ivermectin is currently recommended because it is effective and well tolerated.

Adrenal Cortex Hormones↗

PubMed2002

Clinical manifestations of strongyloidiasis in southern Taiwan.

The diagnosis and management of strongyloidiasis present a continuous challenge in developing countries including Taiwan. In this study, the clinical characteristics and microbiological findings of 27 patients with Strongyloides stercoralis infection were retrospectively analyzed. Intestinal infection was identified in 17 patients and hyperinfection syndrome or disseminated disease in 10 (including 2 autopsy cases). The most frequent clinical findings were diarrhea (74%), fever (70%), abdominal pain (59%), cough (37%), dyspnea (33%), and constipation (26%). The common initial laboratory abnormalities were leukocytosis (81%), anemia (67%), liver function impairment (52%), and eosinophilia (44%). Most of the 27 patients had comorbid conditions, including malnutrition in 20 (74%), corticosteroid dependence in 15 (55%), chronic obstructive pulmonary disease in 9 (33%), chronic liver disease or cirrhosis in 8 (30%), and peptic ulcer disease in 7 (26%). There was no difference in the time interval from symptom onset to diagnosis between the intestinal infection group and the hyperinfection/disseminated group (22 +/- 15 vs 17 +/- 9 days). Larvae of S. stercoralis were identified in the stool of 24 patients, in the sputum smear of 5, in the gastric biopsy of one, and on histology of autopsy specimens in 2. Twenty-six patients received antiparasitic drug therapy of variable duration (mebendazole in 24, albendazole in 2, combined therapy in one). The overall cure rate was 52% (14/27). Relapse occurred in 4 patients. The overall mortality was 26% (7/27). There was a high mortality (up to 50%) in the hyperinfection/disseminated disease group. In conclusion, diagnosis of strongyloidiasis is often delayed and overlooked because of nonspecific symptoms. Physicians in endemic regions should include strongyloidiasis in the differential diagnosis when patients present with gastrointestinal and/or pulmonary symptoms with peripheral eosinophilia.

Adolescent↗

PubMed2002

Improved antigens for IgG-ELISA diagnosis of strongyloidiasis.

Two preparations of antigens for the diagnosis of strongyloidiasis were prepared from an extract of the infective larvae of Strongyloides stercoralis: a crude antigen (CA) and a molecular weight cut-off antigen (MWCOA). Both antigens were analysed by indirect ELISA against the sera of strongyloidiasis (26 cases), other helminthiases (167) and normal controls (30). The larvae were obtained from fecal culture by a modified polyethylene tube technique after screening tests by triple simple smears per case. The larvae were extracted with distilled water and further sonicated to obtain a supernatant, the CA. A part of the CA was separated for an antigen containing molecules of lower than 30 kDa by an ultrafree-MC centrifugal filter tube (PLTK): this was designed as the MWCOA. The CA gave 96.15% sensitivity and 40.12% (67/167) specificity at a cut-off value of 0.980 (5SD); false positives were produced by 19 of 20 different helminthiases. The MWCOA produced 96.15% sensitivity at cut-off value of 0.71 (4SD); the specificity of the test was 78.44% (131/167), higher than that of CA. False positives also appeared with 15 other helminthic infections. This study suggests that MWCOA is more specific than CA. A purified MWCOA will be necessary in order to reduce cross-reactivity and provide the suitable diagnosis of strongyloidiasis.

Animals↗

PubMed2005

Atypical clinical presentation of strongyloidiasis in a patient co-infected with human T cell lymphotrophic virus type I.

Alterations in the immunologic response induced by human T cell lymphotrophic virus type I (HTLV-I) predispose the development of disseminated strongyloidiasis. We report a case of an atypical clinical presentation of strongyloidiasis in a patient co-infected with HTLV-I causing scrotal and perineal pain and infertility. Strongyloides stercoralis was found in the analysis of the sperm and specific therapy for strongyloidiasis was associated with disappearance of the symptoms.

Adult↗

PubMedDate not supplied

[Observations on 35 cases of strongyloidiasis hospitalized at a clinical digestive disease unit].

After a short presentation of the etiopathogenesis of this parasitosis, the authors report their observations on 35 cases of strongyloidiasis followed in the recent years. On the basis of the epidemiologic and clinical analyses of these cases, the authors show that some data, i.e. those on the environment to which the patients belong, or their occupation, and also some clinical manifestations (clinical polymorphism) may suggest the diagnosis of strongyloidiasis in the immunosuppressed in about 30% of the cases. An associated blood eosinophilia may be a more possible for the diagnosis of strongyloidiasis. The positive diagnosis has to take into consideration, beside the repeated diet exam, the method of cultures and also jejunal biopsies, which may also verify the efficiency of the treatment recommended. The authors recommend the treatment with Mintezol and, with lower results, Vermigal and Mebendazol.

Adult↗

PubMed1983

Specific allergic sensitization to Strongyloides antigens in human strongyloidiasis.

Reaginic antibodies to antigens from the human parasite Strongyloides stercoralis were studied by histamine release from basophils in 15 patients with chronic uncomplicated strongyloidiasis and in 12 controls (six North Americans with no evidence of parasitic diseases, two patients with Schistosoma mansoni, two with hookworm, one with Ascaris lumbricoides, and one with Onchocerca volvulus). All of the patients had antibodies to the somatic larval antigens, and 14 of 15 patients also had antibodies to the excretory/secretory products of S. stercoralis larvae. None of the controls had a positive response to any of the antigens tested. These findings indicate that patients with chronic strongyloidiasis have parasite-specific IgE antibodies and that S. stercoralis larval allergens may have a potential role in the immunodiagnosis of strongyloidiasis.

Antigens↗

PubMed1978

Disseminated strongyloidiasis: report of seven cases.

Disseminated strongyloidiasis with associated infection from various organisms in 7 cases on corticosteroid therapy are reported. Either respiratory or abdominal symptoms or both without other obvious etiological factors are its usual clinical manifestations. The highly motile filariform larvae of Strongyloides stercoralis were demonstrated in sputum, gastric content, peritoneal fluid as well as in stool. Associated infection from various organisms were found in 6 cases and it is believed that these contributed to immediate cause of death since disseminated strongyloidiasis had been eradicated before death. Only one case survived. Thiabendazole therapy in conventional dosage is adequate in eradicating disseminated strongyloidiasis.

Adult↗

PubMed1993

Strongyloidiasis in the Northern Territory. Under-recognised and under-treated?

OBJECTIVE: To describe the clinical and laboratory features and management of Strongyloides stercoralis infection in the Top End of the Northern Territory. DESIGN: A 12-month retrospective review of clinical records of patients confirmed on stool microscopy to be infected with S. stercoralis. SETTING: The Royal Darwin Hospital (RDH), a 300-bed referral hospital servicing the tropical areas of the Northern Territory, which have a population of 120,000, 21% of which is Aboriginal. RESULTS: Potentially pathogenic gastrointestinal parasites were identified in 205 patients over the 12 months. Of these, 68 patients had strongyloidiasis--64 were Aboriginal, three were Caucasian and one was of New Guinean origin. Thirty-seven (54%) were under five years of age. Patients came from all regions served by RDH, including urban Darwin. Seventy-five per cent of adults had chronic underlying disease and 80% of children under five years old were below 80% of standard weight for age. Gastrointestinal symptoms were absent in 28%; occasionally, severe disease occurred. Eosinophilia with greater than 0.7 x 10(9) cells/L was present in 57% of patients. Only 57% of cases were treated with thiabendazole. CONCLUSION: In the Top End of the Northern Territory, Strongyloides infection is endemic in Aboriginal communities, but also occasionally occurs in non-Aboriginal people. It is likely that the infection is frequently not recognised. Current community-based anthelmintic regimens have succeeded in reducing the prevalence of hookworm infection, but strongyloidiasis still appears to be a prevalent condition. The possibility of hyperinfection or disseminated strongyloidiasis in immunocompromised patients such as renal transplant recipients and people infected with the human immunodeficiency virus needs consideration in this endemic area. The interaction in northern Australia of S. stercoralis with human T-lymphotropic virus type I and with undernutrition warrants further study.

Adolescent↗

PubMed1978

Strongyloidiasis in childhood.

Strongyloides stercoralis is an intestinal nematode of man that is still regularly encountered in many parts of the United States. Strongyloidiasis should be considered in any child with unexplained eosinophilia, steatorrhea, protein-losing enteropathy, or chronic diarrhea, especially if associated with weight loss, growth failure, or recurrent upper abdominal pain. This parasite should be ruled out in any patient from an endemic region who is to be treated with corticosteroids of immunosuppressive agents. Microscopical examination of duodenal fluid, Baermann's fecal extraction technique, or the Haradi-Mori stool culture method may be required to make a diagnosis because the organism is not routinely found in concentrated feces even after multiple examinations in some infected individuals. A diagnosis of strongyloidiasis is important because the disease is curable.

Child↗

PubMed1987

Monoclonal integration of HTLV-I proviral DNA in patients with strongyloidiasis.

The relationship between strongyloidiasis and HTLV-I was investigated in Okinawa, an area where both conditions are endemic. Thirty-six patients with strongyloidiasis were seropositive for HTLV-I and suffered from several related clinical complications. Fourteen of these patients (39%) were shown to have monoclonal integration of HTLV-I proviral DNA in their blood lymphocytes, a condition designated as "smouldering" adult T-cell leukaemia (ATL). Monoclonal integration of proviral DNA correlated with an increased CD4/CD8 ratio and the presence of abnormal lymphocytes in the peripheral blood, and with a trend for greater severity of the parasitic infection. Although the immunodeficiency caused by HTLV-I could predispose to hyperinfestation by Strongyloides, it is also possible that both the parasitic and the retroviral infestations are important co-factors leading to the development of ATL.

Adult↗

PubMed1984

Intestinal secretion as a cause of hypokalemia and cardiac arrest in a patient with strongyloidiasis.

A 32-year-old white American male contracted strongyloidiasis in Nigeria. Prolonged and severe watery diarrhea was complicated by hypokalemia and cardiac arrest. Steady-state perfusion studies with a plasma-like electrolyte solution revealed net secretion of water, sodium, potassium, and chloride in a segment of jejunum. Mucosal permeability measured by the ratio of [14C]urea and tritiated water diffusion was unchanged. Chloride secretion occurred against both an electrical and chemical gradient, which suggests that chloride secretion was active. Intestinal water and electrolyte secretion may be the mechanism of watery diarrhea in patients with strongyloidiasis.

Adult↗

PubMed2001

Delayed diagnosis of disseminated strongyloidiasis.

We report the case of a 51-year-old woman who presented with a confusing spectrum of systemic symptoms after starting steroid therapy for a rheumatological disorder. The diagnosis of disseminated strongyloidiasis was made after a delay of 2 weeks. This paper outlines the symptom complex with which this critically ill woman presented, the course of her disease and the treatment of her disseminated strongyloidiasis.

Chronic Disease↗

PubMed2006

Disseminated strongyloidiasis: a retrospective study of clinical course and outcome.

A retrospective study was carried out to evaluate the clinical course and outcome of disseminated strongyloidiasis treated in a regional hospital in Hong Kong over a 10-year period. Seven cases were identified, and the case history of each patient was analysed. The most common presenting symptom was fever (100%). Five (71%) patients had gastrointestinal symptoms, the most common being abdominal pain and diarrhoea. Three (42%) patients had a significant drop in haemoglobin. Six (85%) patients had bronchoalveolar infiltrates on chest radiographs. Most patients were immunosuppressed by means of steroid treatment for their underlying primary disease. One patient was diabetic, and another had lymphoma and was receiving chemotherapy. Strongyloides larvae were identified in stool specimens in two patients, in sputum smears in two patients, and in gastric biopsies in three patients. Five (71%) of the patients with lung involvement progressed to respiratory failure and died. Two (29%) cases were complicated by gram-negative bacterial infection. No patient had eosinophilia on presentation. All patients received antihelminthic treatment of variable duration. The case fatality rate in the cohort was 71% despite aggressive supportive therapy. Pulmonary and bowel symptoms were prominent in our series. In conclusion, the diagnosis of disseminated strongyloidiasis is often delayed because of nonspecific presenting symptoms. Early diagnosis relies on a high index of clinical suspicion, especially in immunocompromised hosts. Screening for Strongyloides infection before the initiation of immunosuppressive therapy should be considered, especially in endemic areas.

Adult↗

PubMed2004

Strongyloidiasis in a patient with acquired immunodeficiency syndrome.

Rhabditiform larvae, transforming larvae from rhabditiform to filariform, and eggs of Strongyloides stercoralis were identified in the sputum of a Thai woman with acquired immunodeficiency syndrome (AIDS), and stool microscopy also showed a heavy load of rhabditiform larvae of S. stercoralis. She was treated with 12 mg ivermectin once a day for 2 days for the strongyloidiasis, with good therapeutic results being obtained. Strongyloidiasis may be a curable disease through the use of an appropriate therapy, even in a patient with AIDS.

AIDS-Related Opportunistic Infections↗