Evaluation of three methods for laboratory diagnosis of Strongyloides stercoralis infection.

The direct smear, a modified Baermann technique, and the agar plate culture method were compared for cost and efficiency in recovering Strongyloides stercoralis larvae in a hospital setting in Honduras. Of 427 stool samples, 9 were positive by the direct smear and 33 additional ones were detected by the Baermann technique; the agar plate culture method disclosed 28 more cases for a total of 70 S. stercoralis infections. The modified Baermann method was 3.6 times more efficient than the direct smear, and the agar plate culture increased the modified Baermann efficiency by 0.8 times. Cost for materials alone was cheapest for the direct smear; it increased 4 times for the modified Baermann method and 15 times for the agar plate culture method. This last technique required a better equipped laboratory, more time to perform, and the best trained, most skillful laboratory personnel. In field studies, prevalence of infection should determine the cost-effectiveness of the agar plate culture method; in a clinical setting, when S. stercoralis infection must be ruled out, the agar plate culture method should be made available to the medical community.

Albendazole treatment in human taeniasis.

The results are presented of albendazole trials on human taeniasis infections in Honduras, involving 56 of 68 individuals (2% of the inhabitants) found to be infected during surveys conducted in 15 rural communities. Of the 3 methods used for diagnosis of infection, the Kato cellophane thick smear showed 80% reliability, a combination of Kato and 'Scotch' tape perianal swab 88%, and clinical history of proglottid expulsion less than 50%. Individuals were treated with a dose of 400 mg of albendazole per day for 3 d, followed for 5 d to verify tapeworm expulsion, and evaluated again at 60 and 90 d to assess drug efficacy. All 56 treated individuals remained stool-negative after 60 and 90 d; a partial strobila or segments were recovered from 21 of them (37.5%). Of these, Taenia saginata was identified from 4, and T. solium from 15; 2 specimens could not be specifically identified. Based on negative stool examinations and clinical history after 60 and 90 d, albendazole seems to be a well tolerated, very effective drug for treating infections with Taenia spp. However, confirmation of these results is needed due to the difficulty of making a reliable diagnosis of such infections.

Taeniasis-cysticercosis in Honduras.

Data on human taeniasis and human and animal cysticercosis from Honduras were gathered from laboratory, medical and slaughterhouse records, proglottid identification and surveys. The infection rate for human taeniasis was 2.7/1000 individuals at the University Hospital, 10/1000 in the southern provinces of Choluteca and Valle, and 0.6/1000 in Cortes and Atlantida in the north. In surveys, the rates found ranged from 14 to 62/1000 in 9 of 15 communities studied. Taenia solium was identified in 135 of 181 individuals (74.5%) who submitted proglottids for speciation, 23 of whom were children 0-5 years old. The male:female ratio of infection rate was 1:2. The rates of infection with cysticercosis in pigs and cattle at one abattoir in 1981-1986 were 5% and 0.05% respectively. Diagnosis of human cysticercosis at the University Hospital increased five-fold with the introduction of computerized tomography and an enzyme-linked immunosorbent assay: 22 cases were diagnosed in 1980-1984 and 107 cases in 1985-1988. Rates at the neurosurgical ward were higher (29/1000 patients) than in the general hospital census (1.6/1000 patients). aeniasis-cysticercosis may be a serious health problem in some areas of Honduras.