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PubMed1996

[Chronic recurrent subileus due to Strongyloides stercoralis infection under immunosuppressive therapy].

HISTORY AND CLINICAL FINDINGS: A 33-year-old woman from Laos was admitted due to recurrent vomiting and weight loss. Since one year, she was receiving immunosuppressive therapy (azathioprine 50 mg/d and methylprednisolone 18 mg/d) for a mixed connective tissue disease. Because of a drug induced Stevens-Johnson-Syndrome one month earlier high doses of methylprednisolone (100 mg/d intravenously) had been administered. The patient's general condition was reduced. Examination elicited a mild pain in the middle abdomen on palpation but no resistance or tumour. The differential diagnosis included obstructive and (or) inflammatory disease of the gastrointestinal tract. INVESTIGATIONS: Elevated IgE-levels (1111 IU/ml; normal up to 100 IU/ml) and eosinophilia (8%) lead to the suspicion of a helminthiasis. Oesophagogastroduodenoscopy showed a significant duodenal stenosis. Duodenal biopsy revealed a severe infestation with Strongyloides stercoralis. Stool examinations were negative though. TREATMENT AND COURSE: With administration of thiabendazole (2 g/d) a rapid recovery was noted. A second oesophagogastroduodenoscopy one week after the onset of therapy revealed no further stenosis. Since there was no activity of the mixed connective tissue disease the methylprednisolone dosage was reduced and the administration of azathioprine was ceased. 3 weeks after beginning of treatment the patient was discharged in improved condition. CONCLUSION: In immunocompromised patients suffering from gastrointestinal complaints who have been in endemic areas an infection with Strongyloides stercoralis should be excluded. Without treatment, this helminthiasis may be fatal.

Adult↗
PubMed2003

Strongyloides ratti: the role of interleukin-5 in protection against tissue migrating larvae and intestinal adult worms.

To determine the role of interleukin-5 (IL-5) and eosinophils in protection against Strongyloides ratti, mice treated with anti-IL-5 monoclonal antibody (mAb) were infected with S. ratti larvae. Strongyloides ratti egg numbers in faeces (EPG) in mAb treated mice were higher than those in control mice on days 6 and 7 after inoculation. The numbers of migrating worms in mAb treated mice 36 h after inoculation were higher than those observed in control mice. Intestinal worm numbers in mAb treated mice 5 days after inoculation were higher than those in control mice. These results show that eosinophils effectively protected the host against S. ratti infection by mainly the larval stage in primary infections. The involvement of eosinophils in protection against secondary infection was also examined. Before secondary infection, mice were treated with anti-IL-5 mAb and infected with S. ratti. Patent infections were not observed in either mAb treated or control Ab treated mice. The numbers of migrating worms in the head and lungs of mAb treated mice increased to 60% of that in primary infected mice. Intestinal worms were not found in mAb treated mice or in control mice after oral implantation of adult worms. Eosinophils were therefore mainly involved in protection against tissue migrating worms in secondary infections.

Animals↗
PubMed1989

A serological test for the diagnosis of Strongyloides antibodies in ex Far East Prisoners of War.

This paper gives the results of an ELISA test for Strongyloides stercoralis antibodies in a group of 436 ex Far East Prisoners of War (FEPOWs). Antigen was obtained from third-stage larvae of Strongyloides cebus. Sensitivity of the test is 97%, with a specificity of 99%. The test is being investigated further as regards cross-reactions with other helminths, but initial results look promising.

Animals↗
PubMed1990

The use of isoenzyme electrophoresis in the taxonomy of Strongyloides.

The limited usefulness of traditional taxonomic methods combined with the discovery of a Strongyloides parasitic in man in Papua New Guinea (PNG) that resembles S. fuelleborni, a parasite of man and other primates in tropical Africa, has precipitated the need to apply new methods to the taxonomy of the genus. In this study isoenzyme electrophoresis has been used on Strongyloides isolates of many different origins. Cluster analysis of the data suggested that existence of three main groups within the material considered, consisting of (1) isolates of S. stercoralis, (2) isolates from PNG domestic animals, and (3) isolates from PNG man and African non-human primates. The taxonomic implications of these groups are considered.

Animals↗
PubMed1998

Interferon-gamma and interleukin-4 responses in relation to serum IgE levels in persons infected with human T lymphotropic virus type I and Strongyloides stercoralis.

Possible immunologic interaction between infection with human T lymphotropic virus type 1 (HTLV-1), a retrovirus, and the intestinal parasite Strongyloides stercoralis was investigated in persons infected with one or both agents. This was done by examining the cytokine responses of peripheral blood mononuclear cells (PBMC) to mitogens and Strongyloides antigen. PBMC of subjects infected with HTLV-1 spontaneously produced interferon (IFN)-gamma with levels that correlated inversely with serum IgE levels. HTLV-1-infected subjects also had poor interleukin (IL)-4 responses to mitogenic stimulation, unlike persons without HTLV-1 infection. It is postulated that the IFN-gamma produced by activated T cells in some HTLV-1-infected persons acts to down-regulate IL-4 with consequent reduction of serum IgE levels. The impaired IgE responses and other effects of IL-4 down-regulation may be contributing factors to more severe disease and impaired response to treatment of strongyloidiasis in some HTLV-1-infected persons.

Animals↗
PubMed1991

Case report: adult T-cell leukemia/lymphoma associated with recurrent strongyloides hyperinfection.

Adult T-cell leukemia/lymphoma (ATLL) was demonstrated postmortem in a 47-year-old woman initially manifesting severe hypercalcemia and a vertebral compression fracture. Hyperinfection with Strongyloides stercoralis preceded the appearance of ATLL by several months and ultimately dominated the terminal course. Although HTLV-I and S. stercoralis commonly infect the same host, only three other cases of concomitant ATLL and hyperinfection have been reported in English. The apparent rarity of this association suggests that immunologic sequelae of ATLL do not predispose to dissemination and multiplication of Strongyloides. Observations pertinent to this conclusion are reviewed.

Animals↗
PubMed1987

Strongyloides meningitis.

Acute pyogenic meningitis occurred in a 46-year-old woman receiving long-term steroid therapy. Cultures for bacteria and fungi were negative, and the meningitis failed to respond to broad spectrum antibiotics. Abundant Strongyloides stercoralis larvae were found in the patient's feces a sputum, and a filariform larva was found in a hanging drop preparation from centrifuged cerebrospinal fluid. Therapy with thiabendazole eradicated the Strongyloides from feces and sputum. The abnormal CSF values returned toward normal, and the patient has had no recurrence of illness.

Cerebrospinal Fluid↗
PubMed2004

Determining the optimal developmental route of Strongyloides ratti: an evolutionarily stable strategy approach.

Understanding the processes that drive parasite evolution is crucial to the development of management programs that sustain long-term, effective control of infectious disease in the face of parasite adaptation. Here we present a novel evolutionarily stable strategy (ESS) model of the developmental decisions of a nematode parasite, Strongyloides ratti. The genus Strongyloides exhibits an unusual developmental plasticity such that progeny from an individual may either develop via a direct (homogonic) route, where the developing larvae are infective to new hosts, or an indirect (heterogonic) route, where the larvae develop into free-living, dioecious adults that undergo at least one bout of sexual reproduction outside the host, before producing offspring that develop into infective larvae. The model correctly predicts a number of observed features of the parasite's behavior and shows that this plasticity may be adaptive such that pure homogonic development, pure heterogonic development, or a mixed strategy may be optimal depending on the prevailing environmental conditions, both within and outside the host. Importantly, our results depend only on the benefits of an extra round of reproduction in the environment external to the host and not on benefits to sexual reproduction through the purging of deleterious mutation or the generation of novel, favorable genotypes. The ESS framework presented here provides a powerful, general approach to predict how macroparasites, the agents of many of the world's most important infectious diseases, will evolve in response to the various selection pressures imposed by different control regimes in the future.

Adaptation, Biological↗
PubMed1994

Strongyloides venezuelensis infection in Syrian golden hamster, Mesocricetus auratus, with reference to the phenotype of intestinal mucosal mast cells.

Syrian golden hamster, Mesocricetus auratus, was found to be a moderately susceptible host for the intestinal helminth, Strongyloides venezuelensis. After infection by subcutaneous inoculation with 3000 infective larvae (L3), about 20% of them became adult worms in the small intestine, and, after a stable infection up to day 20, adult worms were slowly and gradually expelled towards day 45. Before infection, mast cells in the jejunum were about 30/10 villus crypt units and over 80% of them were formalin-resistant and berberine sulphate-fluorescence positive. After infection with S. venezuelensis, the number of intestinal mast cells gradually increased with time and about a half of them were formalin-sensitive and berberine sulphate fluorescence-negative. Intraepithelial migration of mast cells was never seen before and after infection. Heterogeneity of mucosal mast cells in terms of granular proteoglycans was further confirmed by the determination of critical electrolyte concentration. In spite of the heterogeneity of proteoglycans, enzyme-histochemical study revealed that practically all mucosal mast cells of Syrian golden hamsters were positive for chymase but negative for tryptase. Mast cells in the skin and tongue were also positive for chymase but negative for tryptase. Together with our previous study on mucosal mast cells of other rodents, phenotypic variances of mucosal mast cells seem to be closely related to the protective capacity against the genus Strongyloides.

Animals↗
PubMed2006

Comparison of efficacy of moxidectin and ivermectin in the treatment of Strongyloides fulleborni infection in rhesus macaques.

BACKGROUND: Strongyloides infection may result in clinical disease or confound experimental protocols that utilize non-human primates. There is presently a Strongyloides fulleborni infection rate of approximately 27% in the Tulane National Primate Research Center's breeding colonies despite the routine therapeutic and prophylactic use of ivermectin. METHODS: A study was conducted to determine if moxidectin treatment offers advantages to the intestinal parasite control program. A total of 150 rhesus macaques (Macaca mulatta) that were removed from the breeding colonies due to illness were selected for the study. The animals were randomly assigned to treatment groups with 75 receiving ivermectin and 75 receiving moxidectin. Egg counts were performed on fecal samples collected pre- and post-treatment. RESULTS: Both treatments resulted in decreases in the number of eggs/g in the post-treatment sample as compared with the pre-treatment sample; however, no significant difference was found between treatment groups. CONCLUSIONS: With the data demonstrating a similar efficacy in both ivermectin and moxidectin treated macaques, the benefit of moxidectin treatment relates to biosafety and topical application.

Administration, Topical↗
PubMed1994

Biliary obstruction resulting from Strongyloides stercoralis infection. Report of a case.

Hepatobiliary manifestations of strongyloidiasis are rare. A case is described of biliary obstruction associated with the presence of Strongyloides stercoralis in the duodenal mucosa and 250 microns rhabditiform larvae in bile. Biliary obstruction resulted from papillary stenosis, which resolved after treatment with thiabendazole. It is proposed that papillary stenosis may be responsible for obstructive jaundice associated with Strongyloides stercoralis infection, and that strongyloidiasis should be added to the causes of papillary stenosis.

Adult↗
PubMed1995

Restrictive pulmonary disease due to interlobular septal fibrosis associated with disseminated infection by Strongyloides stercoralis.

Strongyloidiasis is caused by the nematode Strongyloides stercoralis. The parasite has a unique life cycle that enables it to cause a hyperinfection syndrome in which pulmonary involvement is characteristic. We describe the case of a 68-yr-old Hispanic male from Puerto Rico with disseminated strongyloidiasis who developed intense granulomatous reaction in the lung associated with interlobular septal fibrosis. Granulomatous lung disease leading to fibrosis within the lung has been well demonstrated in schistosomiasis, another parasitic disease. This case represents the first report, as far as we are aware, of fibrosis within the lung and restrictive pulmonary disease in association with Strongyloides stercoralis.

Aged↗
PubMed2003

Strongyloides hyper-infection: a case for awareness.

In patients receiving immunosuppressive therapies, Strongyloides stercoralis can cause a life-threatening septic shock, with multi-organ failure and infestation. Strongyloides hyper-infection should be considered in any immunosuppressed patient who has been exposed to the parasite, even if it is many years since that exposure occurred. Delayed eosinophilia may be a feature and treatment with high doses of anthelmintics may be required. An interesting case of S. stercoralis hyper-infection was recently observed at the Royal Darwin Hospital in tropical, northern Australia. The patient was an 18-year-old female with lupus glomerulonephritis, who was receiving immunosuppression in the form of corticosteroids and pulse cyclophosphamide. The characteristics and intensive-care management of this case, including the use of granulocyte-colony stimulating factor and high-dose ivermectin, are described. The patient, who survived, appears to represent the first reported case of S. stercoralis hyper-infection with suspected myocarditis.

Adolescent↗
PubMed2002

Strongyloides stercoralis infection with bloody pericardial effusion in a non-immunosuppressed patient.

A 63-year-old Taiwan aboriginal male was admitted with exertional dyspnea, appetite loss and general fatigue. Echocardiography revealed moderate pericardial effusion and histological examination of the pericardiocentesis sample revealed an eosinophil-dominated bloody exudate. The larvae of Strongyloides stercoralis were detected in the pericardial specimen. After treatment with anti-nematodal agents, the eosinophilia decreased from 26% to 1% and the patient's symptoms improved. This is a rare case of Strongyloides-induced bloody pericardial effusion in a non-immunosuppressed patient.

Animals↗
PubMed1994

Isolation of Strongyloides venezuelensis from Rattus norvegicus in Kagoshima Prefecture.

On 30 August 1984, Strongyloides sp. specimens were isolated from a rat (Rattus norvegicus) trapped at a pig farm in Kiire-cho, Ibusuki-gun, Kagoshima Prefecture. Both anterior and posterior ovaries of parasitic female were spirally coiled. The means of body length and width, esophagus length, and the distances from mouth to vulva and from anus to tail end were 2,493, 34.5, 719.8, 1,682.8 and 54.4 microns respectively. Filariform larvae measured 544.2, 15.6 and 238.5 microns in the means of body length and width, and esophagus length respectively. These measurements of the present Strongyloides species agreed with those described for S. venezuelensis. Infection rate by oral administration of larvae was low, while subcutaneous inoculation and percutaneous exposure to larvae produced high infection rate to rats which discharged many egg in the feces. The present parasite has been passaged through rats (SD strain) in these 8 years. This isolate is designated as the Kagoshima strain of S. venezuelensis.

Animals↗
PubMed1994

The prevalence and response to therapy of Strongyloides stercoralis in patients with asthma from endemic areas.

STUDY OBJECTIVE: To evaluate the prevalence and response to therapy of Strongyloides stercoralis infection in immigrant patients with asthma from areas endemic for Strongyloides. DESIGN AND INTERVENTIONS: In all patients, we performed a complete history and physical examination, complete blood cell counts (CBC), S stercoralis serologic tests, spirometry, and evaluated three stool samples for ova and parasites. Patients treated for S stercoralis infection had follow-up CBC, spirometry, serologic tests, and at least three additional stool examinations to confirm eradication of the parasite. SETTING: Ambulatory and hospitalized patients who were referred to the respiratory medicine clinic of a general hospital for the evaluation and treatment of asthma. PATIENTS: Forty-five asthmatic adults, representing 12 endemic countries, ranging in age from 20 to 76 years, were prospectively evaluated. RESULTS: Six of 45 patients were infected with S stercoralis, which yielded a prevalence of 13 percent. The patients with asthma and S stercoralis infection had higher blood eosinophil counts (p = 0.006) and were younger (p = 0.006) compared with patients with only asthma. There was no difference in the duration of asthma, spirometry, or steroid use between the two groups. Patients with S stercoralis and asthma tended to be more recent immigrants (p = 0.05). Five of the six patients with S stercoralis agreed to be treated with thiabendazole but only four returned for follow-up evaluation. All four patients had eradication of S stercoralis infection confirmed by negative stool examinations and a decline in S stercoralis serology (160 +/- 25 percent vs 13 +/- 13 percent, p = 0.03). All four patients had a decline in total blood eosinophil counts (2,476 +/- 832 cells per cubic millimeter vs 551 +/- 138 cells per cubic millimeter, p = 0.03) without a clinical improvement in asthma. CONCLUSIONS: Our data suggest that patients with asthma from areas endemic for S stercoralis, who have elevated peripheral blood eosinophil counts, should be screened for S stercoralis infection. Successful eradication of S stercoralis, however, may not result in a clinical improvement of asthma.

Adult↗
PubMedDate not supplied

[Treatment of experimental infection by Strongyloides venezuelensis in rats, with the use of injectable ivermectin and levamisole].

For the therapy of human strongyloidiasis, are necessary effective drugs to eliminate both larvae and adult worm parasitism, which may also be used by parenteral route, to obviate the particular conditions presented by many patients. A study based on the experimental infection by Strongyloides venezuelensis in rats was done, administering injectable ivermectin or levamisole. Both drugs were shown to be active, when used in single doses of 0.2 to 0.5 mg/kg of ivermectin, or 26 mg/kg for levamisole. Ivermectin was slightly more effective as far as larval stage of the infection is concerned, and the same happened for levamisole for the adult worm stage. Promising perspectives are visualized to improve the therapy of patients with serious disseminated infection by Strongyloides stercoralis.

Animals↗