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 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Strongyloides stercoralis is an intestinal nematode which infects a large portion of the world's population. Individuals with infection confined to the intestinal tract are often asymptomatic but may have abdominal pain, weight loss, diarrhea, and other nonspecific complaints. Enhanced proliferation of the parasite in compromised hosts causes an augmentation of the normal life-cycle. Resultant massive invasion of the gastrointestinal tract and lungs is termed the hyperinfection syndrome. If the worm burden is excessive, parasitic invasion of other tissues occurs and is termed disseminated strongyloidiasis. A variety of underlying conditions appear to predispose to severe infections. These are primarily diseases characterized by immunodeficiency due to defective T-lymphocyte function (Table 1). Individuals with less severe disorders become compromised hosts because of therapeutic regimens consisting of corticosteroids or other immunosuppressive medication. The debilitation of chronic illness or malnutrition also predisposes to systemic stronglyloidiasis. The diagnosis of strongyloidiasis can be readily made by microscopic examination of concentrates of upper small bowel fluid, stool, or sputum. Important clues suggesting this infection include unexplained gram-negative bacillary bacteremia in a compromised host who may have vague abdominal complaints, an ileus pattern on X-ray, and pulmonary infiltrates. Eosinophilia is helpful, if present, but should not be relied upon to exclude the diagnosis. The treatment of systemic infection due to Strongyloides stercoralis with either thiabensazole 25 mg/kg orally twice daily is satisfactory if the diagnosis is made early. Because of several unusual features of this illness in compromised hosts, the standard recommendation for 2 days of therapy should be abandoned in such patients. Immunodeficiency, corticosteroids, and bowel ileus reduce drug efficacy. Thus a longer treatment period of at leuch as blind loops or diverticula necessitate longer treatment. Stool specimens and upper small bowel aspirates should be monitored regularly and treatment continued several days beyond the last evidence of the parasite. In particularly difficult situations where either worm eradication is impossible or reinfection is probable, short monthly courses of antihelminthic therapy seem to be effective in averting recurrent systemic illness. Finally, prevention of hyperinfection or dissemination due to Strongyloides stercoralis can be accomplished by screening immunocompromised hosts with stool and upper small bowel aspirate examinations. These would be especially important prior to initiating chemotherapy, or before giving immunosuppressive medications or corticosteroids to patients with nonneoplastic conditions such as systemic lupus erythematosus, nephrotic syndrome, or renal allografts.
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PMID:Overwhelming strongyloidiasis: an unappreciated opportunistic infection. 36 22

Strongyloides stercoralis is an intestinal nematode of man that is still regularly encountered in many parts of the United States. Strongyloidiasis should be considered in any child with unexplained eosinophilia, steatorrhea, protein-losing enteropathy, or chronic diarrhea, especially if associated with weight loss, growth failure, or recurrent upper abdominal pain. This parasite should be ruled out in any patient from an endemic region who is to be treated with corticosteroids of immunosuppressive agents. Microscopical examination of duodenal fluid, Baermann's fecal extraction technique, or the Haradi-Mori stool culture method may be required to make a diagnosis because the organism is not routinely found in concentrated feces even after multiple examinations in some infected individuals. A diagnosis of strongyloidiasis is important because the disease is curable.
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PMID:Strongyloidiasis in childhood. 36 97

This paper focuses on recent developments in the areas of mode of action and clinical efficacy of mebendazole use since its introduction in 1974. Mebendazole blocks glucose uptake by adult intestinal-dwelling nematodes and cestodes and their tissue-dwelling larvae. The drug's poor absorption does not appear to affect clinical efficacy except in the treatment of systemic helminth infections. Mebendazole has been found to be ovicidal for the eggs of roundworm, hookworm, and whipworm with the disadvantages of cost and long duration of therapy; it is also considered the best drug for the treatment of trichuriasis. Among its nonapproved uses, it shows promise in the treatment of capillariasis and hydatid disease. Further investigation is needed to establish its role in the treatment of taeniasis, Hymenolepsis nana, Strongyloidiasis, Trichinosis, and Dipetalonema perstans. Side effects such as diarrhea, abdominal pain, headache, and dizziness have been reported on rare occasions.
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PMID:Mebendazole. 48 64

Recurrent urticaria, abdominal pain, peripheral eosinophilia, hyperimmunoglobulin E and small bowel abnormalities on roentgenograms prompted evaluation of a 36 year old man for intestinal parasitism. Evidence for helminthiasis as the cause of his symptoms included changing antibody titers to helminth antigens and a dramatic response to therapy. Helminth larvae or eggs were not recovered. Diagnosis of strongyloidiasis, the most likely cause of the illness, is discussed.
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PMID:Eosinophilia, elevated immunoglobulin E level and chronic enteritis due to intestinal helminthiasis. 50 2

A 58 year old Chinese male, one week after arriving in Canada from Hong Kong, presented with acute abdominal pain and diarrhoea which was rapidly followed by Escherichia coli infection causing septicaemia and meningitis. His past history revealed bronchial asthma for 15 years treated with steroids. At laparotomy, 7 days after the onset of symptoms, he was found to have extensive haemorrhagic infarction of the small bowel and right colon. Examination of the fibrosed mesenteric vessels revealed numerous filariform larvae of Strongyloides stercoralis, within the walls, and in all layers of bowel wall. The role of the parasite in the production of obliterative arteritis in this fatal case of haemorrhagic enteropathy is discussed. Clinical strongyloidiasis, in uncomplicated cases, varies from mild to severe with gastroenteritis, nausea, colicky abdominal pain, electrolyte imbalance and symptoms of malabsorption syndrome (MARCIAL-ROJAS, 1971). In malnourished individuals and patients with debilitating infections, either newly acquired or asymptomatic latent infection with S. stercoralis can assume severe dimensions (BROWN and PERNA, 1958; HUGHTON and HORN, 1959). Similarly, in patients on steroid (CRUZ et al., 1966; WILLIS and MWOKOLO, 1966; NEEFE et al., 1973) and immunosuppressive therapy for lymphomatous diseases or deficient in immune response (ROGERS and NELSON, 1966; RIVERA et al., 1970), systemic strongyloidiasis is often fatal. The increased frequency of auto-infection in such patients with a breached immune barrier is, however, unclear. Further complications of this infection due to severe enterocolitis result in sepsis, bacteraemia and meningitis (BROWN and PERNA, 1958; HUGHTON and HORN, 1959). This paper presents a fatal case of S. stercoralis infection which illustrates an uncommon if not unique, mechanism in its production of haemorrhagic enteropathy leading to sepsis and death.
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PMID:Fatal bowel infarction and sepsis: an unusual complication of systemic strongyloidiasis. 122 84

A series of children's deaths at a Cambodian refugee camp in Thailand prompted an investigation of children suffering from bloody diarrhoea and severe abdominal pain. Microscopical stool and blood examinations of 15 cases aged 1-7 years revealed hyperinfective strongyloidiasis as the cause of illness. Nine of 14 cases were infected wtih Strongyloides stercoralis, and 6 (42%) had concurrent infection with hookworm. Examination of 958 outpatients at the camp's daily clinic showed that mixed infections of S. stercoralis and hookworm were present in only 4.8% of the outpatients of the same age group.
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PMID:Strongyloidiasis on the Thai-Cambodian border. 823 15

We treated strongyloidiasis patients and obtained the following results: Of the 299 patients (184 males and 115 females), 81 patients (27.1%) had no complaints before treatment, 218 patients complaints of some symptoms, including arthralgia and/or lumbago (28.4%), abdominal pain and/or borborygmus (19.3%), numbness of extremities (18.1%), constipation (16.3%) and itching (15.7). We treated 219 patients with mebendazole and symptoms improved after treatment described below: Thirty-seven of the 63 patients (58.7%) with arthralgia and/or lumbago improved. Twenty-seven of the 36 patients (75.0%) with numbness of extremities improved. Thirty-one of the 32 patients (96.9%) with heartburn improved. We treated 26 patients with mebendazole plus thiabendazole and twelve of 14 patients (85.7%) with abdominal pain and/or borborygmus were improved after treatment. We treated 54 patients with ivermectin and five of 18 patients (27.8%) with arthralgia and/or lumbago were improved after treatment.
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PMID:[Clinical study on symptoms in patients with strongyloidiasis]. 129 17

We reported the efficacy of albendazole (ABZ) for the treatment of 27 patients with strongyloidiasis. Twenty-seven patients, 23 males and 4 females, received 200 mg of ABZ one hour before breakfast and supper for 3 days and this treatment was repeated 2 weeks later. The following results were obtained: 1) The eradication rate at 2 weeks after the initial treatment was 70.4% (19 of 27 patients) and 2 weeks after the second course was 66.7% (16 of 24 patients). 2) One patients (3.7%) complained of abdominal pain after the first treatment. Four patients (14.8%) complained of headache (n = 2), nausea (n = 1) and exanthema (n = 1) after the second treatment. But all symptoms were mild and required no treatment and subsided in a few days. 3) Positive rate of HTLV-1 antibody was 45.8% in the patients. As described above, side effects occurred in some cases, although they were mild and transient. From these results, it can be concluded that on increased dose of ABZ could be much more favorable for the treatment of strongyloidiasis.
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PMID:[Clinical study of albendazole therapy for strongyloidiasis]. 143 82

From May 1988 to September 1990 the microbiology laboratory of the Ivrea-Castellamonte Hospital (Province of Turin) carried out 1464 coproparasitological investigations. 0.5% of the samples, coming from 5 patients, proved to be Strongyloides stercoralis positive. 4 cases were diagnosed in recovery conditions, and on these we carried out a retrospective study (taking into consideration some epidemiological and clinical aspects). The average age of these patients, three men and one woman, was 70.5; all native of the Canavese and resident in agricultural zones; two farmers still working, a worker and a retired worker. All of them presented one or more associated pathologies and/or a tendency to parasitosis. The clinical picture was characterized by abdominal pain, present in three cases, while diarrhoea was observed in only one case; a slight temperature in two, a high temperature in one; nettle-rash manifestations in one case and breathing symptomatology in two. In two cases there appeared abdominal relaxation (meteorism) and in one of these there was a serious paralytic ileus. Eosinophilia was present in all the patients, even if at different levels (from 5.9% to 20%). The treatment was carried out with different drugs: mebendazole in two cases, thiabendazole in one and "pyrvinium pamoate" in another. Our conclusion is that there exist in the Canavese the climatic, environmental and social-economical conditions which can favour Strongyloidiasis.
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PMID:[Strongyloidosis in Canavese: 4 cases seen at the 'Ospedale di Ivrea-Castellamonte. Epidemiological and clinical considerations]. 213 27

During 1983, a multinational military intervention took place on Grenada. After deployment, troops from several U.S. Army units noted signs and symptoms consistent with soil-transmitted helminthic infection. Of 684 soldiers screened five to seven weeks post-deployment, over 20% reported abdominal pain and/or diarrhea during or after the action. Eosinophilia of at least 10% was observed in 119 (22.5%) of 529 soldiers evaluated further; eosinophilia of 5-9% was documented in another 126 (23.8%) of the 529 soldiers. Stool examinations confirmed hookworm infection in 35 soldiers. One case of strongyloidiasis was also documented. Infection was attributed to ground exposure near homes with compromised sanitation. Units that joined the operation after the initial assault phase were at low risk of hookworm infection.
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PMID:An outbreak of hookworm infection associated with military operations in Grenada. 249 77


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