A Case of Steroid-induced Hyperinfective Strongyloidiasis with Bacterial Meningitis / 대한소화기학회지

Strongyloides stercoralis is a soil transmitted intestinal nematode that is endemic in the tropical and subtropical regions. In most individuals who are infected, chronic, usually asymptomatic, gastrointestinal infection persists. But, in immunocompromized hosts or in patients receiving immunosuppressive therapy, autoinfection of S. stercoralis may result in the dissemination of larvae, leading to fatal hyperinfection and increased rate of complications. We report a case of hyperinfective strongyloidiasis with bacterial meningitis in a patient receiving steroid therapy. Strongyloidiasis was diagnosed by the presence of filariform larvae of S. stercoralis in the bronchoalveolar lavage cytology and upper gastrointestinal endoscopic biopsy specimen. Her clinical symptoms had progressively aggravated and developed bacterial meningitis during treatment. She died despite aggressive antibiotic and antihelminthic therapy.

Atividade predatória dos fungos nematófagos Duddingtonia flagrans, Monacrosporium thaumasium e Artrobotrys robusta sobre larvas infectantes de Strongyloides stercoralis / Predatory activity of the nematophagous fungi Duddingtonia flagrans, Monacrosporium thaumasium and Arthrobotrys robusta on Strongyloides stercoralis infective larvae

INTRODUÇÃO: Strongyloides stercoralis é um nematoide que infecta grande parte da população mundial. MÉTODOS: O objetivo deste trabalho foi comparar a capacidade predatória dos fungos nematófagos Duddingtonia flagrans (AC001), Monacrosporium thaumasium (NF34) e Arthrobotrys robusta (I-31) sobre larvas infectantes (L3) de Strongyloides stercoralis em condições laboratoriais no meio ágar-água 2 por cento. RESULTADOS: Ao final do experimento, os percentuais de redução de L3 de Strongyloides stercoralis observados foram de: 83,7 por cento (AC001); 75,5 por cento (NF34) e 73,2 por cento (I-31). CONCLUSÕES: Os fungos nematófagos foram capazes de capturar e destruir in vitro as L3, podendo ser utilizados como controladores biológicos de Strongyloides stercoralis.

INTRODUCTION: Strongyloides stercoralis is a nematode that infects much of the population worldwide. METHODS: This study aimed to compare the ability of predatory nematophagous fungi Duddingtonia flagrans (AC001), Monacrosporium thaumasium (NF34) and Arthrobotrys robusta (I-31) on infective larvae (L3) of Strongyloides stercoralis in laboratory conditions on 2 percent water-agar. RESULTS: At the end of the experiment, the percentage reductions in Strongyloides stercoralis L3 were 83.7 percent (AC001), 75.5 percent (NF34) and 73.2 percent (I-31). CONCLUSIONS: The nematophagous fungi were able to capture and destroy the L3 in vitro and may be used as biological controls of Strongyloides stercoralis.

Immunoparasitological diagnosis of Strongyloides stercoralis in garbage collectors in Uberlândia, MQ Brazil

The objective of this study was to determine the presence of Strongyloides stercoralis in urban garbage collectors through the use of immunological and parasitological methods. A total of 92 individuals were evaluated from August, 1997, to June, 1998. For the parasitological diagnosis Baermann and Lutz' methods were applied. The immunological diagnosis involved the indirect fluorescence antibody test (IFAT) and the enzyme-linked immunosorbent assay (ELISA) to detect specific IgG antibodies. Of the 92 workers examined, six (6.5 percent) were infected with larvae of S. stercoralis. The IFAT detected 19 (16.3 percent) and the ELISA 17 (18.5 percent) positive serum samples. The differences between the results of parasitological and immunological methods were statistically significant (p<0.05). These results demonstrate that there is a need to improve the health conditions of this category of city employees.

Larva currens in a case of organophosphorous poisoning.

A 20-year-old healthy farmer consumed organophosphorous poison. On third day he developed diarrhoea and on fourth day linear serpiginous ulcers appeared on both buttocks. Clinically lesions were considered as decubitus ulcers. By stool examination and other laboratory investigations it was diagnosed as cutaneous larva currens due to Strongyloides stercoralis in a case of organophosphorus poisoning. Patient responded very well to a course of albendazole.

Human strongyloidiasis in AIDS era: its zoonotic importance.

Human strongyloidiasis is caused by a nematode Strongyloides stercoralis. Many species cause strongyloidiasis in animals. The parasite has predilection to one host only but the host specificity is not strict. When animal species infects humans there is intense allergic reaction in the form of cutaneous larva currens and larva migrans. Therefore, strongyloidiasis in strict terms is a zoonotic disease. The strongyloides species have three stages. The parasitic form inside the host, the free form stage in the soil or water that moults to infective third stage. The later infects the host through skin and migrate to the heart and lung and finally swallowed back to cause intestinal infection. However, in some cases intense pulmonary manifestations may take place. The Strongyloides stercoralis has unique feature of moulting from parasitic form to infective stage within the body, rather than coming out and forming free living stage and causing autoinfection. This may lead to latent infection for indefinite period in an immunocompetant person but fatal hyper or disseminated infection in immunocompromised person like patients of AIDS, organ transplant recipients, cancer and other patients put on immunosuppressive therapy, in whom it can involve any organ of the body. Because this group of patients in last few years have increased tremendously in Africa and South-East Asia, more and more cases of strongyloidiasis are being reported in english literature. The diagnosis of intestinal strongyloidiasis is made by repeated stool smear examinations and in extraintestinal strongyloidiasis the appropriate specimen is examined for the rhabditiform larvae. Recently serological tests have also been developed that can be used for epidemiological purposes. The drug of choice for the treatment of strongyloidiasis remains thiabendazole but due to its unacceptable side effects other medicines like albendazole and ivermectine are being used more frequently. The prevention of the infection is possible by adopting good personal hygiene and safe drinking water supply.

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.