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PubMed2004

[Efficacy of ivermectin in the treatment of children parasitized by Strongyloides stercoralis].

In a small village of Amazonian Colombia, the efficacy of ivermectin (200 microg/kg/day) was determined in a two-day treatment of children with uncomplicated strongyloidiasis. Criteria for inclusion in the study were as follows: absence of acute disease, no pretreatment with antiparasitic drugs within the last month, absence of severe liver or neurological disorders, and at least 2 of 4 stool samples positive for Strongyloides stercoralis. The Baermann technique was used to detect larvae; it had the advantage of reducing the frequency of false negative results in the subsequent examinations. Of 60 potential subjects, 49 fulfilled the above criteria. The cure rate for the S. stercoralis infection was 94% (46/49), with slight and temporary side effects. The effects of ivermectin on other intestinal parasites were characterized as well. In conclusion, a 200 microg/kg/d ivermectin dose was an adequate therapeutic regimen in the treatment of uncomplicated strongyloidiasis in children.

Animals↗
PubMed2004

Mucosal mast cell-derived chondroitin sulphate levels in and worm expulsion from FcRgamma-knockout mice following oral challenge with Strongyloides venezuelensis.

Mucosal mast cell-derived chondroitin sulphates (sulphated proteoglycans) were assayed in gut washings and homogenate of FcRgamma-knockout (KO) and wild-type (WT) C57BL/6 mice challenged with Strongyloides venezuelensis in order to assess their possible role in secondary immunity against enteric nematodes. Groups of immune KO and WT mice were challenged by oral gavage with 300 infective larvae (L3). Establishment of infection was assessed by daily faecal analysis to determine the number of eggs per gram of faeces (EPG) and by adult worm recovery on days 5 and 13 post challenge. Mucosal mast cell (MMC) counts were done on days 5 and 13 post challenge while MMC-derived chondroitin sulphates in gut washings (days 1 and 5) and homogenate (day 8) were assayed by high performance liquid chromatography (HPLC). Results showed that patent infection occurred in challenged KO but not WT mice despite significantly higher mastocytosis in jejunal sections of KO than WT mice (p<0.001). Similarly but against prediction, significantly higher concentration of MMC-derived chondroitin sulphates was observed in gut homogenate of KO than WT mice (p<0.05). In contrast, significantly higher concentration of chondroitin sulphates was observed in gut washings of WT than KO mice (p<0.05). These results suggest that MMC in KO mice failed to release sufficient amount of sulphated proteoglycans into the gut lumen as did the WT mice, which may have been part of the hostile environment that prevented the establishment in and eventual expulsion of adult S. venezuelensis from the gut of WT mice following challenge.

Animals↗
PubMed2005

Prevalence of strongyloides in Northern Thailand and treatment with ivermectin vs albendazole.

The stools of 697 cases were examined by agar plate technique at Tambon Makam Luang, Sun Pa Tong district, Chiang Mai; there were Strongyloides stercoralis 15.9%,Opisthorchis viverrini 5.1%, intestinal fluke 0.1%. Treatment with ivermectin 78 cases and albendazole 33 cases of strongyloidiasis gave cure rates at 98.7% and 78.7%, respectively. Alkaline phosphatase in some patients were increased at mild level after treatment. Side effects in ivermectin group were anorexia, nausia, diarrhea, diffuse itching and drowsiness; and in albendazole group were nausia and diarrhea. The efficacy of single dose and mild side effects suggest ivermectin as drug of choice for strongyloidiasis treatment.

Albendazole↗
PubMed2005

Subcutaneous ivermectin as a safe salvage therapy in Strongyloides stercoralis hyperinfection syndrome: a case report.

Strongyloides stercoralis hyperinfection syndrome due to the acceleration of the autoinfective cycle of the nematode is a life-threatening form of the infection occurring in immunocompromised hosts. Intestinal ileus, which is commonly encountered in this form, may reduce the bioavailability and thus the efficacy of oral anthelminthic drugs used in the treatment of the S. stercoralis hyperinfection syndrome. We report the efficacy and safety of subcutaneous administration of ivermectin in a patient infected with human T cell lymphotropic virus type I with S. stercoralis hyperinfection syndrome who was unresponsive to an oral combination of ivermectin and albendazole.

Adult↗
PubMedDate not supplied

Infiltrating Strongyloides stercoralis presenting as duodenal obstruction.

Small intestinal obstruction due to Strongyloides stercoralis is rare and has not been reported in an immunocompetent patient. We describe a 70-year-old immunocompetent man presenting with duodenal obstruction secondary to severe S. stercoralis infestation, as documented on duodenal biopsy. He was treated with ivermectin, with which he recovered remarkably.

Aged↗
PubMedDate not supplied

[Thiabendazole for the control of Strongyloides stercoralis infection in a hyperendemic area in Peru].

Strongyloides stercoralis infection is a disease caused by an intestinal parasite. This helminth is highly prevalent in tropical and subtropical areas. The preferred treatment is ivermectin, and thiabendazole as a second option available in certain Peruvian institutions. The purpose of the study was to assess the efficacy and tolerability of thiabendazole (25 mg/kg/day) administered twice a day (after meals) for three days in individuals with S. stercoralis chronic infection. The study was conducted at Hospital de La Merced, Province of Chanchamayo, Peru (endemic area), during a 90 day period. The study included 32 individuals (22 female and 10 male, average age +/- SD = 9.31 +/- 8.11 years) with a diagnosed S. stercoralis infection. Follow up tests were eosinophil count, hematocrit, agar plate feces culture, and Baermann technique modified by Lumbreras. Healing rate was 90.6%. The average eosinophil count in healed patients significantly decreased (1168 to 665 eosinophils/cc, p=0.006) as compared to the treatment failure group, which showed a slight increase (618 to 897 eosinophils/cc, p=0.125). Hematocrit increased in both groups (2% and 3%, respectively). Adverse effects were headache, dizziness, and epigastralgia in 6.2% of individuals. It was concluded that the studied scheme showed a high effectiveness rate and was well tolerated. Therefore this scheme may be taken into account for control programs of this parasite in hyperendemic areas.

Adolescent↗
PubMedDate not supplied

Fatal Strongyloides stercoralis infection in a young woman with lupus glomerulonephritis.

We report a case of fatal Strongyloides stercoralis (S. stercoralis) infection in a 35-year-old female with lupus glomerulonephritis after prolonged steroid therapy. An epidemiological evaluation revealed that our patient originated from a rural area in Bosnia and Herzegovina, which was an endemic region of S. stercoralis infection in the former Yugoslavia. She had severe gastrointestinal and pulmonary symptoms and history of a 13 kg weight loss in 3 months. Histopathological examination of large bowel mucosa showed nematode larvae. Microscopy of stool, sputum and urine samples confirmed S. stercoralis. The diagnosis was delayed because of the low suspicion index, the absence of eosinophilia and non-specific signs of infection, which could be a result of the underlying disease or the effects of corticosteroids. This case highlights the importance of screening for S. stercoralis in patients starting immunosuppressive therapy, especially if they are from endemic areas. Timely diagnosis and therapy could save the patient's life.

Adult↗
PubMed2005

Host-finding behavior of Strongyloides stercoralis infective larvae to sodium cation, human serum, and sweat.

The host-finding behavior of Strongyloides stercoralis infective larvae was examined by in vitro agarose assay method. As human body fluid contains 0.85% (ca 0.15 molar) NaCl, various concentrations of sodium chloride, from 0.5M to 0.01M (7 steps), were examined. Many larvae were attracted at concentrations between 0.5 and 0.05M of sodium chloride. The concentration of 0.05M attracted the most larvae. The concentration of 0.02M of sodium chloride showed greatly reduced larval attraction compared with 0.05M. Therefore, the threshold concentration was determined as 0.05M. Then, 0.05M of chemicals were examined in a further experiment. Chloride compounds (NaCl, KCl, CaCl2, MgCl2) were investigated. These chemicals are components of human body fluids. Distilled water was used as the control in all experiments. Only sodium chloride attracted the larvae. Next, alkaline compounds were examined [NaOH, KOH, Ca(OH)2, and Mg(OH)2]. Larvae accumulated only at the NaOH site. The results suggested that the Na cation is important for larval attraction. A high pH value did not influence attraction at all. Next, human serum was tested. The human serum used was from normal serum to 1:32 diluted sera by distilled water (7 steps). Hierarchical attraction was seen according to serum concentration. Next, human sweat was collected from a limited zone of chest skin where only eccrine glands were distributed. Non-diluted sweat attracted the most larvae. Sweat might act as one of the most probable factors for infection by this skin-penetrating nematode.

Agar↗
PubMed2006

Impairment of host immune response against strongyloides stercoralis by human T cell lymphotropic virus type 1 infection.

A large-scale study was undertaken to clarify the prevalence rate of strongyloidiasis in Okinawa, Japan and to evaluate the relationship between strongyloidiasis and infection with human T cell lymphotropic virus type 1 (HTLV-1). The prevalence rate of Strongyloides stercoralis and HTLV-1 infection were 6.3% and 14.0%, respectively. Among 2,185 patients more than 50 years of age, the rate of S. stercoralis infection was significantly higher in patients with HTLV-1 infection compared with patients without HTLV-1 infection. In 252 patients treated with ivermectin, serum IgE levels and peripheral eosinophil counts were significantly lower in HTLV-1 co-infected patients compared with patients without HTLV-1 infection. In addition, the anthelmintic effect was significantly lower in patients with HTLV-1 infection compared with patients without HTLV-1 infection. Our prospective study demonstrated a prevalence rate for strongyloidiasis and HTLV-1 infections, and clearly demonstrated that co-infection with HTLV-1 impaired the immune response against S. stercoralis.

Adolescent↗
PubMedDate not supplied

[Strongyloides stercoralis: histopathological findings of duodenal mucosa (1999-2005)].

Strongyloidiasis is a parasitosis, which endoscopic and histopathologic presentations are very varied. It is mainly found in the duodenum, where the larva matures into adult female and induces varied patterns of inflammatory reactions. All histological slides with diagnosis of duodenal strongyloidiasis, and the description of the endoscopy report for a six year period (January 1999-November 2005), were reviewed. The most frequent endoscopic findings were swollen foldings of nodular aspect Severe duodenitis (according to the Jenkins classification) was found in 57% of the cases, and villi atrophy was found in all cases, most of them Grade 4 (according to the Drutt classification). Plasma cells did not decrease in severe duodenitis, unlike those reported on peptic duodenitis. Our findings show greater commitment by our patients than those reported in the revised literature. We propose to study the relation between plasma cells, villi atrophy, severe duodenitis and strongyloides.

Adolescent↗
PubMedDate not supplied

[Evaluation of nematode predacious fungus Duddingtonia flagrans on infective Haemonchus contortus and Strongyloides papillosus larvae of goats].

One brazilian isolate of nematode-trapping fungus Duddingtonia flagrans AC 001 was evaluated regarding the capacity of supporting passage through the gastrointestinal tract of goats without losing the ability to entrap infective Haemonchus contortus and Strongyloides papillosus larvae (L3). Ten saneen goats of eight months old, males and infected naturally were divided in two groups of five animals. In the group 1, the animals received orally 20 g of pellets of the D. flagrans. In the group 2 (control), the animals received orally 20 g of pellets without fungi. Fecal Samples were collected at 14, 20, 24, 36 and 46 hours after the treatments and were allocated in fecal cultures at 25 degrees C during fifteen days. There was significant reduction (p<0.05) of the average number of S. papillosus larvae recovered of the fecal cultures in the animals treated with fungus when compared with the control animals at 14 and 46 hours, in the end of the experiment, this difference was 82.3%. There was significant reduction (p<0.05) of the average number of H. contortus larvae recovered of the fecal cultures in the animals treated with fungus when compared with the control animals at 14, 20 and 46 hours, in the end of the experiment, this difference was 59.3%. Such evidences confirm the transit of these fungi pellets by the digestive tract of the goats without loss of the predatory viability on L3 of H. contortus and S. papillosus.

Animals↗
PubMed2006

A modified filter paper culture technique for screening of Strongyloides stercoralis ivermectin sensitivity in clinical specimens.

An in vitro test for the detection of ivermectin sensitivity of Strongyloides stercoralis in human clinical specimens was developed. The test has a simple procedure that combines parasite culture with a drug assay. It is based on the principle of the drug effect on larval development test, combined with a modified coproculture using the filter paper culture technique. This does not require parasite isolation, and drug sensitivity can be shown in relationship to the dose. This test can be applied in field surveys for anthelmintic sensitivity and for appropriate drug rotation strategies when drug resistance occurs.

Animals↗
PubMedDate not supplied

[Strongyloides stercoralis and HIV: a case report of an indigenous disseminated infection from non-endemic area].

Strongyloides stercoralis affects people who live in the tropics, but it also extends to temperate regions where its low incidence rate may lead to misdiagnose it. Inside the host this nematode may remain silent for many years, nevertheless, in patients infected with HIV its reactivation leads to a disseminated infection in ectopic sites. This report presents the case of a 34 years-old man infected with HIV who lived in a highland area in the province of Córdoba, Argentina. He was admitted to the hospital because of a complicated Pneumocystis jiroveci pneumonia, receiving trimethoprim-sulfamethoxazole and prednisone treatment. A few days after admission his conditions deteriorated badly, a sputum examination revealed filariform larvae of S. stercoralis, he was then given oral ivermectin medication (200 microg/kg/d). Malabsorption and ileus were installed and he died from multiorganic failure. The evolution of HIV infection to AIDS, a steroids treatment and therapy failure despite oral ivermectin triggered larvae proliferation and lead to disseminated hyperinfection until he died. This report presents not only the first case of disseminated strongyloidiasis detected in our Hospital but also an indigenous infection acquired in a non-endemic area. An awareness of an increased predisposition to this infection, especially in immunocompromised patients with malabsorption and ileus is of paramount importance, since failure to initiate appropriate therapy can lead to catastrophic outcomes, as illustrated in this case report.

Adult↗
PubMedDate not supplied

[Factors associated with strongyloides stercoralis infection in an endemic area in Peru].

In order to determine the epidemiological factors and clinical symptoms associated with Strongyloides stercoralis infection, we carried out a descriptive study with a control group in the District of Chanchamayo, Province of Chanchamayo, Junin, Peru. Group I (n = 50) represented those individuals with strongyloidosis and group II (n = 50) were those who tested negative for S. stercoralis by parasitological methods. Epidemiological variables significantly associated with group I were: bathing in the river 3-4 times per week, consuming non-drinking water, defecating in the field; and with group II: drinking boiled water, wearing sneakers and living in houses with cement floor. The clinical symptoms of epigastric pain, daily abdominal pain, semi liquid feces, liquid feces, daily defecation frequency, urticaria and nausea were significantly associated with group 1; whereas more solid feces and defecating every other day were significantly associated with group II. Among individuals under the age of 20 there was a higher percentage of malnutrition according to the weight-age index in group I (p = 0.045). We conclude that infection by S. stercoralis should be suspected in persons from tropical areas who are in frequent contact with rivers or streams or live close to watercourses, who have gastroenterological or dermatological symptoms or who are malnourished, especially if they are children or adolescents.

Adolescent↗
PubMed1991

Antibody responses and protective immunity in rats receiving repeated inoculations of Strongyloides ratti.

The relationship between specific antibody responses and protective immunity against Strongyloides ratti was examined in rats receiving 10, 50, or 500 infective larvae (L3) at weekly intervals. No specific IgG response was detected in rats receiving 10-L3 inoculations for 7 wk. Fifty- and 500-L3 inoculations induced an IgG response by weeks 2 and 3, respectively, and a higher IgG response was induced in rats receiving the higher doses. All 3 inoculation doses induced high IgE responses, but the kinetics were different. IgE in the 10-L3 group continued to rise from weeks 4 to 7. In the 50- and 500-L3 groups, IgE was detected first at week 3 and increased until week 5. It then declined in the 500-L3 group and the titer at week 7 was significantly lower than that at week 5, whereas it remained the same in the 50-L3 group. The number of larvae recovered from the head 40 hr after a challenge inoculation (1,000 L3) significantly declined by weeks 7, 3, and 2 in rats receiving 10, 50-, and 500-L3 inoculations, respectively. Intestinal worm burdens increased for 7 wk in the 10-L3 group, 5 wk for the 50-L3 group, and 2 wk for the 500-L3 group. These findings indicate that repeated inoculations of low doses of L3 induce delayed and limited protective immunity to a heavy challenge and worm expulsion from the intestine. There was a temporal correlation between the levels of protection and serum IgG, whereas circulating IgE level did not seem to affect directly either the level of the resistance or expulsion of intestinal worms.

Animals↗
PubMed1991

Eosinophilic ascites due to hyperinfection with Strongyloides stercoralis.

We report the case of a patient with cryptogenic cirrhosis, new onset ascites, and hyperinfection with Strongyloides stercoralis who had significant eosinophilia of the peritoneal fluid. The eosinophilia resolved with treatment of the S. stercoralis infection, and did not recur during two subsequent episodes of ascites and spontaneous bacterial peritonitis. Eosinophilic ascites is rare in parasitic infection, but it has been described in a variety of disorders which are discussed.

Animals↗