Strongyloidiasis as an opportunistic infection in a HAM/TSP patient

Infection by human T-cell lymphotropic virus type I (HTLV-I) is associated with neurological diseases, malignancies, and other less commun pathologies. In addition, infection by HTLV-I has been implicated in some degree of immunological impairment. Some previous reports detected an association between HTLV-I infection and an increased rate of antibodies against S. stercoralis, as well as a higher frequency of S. stercoralis carrier state. Here, we report a case of a chronic, recurrent S. stercoralis parasitism in a patient infected by HTLV-I. The patient demonstrated evidence of immunosupression characterized by skin allergy to commun antigens, oral candidiasis and severe, recurrent diarrhea caused by S. stercoralis. The infection requires maintenance of supressive therapy to control diarrhea and its consequences. We postulate that S. stercoralis may act as an opportunistic agent in patients infected by HTLV-I.

Tratamento de parasitoses intestinais / Intestinal parasitosis treatment

Os autores apresentam um trabalho de revisão sobre tratamento de parasitoses intestinais, onde expõem de forma racional e adaptada ao nosso meio as parasitoses mais freqüentes. Também relatam os aspectos epidemiológicos e os métodos de diagnóstico laboratorial recomendados de acordo com o parasita. Fazem uma revisão detalhada das drogas antiparasitárias nos seus aspectos farmacológicos e apresentam uma proposta de conduta terapêutica em situações especiais como estrongiloidíase disseminada, neurocisticercose e na sub-oclusão intestinal por ascaridíase (au)

Disseminated Strongyloides stercoralis infection in an AIDS patient: The role of suppressive therapy

Patients with AIDS are prome to develop infections caused by opportunistic pathogens. Unusual agents, such as Stongyloides stercoralis, are being described in this syndrome, resulting in disseminated disease which is always severe and, in some cases, fatal. We describe a case of patient with AIDS and Strongyloides stercoralis infection involving the gastrointestinal tract and lungs. Therapy with thiabendazole for ten days led to resolution of the acute episode. Preventive therapy with 3g of thiabendazole once a week was then prescribed, and repeated fecal examinations were negative for larvae. Following discontinuation of treatment, however, the patient again had a positive fecal examination for Strongyloides stercoralis larvae, even though reinfection was considered to be very unlikely. The patient was retreated with a shorter course of therapy and once per week preventive therapy was reintroduced. After four months of follow-up, repeated fecal examinations were negative. When the treatment was changed to thiabendazole given once every two weeks, however, pulmonary Strongyloides stercoralis recurred. Subsequently, because of intolerance to thiabendazole, the patient was treated with cambendazole. The patient died three months later due to Pseudomonas aeruginosa pneumonia. Prolonged therapy for Strongyloides stercoralis infection may be necessary. Although further evaluation is needed, 3g of thiabendazole once a week may be adequate for this purpose. Cambendazole may be a useful alternative for disseminated Strongyloides stercoralis.

Avaliaçäo da atividade terapêutica do Albendazol em ratos experimentalmente infectados com Strongyloides venezuelensis / Evaluation of the therapeutic activity in rats experimentally infected with Strongyloides venezuelensis

Com a finalidade de demarcar mais precisamente o espectro de açäo do albendazol, foi estudada a atividade terapêutica desse anti-helmíntico em ratos experimentalmente infectados com Strongyloides venezuelensis, tendo sido usada, como termo de comparaçäo, a açäo do cambendazol e do mebendazol, dois outros benzimidazólicos. Os três compostos mostraram-se eficientes quando utilizadas doses únicas de 6,75 12,5, 25 e 50 mg/kg, pois motivaram desaparecimento total das formas adultas no intestino. Com a posologia de 5 mg/kg sucederam porcentagens médias de reduçöes dos números de vermes de 87%, 98% e 80%, respectivamente, como decorrência do emprego do albendazol, do cambendazol e do mebendazol, traduzindo superioridade da segunda droga citada