Infiltrating Strongyloides stercoralis presenting as duodenal obstruction.

Small intestinal obstruction due to Strongyloides stercoralis is rare and has not been reported in an immunocompetent patient. We describe a 70-year-old immunocompetent man presenting with duodenal obstruction secondary to severe S. stercoralis infestation, as documented on duodenal biopsy. He was treated with ivermectin, with which he recovered remarkably.     

Parasitic arthritis induced by Strongyloides stercoralis.

A 40-year-old man presented with palpable purpura and symmetrical polyarticular arthritis. Histological examination of the synovial membrane and fluid unexpectedly disclosed Strongyloides stercoralis infestation of the ankle joint.     

Biliary obstruction resulting from Strongyloides stercoralis infection. Report of a case.

Hepatobiliary manifestations of strongyloidiasis are rare. A case is described of biliary obstruction associated with the presence of Strongyloides stercoralis in the duodenal mucosa and 250 microns rhabditiform larvae in bile. Biliary obstruction resulted from papillary stenosis, which resolved after treatment with thiabendazole. It is proposed that papillary stenosis may be responsible for obstructive jaundice associated with Strongyloides stercoralis infection, and that strongyloidiasis should be added to the causes of papillary stenosis.     

Strongyloides stercoralis in the south of Galicia

Strongyloides stercoralis is the only parasite which can produce a chronic illness in humans, being through autoinfection. This nematode can also provoke death when patient's immunologic state deteriorates producing a massive hyper infection. The first patient with strongyloidiasis who has always lived in the Galician South area is described. The clinical picture consisted of unspecific cutaneous lesions and abdominal pain with severe peripheral eosinophilia (> 20,000/ml. The diagnosis was carried out observing the larvae in the fecal examination and was confirmed with a culture. Treatment with albendazole failed and the healing was reached with ivermectin. We must consider the possibility of strongyloidiasis because misdiagnosing these patients as eosinophilic gastroenteritis there would be a higher risk of hyperinfection if they are treated with corticosteroids.     

Strongyloides stercoralis. The cause of an urticarial-like eruption of 65 years' duration

A 74-year-old woman with a history since childhood of skin eruptions and gastrointestinal problems was found to have peripheral eosinophilia. This finding was subsequently related to a chronic infection with the parasite Strongyloides stercoralis. This parasite is capable of autoinfection, which would account for the infection persisting for about 65 years. The intraduodenal habitat of S stercoralis and the negative results of numerous stool examinations promoted the use of the duodenal string test, which was diagnostic. A high index of suspicion should exist for patients from endemic regions in Southeast Asia and the Southeastern United States.     

Diagnosis of Strongyloides stercoralis infection.

Strongyloides stercoralis infects 30 million people in 70 countries. Infection usually results in asymptomatic chronic disease of the gut, which can remain undetected for decades. However, in patients receiving long-term corticosteroid therapy, hyperinfection can occur, resulting in high mortality rates (up to 87%). Strongyloidiasis is difficult to diagnose because the parasite load is low and the larval output is irregular. Results of a single stool examination by use of conventional techniques fail to detect larvae in up to 70% of cases. Several immunodiagnostic assays have been found ineffective in detecting disseminated infections and show extensive cross-reactivity with hookworms, filariae, and schistosomes. Although it is important to detect latent S. stercoralis infections before administering chemotherapy or before the onset of immunosuppression in patients at risk, a specific and sensitive diagnostic test is lacking. This review describes the clinical manifestations of strongyloidiasis, as well as various diagnostic tests and treatment strategies.     

Strongyloides stercoralis infection in the immunocompromised host

Strongyloides stercoralis is an intestinal nematode acquired in the tropics or subtropics. Most often, it causes chronic, asymptomatic infection, but a change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. Corticosteroid use is most commonly associated with hyperinfection syndrome. Diagnosis of Strongyloides infection is based on serology and serial stool examinations for larvae. The treatment of choice for chronic, asymptomatic infection is oral ivermectin. Alternative pharmacologic agents include albendazole and thiabendazole. For hyperinfection syndrome, ivermectin remains the drug of choice, though therapy duration must be individualized with the end point being complete parasite eradication. Recurrent strongyloidiasis should prompt an evaluation for human T-cell lymphotropic virus type 1 coinfection. No test of cure is currently available, although immunoglobulin G antibody levels have been shown to decline within 6 months of successful treatment.     

Strongyloides stercoralis infection as a cause of acute granulomatous appendicitis in an HIV-positive patient in Athens,Greece

A case of acute granulomatous appendicitis due to Strongyloides stercoralis infection in an HIV-positive patient is described. To our knowledge this is the first case presented in the literature.     

Bronchial obstruction by incorporation of aspirated vegetable material in the bronchial wall.

The bronchoscpie, cytologic, and histologic features of a foreign body of vegetable origin embedded in the wall of a bronchus are described. The utility of bronchial biopsy in the diagnosis of this obscure cause of bronchial obstruction is emphasized, and the mode of treatment described.     

Early-onset polyarthritis as presenting feature of intestinal infection with Strongyloides stercoralis

SIR, In a patient with symmetrical polyarthritis the diagnosisof rheumatoid arthritis (RA) is advocated, especially if nosigns of (recent) infection are present. It is considered goodclinical practice nowadays to start early treatment with anti-rheumaticdrugs, including corticosteroids or tumour necrosis factor-(TNF-)-blocking agents. To prevent a life-threatening outcome,however, some rare infections have to be excluded. We describea patient who presented with recent-onset symmetrical polyarthritisand infection with Strongyloides stercoralis. A 35-yr-old male was referred to our     

吸毒者感染粪类圆线虫1例报告

本文报道了吸毒者感染粪类圆线虫1例，用肠虫清按常规治疗，治愈。     

Strongyloides stercoralis: a cause of morbidity and mortality for indigenous people in Central Australia

Background: Strongyloides stercoralis may cause a complicated infection in immunocompromised patients, which has a high case fatality rate. Death generally results from sepsis with enteric pathogens. Globally, infection with the human T‐cell lymphotropic virus type 1 (HTLV‐1) is a major risk factor for this syndrome. Both S. stercoralis and HTLV‐1 are endemic to Central Australia. Aims: The aim of the study was to determine whether complicated strongyloidiasis occurs in association with HTLV‐1 infection in Central Australia. Methods: A retrospective audit of all cases of complicated strongyloidiasis presenting to Alice Springs Hospital between January 2000 and December 2006 was carried out. Diagnosis was defined as definite or probable according to whether diagnosis was made by faecal studies or serology respectively. The medical records, investigations and outcomes of patients who met predetermined criteria for a diagnosis of complicated strongyloidiasis were reviewed. Results: Eighteen indigenous patients met the criteria for complicated strongyloidiasis (definite 9, probable 9). Seven of 11 patients tested were HTLV‐1 seropositive. At diagnosis, no treatment was documented for nine patients (definite 4, probable 5), three received a single dose of ivermectin and one a single dose of albendazole. Fifteen patients (83%) died because of sepsis (definite 7, probable 8). Pathogens isolated and their foci of infection included Klebsiella pneumoniae pneumonia (4), bloodstream infection with Enterococcus spp. (2), K. pneumoniae peritonitis (1) and streptococcal meningitis (1). Conclusion: Complicated strongyloidiasis occurs in association with HTLV‐1 infection in central Australia. This finding has significant implications for the management of S. stercoralis in the region.     

粪类圆线虫病重度自身感染一例

患者 ,男性 ,73岁 ,农民。因发热 ,咳嗽、咳痰 ,哮喘于 2 0 0 2年 12月 2 4日入院。患者近 2月来经常腹痛、腹泻、恶心呕吐、食欲差 ,间歇性稀便 ,时有粘液 ,一天 3～ 4次 ,自觉疲乏无力。曾服过多种中草药和抗生素均无效 ,病情逐渐加重。体检 :消瘦贫血病容 ,体温 3 8.5℃ ,脉搏 98/min ,呼吸 2 6次 /min ,双肺闻及干湿性 口罗音 ,心脏收缩期杂音Ⅱ级 ,下腹部轻度压痛 ,阴囊象皮肿鞘膜内积液 ,呈圆形 ,直径约 15cm。肺部X线照片呈现弥漫性炎性阴影。血液检查 ,血红蛋白 5 0 g/L ,白细胞 11× 10 9/L ,嗜酸粒细胞 1× 10 9/L(直接法 )。粪…     

Molecular diagnosis of Strongyloides stercoralis among transplant candidates

Strongyloidiasis can occur without any symptoms or as a potentially fatal hyperinfection or disseminated infection, principally in immunosuppressed patients. Our study aimed to evaluate the application of conventional polymerase chain reaction (cPCR) and real‐time PCR (qPCR). Polymerase chain reaction (PCR) and real‐time PCR (qPCR) targeting the 18S rRNA gene for detection of Strongyloides stercoralis infection among transplant candidates were applied in stool samples obtained from 150 transplant candidates, preliminarily analyzed by parasitological methods. S. stercoralis larvae were visualized in 15/150 (10.0%) transplant candidates by parasitological methods. DNA from S. stercoralis was amplified in 26/150 (17.3%) and 49/150 (32.7%) stool samples of transplant candidates, using cPCR and qPCR, respectively. The results suggest that molecular methods, especially qPCR, should be used as an additional tool for diagnostic of S. stercoralis infection among transplant candidates.