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PubMedDate not supplied

Diagnosis of Strongyloides and hookworm infections: comparison of faecal and duodenal fluid microscopy.

Faecal microscopical diagnosis of Strongyloides and hookworm infections is insensitive. We have therefore compared duodenal fluid and faecal microscopy for detection of these parasites in a group of 292 patients being investigated for gastrointestinal symptoms who were examined by both techniques. Thirty-three of these patients (8%) were infected with Strongyloides stercoralis and 88 (30%) had hookworm infections. Microscopical examination of up to 3 faecal specimens detected only 33% and 65% of patients with Strongyloides and hookworm infections, respectively. Microscopical examination of a single specimen of duodenal fluid was more sensitive for detection of strongyloidiasis, identifying 76% of patients; the parasite was found exclusively in duodenal fluid (and not in faeces) in 67% of patients. For hookworm, the diagnostic sensitivity was similar with both techniques but duodenal fluid microscopy detected some patients (35%) who had not been identified by faecal microscopy. This study confirms previous work indicating the insensitivity of faecal microscopy in these infections and emphasizes the need to consider routine examination of duodenal fluid to exclude chronic strongyloidiasis. This may have particular relevance for south-east Asian war veterans and immunocompromised patients.

Ancylostomatoidea↗
PubMed2003

Strongyloides appendicitis: unusual etiology in two siblings with chronic abdominal pain.

Appendicitis is one of the most common causes of acute surgical disease in children and young adults. Parasites, however, are one of the uncommon etiologies. An 8-year-old girl and her 7-year-old sister presented with more than 2 months of chronic abdominal pain that became worse over a 1-week period before presentation. The 2 sisters presented 1 month apart. Both had similar symptomatology and physical examination findings. At operation, the surgical findings included an inflamed appendix with a cross section of the parasite Strongyloides. Strongyloides appendicitis has occurred almost exclusively in areas endemic to the parasite. Its environment is more common outside the United States but occasionally is seen in the Southeast region and in institutionalized individuals. The presentation of acute exacerbation of chronic abdominal pain coupled with the pathologic finding of Strongyloides in an acutely inflamed appendix, should alert the clinician of other possible cases. This increased index of suspicion will allow more prompt diagnosis and help avoid the morbidity of delayed operation.

Abdominal Pain↗
PubMed2005

[Massive haemoptysis associated with pulmonary Strongyloides stercoralis hyperinfestation].

INTRODUCTION: Pulmonary infestation with Strongyloides stercoralis is an exceptionally rare cause of haemoptysis, the diagnosis being difficult and often delayed. CASE REPORT: We report the case of a retired coal miner suffering from pneumoconiosis who presented with acute respiratory insufficiency and massive haemoptysis, with a fatal outcome, associated with pulmonary stongyloidosis. The only identified source of infestation with Strongyloides stercoralis was his period in the coal mine and the only risk factors for the hyperinfestation were a short course of systemic corticosteroid therapy and the presence of a peritoneal-auricular valve. CONCLUSION: This observation illustrates the importance of a systematic search for anguillosis in ex coal miners prior to any immunosuppressant treatment in order to avoid the serious and frequently fatal form of hyperinfestation with Strongyloides stercoralis.

Aged↗
PubMed1996

Hyperacute pneumonitis in a patient with overwhelming Strongyloides stercoralis infection.

The case of a 64-year-old man who was admitted to hospital with fever, general deterioration and anorexia is reported. For the past 4 years, the patient had been receiving corticosteroid therapy for a chronic inflammatory demyelinating polyradiculoneuropathy. Soon after admission the patient developed respiratory insufficiency as a result of a massive pneumonitis, with severe hypoxia, acute anaemia, acute renal failure and a systemic inflammatory response syndrome (SIRS) requiring admission to the Intensive Care Unit (ICU). All faecal, bronchial, duodenal and urine samples showed Strongyloides stercoralis larvae. Despite antihelmintic therapy and cardiorespiratory support, the patient died from the consequences of irreversible shock. Strongyloidiasis is present worldwide and can be a chronic, essentially asymptomatic infection. This nematode can produce an overwhelming hyperinfection syndrome, especially in patients showing deficient cell-mediated immunity. Strongyloides hyperinfection syndrome is frequently fatal but is potentially a treatable clinical condition. Patients undergoing immunosuppressive therapy or with suspected immunity deficiency (HIV infection, malnutrition, lymphomas, leukaemias or other neoplasia treated with systemic radiotherapy or chemotherapy) must be also monitored for opportunistic Strongyloides stercoralis infection, because clinical manifestation of the systemic hyperinfection syndrome can be rather non-specific.

Animals↗
PubMed2003

Clinical presentation and diagnostic sensitivity of laboratory tests for Strongyloides stercoralis in travellers compared with immigrants in a non-endemic country.

OBJECTIVES: To assess whether the clinical and laboratory methods for diagnosing Strongyloides stercoralis infection in non-endemic countries is different between those who are chronically exposed and those who travel. METHODS: Analysis of laboratory and clinical data from 204 patients having S. stercoralis infection at the Hospital for Tropical Diseases, London. RESULTS: Sixty-four travellers and 128 immigrants from endemic countries had laboratory-proven strongyloides. In those with microscopically proven disease, serology was 73% sensitive in travellers and 98% sensitive in immigrants (P < 0.001). There was no difference in the eosinophil count between the two groups with 19% having a normal count. Patterns of symptoms varied between the groups, and around one-third were asymptomatic in both groups. Serology was of limited use in follow-up. CONCLUSIONS: Eosinophil count and stool microscopy are insufficiently sensitive to be used alone for screening strongyloides. The sensitivity of serology is good in immigrants with chronic infection, but lower in travellers.

Adolescent↗
PubMed1996

Strongyloides stercoralis eosinophilic granulomatous enterocolitis.

Six patients suffering from an unusual form of colitis produced by Strongyloides stercoralis hyperinfection are described. In contrast to the usual Strongyloides hyperinfection syndrome, in which small intestinal and pulmonary manifestations are seen in patients with some forms of immunodeficiency, the patients described here presented with only a characteristic transmural eosinophilic granulomatous inflammation affecting mostly the colonic wall and clinically mimicking ulcerative colitis or Crohn's disease. This Strongyloides eosinophilic granulomatous enterocolitis apparently results from a florid inflammatory response by eosinophils, histiocytes, and giant cells with formation of granulomas that destroy the larvae entering the colon. This morphologic picture differs from that of the well-described hyperinfection syndrome, in which the bulk of the larvae pass through the colonic wall to complete the life cycle, with only a few larvae destroyed in the colon. The probable pathophysiologic mechanism of this unusual manifestation of hyperinfection is discussed based on the anatomic and clinical observations of patients who presented at different stages in the evolution of their condition and whose length of follow-up varied.

Aged↗
PubMed2005

Strongyloides hyperinfection and hypogammaglobulinemia.

We report strongyloides hyperinfection in two patients with generalized hypogammaglobulinemia from multiple myeloma and nephrotic syndrome, despite a significant strongyloides-specific immunoglobulin G (IgG) response. In contrast to reports on animals, where human IgG was shown to be a protective antibody, our observation suggests that in humans, immunity to the infective-stage larvae is not protective against the autoinfective larvae, which are the causative agents of strongyloides hyperinfection.

Agammaglobulinemia↗
PubMed1997

Intestinal immune cells in Strongyloides stercoralis infection.

BACKGROUND: Strongyloides stercoralis can cause a wide spectrum of disease in man, ranging from a chronic asymptomatic infection to a hyperinfective, often fatal syndrome. In rodents, spontaneous expulsion of Strongyloides spp occurs after experimental infection. Mast cells, goblet cells, and eosinophils have been identified as possible effectors of this expulsion. AIMS: To investigate intestinal histopathology and mucosal immunity in immunocompetent patients with chronic S stercoralis infection. METHODS: Jejunal biopsies were performed in 19 immunocompetent patients with a positive stool examination for S stercoralis and few or no symptoms, and in seven healthy controls. Specimens were processed for histopathological analysis and stained by the immunoperoxidase technique, using the following monoclonal antibodies: CD2, CD3, CD4, CD8, anti-T cell receptor (TcR) gamma/delta, RFD1 and RFD7 (two different macrophage markers), Ki67+ (proliferating) cells, antihuman leucocyte antigen (HLA)-DR, and anticollagen IV. In addition, CD25+ cells, mast cells, IgE expressing cells, calprotectin containing cells, and neutrophil elastase positive cells were stained by the alkaline phosphatase method. RESULTS: Jejunal morphology and the numbers of different T cell subsets, mast cells, IgE expressing cells, eosinophils, and goblet cells were unaffected by S stercoralis infection. Conversely, the numbers of mature macrophages and dividing enterocytes in the crypts were reduced significantly. Crypt enterocytes did not express HLA-DR in both groups. The expression of HLA-DR by villus enterocytes was also comparable in patients and controls. There were no activated (CD25+) cells in the mucosa of either patients or controls. CONCLUSIONS: Compared with seven healthy uninfected volunteers, a group of 19 Brazilians with clinically mild strongyloides infection showed no abnormality of mucosal structure and no increase in non-specific inflammatory cells. Likewise, there was no increase in mucosal T cells or macrophages.

Adult↗
PubMed2006

Dissemination of Strongyloides stercoralis as an immune restoration phenomenon in an HIV-1-infected man on antiretroviral therapy.

We present a case of Strongyloides stercoralis infection in an HIV-infected man, resulting in Escherichia coli meningitis after initiation of antiretroviral therapy. Recent evidence from studies of strongyloides development supports the concept that strongyloides dissemination in this case is an example of an immune reconstitution inflammatory syndrome.

Adult↗
PubMed2004

Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management.

Strongyloidiasis, which is caused by the nematode Strongyloides stercoralis, is a common and persistent infection, particularly in developing countries. In the setting of compromised cellular immunity, it can result in fulminant dissemination with case-fatality rates of over 70%. The majority of new Canadian immigrants come from countries where Strongyloides is highly endemic; therefore, the burden of Strongyloides may be underappreciated in Canada. Because early diagnosis and therapy can have a marked impact on disease outcome, screening for this infection should be considered mandatory for patients who have a history of travel or residence in a disease-endemic area and risk factors for disseminated disease (e.g., corticosteroid use and human T-lymphotropic virus type I infection).

Animals↗
PubMedDate not supplied

Studies on prevalence of Strongyloides infection in Holambra and Maceió, Brazil, by the agar plate faecal culture method.

Prevalence of Strongyloides stercoralis infection in three areas of Brazil was surveyed by a recently developed faecal culture method (an agar plate culture). The Strongyloides infection was confirmed in 11.3% of 432 subjects examined. The diagnostic efficacy of the agar plate culture was as high as 93.9% compared to only 28.5% and 26.5% by the Harada-Mori filter paper culture and faecal concentration methods, when faecal samples were examined simultaneously by these three methods. Among the 49 positive samples, about 60% were confirmed to be positive only by the agar plate culture. These results indicate that the agar plate culture is a sensitive new tool for the correct diagnosis of chronic Strongyloides infection.

Adolescent↗
PubMed2005

Strongyloides ratti infection in the large intestine of wild rats, Rattus norvegicus.

The large intestine of a rat has been neglected almost completely as a site of Strongyloides sp. infection. We reported that adult Strongyloides ratti remained in the large intestine for more than 80 days, producing more number of infective larvae than small intestine adults, and therefore hypothesized that parasitism in this site could be a survival strategy. In wild rats, however, no study has focused on large intestine infections of Strongyloides. The present study revealed that 32.4% of 68 wild rats, Rattus norvegicus, had the infection of S. ratti in the large intestine, with an average of 4.7 worms. These worms harbored normal eggs in the uterus. In a laboratory experiment with S. ratti and Wister rats, daily output of infective larvae by 4.7 females in the large intestine was estimated to be 4,638.4, suggesting that a few parasites could play a role in the parasite transmission. Five species of nematode found in the wild rats showed seasonality in infection intensity, with highest intensities in March-May. The number of S. ratti in the large intestine was also highest in these months.

Animals↗
PubMed1994

Short report: gastric infection by Strongyloides stercoralis.

Strongyloides stercoralis ordinarily matures in the human proximal small intestine and embeds in the small intestine mucosal wall where eggs are produced. Although Strongyloides may infect many sites in hyperinfection syndromes, reports of gastric involvement are rare. We report a patient taking prednisone and an H2 blocker who developed hyperinfection syndrome, with mucosal Strongyloides larvae seen in a gastric biopsy.

Animals↗
PubMed2004

Death caused by strongyloides hyperinfection in a leprosy patient on treatment for a type II leprosy reaction.

Strongyloides stercoralis is present worldwide and can cause hyperinfection in patients on long-term immunosuppressive doses of steroids, as is sometimes the case for patients treated for leprosy reactions. Strongyloides hyperinfection can present with ileus, as is discussed in this case report. Physicians, including surgeons, should be aware of this entity in order to avoid an unnecessary laparotomy. Though patients may survive if diagnosed at an early stage, strongyloides hyperinfection syndrome has a mortality rate of 87% and prevention is therefore of utmost importance.

Adult↗
PubMed1990

An evaluation of the agar plate method for the detection of Strongyloides stercoralis in northern Thailand.

An examination of the stools from school-children in northern Thailand was performed in order to compare the efficacy of a new method--the agar plate method--for the detection of Strongyloides stercoralis with traditional methods. Twenty-three positive specimens (15.5%) from a total of 148 specimens were detected as follows: 18 cases by the agar plate method, 13 cases by direct stool smear, 11 cases by filter paper culture, and four cases by the formalin-ether method (MGL). On the basis of the above results, the agar plate method appeared to be more efficient than traditional methods for detecting Strongyloides in human stool samples. Other positive factors in its favour were ease of manipulation and low cost. There were some problems with using this method. Five cases shown to be positive by traditional methods were negative in the agar plate method, and it was necessary to discriminate Strongyloides microscopically from other similar nematode larvae, especially in an area, such as northern Thailand, with a high prevalence of hookworms.

Animals↗
PubMed1986

[Effectiveness of ivermectin in Strongyloides westeri cases in foals].

Efficacy of Ivermectin in combating Strongyloides westeri infection of foal. The efficacy of Ivermectin and Mebendazol in combating spontaneous Strongyloides westeri infections in foals has been tested by examining faecal egg output reduction. Ivermectin as a paste formulation was given to sucking foals and pregnant mares in a single dosage of 200 micrograms/kg bodyweight by oral administration. A high efficacy of Ivermectin in combating patent Strongyloides westeri infection could be demonstrated; no side effects have been observed. Mebendazol at a dosage rate of 8 mg/kg did not yield satisfactory results.

Animals↗
PubMed1977

Cytology, reproduction, and sex determination of Strongyloides ransomi and S. papillosus.

Parasitic females of Strongyloides ransomi and Strongyloides papillosus have 4 chromosomes and reproduce exclusively by mitotic (apomictic) parthenogenesis. The free-living generation includes females and males. The females have 2 pairs of chromosomes of unequal size and reproduce by meiotic parthenogenesis following obligatory pseudofertilization (gynogenesis). The males undergo spermatogenesis by the regular meiotic process and have the same chromosomal complement as the females. During prophase I, however, a portion of one homologue of the large bivalent breaks free and subsequently is diminished, as in S. ransomi, or it rejoins the original homologue, as in S. papillosus. This behavior of meiotic chromosomes during spermatogenesis suggests that the karyotype of these species has evolved from a karyotype analogous to that of Strongyloides ratti with 2 pairs of autosomes and a pair of X chromosomes, following fusion of the X chromosome with an autosome and the formation of a Neo-X and a Neo-Y chromosome. The female karyotype of S. ransomi and S. papillosus thus may be 2A + 2 Neo-X. The males are phenotypic males and have the same karyotype as the females, but their functional karyotype may be 2A + Neo-X + Neo-Y.

Animals↗
PubMed1995

[Strongyloides stercoralis in a region of northwestern Italy. An epidemiological note and presentation of a case of eosinophilic infiltration of the lung].

The Authors report a case of Strongyloides stercoralis infection in an autochthonous farmer from Piedmont (Northern Italy) presenting as an eosinophilic lung disease. After having briefly considered the epidemiological and clinical characteristics of the Strongyloides stercoralis infection, the Authors conclude by affirming that the appearance of migratory pulmonary infiltrates in autochthonous subjects or resident in Canavese area (Piedmont), especially if blood and sputum eosinophilia is present, should raise the possibility of Strongyloides-induced lung disease and lead to appropriate examination of sputum, feces, and eventually duodenal contents.

Aged↗