ABSTRACT
Strongyloides stercoralis is a common intestinal parasite in tropics and subtropics. In Bangladesh, prevalence is likely to be high due to poor sanitation. Clinical presentations are frequently nonspecific. However, in immunosuppressed individuals, infection becomes overwhelming and may disseminate and results in high rates of mortality. Unless a high index of suspicion, this readily treatable disease may be missed. Here we report a case of hyperinfection with Strongyloides stercoralis in a patient who was on corticosteroid treatment. A 45 years old male was admitted in Gastroenterology department of Bangabandhu Sheikh Mujib Medical University (BSMMU) with the complaints of abdominal pain, vomiting and diarrhea for 2 weeks. He was on prednisolone 60 mg with omeprazole 40 mg daily for 4 weeks for his eyelid drooping prior to the development of abdominal symptoms. Physical examination revealed a severely malnourished, moderately anemic patient with muscle wasting, angular stomatitis, desquamated skins of feet and hands. Abdominal examination revealed generalized tenderness with moderate ascites. Investigations revealed Hb-7.4 gm/dl with normal WBC count (eosinophil-11% before steroid therapy), S.albumin-19gm/l with prolonged prothrombin time and hypokalemia. USG of abdomen revealed moderate ascites. Endoscopy of upper GIT showed congestion and multiple erosions in the stomach and also in the duodenum. Biopsy from the duodenum revealed adult Strongyloides stercoralis on the surface, larva and ova in the duodenal crypts. The patient was treated with 10 days of oral ivermectin along with blood transfusion, correction of nutritional status and electrolyte imbalance. Patient was discharged home after a total of 20 days of hospitalization.
ABSTRACT
Carcinoma stomach is the second leading cause of cancer death worldwide. This study was undertaken to determine the clinical and pathological profile of carcinoma stomach in Bangladesh and to find out the prevalence of H. pylori infection in carcinoma stomach subjects. Patients with carcinoma stomach confirmed on histopathology were included in the study. Data were recorded regarding demography, clinical features, blood group of the patients, location and macroscopic type of the cancer at endoscopy. Three to five biopsies from non-necrosed region and two paired biopsies from non-cancerous part of stomach were taken. One piece of each paired specimen was placed in the urea-agar media for CLO test and the other piece was used for histological examination. Out of 50 patients, 64% were male and 36% were female. The mean age was 51.05±14.98 years. Common presenting complains were dyspepsia/ abdominal pain, vomiting and dysphagia; abdominal mass, metastatic lymph node and ascites were predominant signs. About one third (34%) patients had blood group A. About 50% cancer was located in antrum followed by antrum and body (24%), then body (18%), fundus and body (4%) and fundus (4%). In 56% cases the lesion was ulcerative followed by polypoid (34%) and ulceroinfiltrative (10%). Histopathologically 52% was intestinal type, 28 % was diffuse type 20% was poorly differentiated adenocarcinoma. The prevalence of H. pylori in overall carcinoma stomach cases was 60% but individually in intestinal type 88%, in diffuse type 57% and in poorly differentiated type 50%.