Alcohol consumption alters anti-Strongyloides stercoralis antibodies production.

Individuals infected with Strongyloides stercoralis have been reported to produce different immunoglobulins isotypes, yet few studies have evaluated their use in strongyloidiasis diagnosis. The aim of this work was to evaluate the immunoreactivity of different classes and subclasses of anti-S. stercoralis circulating antibodies in alcoholic patients by ELISA and to perform immunoblotting in samples with discordant results between parasitological and immunological methods. 345 male patients with a clinical diagnosis of alcoholism hospitalized at a reference center for alcoholics in Salvador, Bahia, Brazil, were included in this study. The fecal samples were examined by three different parasitological methods (spontaneous sedimentation, Baermann-Moraes and Agar Plate Culture methods). The ELISA was performed for the detection of IgG, IgG1, IgG4, IgE and IgA1 anti-S. stercoralis. Immunoblotting, for the detection of specific IgA1, was used to elucidate discordant results between parasitological and immunological methods. S. stercoralis infection frequency in alcoholic patients by parasitological methods was 21.4% (74/345). Although IgE-ELISA demonstrated a high sensitivity and specificity in non-alcoholic patients, about 30% (22/74) of alcoholics with larvae in feces were negative. IgG1-ELISA detected the lowest frequency of antibodies in alcoholic patients with larvae in feces, only 57% (42/74). IgG4-ELISA was the best assay for S. stercoralis infection immunodiagnosis. Immunoreactivity in the immunoblotting for IgA1 at 90, 75, 26 and/or 17 kDa bands was observed in 92% (33/36) of alcoholics with larvae excretion and negative ELISA for one or more antibody isotypes. In conclusion, IgG4-ELISA showed the highest sensitivity and specificity, thus demonstrating its superiority for strongyloidiasis immunodiagnosis in alcoholic and non-alcoholic individuals. Both, IgE and IgG1-ELISA presented high sensitivities and specificities for S. stercoralis infection diagnosis in non-alcoholics, however there was low reactivity in alcoholic individuals. This can be associated with an increased susceptibility to severe strongyloidiasis in these patients. IgA1-immunoblotting can be used to confirm S. stercoralis infection when there are discordant results between parasitological methods and ELISA.

Enteroparasitoses e aspectos socioeconômicos em pacientes alcoolistas / Intestinal parasites and socioeconomic aspects of alcoholic patients

Introdução: as enteroparasitoses constituem um problema de saúde pública que atinge as populações mais vulneráveis. O alcoolismo é um problema que afeta milhões de pessoas em todo o mundo, apresenta efeitos nocivos à saúde dos indivíduos e predispõe à infecção por S. stercoralis e às formas mais graves da estrongiloidíase. Objetivo: avaliar a prevalência da infecção das enteroparasitoses, bem como fatores socioeconômicos e sanitários de pacientes alcoolistas atendidos em um centro de tratamento especializado em Salvador, Bahia. Metodologia: trata-se de um estudo transversal, realizado com pacientes alcoolistas (n=277), do sexo masculino, atendidos em um centro de tratamento entre julho de 2014 e junho de 2017. O estudo foi realizado através da aplicação de um questionário estruturado para obtenção de dados socioeconômicos, demográficos e sanitários, sendo solicitadas, ainda, pelo menos duas amostras de fezes em dias alternados. O diagnóstico parasitológico foi realizado pelos métodos de sedimentação espontânea, Baermann-Moraes e cultura em placa de ágar. Resultados: a média de idade dos pacientes inclusos foi de 44,8 ± 9,5 anos. Verificouse que 35,7% dos pacientes estavam infectados com algum enteroparasito e, desses, 30,3% eram monoparasitados. Os parasitos mais frequentes foram S. stercoralis, Endolimax nana e ancilostomídeos, correspondendo 16,6%, 11,2% e 5,8%, respectivamente. Conclusão: dessa forma, S. stercoralis foi o parasito mais frequente, e a associação entre a infecção por esse parasito e o alcoolismo pode levar à estrongiloidíase grave. A elevada frequência de enteroparasitoses nesses pacientes, principalmente por protozoários, deve-se à ausência de higiene pessoal, pois esses indivíduos são suscetíveis à infecção oral fecal. A implementação de medidas de saneamento básico e de campanhas de conscientização para prevenção de infecções parasitárias é imprescindível para a saúde das populações mais vulneráveis.

Introduction: intestinal parasitoses are a public health issue that notably affects vulnerable populations. Alcoholism is a problem that affects millions worldwide by causing damaging effects to the health of individuals as it predisposes them to that infection through stercralisàs and more evolved forms of strongyloidiasis. Objective: evaluate the prevalence of intestinal parasite infections as well as socioeconomic and sanitation factors in a population of alcoholic patients at a specialized treatment facility in Salvador, Bahia. Methodology: this cross-sectional study was carried out with male alcoholic patients (n=277) at a treatment facility from July/2014 to June/2017. The research data were collected through a structured questionnaire aimed to obtain socioeconomic, demographic and sanitation information. Stool tests were ordered in alternate days. The parasitological diagnosis was based on methods of spontaneous sedimentation, Baermann-Moraes and Agar plate growth medium. Results: the patients' average age was 44,8 ± 9,5 years. A total of 35% of the patients was infected with a type of enteroparasite, of whom 30,3% was mono-infected. The most commonly found parasites were S. stercoralis, Endolimax nana and hookworm, corresponding to 16,6%, 11,2% e 5,8%, respectively. Conclusion: as such, S. Stercoralis was the most frequent parasite in this population and the association between the infection by this parasite and alcoholism may lead to severe strongyloidiasis. The high rates of enteroparasitism in those patients, particularly protozoa, are due to the lack of adequate personal hygiene, given those individuals are prone to acquire infections transmitted through the oral fecal route. An implementation of public health sanitation measures and the launch of public awareness campaigns in order to prevent parasite infections are vital to the health of vulnerable populations.

Difficulties in emotion regulation mediate negative and positive affects and craving in alcoholic patients.

The aim of this study was to assess the mediating effects of difficulties in emotion regulation (DER) on the relations of negative and positive affects to craving in alcoholic patients. 205 treatment-seeking alcoholic outpatients were included. DER, positive and negative affects as well as craving were evaluated by the Difficulties in Emotion Regulation Scale (DERS), the Positive/Negative Affect Scales, and the Obsessive Compulsive Drinking Scale (OCDS) respectively. Clinical factors including depression and severity of alcohol dependence were investigated by the Alcohol Use Disorders Identification Test (AUDIT) and the Beck Depression Inventory-II (BDI-II) respectively. Results revealed that both increased negative affect and decreased positive affect indirectly influenced craving through limited access to emotion regulation strategies. It was concluded that limited access to emotion regulation strategies may be important in predicting craving for alcoholics who experience both increased negative affect and decreased positive affect. This suggests that treatment and prevention efforts focused on increasing positive affect, decreasing negative affect and teaching effective regulation strategies may be critical in reducing craving in alcoholic patients.

Mortality risk in a cohort of Italian alcoholic individuals treated for alcohol dependence.

INTRODUCTION AND AIMS: The aim of this study was to investigate the mortality risk and to explore the presence of subjects more at risk of dying in a cohort of alcoholic individuals treated for alcohol dependence over a lengthy follow-up period. DESIGN AND METHODS: A total of 2363 subjects attending 10 centres for addiction treatment for alcohol dependence were recruited. RESULTS: During the 17 year follow-up period, 14.7% of the entire cohort died. Total standardised mortality rates (SMR) were higher in women (SMR = 5.94) as compared with men (SMR = 4.65). Higher SMRs were found for several diseases, for traumatic episodes (SMR = 6.65) and in younger patients (18-44 age group) (SMR = 8.16). Alcoholic women showed a higher survival rate as compared with men. In addition, a higher risk of death for men and unemployed subjects, with a progressive increase of risk in line with the increase of the age of admission to treatment, and with a progressive decrease of risk after 1 year from the beginning of the treatment, was also found. DISCUSSION AND CONCLUSIONS: This study confirms that mortality risk in alcoholic individuals in treatment is higher in comparison with the general population. Moreover, alcoholics men, unemployed, >40 years at time of admission and during the first year of treatment are more at risk to die. Thus, much more attention to patients with these characteristics should be planned by the professional staff working in centres for addiction treatment. [ Pavarin R M, Caputo F, Zoli G, Domenicali M, Bernardi M, Gambini D. Mortality risk in a cohort of Italian alcoholic individuals treated for alcohol dependence Drug Alcohol Rev 2017;36:186-191].

Prevalence of Hepatitis C, B and Human Immunodeficiency Virus among Drug Users and Chronic Alcoholic Patients in Korea / 대한내과학회지

OBJECTIVES: After introduction of anti-HCV assay as screening test of blood donors, the proportion of trasfusion-associated hepatitis C declined, but the proportion of hepatitis C patients with a history of parenteral drug use increased, HCV, HRV, and H1V share similiar modes of transmission and prevalent among intravenous drug users in America. Recently the number of drug users in Korea has been increasing. Therefore we investigated the prevalence of HCV, HBV, and HIV among drug users in our country. In addition several recent reports showed that anti-HCV were freguently positive in the chronic alcoholics and HCV might play a role in the development of severe liver disease in these patients. We assessed the prevalence of anti-HCV and its re1ationship to the severity of liver disease in chronic alcoholic patients. METHODS: The prevalence of anti-HCV, HHsAg, and anti-HIV among 185 drug users who were admitted at Taegu Medical Center from January 1994 to December 1995 has been studied using ELISA and the history of drug use including sort, route, and duration investigated. In addition, We studied the prevalence of anti-HCV and its relationship to the severity of liver disease in 73 chronic alcoholics. RESULTS: 1) Among 176 methamphetamine intravenous users, the prevalence of anti-HCV was 80%, that of HBsAg was 4%, and there was none with anti-HIV positive in 131 cases tested. Of the 9 marihuana smokers, all of them were negative in anti-HCV or anti-HIV, and only 1 caese(11%) was HBsAg positive. 2) Longer duration of intravenous drug use was significantly associated with anti-HCV seropositivity, Elevated ALT level was found in 80 cases(57%) of the anti-HCV seropositive 140 cases and their mean was 971U/L. 3) The group with higher optical density of anti-HCV showed inclination of elevated ALT level; however there was no significant correlation between anti-HCV optical density and ALT level. 4) The prevalence of anti-HCV was 11% in 73 chronic alcoholic patients, and that of HBsAg was 4%. The seropositivity of anti-HCV correlated with the severity of liver disease: none in patients with no liver problem or fatty liver, 12.5% in patients with chronic liver disease, 1996 in patients with cirrhosis classified by clinical, biochemical, and ultrasonographic findings, However the presence of anti-HCV was not associated with impaired liver function tests in chronic liver disease and cirrhosis groups. CONCLUSION: The prevalence of anti-HCV among intravenous drug users in Korea was 80%, similiar to that in America, By contrast the prevalence of HBsAg was only 4%, lower than that of general population. And there was no HIV-infected cases among intravenous drug users in our study. The seropositivity of anti-HCV among chronic alcoholic patients was 11%. And increased prevalence of anti-HCV in alcoholic patients with severe liver disease might suggest that hepatitis C virus is involved in liver damage in these patients.