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PubMed1995

Corticosteroid-induced asthma: a manifestation of limited hyperinfection syndrome due to Strongyloides stercoralis.

Inadequate therapeutic response to parenteral corticosteroids in patients with acute bronchial asthma is infrequent. We report four patients whose bronchial asthma symptoms worsened after treatment with parenteral corticosteroids. All had larvae of Strongyloides stercoralis in the stool. The new attack or the exacerbation of asthma appeared to be precipitated by systemic corticosteroid administration. The paradoxic therapeutic response of asthma to glucocorticoides was the major pulmonary manifestation of Strongyloides superinfection; there was no evidence of other organ involvement. Individuals with new onset of bronchial asthma or worsening of asthmatic episodes concurrent with the use of systemic corticosteroids should have thorough investigation for possible superinfection due to Strongyloides stercoralis. This is particularly important for patients who have resided in areas where intestinal helminthic infections are endemic. Discontinuance of steroid therapy or reduction in dosage of parenteral steroids appears necessary. Treatment with thiabendazole appears to be effective in patients with limited hyperinfection syndrome.

Acute Disease↗
PubMed1993

Diagnostic methods for intestinal parasites in southern Iraq with reference to Strongyloides stercoralis.

Three hundred and thirty-two stool samples were examined for the presence of intestinal parasites including Strongyloides stercoralis. Each sample was processed and examined by direct smear, formalin-ether and Harada and Mori culture methods. Nine parasites were recovered from patients attending Basrah Teaching Hospital, southern Iraq during 1989. The prevalence rate of infection was 64.2%. It was higher in rural (74.2%) than in urban (57.5%) region (p < 0.01). Sex distribution was 120 (36.1%) males and 87 (26.2%) females (p > 0.05). The most common parasites were Blastocystis hominis, Giardia lamblia, Entamoeba histolytica, Hymenolepis nana and Strongyloides stercoralis. Formalin-ether concentration method was 3.75 times better than the direct smear method in the diagnosis of helminth rather than protozoan infections. The yield obtained by the usage of the Harada and Mori culture method (4.5%) was significantly higher than that obtained by formalin-ether (2.7%) or direct smear (0.3%) methods. Therefore, the Harada and Mori culture method is recommended in patients with undiagnosed diarrhea and where strongyloidiasis is endemic or suspected. Investigation of the relationship between age of the patients and prevalence showed that the prevalence of total intestinal parasites and of Strongyloides alone had essentially levelled off by age 11-20 and 21-30 years old, respectively. Clinical symptoms associated with S. stercoralis infection were diarrhea, anorexia and abdominal pain. Thiabendazole is still a drug of choice in the treatment of strongyloidiasis.

Adolescent↗
PubMed1995

[Disseminated Strongyloides stercoralis infection mimicking pneumonia].

Strongyloides stercoralis is an intestinal nematode. In an immunocompetent host, Strongyloides infections usually produce only mild gastrointestinal symptoms. However, in an immunocompromised host, widespread dissemination of larvae to the extra-intestinal organs may occur. If unrecognized, the mortality rate is high. Here we report a case of disseminated strongyloidiasis in a chronic obstructive pulmonary disease (COPD) subject whose chest radiograph demonstrated multiple pneumonic patches and interstitial infiltrates. Strongyloides larvae were found in stool, sputum, and urine, and embryonated eggs were also found in sputum. The patient was treated successfully with mebendazole and alben albendazole. In conclusion, although high mortality rate is noted in disseminated strongyloidiasis, it is still a curable disease when early diagnosis and treatment could be made.

Animals↗
PubMed1997

Molecular differences between several species of Strongyloides and comparison of selected isolates of S. stercoralis using a polymerase chain reaction-linked restriction fragment length polymorphism approach.

The relationships between the parasitic nematodes of medical importance belonging to the genus Strongyloides was studied using a polymerase chain reaction (PCR)-linked restriction fragment length polymorphism approach. We used several human and dog isolates of S. stercoralis, a monkey isolate of S. fulleborni, and S. ratti, a rodent parasite. The molecular analysis was based on amplification of the internal transcribed spacer and the 5' portion of the 23S-like rRNA gene followed by restriction enzyme digests. The length of the PCR product was specific to each species and varied around 1.5 kilobase pairs. Using nine restriction enzymes, we were able to analyze both interspecific and intraspecific variations. With four restriction enzymes (Taq I, Dde I, Dra I, and Mwo I), human isolates of S. stercoralis from different parts of the world showed identical patterns and could be differentiated from the dog isolate of S. stercoralis. Interspecific differences were readily observed with these and other enzymes. In addition to providing new information on the genomic characteristics of Strongyloides parasites, the results suggest that this technique could be useful for diagnostic and epidemiologic investigations.

Animals↗
PubMed1993

Central nervous system Strongyloides stercoralis in acquired immunodeficiency syndrome: a report of two cases and review of the literature.

Hyperinfection with Strongyloides stercoralis is rare in acquired immunodeficiency syndrome (AIDS), despite endemicity in areas where infection with human immunodeficiency virus is highly prevalent. We autopsied two patients with AIDS and disseminated Strongyloides and describe their central nervous system findings. The microscopic patterns of brain infection were dissimilar in the two patients, and reflected histology in systemic viscera. In one patient, a granulomatous response accompanied filariform larvae in all locations, including granulomatous ependymitis in brain. Additionally in the brain, larvae without tissue reaction were seen. In the second patient, the absence of tissue response to larvae was body wide, and isolated parasites were found in centrum semiovale. The occurrence of these patients in a region where Strongyloides is not endemic suggests that this infection may be more prevalent in AIDS than formerly suspected.

Acquired Immunodeficiency Syndrome↗
PubMed1987

An intervention study using thiabendazole suspension against Strongyloides fuelleborni-like infections in Papua New Guinea.

In an isolated rural community in Papua New Guinea, 88 children were found to be infected with Strongyloides cf. fuelleborni; 50 of these also had hookworm infections. Their ages ranged from one to 124 months and all were treated with thiabendazole suspension, 25 mg/kg twice daily for 3 days. 2 patients with Strongyloides and 5 with hookworm were still passing ova 2 weeks after treatment although their egg counts were lower or the same as the pre-treatment counts. 26 children experienced some side effects from the drug, vomiting being the most common; in none did side effects prevent completion of therapy. No association between Strongyloides egg load and nutritional status, hepatosplenomegaly, respiratory ailments, oedema or serum albumin levels was found.

Child↗
PubMed2004

Pelodera strongyloides infestation presenting as pruritic dermatitis.

Pelodera strongyloides is a free-living soil nematode of the order Rhabditida. We report an 18-year-old man with P strongyloides skin infestation. In this case, pruritic follicular papulopustules developed on the buttocks, then the right flank. Skin scrapings revealed many live rhabditiform larvae that were cultured adult worms and hatched ova, identified as P strongyloides . The eruption was treated effectively with topical 1% gamma-hexachlorocyclohexane ointment.

Adolescent↗
PubMed2004

Advances in developing molecular-diagnostic tools for strongyloid nematodes of equids: fundamental and applied implications.

Infections of equids with parasitic nematodes of the order Strongylida (subfamilies Strongylinae and Cyathostominae) are of major veterinary importance. In last decades, the widespread use of drugs against these parasites has led to problems of resistance within the Cyathostominae, and to an increase in their prevalence and intensity of infection. Novel control strategies, based on improved knowledge of parasite biology and epidemiology, have thus become important. However, there are substantial limitations in the understanding of fundamental biological and systematic aspects of these parasites, which have been due largely to limitations in their specific identification and diagnosis using traditional, morphological approaches. Recently, there has been progress in the development of DNA-based approaches for the specific identification of strongyloids of equids for systematic studies and disease diagnosis. The present article briefly reviews information on the classification, biology, pathogenesis, epidemiology of equine strongyloids and the diagnosis of infections, highlights knowledge gaps in these areas, describes recent advances in the use of molecular techniques for the genetic characterisation, specific identification and differentiation of strongyloids of equids as a basis for fundamental investigations of the systematics, population biology and ecology.

Animals↗
PubMed1989

Strongyloides and hookworm in Papua New Guinea: longitudinal studies on treated and untreated children.

Helminth egg counts were made on 86 treated and 38 untreated children in an isolated Papua New Guinea community before treatment and on nine subsequent occasions over an 18-month period. No predisposition could be detected to heavy or light infection with hookworm, either in the rate of reinfection or in the maximum post-treatment egg counts. Indications of predisposition in Strongyloides cf. fuelleborni were not statistically significant. In untreated children, sequential age-standardized hook-worm egg counts remained significantly correlated with each other at time lags up to nine months, but those for Strongyloides showed good correlation if made up to 14 months apart. Possible explanations include a surprising longevity of Strongyloides worms or unexpected external auto-infection.

Animals↗
PubMed1986

Pancreatic mass due to Strongyloides stercoralis infection: an unusual manifestation.

A 30-year-old man returning from a trip through India complained of epigastric pain, diarrhea, loss of weight, and jaundice. Stool examination was positive for Strongyloides stercoralis. On ultrasonographic investigation, intravenous cholangiography, and endoscopic retrograde cholangiopancreaticography, stenosis of the distal common bile duct and enlargement of the pancreatic head were observed. The patient was treated for the Strongyloides infection. The jaundice disappeared within days, the laboratory finding normalized, and the patient recovered rapidly. However, the ultrasonographic examination showed a complete recovery in the course of about 2 years. From this report we conclude that in patients with obstructive jaundice and Strongyloides stercoralis infection, serious abnormalities resembling pancreatic tumour or pancreatitis can be found on ultrasonographic and radiological investigations, and this should be considered in the differential diagnosis of pancreatic mass in patients living in or returning from endemic areas.

Adult↗
PubMed2006

Pelodera (syn. Rhabditis) strongyloides as a cause of dermatitis--a report of 11 dogs from Finland.

BACKGROUND: Pelodera (Rhabditis) strongyloides is a small saprophytic nematode that lives in decaying organic matter. On rare occasions, it can invade the mammalian skin, causing a pruritic, erythematous, alopecic and crusting dermatitis on skin sites that come into contact with the ground. Diagnosis of the disease is based on case history (a dog living outdoors on damp straw bedding) with characteristic skin lesions and on the demonstration of typical larvae in skin scrapings or biopsy. Pelodera (rhabditic) dermatitis cases have been reported mainly from Central European countries and the United States. CASE PRESENTATION: During 1975-1999, we verified 11 canine cases of Pelodera dermatitis in Finland. The cases were confirmed by identifying Pelodera larvae in scrapings. Biopsies for histopathology were obtained from three cases, and typical histopathological lesions (epidermal hyperplasia, epidermal and follicular hyperkeratosis, folliculitis and furunculosis with large numbers of nematode larvae of 25-40 microm of diameter within hair follicles) were present. The Pelodera strongyloides dermatitica strain from the first verified case in Finland has been maintained in ordinary blood agar in our laboratory since 1975. Light microscopy (LM) and scanning electron microscopy (SEM) studies were employed to obtain detailed morphological information about the causative agent. The rhabditiform oesophagus at all developmental stages, the morphology of the anterior end of the nematode, copulatory bursa and spicules of the male and the tail of the female were the most important morphological features for identifying P. strongyloides. CONCLUSION: These cases show that Pelodera dermatitis occurs in Finland, and also farther north than described earlier in the literature. This condition should be considered when a dog living outdoors has typical skin lesions situated at sites in contact with the ground as the main presenting clinical feature. The fastest and easiest way to confirm the diagnosis is to demonstrate typical larvae in skin scrapings. In uncertain cases, skin biopsy and culturing of the worms are recommended as supplementary diagnostic procedures.

Animals↗
PubMed1998

An epidemiological survey on intestinal parasite infection in Khammouane Province, Lao PDR, with special reference to Strongyloides infection.

To estimate the current prevalence of intestinal helminth infection in Lao PDR, a parasitological survey was conducted in three villages in Khammouane Province in December 1996, with special reference to Strongyloides infection. A total of 669 fecal samples were collected in the villages and examined by agar-plate culture method and Kato-Katz thick smear method. Intestinal helminths were demonstrated in 82% of the samples as follows: Ascaris lumbricoides (30.5%), Trichuris trichiura (23.7%), hookworm (28.8%), Strongyloides stercoralis (19.0%), Enterobius vermicuralis (3.4%), Opisthorchis viverrini (56.7%) and Taenia sp (3.0%). The infection rates of S. stercoralis were 27.5% and 18.4% in two rural villages, but only 9.4% in an urban village. The highest prevalence rate of Strongyloides infection was obtained in the age group from 20 to 29 years old, although the infection rate already reached 10% in the age group under 10 years old. The prevalence was consistently higher in male subject than females in almost all age groups.

Adolescent↗
PubMedDate not supplied

Screening for Strongyloides infection among the institutionalized mentally disabled.

BACKGROUND: Strongyloidiasis is an intestinal helminthic infection common among the mentally disabled population and can cause persistent occult infection before resulting in disseminated, possibly fatal disease. METHODS: Two cases of strongyloidiasis are described. The literature was searched using the key words "Strongyloides" and "mass screening." RESULTS AND CONCLUSION: Strongyloidiasis is clinically important and well documented in the mentally disabled populations both in endemic and nonendemic regions of North America. It has a substantial latent phase during which screening can be conducted, and its treatment with thiabendazole is convenient, effective, and reasonably well tolerated. Although strongyloidiasis is usually incidentally detected by findings of eosinophilia during routine blood screening, peripheral eosinophilia occurs only in 50% to 80% of infected persons and is extremely nonspecific for Strongyloides infection. Given the high cost of critical care for a patient with disseminated disease, screening mentally disabled populations in institutional settings for strongyloidiasis by administering the Strongyloides stercoralis antibody ELISA appears justifiable, particularly if risk factors for hyperinfection syndrome are used to select a subpopulation to be screened.

Anthelmintics↗
PubMed2004

Strongyloides serology--useful for diagnosis and management of strongyloidiasis in rural Indigenous populations, but important gaps in knowledge remain.

General practitioners who care for Aboriginal patients in rural and remote communities from tropical Australia must be aware of strongyloidiasis. The prevalence of this parasitic infection is high and occasional cases can have a fatal outcome. Other groups in Australia at high risk of strongyloidiasis are immigrants from endemic countries, particularly from Southeast Asia, and military personnel who have served overseas in endemic areas. Elimination programs for enteric parasites in rural Australian Indigenous communities are so important that a nationally coordinated approach has been advocated. Wisely used, cost-effective diagnostic tests are a critical component of an elimination program. Strongyloidiasis must be confirmed by laboratory diagnosis and the strongyloides ELISA, although not ideal, is a useful test that can be used to diagnose strongyloidiasis and to monitor cure. In this article the value of the current strongyloides ELISA is discussed and a cost-benefit analysis is conducted using direct costs only. In a typical rural Aboriginal community in tropical Australia with prevalence of strongyloidiasis at 20% each true positive case detected by the strongyloides ELISA is estimated to cost approximately AU590 dollars to diagnose and manage until cure, proven by negative serology.

Journal Article↗
PubMed1981

Eosinophilic appendicitis. Demonstration of Strongyloides stercoralis as a causative agent.

A 50-year-old man had severe ileus from strongyloidiasis. Pathologic examination of the appendix revealed the presence of an intact Strongyloides larva surrounded by an eosinophilic granuloma. This finding provides very strong evidence for Strongyloides as the causative agent of appendiceal eosinophilic granulomas previously only inferred to be due to Strongyloides in patients with evidence of strongyloidiasis.

Appendicitis↗
PubMed1994

[Strongyloides infections in former prisoners of war in South-East Asia in the second World War; additional information from serological diagnosis].

OBJECTIVE: To analyse the efficacy of ELISA serology in patients with Strongyloides infection acquired during World War II and maintained through repeated autoinfection. DESIGN: Descriptive. SETTING: Laboratory of Parasitology, Faculty of Medicine, Leiden, the Netherlands. METHODS: Parasitological and clinical data on 193 ex-prisoners of war (South-east Asia) were presented previously (1990) by Verburg and De Geus. ELISA using L-3 S. ratti antigen was carried out with sera of these patients and the results were compared with those of repeated stool examinations using Baermann's method. RESULTS: All subjects harbouring larvae in repeated stool examinations (26) were positive in serology. In 21 out of 167 patients in whom no larvae could be demonstrated, specific antibodies were detected. Anamnestic information together with data on eosinophilia and IgE levels suggested that the majority of these subjects were actually infected. The serological prevalence of infection with Strongyloides stercoralis was 33% for those imprisoned in Burma and 4% for those who were prisoners of war in the former Netherlands East Indies. CONCLUSION: In the group of subjects studied, in whom Strongyloides infection was apparently maintained through a process of autoinfection for a period of over 40 years, serology appears a sensitive and specific diagnostic tool. Larvae could be detected in no more than 26 out of 47 serologically positive subjects.

Aged↗
PubMed1995

Cross-resistance between Strongyloides venezuelensis and S. ratti in mice.

Cross-resistance between Strongyloides venezuelensis and S. ratti was tested in mice. The mice were immunized with S. ratti and challenged with infective filariform larvae or larvae recovered from the lungs of mice, of a heterologous species, S. venezuelensis. In this system, cross-resistance was expressed to the intestinal stage but not to the migrating stage of the parasite. Anti-interleukin (IL)-5 monoclonal antibody (mAb) treatment showed that peripheral blood eosinophilia after infection with both species of the genus Strongyloides was dependent on IL-5. Cross-resistance expressed to the intestinal stages was inhibited partially by injection of anti-IL-5 mAb.

Animals↗
PubMed2005

In vitro antiparasitic activity of extracts of Cardiospermum halicacabum against third-stage larvae of Strongyloides stercoralis.

Extracts of Cardiospermum halicacabum, medicinal plant, were tested in vitro for their effectiveness against third-stage larvae of Strongyloidesstercoralis. Third-stage larvae of S. stercoralis were isolated from cultures of dog's feces using agar plate culture method. The larvae (1,000 larvae/ml), suspended in phosphate buffer saline solution, pH 7.4, were exposed to aqueous and alcohol extracts (2,000 microg/ml) of C. halicacabum at 37 degrees C with 5% CO2. Ivermectin (250 microg/ml) and piperazine (2,000 microg/ml) were also used as the reference drugs. The survival of Strongyloides larvae based on its motility was determined daily for 7 days. Strongyloides larvae were viable after contact with ivermectin, piperazine and C. halicacabum (aqueous and alcohol) solutions, but most of them were immobilized, after exposure to aqueous and alcohol extracts of C. halicacabum within 72 and 48 h, respectively, while ivermectin took from 72 to 144 h, and piperazine more than 7 days, to achieve the same rate of nonmotility. Clearly, the viability of S. stercoralis larvae was significantly reduced when exposed to extracts of C. halicacabum. Further study is needed on the antiparasitic activity of aqueous and alcohol extracts of C. halicacabum against S. stercoralis.

Animals↗