Tratamento farmacológico da estrongiloidíase em pacientes transplantados / Pharmacological treatment of strongilloidiasis in transplanted patients

O objetivo deste artigo foi comparar o uso da ivermectina e do albendazol em pacientes transplantados e relatar os respectivos sucessos terapêuticos nessa população. Foram analisados artigos que abordassem relatos de casos publicados nos últimos 4 anos no PubMed® relacionando os descritores "transplante de órgãos", "estrongiloidíase" e "tratamento". Foram encontrados e analisados dez relatos de caso que abordaram a estrongiloidíase em situa- ção pós-transplante contemplando 13 indivíduos. Desses, cinco (38,5%) utilizaram ambos os medicamentos, dos quais quatro (80%) se curaram, tendo recebido albendazol e ivermectina por via subcutânea (50%) ou albendazol e ivermectina por vias oral/ subcutânea (50%). O paciente que morreu recebeu albendazol e ivermectina por via subcutânea. Sete (53,8%) indivíduos utiliza- ram apenas ivermectina, dos quais três (42,8%) se curaram tendo recebido o medicamento oral (dois pacientes) ou subcutâneo (um paciente); dois (28,6%) morreram recebendo o medicamento via oral, dois (28,6%) usaram profilaticamente via oral e apenas um não manifestou sintomas. Apenas um (7,7%) indivíduo utilizou somente albendazol via oral tendo sobrevivido à infecção. A uti- lização combinada dos medicamentos ivermectina e albendazol parece ter efeito positivo no tratamento da estrongiloidíase. A administração da ivermectina por via subcutânea apresentou resultados promissores, contudo estudos controlados de siner- gia medicamentosa e vias de administração devem ser realizados para efetiva avaliação.

The objective of this article was to compare the use of ivermec- tin and albendazole in transplanted patients and to report the respective therapeutic successes in this population.Articles ad- dressing case reports published in the last 4 years in the PubMed relating the descriptors "organ transplantation", "strongyloidia- sis", and "treatment" were analyzed. Ten case reports addres- sing strongyloidiasis in a post-transplant situation, covering 13 individuals, were found and analyzed. Of these, five (38.5%) used both drugs of which 4 (80%) were cured having received subcu- taneous albendazole and ivermectin (50%) or oral/subcutaneous albendazole and ivermectin (50%). The patient who died received subcutaneous albenzadole and ivermectin. Seven (53.8%) indi- viduals used only ivermectin, of which three (42.8%) were cured having received the oral (2/3) or subcutaneous (1/3) medication, two (28.6%) died receiving the oral medication, and two (28.6%) used oral medication prophylactically, and only one did not show symptoms. Only one (7.7%) individual used only oral albenzadole and survived the infection. The combined use of the drugs iver- mectin and albendazole seems to have a positive effect on the treatment of strongyloidiasis. The administration of subcuta- neous Ivermectin has shown promising results; however, con- trolled studies of drug synergy and administration routes shall be performed for effective evaluation.

EFFECT OF Bifidobacterium animalis ON MICE INFECTED WITH Strongyloides venezuelensis / Efeito da administração de Bifidobacterium animalis sobre a infecção por Stongyloides venezuelensis em camundongos

The administration of viable Bifidobacterium animalis was tested to induce resistance against Strongyloides venezuelensis infection in mice. Effects on parasite burden, worm length, egg output, and intestinal mucosal histology were evaluated. The oral administration of B. animalis, strain 04450B, starting 14 days before the inoculation of nematode larvae significantly decreased the worm burden and egg output. In probiotic treated animals, the percent reduction of adult worms in the intestine was of 33% and the reduction of egg production was of 21%, compared with those of the control group. The duodenum villous height and villous/crypt ratio were significantly higher in probiotic-treated mice, indicating that this group could be experiencing less intestinal damage. The present findings revealed that the administration of B. animalis for the amelioration of host response to nematode infections is biologically plausible and could have some potential for impacting public health. Meanwhile, further study is needed to delineate the nature and identity of the factor(s) involved in these beneficial effects.

Os efeitos da administração de Bifidobacterium animalis viáveis sobre a infecção por Strongyloides venezuelensis foram avaliados em camundongos experimentalmente infectados. Os parâmetros analisados incluíram a carga parasitária, o comprimento dos vermes, a quantidade de ovos eliminados e a histologia da mucosa intestinal. A administração oral da cepa 04450B de B. animalis, iniciada 14 dias antes da inoculação de larvas do nematódeo, foi acompanhada de uma redução significativa do número de vermes que se estabeleceu no intestino e do número de ovos eliminados nas fezes. Nos animais tratados com o probiótico, o percentual de redução de vermes adultos no intestino foi de 33% e da produção de ovos foi de 21%, em comparação com os do grupo controle. O comprimento das vilosidades do duodeno e a relação vilus/cripta foram significativamente maiores nos animais tratados, indicando que nestes animais as lesões intestinais foram mais leves. Os resultados do presente trabalho revelaram que a administração de B. animalis com o propósito de modular a resposta do hospedeiro contra infecções por nematódeos é uma possibilidade biologicamente plausível com impacto potencial em saúde pública. No entanto, são ainda necessários mais estudos para esclarecer os mecanismos de ação destes microrganismos e identificar os fatores envolvidos na produção dos efeitos benéficos.

Hiperinfecção por Strongyloides stercoralis associada ao uso crônico de corticosteróide / Hyperinfection by Strongyloides stercoralis associated with chronic use of corticosteroid

O Strongyloides stercoralis é um nematóide parasita com distribuição mundial, porém, é encontrado com freqüência em países de clima tropical. Causa uma doença conhecida como estrongiloidíase, geralmente assintomática que, em pacientes imunocomprometidos, pode levar à complicações muitas vezes fatais. Este trabalho relata um caso de síndrome hiperinfecciosa por Strongyloidesstercoralis em uma paciente de 69 anos, com doença broncopulmonar obstrutiva crônica, usuária crônica de terapia com corticosteróide, e apresenta uma revisão da literatura a este respeito. Ressalta-se a importância do diagnóstico e tratamento da estrongiloidíase em pacientes imunocomprometidos, com ênfase àqueles submetidos à terapia com corticosteróide, com a finalidade de prevenir a estrongiloidíase invasiva e disseminada.

Strongyloides stercoralis is a nematoid parasite with world distribution present in higher frequencies in countries with tropical climate. It causes a disease known as strongyloidiasis that, despite generally asymptomatic, can cause complications and many times death in imunocompromised patients. This report presents a case of hiperinfective syndrome by Strongyloides stercoralisin a 69 years old female who has a chronic obstructive bronchopulmonary disease and makes chronic use of corticosteroid therapy. A review of related literature is also presented. The relevance of the diagnosis and treatment of strongyloidiasis in imunocompromised patients, specially those making use of corticosteroid therapy, in order to prevent hyperinfection or invasive strongyloidiasis is also discussed.

The prevalence of enteropathy due to strongyloidiasis in Puerto Maldonado (Peruvian Amazon)

Human strongyloidiasis is an important health problem in the southeast region of Peruvian Amazon, due to its prevalence and long term morbidade. An epidemiological study was conducted in the Peruvian Amazon area of Puerto Maldonado to determine the prevalence of strongyloidiasis in the population. Stool samples were collected from 1,133 patients at the outpatient department of our clinic. Strongyloidiasis affected 221 examined patients (20 percent). Prevalence was highest in males, mostly in children and elderly men. People living in urban and marginal urban areas, those coming from outside the region, and Andean people, showed the highest prevalences. Pre-school children were more likely to be parasitized than older children. The most common symptoms were diarrhea (55 percent), abdominal pain (32 percent) and cough (53 percent). One in 7 (13 percent) affected patients presented with moderate or severe symptoms, including life-threatening complications. Other intestinal parasites were found frequently in patients diagnosed with strongyloidiasis. Improved human waste disposal services are considered to be main requirement to reduce the high prevalence of this disease.

Estrongiloidiasis diseminada / Disseminated strongyloidiasis

La estrongiliodiasis diseminada (ED) es una afeccion frecuentemente fatal debida a la autoinfeccion interna con larvas de Strongiliodes stercoralis, oportunista ante alteracions de la inmunidad del huesped, como inmunosupresion farmacologica en pacientes transplantados o con enfermedad neoplasica o autoinmune. Revisamos la ED en los archivos de autopsias del Hospital San Juan de Dios y la Misericordia de Bogota para conocer la entidad basica facilitadora de la diseminacion larvaria y averiguar si la ED ha aumentado recientemente. Se encontraron solo 12 enfermos en mas de 14000 protocolos revisados desde 1954 a 1986 con edades entre 1 y 62 anos. Los pacientes presentaron diarrea cronica, fetida o sanguinolenta, vomito, dolor abdominal, anorexia y tos, a veces hemoptoica. Todos tenian desnutricion avanzada y solo uno habia recibido tratamiento inmunosupresor con esteriodes y ciclofosfamida para glomerulonefritis progresiva. Un paciente recibio esteriodes para "colitis ulcerativa" que luego se comprobo era debida a estrongiloidiasis. Solo una vez se hizo diagnostico clinico de ED. En tres pacientes se encontraron larvas en la materia fecal pero no se considero la posibilidad de ED. Los diagnosticos clinicos considerados fueron: desnutricion, sindrome anemico, carcinoma gastrico, TBC pulmonar e intestinal, parasisitismo y sindrome meningeo. Una enferma presento endocarditis bacteriana tricuspidea y dos miningoencefalitis, unidas al cuadro gastrointestinal. La meningitis fue de tipo bateriano, aguda, sin granulomas ni larvas

Control trial of soil-transmitted helminthic infections with pyrantel pamoate.

Pyrantel pamoate at dosage of 10 mg per kilogramme body weight was given to each villager at 4-6 weeks intervals for three times. The infection rates of hookworms among those who received and did not received the drug decreased from 60.5% pre-treatment to 19.6% after the third treatment and then increased to 32.4% one year after the third treatment. Infection rates of A. lumbricoides and Strongyloides spp. among the villagers who received and did not received the drug decreased from 27.5% pre-treatment to 2.2% after the third treatment and then increased to 20.1% one year later for the former, while the latter decreased from 6.5% pre-treatment to 2.3% after the third treatment and 0.4% one year later. The infection rate of T. trichiura was found to increase as pyrantel pamoate had no effect on this nematode. The authors suggested that to obtain more satisfactory results the anthelmintic drug used must likewise be effective against T. trichiura particularly in areas where this nematode is a public health problem. It was also suggested that the duration of treatment should be prolonged.