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PubMed2002

Efficacy of ivermectin for chronic strongyloidiasis: two single doses given 2 weeks apart.

We assessed the efficacy and adverse effects of ivermectin for the treatment of chronic strongyloidiasis. Fifty patients were treated with a single dose of ivermectin at approximately 200 microg/kg, and the dose was repeated 2 weeks later. The eradication rate was 96% (48 of 50 patients) at 2 weeks after the first dose and 98% at 2 weeks after the second dose (49 of 50 patients). In the latter cases, no recurrence was noted at the end of the 4-month post-treatment follow-up period. The gastrointestinal symptoms observed most frequently before the treatment were borborygmus, constipation, and diarrhea. These symptoms improved in the majority of patients after the treatment. Side effects, including nausea and vomiting, occurred in 1 patient (2%), but these were mild and transient. Although abnormal values in laboratory tests were observed in 4 patients (8%), they were mild, and no particular clinical care was required. Thus, ivermectin showed an excellent antihelminthic effect, with little toxicity. Our results indicate that a regimen of two single doses of 200 microg/kg ivermectin, given 2 weeks apart, is clinically suitable for the treatment of chronic strongyloidiasis.

Adult↗
PubMed1985

Pulmonary strongyloidiasis. Diagnosis by sputum gram stain.

Sputum Gram stain was diagnostic for pulmonary strongyloidiasis in four patients from Tennessee with chronic obstructive lung disease treated with steroids. The case reports of these patients and photomicrographs of the larval forms by Gram stain are presented. Sputum Gram stain may be a useful procedure to screen for pulmonary strongyloidiasis in steroid-treated patients with chronic lung disease who come from an endemic area.

Aged↗
PubMed1990

Application of enzyme-linked immunosorbent assay for mass examination of strongyloidiasis in Okinawa, Japan.

The enzyme-linked immunosorbent assay was tested to evaluate whether it could be applicable in screening for mass examination of strongyloidiasis. A total of 2906 inhabitants in three areas (858 in Gushikawa Village, 849 in Nakazato Village and 1199 in Sashiki Town) were screened by the enzymatic assay and approximately 11-30% (11.8% in Gushikawa, 17.0% in Nakazato and 27.7% in Sashiki) were considered to be antibody positive. In the parasitological follow-up examinations of those who were antibody positive, actual infection was found in more than half (51%) the subjects. The overall infection rates estimated from the results reached 5.8% in Gushikawa, 9.1% in Nakazato and 14.0% in Sashiki (mean = 10.4%). The infection rates were significantly higher than those in previous surveys conducted in the same areas. The ELISA technique was found to be useful for strongyloidiasis screening and for seroepidemiological purposes in Okinawa.

Animals↗
PubMed1975

Fatal bowel infarction and sepsis: an unusual complication of systemic strongyloidiasis.

A 58 year old Chinese male, one week after arriving in Canada from Hong Kong, presented with acute abdominal pain and diarrhoea which was rapidly followed by Escherichia coli infection causing septicaemia and meningitis. His past history revealed bronchial asthma for 15 years treated with steroids. At laparotomy, 7 days after the onset of symptoms, he was found to have extensive haemorrhagic infarction of the small bowel and right colon. Examination of the fibrosed mesenteric vessels revealed numerous filariform larvae of Strongyloides stercoralis, within the walls, and in all layers of bowel wall. The role of the parasite in the production of obliterative arteritis in this fatal case of haemorrhagic enteropathy is discussed. Clinical strongyloidiasis, in uncomplicated cases, varies from mild to severe with gastroenteritis, nausea, colicky abdominal pain, electrolyte imbalance and symptoms of malabsorption syndrome (MARCIAL-ROJAS, 1971). In malnourished individuals and patients with debilitating infections, either newly acquired or asymptomatic latent infection with S. stercoralis can assume severe dimensions (BROWN and PERNA, 1958; HUGHTON and HORN, 1959). Similarly, in patients on steroid (CRUZ et al., 1966; WILLIS and MWOKOLO, 1966; NEEFE et al., 1973) and immunosuppressive therapy for lymphomatous diseases or deficient in immune response (ROGERS and NELSON, 1966; RIVERA et al., 1970), systemic strongyloidiasis is often fatal. The increased frequency of auto-infection in such patients with a breached immune barrier is, however, unclear. Further complications of this infection due to severe enterocolitis result in sepsis, bacteraemia and meningitis (BROWN and PERNA, 1958; HUGHTON and HORN, 1959). This paper presents a fatal case of S. stercoralis infection which illustrates an uncommon if not unique, mechanism in its production of haemorrhagic enteropathy leading to sepsis and death.

Colon↗
PubMedDate not supplied

Gelatin particle indirect agglutination test for mass examination for strongyloidiasis.

An indirect agglutination test using recently developed gelatin particles was assessed to determine its applicability as a screening test for mass examination for strongyloidiasis. 1199 individuals in Sashiki Town, Okinawa Island, were screened by the test and 34.7% were determined to be antibody positive. Follow-up examination of the persons whose sera showed positive antibody responses demonstrated the presence of faecal larvae in 41.7%. The calculated infection rate (14.5%) was similar (14.1%) to that indicated by another survey using the micro-enzyme-linked immunosorbent assay (micro-ELISA), conducted simultaneously among the inhabitants. The indirect agglutination test was simple to perform in a short time and without specialized equipment. Additionally, the gelatin particles have many advantages as an antigen carrier, e.g. in handling, reading of the resulting pattern, and stable, long-term preservation. The test was considered to be more convenient than the micro-ELISA for mass screening for strongyloidiasis.

Adult↗
PubMed1989

Peripheral lymphocyte subsets and their responsiveness in human strongyloidiasis.

Surface phenotypes and proliferative responses of peripheral lymphocytes were investigated in a total of 64 patients with strongyloidiasis. A significant increase of CD4+ and OKIa1+ cells and a relative decrease of CD8+ cells were observed among the patients. A considerable rise of spontaneous mitogenesis and an enhanced ability to produce interleukin 2 of peripheral lymphocytes were also found in many patients. On the other hand, lymphoproliferative responses to mitogens were found to be significantly lower in the strongyloidiasis patients than in the controls. The possible relationships among these observations were discussed.

Adult↗
PubMed1994

Application of enzyme immunoassay for postchemotherapy evaluation of human strongyloidiasis.

Posttherapy evaluation of strongyloidiasis is frequently difficult because coprologic examination is not sensitive enough for diagnosis of chronic infection. In the present study, anti-Strongyloides enzyme-linked immunosorbent assay antibodies were monitored before and after treatment with thiabendazole and pyrvinium pamoate in 199 patients with chronic strongyloidiasis in Okinawa, Japan. A significant decrease in antibody levels was observed in patients who became negative for fecal larvae after the treatment, whereas the antibody levels did not show a significant change after the treatment in patients who were still harboring the parasite. In the group coprologically negative in the follow-up examination, however, many individuals did not show a significant fall in antibody titers after treatment, which suggests that these cases were equivocal for complete cure. By the subsequent fecal reexamination performed on the equivocal cases, approximately 20% were additionally found to be still harboring the parasite. These results indicate that serologic testing is useful to check whether a real cure has been achieved among the patients in whose fecal samples the presence of larvae has not been demonstrated after treatment.

Adult↗
PubMed1995

Value of the agar plate method for the diagnosis of intestinal strongyloidiasis.

An agar plate method for the diagnosis of intestinal strongyloidiasis was compared to the standard formalin-ethyl acetate concentration method. A total of 13 of 225 patients with eosinophilia had positive stools for strongyloides larva by agar plate compared to six of 225 by the formalin-ethyl acetate method (P = .0455). Nine positive stool specimens by the agar plate method were tested by the Baermann technique, and five were positive. The agar plate method is a sensitive and efficient technique for the diagnosis of strongyloidiasis.

Acetates↗
PubMed2004

Characteristics and geographical profile of strongyloidiasis in healthcare area 11 of the Valencian community (Spain).

INTRODUCTION: This study describes the epidemiological characteristics of all cases of strongyloidiasis diagnosed in the period 1995-1999 (both years included) in Area 11 of the Valencian Community (Spain) and their possible correlation to certain geographical and environmental conditions. MATERIAL AND METHODS: This is a retrospective, descriptive study. Information was collected using a telephone survey. RESULTS: A total of 473 cases of strongyloidiasis were diagnosed. Of the total patients, 282 (60%) answered to the survey. There were 342 males (72%) and 131 females (28%). Ninety-four percent of the patients were in the 51-91 years age interval. Only three patients had been born abroad, while 15 had been on brief holidays to countries where the disease is endemic. The largest concentration of cases was found in zones 1 (0.49%) and 6 (0.9%), both having similar geomorphic characteristics. The professional activity of patients was recorded in 215 cases. The most frequent occupation was agriculture, with 124 cases (58%). Risk activities were recorded in 184 cases, the growing of rice in 145 patients (79%) being the most important. DISCUSSION: Strongyloides stercoralis infestation is endemic and possibly related to agricultural activities performed in previous years, and to the geographical characteristics of some parts of the area.

Adult↗
PubMed2006

Utility of serological follow-up of chronic strongyloidiasis after anthelminthic chemotherapy.

The difficulty of establishing a diagnosis and confirming cure of strongyloidiasis is widely appreciated. As parasitological diagnosis is often unsatisfactory, serodiagnosis is frequently relied upon. The aim of this study was to investigate changes in Strongyloides-specific antibody levels among a group of 79 seropositive Indigenous Australians living in a Strongyloides-endemic region. Testing before and after treatment revealed that seroreversion occurred most commonly after multiple courses of ivermectin therapy, with antibody titres of 35/42 (83%) subjects becoming negative. Seroreversion was also common following a single course of ivermectin or multiple courses of a 3-day regimen of albendazole, with seroreversion occurring in 13/19 (68%) and 7/10 (70%) subjects respectively. One 3-day course of albendazole was less effective with 4/10 (40%) subjects seroreverting, whereas none of the five subjects receiving a single dose of albendazole and 1/10 (10%) of subjects receiving no therapy seroreverted. These results support the use of serological follow-up for strongyloidiasis, and indicate that reversion to negative serostatus after ivermectin therapy is frequent.

Adolescent↗
PubMed2001

[Agricultural occupation and strongyloidiasis. A case-control study].

BACKGROUND: In the last few years, Strongyloides stercoralis has been repeatedly recovered from indigenous farmers in the Safor area (Valencia Community). The relationship between the different occupational activities, mainly farming, and the presence of strongyloidiasis was investigated. PATIENTS AND METHODS: A paired case-control study was designed. The investigation was conducted at Oliva Centro de Salud, from October 1997 to October 1999. Diagnosis was established when Strongyloides stercoralis was observed in any of the three serial fecal samples requested when eosinophilia was observed in the hemogram. Controls were persons matched by sex and age (+/- 5) years, with no eosinophilia in the hemogram and in whom the presence of the parasite was excluded in fecal samples. RESULTS: Participants in the study were 47 cases and their respective controls. Each group included 39 (83%) men and 8 (17%) women. Forty-five cases (95%) and 42 controls (89%) had been born in Safor. Only two cases had travelled to endemic areas. Farming was the main activity in 32 (68%) cases and 31 (66%) controls. The only occupational activity which showed influence on strongyloidiasis was working in ricefields, with an OR of 2.97 (95% CI: 1.16-7.71). Dermatologic symptoms were significant for pruritus, OR 7.39 (95% CI: 2.29-27.60). One case with hyperinfection and another with larva currens were diagnosed. CONCLUSION: In our area, working in ricefields and chronic pruritus are associated with chronic strongylodiasis.

Adult↗
PubMed2004

[Disseminated strongyloidiasis associated with pulmonary fibrosis and gastrointestinal bleeding].

Strongyloidiasis is a parasitic disease that can be lethal in immunosuppressed patients especially if lung fibrosis is associated, which has been rarely reported. We report the case of a patient treated with corticosteroids for pulmonary fibrosis who developed disseminated strongyloidiasis revealed by massive gastrointestinal bleeding. Diagnosis was based on histological analysis of gastrointestinal biopsies and broncho-alveolar lavage. Treatment improved digestive features as well as respiratory function.

Aged↗
PubMed1996

Parasitic diseases in immunocompromised hosts. Cryptosporidiosis, isosporiasis, and strongyloidiasis.

Cryptosporidiosis and isosporiasis are intestinal infections caused by the protozoan parasites Cryptosporidium parvum and Isospora belli, respectively. HIV infection and other immunodeficiency diseases predispose human subjects to severe and prolonged cryptosporidiosis. There is also evidence that HIV infection predisposes to chronic isosporiasis. Strongyloidiasis is caused by a nematode worm, Strongyloides stercoralis. Administration of corticosteroids to patients with chronic low-grade S. stercoralis infection can trigger a fulminant, life-threatening form of strongyloidiasis.

AIDS-Related Opportunistic Infections↗
PubMed2003

Strongyloidiasis pre and post autologous peripheral blood stem cell transplantation.

Hyperinfection with strongyloides stercolis occurs in the setting of chronic strongyloides infection in conjunction with immune suppression. Although malnutrition remains the major secondary cause worldwide in the developed world, iatrogenic immune suppression is an important precipitant. Autologous stem cell transplantation recipients are significantly immunocompromised albeit temporarily. Despite the increasing use of haemopoetic stem cell transplantation, hyperinfection with strongyloides has rarely been reported. We describe two cases of patients transplanted with chronic strongyloidiasis. In one case eradication therapy was given prior to the transplant which was uncomplicated. In the second case strongyloidiasis was diagnosed post transplant which was complicated by infection and respiratory compromise. Fatal hyperinfection subsequently developed after corticosteroid therapy was started for a disease progression in the CNS.

Aged↗
PubMed2001

A three years follow-up of total serum IgE levels in three patients treated for strongyloidiasis.

A three years follow-up of the level of serum total IgE was made for the first time in three patients with strongyloidiasis after efficient treatment. The decrease of IgE was slow and progressive, showing a logarithmic curve. This regular decrease of total serum IgE could be used as an additional criterion for the evaluation of the efficiency of drug therapy in patients with strongyloidiasis. The persistence of high levels of total IgE two or three years after the elimination of the intestinal parasites, after the return of blood eosinophils to a normal level (within six months), and after the disappearance of specific antibodies, shows that the regulation of the IgE elimination seems to be a complex mechanism.

Aged↗
PubMed1983

Strongyloidiasis. When to suspect the wily nematode.

Strongyloidiasis is a tenacious soil-transmitted nematode infestation endemic in the south-eastern United States. Thirty-three cases were diagnosed in a series of 1,290 stool examinations in 971 patients at Veterans Administration Medical Center, Mountain Home, Tennessee. Most patients had a concurrent major illness, such as chronic lung disease, serious bacterial infection, or cancer. A minority presented with gastrointestinal symptoms alone. Skin rash was uncommon. Eosinophilia, IgE elevation, and skin anergy were common. Atypical presentations included severe proctitis, colitis, and exacerbation of inflammatory bowel disease. In a patient with the hyperinfection syndrome, the diagnosis was made only at autopsy. Since strongyloidiasis seems to present like an opportunistic illness, all physicians, not just those in endemic areas, should consider its presence in the appropriate setting.

Adult↗
PubMed2004

Why does HIV infection not lead to disseminated strongyloidiasis?

We investigated the hypothesis that host immunosuppression due to advancing human immunodeficiency virus (HIV) disease favors the direct development of infective larvae of Strongyloides stercoralis, which may facilitate hyperinfection and, hence, disseminated strongyloidiasis. To do this, we sought correlations between the immune status of the subjects and the development of S. stercoralis infections. Among 35 adults, there were significant negative rank correlations between CD4+ cell counts and the proportions of free-living male and female worms. Thus, in individuals with preserved immune function, direct development of S. stercoralis is favored, whereas, in individuals with lesser immune function, indirect development is relatively more common. These results may explain the notable absence of disseminated strongyloidiasis in advanced HIV disease. Because disseminated infection requires the direct development of infective larvae in the gut, the observed favoring of indirect development in individuals immunosuppressed by advancing HIV disease is not consistent with the promotion of disseminated infection.

AIDS-Related Opportunistic Infections↗