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The 4 cases of Strongyloides stercoralis colitis presented show various radiological manifestations of colonic reaction. Mild involvement may be associated with minimal radiographic changes. Invasion of the bowel wall by the larvae results in ulceration and edema with loss of haustral markings; stricture may develop. Barium-enema examinations can help in evaluating the nature and clinical progress of the disease.
Papillomatous digital dermatitis is a common disease in cattle. The pastern dermatitis observed in a horse shared many of the gross characteristics of papillomatous digital dermatitis in cattle. Lesions included a mixture of proliferative and erosive changes, with a verrucose appearance in some areas. Microscopic similarities included pseudoepitheliomatous and papillomatous epidermal hyperplasia with hyperkeratosis, spongiosis of the epidermis, and intraepidermal spirochetes. The horse was also concurrently infected with Pelodera strongyloides. Papillomatous digital dermatitis in cattle is associated with poor husbandry practices. The environment of the affected horse was heavily contaminated with urine, manure, and other organic debris. Verrucous pododermatitis of horses may be the same as or similar to bovine papillomatous digital dermatitis, and these conditions have similar etiologies.
For obtaining the preliminary data on the pathogenesis of sudden death in calves naturally heavily infected with Strongyloides papillosus, we monitored 8 Holstein calves experimentally infected with the larvae on electrocardiographic and pneumographic changes. Six calves died suddenly on days 11 to 17 after infection. Sinus tachycardia had been recorded continuously since 1 to 6 days before death. Heart rates increased gradually until death. Since 1 or 2 days before death, various patterns of tachyarrhythmia and bradyarrhythmia had been observed among patterns of sinus tachycardia. Arrhythmias included serious ventricular premature beat, paroxysmal ventricular tachycardia, complete atrioventricular block and so on. The terminal pattern observed suddenly in all of the cases was ventricular arrhythmias consisting of serial ventricular tachycardia, flutter and fibrillation, which were followed by respiratory arrest. Abnormal pneumograms were not obtained before the terminal ventricular fibrillation. Two of 8 calves recovered from the infection, only one of which showed sinus arrest and the second degree of atrioventricular block transiently. We concluded that calves heavily infected with the larvae died due to sudden cardiac arrest.
We report a case of respiratory failure caused by Strongyloides stercoralis in a patient with a renal transplant; the respiratory failure showed dramatic response to therapy with thiabendazole. The clinical aspects of infestation with S stercoralis in the immunocompromised host are discussed, and features are demonstrated which may have significant implications concerning primary treatment and prophylaxis.
Overwhelming helminthiasis is still a problem in endemic areas, especially in immunocompromised patients. We report a case of invasive intestinal strongyloidiasis that was clinically expressed as acute abdominal distress in a 73-year-old man from São Paulo who had been receiving methylprednisone, 20 mg/day, for one year for osteoarthritis. A surgical specimen from the ileum revealed invasive enteritis with severe infestation by Strongyloides stercoralis. The patient died of sepsis 6 days after surgery. The possibility of invasive strongyloidiasis should be considered in the differential diagnosis of acute abdominal distress in patients undergoing immunosuppressive therapy.
A case of reactive arthritis combined with uveitis associated with a longstanding and heavy infestation with Strongyloides stercoralis is reported in a 32-year-old HTLV-1 positive West Indian man. Stool examination revealed numerous adult worms and larvae. Treatment with thiabendazole and ivermectin resulted in prompt improvement.
A case of Strongyloides stercoralis infection wss experienced in a 73-year old Korean female patient, was hospitalized with relapse of cholecystitis. The patient developed cough and dyspnea 17 days after the admission. On the 27th hospitalized day, diarrhoea, nausea, vomiting and abdominal pain started. A number of parasitic larvae were incubated at 25 degrees C for 2 days. Typical fork tailed filariform larvae of S. stercoralis (Bavay, 1876) Stiles and Hassall, 1902, were identified after cultivation. There was no improvement of diarrhoea after the medication with mebendazole. After the administration of thiabendazole, however, diarrhoea was stopped. On the 6th day of medication, S. stercoralis larvae were no more detected, and thereafter no larva was observed by repeated stool examinations upto 2 months after chemotherapy. The patient had the history of administration of steroid for articular rheumatism. Therefore this case seems to be a hyperinfection of S. stercoralis due to an autoinfection and to be the first report on the hyperinfected strongyloidiasis in Korea. Related literature was briefly reviewed.
Rhabditiform larvae, and in two cases eggs, of Strongyloides spp. identified in the stools of Zambian patients were cultured to the free-living adult stage. Free-living adults of S. fülleborni, a parasite common in primates in Africa and Asia, were present in cultures from 13 (9.9%) of 131 cases of strongyloidiasis. In three of these cases, both S. fülleborni and S. stercoralis free-living adults were found.
The elimination of adult parasites from the intestines of rats after a first and second infection of Strongyloides ratti was studied. Expulsion after a second infection was anamnestic, indication that the response is immunologic. Intestinal mast cell responses accompanied damage and expulsion of worms, the secondary mast cell response being more rapid but less intense that the first. Antithymocyte serum suppressed expulsion as well as both the intestinal mast cell and circulating eosinophil responses to primary infection.
Cortisone (5 mg daily subcutaneously) suppressed both primary and secondary immune explusion of Strongyloides ratti, and reduced the intestinal mast cell response, but did not induce hyperinfection in rats. Cortisone-treated animals expelled primary worm burdens without complication about 2 wk after steroid treatment. A model for gastrointestinal hypersensitivity syndromes in discussed.
Strongyloides stercoralis hyperinfection in a malnourished 6-year-old boy was characterized by severe diarrhea, dehydration and marked hypokalemia, followed by acute respiratory failure due to respiratory muscle paralysis, and cardiac arrest. He was resuscitated and maintained with positive pressure ventilation and intravenous infusion of potassium and gluco-saline solution. These measures produced recovery from the respiratory muscle paralysis. Stool examination revealed eggs and numerous larvae of S. stercoralis, and thiabendazole was initiated. He continued to have severe diarrhea and again developed marked hypokalemia with respiratory muscle paralysis, abdominal distention, and cardiac arrhythmias with cardiac arrest episodes. In spite of fluid and electrolyte replacement the patient died.
The small intestine is the usual site of chronic infection with Strongyloides stercoralis. Colonic involvement has generally been seen in the hyperinfection syndrome in immunosuppressed individuals. We describe an immunologically competent female who underwent multiple abdominal operations over a 5-year period for hematochezia and diffuse abdominal pain of obscure etiology. Eosinophilia had been present but never investigated until 1981, at which time stool examination revealed S. stercoralis larvae. Pathological specimens from operations in 1977 and 1981 demonstrated extensive colonic wall invasion with filariform larvae consistent with S. stercoralis. Involvement of other organs was never documented. We believe this case is consistent with chronic colitis due to strongyloidiasis. This entity has not been previously described, and expands the spectrum of this disease.
Authors report about a case of Strongyloides stercoralis infestation. The patient, a 65-year old man, presented with a clinical history of eosinophilia but without symptomatology. Several stool specimen showed the presence of rhabditiform larvae of S. stercoralis and after therapy the patient had a normalization of the white blood ceIls count. The authors wish to point out the importance of the diagnosis because a change in immune status may convert a previously asymptomatic infection to hyperinfection.
Prenatal infection of pigs with Strongyloides ransomi occurred in 12% of 104 pigs and in 14% of 21 litters farrowed by 13 sows experimentally exposed to infective larvae as weanlings. Transmammary passage was observed in 38 of 39 litters studied. Milk samples obtained from 14 sows showed that larvae were usually shed in the colostrum within 24 hours after farrowing; however, larvae were recovered from samples of milk of sows up to 20 days after parturition. Larvae were recovered from milk samples obtained after each parturition up to the fourth. Prenatal infection in pigs was not detected after the 1st litter.
The epidemiology of Strongyloides stercoralis infection was compared among three localities with various prevalences of human T lymphotropic virus type 1 (HTLV-1) infection in Okinawa Prefecture, Japan, using agar-plate culture of faeces. The prevalence of S. stercoralis infection is much higher in Gusukube, where HTLV-1 infection is rare, than in Yomitan, where this viral infection is common. In all localities the parasite prevalence is significantly higher in males than in females, whereas the prevalence of HTLV-1 infection is much higher in females. These epidemiological facts suggest that infection by S. stercoralis occurs independently of that by HTLV-1.
A repetitive administration of recombinant interleukin-3 (rIL-3), which can induce the expulsion of Strongyloides ratti in athymic nude mice, did not affect the expulsion of Nippostrongylus brasiliensis. Nude mice infected with N. brasiliensis were injected i.p. with a total of 6.8 x 10(5) U rIL-3 or medium twice a day from Day 5 to Day 11 post-infection. The kinetics of expulsion estimated by egg excretion in faeces up to Day 20 post-infection and adult worm burden on Day 21 was not affected by the IL-3 administration. A similar administration with a higher dose (total 10.6 x 10(5) U) of rIL-3 did not alter the adult worm burden on Day 13. The number of intestinal mucosal mast cells on Day 13 was markedly increased by the treatment, although the number of intestinal goblet cells was comparable between the treated and control mice. When nude mice were infected concurrently with N. brasiliensis and S. ratti and then injected repeatedly with rIL-3 (total 2.2 x 10(5) U) from Day 5 to Day 11, adult worms of S. ratti were expelled from the small intestine by Day 13; however adult worms of N. brasiliensis were retained. Again in the concurrent infection, the number of intestinal mucosal mast cells was significantly increased but that of intestinal goblet cells was not altered by the rIL-3 administration. These results indicate that the expulsion of S. ratti is dependent on IL-3 whereas that of N. brasiliensis is less dependent on IL-3.
A twenty-year-old landscape worker was evaluated for a widespread cutaneous eruption consisting of papules, pustules, and burrows. Cutaneous scrapings revealed live and dead larvae of a free-living soil nematode, Pelodera strongyloides. This is the third instance of human dermatitis due to this organism, and the first reported in an adult host.
We depleted or neutralized interleukin-5 (IL-5) and IL-5 receptor of C57BL/6 mice, using rat anti-murine IL-5 monoclonal antibody (NC17) and anti-murine IL-5 receptor monoclonal antibody (H7). Mice treated with these monoclonal antibodies were infected with Strongyloides venezuelensis larvae. The time-course of faecal egg output and peripheral eosinophilia were monitored. In a primary infection, anti-IL-5 treatment did not affect faecal egg output, although the eosinophil count in peripheral blood was markedly reduced. There was no difference in intestinal worm burden or faecal egg output between anti-IL-5 treated and non-treated mice. In a secondary infection, worms were expelled from the small intestine of anti-IL-5-treated mice as well as from non-treated mice. Worm recovery from the lungs of mice treated with either anti-IL-5 or anti-IL-5 receptor monoclonal antibody was the same as that of normal controls. However, a marked reduction in worm recovery was observed in re-infected mice that had not been treated with monoclonal antibodies. Treatment with anti-IL-5 or anti-IL-5 receptor monoclonal antibody suppressed blood and tissue eosinophilia. Thus the results suggested that the host's protective immunity against tissue-migrating larvae was IL-5-dependent but intestinal immunity was not.