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PubMed1994

[Clinical study on ivermectin against 125 strongyloidiasis patients].

We treated 125 patients with strongyloidiasis (78 males and 47 females) by 2 oral doses of ivermectin (6 mg) at 2-week interval, and obtained the following results: 1. Eradication rate after treatment was 86.4% (108 of 125 patients), responsively. Out of the total 17 patients were resistant (non-responsive) to treatment, 8 patients received a further course of ivermectin and all Strongyloides stercoralis in their feces were eradicated. 2. Side effects were observed in 7.2% of the patients after the first dose treatment and in 3.2% after the second dose. But all symptoms were mild and self-limited. Although liver disfunction developed in 13.6% of the patients, no symptoms occurred and no special treatment was required. 3. Positive rate of anti-HTLV-I antibody in the resistant group was significantly higher (80.0%) than in the eradicated group (29.2%) and in the stool-negative group (0%). 4. Although eosinophils before treatment in the eradicated group was significantly higher than that of controls, there was no significant difference between the resistant group and controls. IgE levels in the resistant group was significantly lower than in the eradicated group. We would like to conclude that IVM is the best drug for treatment of the patient with Strongyloides stercoralis not only from this results but also our previous reports which had investigated the clinical efficacy on thiabendazole, mebendazole and albendazole.

Adult↗
PubMed1994

[Strongyloidiasis associated with multiple myeloma in Ehime prefecture].

A 76-year-old male with multiple myeloma, who was born and had lived in Ehime Prefecture was admitted to our hospital because of high fever. The chest X-p film showed right middle lobal pneumonia. Eosinophilia was detected and a stool smear examination revealed rhabditis form larvae of the nematode. The filaria form larvae of Strongyloides stercoralis were detected by stool culture. Antibiotics and pyruvinium pamoate were administered to bacterial pneumonia and hyperinfection of the strongyloides, respectively. Consequently, pneumonia and strongyloidiasis were promptly improved. It was considered that he was infected with strongyloides in south-east Asia during World-War II and a little autoinfection of this nematode had continued about 50 years. In addition, it was suggested that hyperinfection of strongyloides resulted from the immunosuppressive state induced by the chemotherapy for multiple myeloma.

Aged↗
PubMed1997

[A case of bacterial meningitis induced by strongyloidiasis].

A 75-year-old female with diabetes mellitus, who was born and lived in West north Kyusyu, was admitted to our hospital, because of unconsciousness and loss of appetite. The physical examination showed neck stiffness and a high fever. The laboratory data showed accentuation of inflammatory reaction and azotemia and positive HTLV-1 antibody. The spinal fluid showed increase of cell count and amount of protein. A stool and sputum smear revealed rhabditis form larvae of the nematode. Antibiotics and ivermectin were administered for the bacterial meningitis and hyperinfection of the strongyloides, respectively. Consequently, meningitis and strongyloidiasis improved. It was considered that the patient was infected with strongyloides from her husband who serve in the army during World-War II, and hyperinfection of strongyloides resulted from the immunosuppressive state of diabetes mellitus. Ivermectin, and anti-strongyloides agent, was effective, and no side effects were seen. However, the therapeutic resistance in this case was associated with the positive HTLV-1 antibody.

Aged↗
PubMed1980

Strongyloidiasis in Allied ex-prisoners of war in south-east Asia.

One hundred and sixty ex-servicemen who had been prisoners of war in south-east Asia during 1942-5 were investigated for infection with Strongyloides stercoralis. Larvae were found in 44 (27.5%) of the men, who had therefore been infected for 34-37 years. Direct microscopy of the faeces was the most successful diagnostic method, giving a positive result in 37 cases (84%); multiple examinations were often necessary. Faecal culture was positive in 30 cases (68%), but examination of duodenal fluid obtained with the string test gave a positive result in only 17 (39%). The mean blood eosinophil count and mean serum IgE concentration were higher in the infected men, though normal values were often found in individual cases. Clinical manifestations of isolated strongyloides infection were analysed by comparing the infected men with control groups of ex-prisoners in south-east Asia without proved strongyloidiasis and ex-prisoners in Europe. Twenty-nine infected men (66%) complained of non-specific urticaria, and 13 (30%) had pathognomonic larva currens. Gastrointestinal symptoms significantly more common in the infected group were diarrhoea, indigestion, lower abdominal pain, pruritus ani, and weight loss (p <0.05-p <0.0005).The study group was thought to be reasonably representative of Allied ex-servicemen imprisoned in south-east Asia during the second world war. Probably there are many thousands of infected persons in several countries. The worm has an unusual ability to multiply, and larvae may spread throughout the body in immunosuppressed subjects.

Aged↗
PubMed1976

Opportunistic pulmonary strongyloidiasis complicating asthma treated with steroids.

A man aged 57 years who had lived most of his life in London, suffered from asthma which had begun during army service in Burma 37 years previously. Latterly he was treated with increasing doses of corticosteroids but his symptoms continued to worsen and he died of asthma. Necropsy revealed a heavy opportunistic infection of the bronchi and lungs by the nematode Strongyloides stercoralis which he had presumably acquired while on service abroad. The case illustrates the need, even in non-endemic areas, to suspect opportunistic pulmonary strongyloidiasis when a patient's asthma worsens despite treatment with increasing doses of corticosteroids. Although it is a potentially lethal iatrogenic opportunistic infection, it is amenable to treatment with anthelminthic agents if recognized in time.

Adrenal Cortex Hormones↗
PubMed2006

A rare intestinal manifestation in a patient with common variable immunodeficiency and strongyloidiasis.

We report an immunodeficient patient with a rare gastrointestinal manifestation. A 26-year-old male with common variable immunodeficiency (CVID) and bronchiolitis obliterans, who was on intravenous gamma-globulin and prednisone, presented diffuse abdominal pain, nausea, vomiting and constipation of 3 days' duration. He reported 5 years of recurrent respiratory infections and diarrhea with negative stool tests, including tests for Strongyloides stercoralis. A physical exam revealed a poor general condition, anemia, dehydration and a distended painful abdomen with guarding, without abdominal sounds. The radiological study showed marked dilation of the small bowel that was edematous. Resection of the affected loop was performed and the histopathologic study showed transmural infection with S. stercoralis and hemorrhagic necrosis of the muscular layer, without mucosal destruction. The patient developed malabsorption syndrome and septic shock; he was treated with antibiotics and thiabendazole and was finally discharged in a good general condition. CVID is a rare disease and its association with systemic strongyloidiasis is very uncommon, but it has been reported in patients on corticosteroids. Hemorrhagic necrosis of the muscular layer without mucosal destruction was not found in the literature studied.

Adrenal Cortex Hormones↗
PubMed1985

Larva currens following systemic steroid therapy in a case of strongyloidiasis.

The authors report a case of larva currens following systemic steroid administration for acute contact eczema. The patient was found affected with subclinical strongyloidiasis. Strongyloides is not very common in Northern Italy; it is occasionally diagnosed from stool samples from patients complaining of persisting itching.

Aged↗
PubMed1978

Fatal strongyloidiasis in gibbons (Hylobates lar).

A 6-year retrospective study of necropsy material from a colony of 200 gibbons showed strongyloidiasis to be the most frequent cause of death (24 cases). Clinical signs included diarrhea, constipation, weight loss, paralytic ileus and dyspnea. Lesions were most frequent in the gastrointestinal tract and lungs. In the gut there were erosive and ulcerative enteritis associated with adult female parasites and rhabditiform larvae and acute and granulomatous enterocolitis associated with invading filariform larvae. There was severe multifocal or diffuse hemorrhage associated with migrating larvae in the lungs of 23 gibbons. Filariform larvae and the lesions they caused also occurred in various tissues; this was commensurate with the wide distribution of these larvae when hyperinfection occurred.

Animals↗
PubMed2004

Strongyloidiasis: challenges in diagnosis and management in non-endemic Kuwait.

Among immunocompromised individuals, hyper-infection with Strongyloides stercoralis may occur and lead to fatal strongyloidiasis. To clinicians and laboratory diagnosticians in non-endemic countries such as Kuwait, this severe infection poses a particular problem. The clinical histories and signs and symptoms of four Kuwaiti cases of S. stercoralis hyper-infection were reviewed. Each of the four was found not only to have lived in an area where S. stercoralis was endemic but also to have been treated with immunosuppressive steroids (for medical problems unrelated to the nematode infection). When they presented with undiagnosed hyper-infections their clinical features were confusing. Three of the cases, all with low eosinophil counts, died but the other, who was treated with thiabendazole, survived. In the light of these observations, healthy medical examinees who had recently moved from endemic zones were checked for asymptomatic S. stercoralis infection, both by stool examination and ELISA-based serology. Of 381 stool samples investigated over a 3-month period, 183 (48%) were found positive for helminths, 7% for S. stercoralis. Of 198 individuals from endemic zones who were screened after another medical examination, 71 (35.8%) were found positive for intestinal helminth parasites, including one (1.45%) infected with S. stercoralis. Although ELISA appear reliable in making a presumptive diagnosis of strongylodiasis, the results of such assays are not very specific and are best interpreted in conjunction with the patient's clinical status. The concurrent administration of anthelminthics to patients prescribed steroids who, because they live or have lived in an area where S. stercoralis is endemic, are at risk of infection with the nematode, should be considered.

Adult↗
PubMedDate not supplied

Parasitological and immunological diagnoses of strongyloidiasis in immunocompromised and non-immunocompromised children at Uberlândia, State of Minas Gerais, Brazil.

Parasitological and immunological diagnoses were part of a study conducted among 151 children, 83 immunocompromised (IC) and 68 non-immunocompromised (non-IC) aged from zero to 12, seen at the University Hospital, Universidade Federal de Uberlândia, State of Minas Gerais, Brazil, from February, 1996, to June, 1998. Three fecal samples from each child were analyzed for the parasitological diagnosis by Baermann-Moraes and Lutz methods. The immunological diagnosis to detect IgG and IgM antibodies was carried out by the indirect immunofluorescence antibody test (IFAT) with cryo-microtome sections of Strongyloides stercoralis and Strongyloides ratti larvae as antigens and by the ELISA test with an alkaline extract of S. ratti as the antigens. Of the 151 children 5 (3.31%) were infected with larvae of S. stercoralis (2 cases IC, 2.41%, and 3 cases non-IC, 4.41%). The IFAT-IgG detected 7 (8.43%) serum samples positive among IC, and 2 (2.94%) cases among non-IC. The ELISA-IgG test detected 10 (12.05%) serum samples positive among IC, and 1 (1.47%) case among non-IC. The IFAT-IgM detected 6 (7.22%) positive cases among IC, and 3 (4.41%) cases among non-IC. ELISA-IgM test detected 10 (12.05%) positive cases among IC, and 3 (4.41%) cases among non-IC. It was concluded that the immunological tests can help in the diagnosis of strongyloidiasis in immunocompromised children.

Animals↗
PubMedDate not supplied

[The evaluation of antigenic preparations of Strongyloides stercoralis for the immunodiagnosis of strongyloidiasis].

Aqueous-soluble (AS) antigens from larvae of Strongyloides stercoralis, extracted with phosphate-buffered saline, are traditionally used for serodiagnosis of strongyloidiasis. To identify sources of antigens for use in serodiagnosis, residual particulates from parasite larvae after aqueous extraction were solubilized with Tris-buffered 8M urea, yielding a urea-soluble (US) antigen fraction. Both AS and US antigens from S. stercoralis were evaluated by an enzyme-linked immunosorbent assay. No significative differences were observed between AS and US antigens from the parasite regarding specific antigenic activity and cross-reactivity. Immunoassays are highly dependent on the antigen for sensitivity and specificity. Crude extracts from S. stercoralis should be further studied, mainly in relation to antigenic fractions which could provide even more sensitive and specific results. Studies of fractionation of S. stercoralis must take into account the antigen yield of both the crude extract and fractions, since larvae of parasite are normally difficult to obtain. Considering this aspect, the results from this study are very useful, since the extraction with urea substantially increased the amounts of antigenic materials normally obtained with the classical aqueous extraction.

Animals↗
PubMedDate not supplied

[Association of thymoma and severe intestinal strongyloidiasis].

A 59-years-old man with thymoma and severe intestinal strongyloidiasis is reported. The authors pointed out a possible influence of immunological response related with thymoma in the development of hyperinfection by Strongyloides stercoralis.

Humans↗
PubMed2001

Strongyloidiasis in a Cope's grey tree frog (Hyla chrysoscelis).

A male Cope's grey tree frog (Hyla chrysoscelis) died spontaneously with ventral subcutaneous edema and was necropsied. Thickening of the intestinal mucosa was observed histopathologically, with villous atrophy and intraepithelial nematodes present. Adult female Strongyloides sp. nematodes were isolated from the fixed intestinal tract, the first time this nematode genus has been recovered from this frog genus. Intestinal strongyloidiasis should be considered as a cause for protein-losing enteropathy and death in frogs.

Animals↗
PubMedDate not supplied

Fatal strongyloidiasis latent over 42 years in the antineoplastic chemotherapy of a case with malignant lymphoma.

A 66-year-old man with non-Hodgkin lymphoma died of strongyloides hyperinfection following antineoplastic chemotherapy. The patient had a military service in Micronesia in World War II where he was supposed to acquire strongyloidiasis. Here we stress the utility of bronchoscopic examination and importance of patients' lives in tropical climates in immunocompromised patients.

Aged↗
PubMed1986

Strongyloides stercoralis infections in the muscles of mice: a model for investigating the systemic phase of strongyloidiasis.

The sequence of events following infection of mice with the intestinal nematode, Strongyloides stercoralis, has been observed. Most infective larvae passed to the muscles where they did not develop further. In mice given primary infections, larvae were found in muscles for the first 9 d or so, then disappeared spontaneously. This was associated with an inflammatory reaction, predominantly eosinophilic and histiocytic in nature, around dying larvae. In mice exposed to the worms previously, both inflammation and worm destruction were hastened indicating the acquisition of resistance. A number of immunological parameters were measured in both primary and challenge infections. Specific antibodies of the IgM and IgG classes appeared, a marked immediate hypersensitivity reaction to injected antigen developed, and a transient blood eosinophilia occurred. No effects on phytohemagglutinin-induced spleen cell transformation were discerned, nor was transformation induced by specific antigen. It is concluded that this system provides a potentially useful model for investigating the systemic phase of strongyloidiasis, particularly with respect to assessing anthelmintic efficacy and the functions of fractionated antigens.

Animals↗
PubMed1997

SLE with death from acute massive pulmonary hemorrhage caused by disseminated strongyloidiasis.

We describe a case of disseminated strongyloidiasis involving a female patient with active systemic erythematosus (SLE). The cause of death was massive pulmonary hemorrhage induced by a filariform larvae infection. This was initially diagnosed during examination of the bronchoalveolar lavage fluid just 2 days before her death. The case indicated that immunosuppressed individuals would be paid attention to possible parasitic infection prior to starting therapy even in non-endemic areas as well as other microorganisms.

Acute Disease↗
PubMed1992

[A case of fatal malabsorption syndrome caused by strongyloidiasis complicated with isosporiasis and human cytomegalovirus infection].

This 54-year-old Korean coal miner suffered from continuous watery diarrhea and weight loss after corticosteroid treatment (beta-methasone, 4 mg daily for 1 week) due to hip-bone fracture in January 1991. Except for the short therapy of steroid, no other histories were contributory. The malabsorption syndrome was aggravated while the case was treated under the impression of amebiasis or intestinal tuberculosis. AIDS antibody test by EIA was negative and quantitative analysis of serum immunoglobulins was in normal ranges. Nine months after the onset of symptoms, the case was diagnosed as malabsorption syndrome caused by complexed and aggravated infection by Strongyloides stercoralis, Isospora and cytomegalovirus in the small intestine, which were proved by stool examination and duodenal biopsy. His clinical course became worse even after high-dosed and prolonged albendazole treatment for strongyloidiasis with supportive fluid therapy. The patient was discharged in hopeless status in November, 1991 and died after one week at home.

Animals↗