Maltreatment of Strongyloides infection: case series and worldwide physicians-in-training survey

Background

Strongyloidiasis infects hundreds of millions of people worldwide and is an important cause of mortality from intestinal helminth infection in developed countries. The persistence of infection, increasing international travel, lack of familiarity by health care providers, and potential for iatrogenic hyperinfection all make strongyloidiasis an important emerging infection.

Methods

Two studies were performed. A retrospective chart review of Strongyloides stercoralis cases identified through microbiology laboratory records from 1993-2002 was conducted. Subsequently, 363 resident physicians in 15 training programs worldwide were queried with a case scenario of strongyloidiasis, presenting an immigrant with wheezing and eosinophilia. The evaluation focused on resident recognition and diagnostic recommendations.

Results

In 151 strongyloidiasis cases, stool ova and parasite sensitivity is poor (51%), and eosinophilia (>5% or >400 cells/μL) commonly present (84%). Diagnosis averaged 56 months (intra-quartile range: 4-72 months) after immigration. Presenting complaints were nonspecific, although 10% presented with wheezing. Hyperinfection occurred in 5 patients prescribed corticosteroids, with 2 deaths. Treatment errors occurred more often among providers unfamiliar with immigrant health (relative risk of error: 8.4; 95% confidence interval, 3.4-21.0; P <.001). When presented with a hypothetical case scenario, US physicians-in-training had poor recognition (9%) of the need for parasite screening and frequently advocated empiric corticosteroids (23%). International trainees had superior recognition at 56% (P <.001). Among US trainees, 41% were unable to choose any parasite causing pulmonary symptoms.

Conclusions

Strongyloidiasis is present in US patients. Diagnostic consideration should occur with appropriate exposure, nonspecific symptoms including wheezing, or eosinophilia (>5% relative or >400 eosinophils/μL). US residents’ helminth knowledge is limited and places immigrants in iatrogenic danger. Information about Strongyloides should be included in US training and continuing medical education programs.     

白三烯受体拮抗剂治疗和预防呼吸道合胞病毒毛细支气管炎及感染后反复喘息的临床观察

目的观察白三烯受体拮抗剂（孟鲁司特）治疗和预防呼吸道合胞病毒（RSV）毛细支气管炎及感染后反复喘息的发生。方法选择2008年11月～2010年02月我院收治的RSV毛细支气管的住院患儿104例,随机分为治疗组（52例）和对照组（52例）,在相同的综合治疗基础上,对照组常规使用激素和用布地奈德、异丙托溴铵、沙丁胺醇悬液雾化吸入,治疗组同时予孟鲁司特4mgpoqn,连用4周,观察急性期喘憋、呼吸困难、咳嗽、肺部喘鸣音消失时间,平均治疗天数及随访1月内喘息再发情况。结果两组比较差异均有统计学差异。结论应用白三烯受体拮抗剂（孟鲁司特）治疗RSV毛细支气管炎,可以明显缩短急性期病程,减少日后反复发作的喘息。     

Airway tone dysfunction among pre-schoolers with positive asthma predictive index: A case–control study

ObjectiveTo measure lung function by impulse oscillometry (IOS) and spirometry in recurrent wheezer pre-schoolers according to their asthma predictive index (API) condition.MethodsWe performed a case–control study enrolling all pre-schoolers with recurrent wheezing episodes (>3 episodes confirmed by physician) who presented at a paediatric pulmonology clinic. The population was divided according to stringent API criteria into positive or negative.ResultsIn the nine-month period, 109 pre-schoolers were enrolled. After excluding one patient (due to lung function technique problems) 108 pre-schoolers (56 males, age range from 24 to 72 months) completed the study; 50 belong to positive API and 58 to negative API group. There were no differences in demographics between groups. More use of ICS was found in those with positive API than with negative API (62% vs. 12%, respectively, p = 0.001). No differences in basal lung function and post-bronchodilator response to salbutamol (by IOS or spirometry) were found between positive and negative API pre-schoolers. However, those positive API pre-schoolers with ICS had significantly higher central basal airway resistance (RA at 20 Hz) and higher post-BD response (% change in FEF_25–75 and in FEV_0.5) than those positive API without ICS.ConclusionRecurrent wheezer pre-schoolers with positive API and ICS used may have airway dysfunction. More studies are needed to confirm this finding.     

不同装置雾化吸入治疗在婴幼儿急性喘息性疾病中的对比研究

目的比较不同雾化装置吸入治疗在婴幼儿急性喘息性疾病中的效果及影响因素。方法将185例3个月~3岁急性喘息性疾病患儿随机分为压力定量式气雾剂+储雾罐治疗组(P组)、雾化器治疗组(N组)、口服沙丁胺醇治疗组(对照组,C组),雾化吸入药物均为糖皮质激素加短效β2受体激动剂(沙丁胺醇),观察各组的显效率、有效率及P组和N组雾化治疗的依从性和不良反应情况,并使用Logistic回归分析来探讨雾化治疗效果的影响因素。结果 P组和N组显效率均高于对照组;P组和N组雾化治疗效果及依从性无显著性差异,不良反应均较少;哮喘预测指数阳性及雾化治疗依从性高可能是疗效的保护性因素。结论压力定量式气雾剂+储雾罐及雾化器雾化吸入糖皮质激素联合短效β2受体激动剂治疗婴幼儿急性喘息性疾病均安全有效,选择治疗方案时要关注哮喘预测指数及依从性。     

The relationship between second-hand smoke and wheezing in infants from Córdoba,Argentina

BackgroundWheezing constitutes a common respiratory symptom in children, and several risk factors have been associated with the prevalence of recurrent wheezing (RW) and its severity, especially viral respiratory infections and second-hand smoke (SHS) exposure.ObjectiveTo analyze the relationship between smoking patterns in the home and wheezing, in infants from the city of Córdoba, Argentina, during their first year of life.MethodsParents of infants were invited to complete a standardized questionnaire voluntarily and anonymously (WQ-P1-EISL). Wheezing in the first 12 months of life was classified as occasional wheezing (OW) when having one or two episodes during the first 12 months of life; recurrent wheezing (RW) if having three or more, and more frequent wheezing (MFW) ≥6 episodes.Results409 infants (39.0%) had one or more episodes of wheezing in the first 12 months. Of these, 214 infants (52.3%) presented occasional wheezing (OW), 135 (33%) had recurrent wheezing (RW), and 60 (14.7%) more frequent wheezing (MFW). SHS was significantly related to MFW, especially if the mother smoked (OR = 2.7; IC 95%: 1.4–5.18; p = 0.0009) or if she smoked during pregnancy (OR = 4; IC 95%: 1.8–8.5; p = 0.0001). This group of MFW was also associated with SHS as well as having been to the emergency room for wheezing (40.87%, p = 0.0056).ConclusionThe results indicate that second-hand tobacco smoke is a significant risk factor for the presence of wheezing in infants, and for its severity. Our findings have significant implications for public health, as smoking is a modifiable behavior.     

定喘汤加减治疗小儿支气管哮喘106例

目的:观察定喘汤治疗小儿支气管哮喘的临床疗效。方法:将189例支气管哮喘患儿随机分成治疗组106例和对照组83例,对照组予西医常规治疗,治疗组在对照组治疗基础上加用定喘汤加减治疗。结果:对照组中,临床控制11例,显效15例,有效33例,无效24例,有效率为71.1%;治疗组中,临床控制30例,显效34例,有效33例,无效9例,有效率为91.5%,两组有效率比较,差异有显著性(P<0.05)。结论:定喘汤加减治疗小儿支气管哮喘疗效显著。     

Prevalence of Asthma and Related Symptoms in Sivas,Central Anatolia

Background.?In our clinical experience, asthma is an important health problem in our region, but we did not know its prevalence. Objective.?The main objective of our study was to assess the prevalence of asthma in Sivas, a city in Central Anatolia. Methods.?A cross-sectional study was performed using a screening questionnaire adopted from European Community Respiratory Health Survey (ECRHS). A total of 5448 adults of both genders between 20 and 107 yr of age living in Sivas, a city in the central region of Anatolia in Turkey, participated in the survey. Of the cohort, 2691 were men (49.4%) and 2757 (50.6%) were women. Results.?The mean age was 38.2 yr (SD = 12.7 yr), almost half of the study population was at or younger than 40 yr of age. The prevalence of wheezing in the last 12 months, diagnosis of asthma, asthma attack in the last 12 months, and use of asthma medicine were 20.9%, 4.5%, 4.9%, and 3.4%, respectively. Awakening with chest tightness, with shortness of breath, or with cough were reported as 14.2%, 14.8%, and 22.7%, respectively. The prevalence of respiratory symptoms related to asthma was statistically higher in women than that of men (p = 0.000, OR 1.346, 95% CI: 1.228–1.475). Those who had asthma/allergic symptoms in their family members were significantly younger than others (p : 0.001). Conclusions.?The results of this study demonstrate that symptoms suggestive of asthma are quite common and constitute a major health problem in Sivas, Turkey. This study also showed that, despite a high rate of reported symptoms exists, the rate of diagnosis and treatment of asthma is low among the adult population in Sivas.     

应用孟鲁司特钠联合干扰素α1b治疗小儿喘息性支气管炎的疗效分析

目的探讨小儿喘息性支气管炎应用孟鲁司特钠联合干扰索α1b治疗的疗效优势。方法随机选取深圳市远东妇儿科医院收治的喘息性支气管炎患儿156例,按分层随机分组法均分为对照组和治疗组（n=68）。对照组在静脉抗感染,止咳化痰等常规治疗基础上加用利巴韦林抗病毒治疗;治疗组在常规对症处理基础上加用干扰索α1b雾化吸入,并每晚予以孟鲁司特钠口服治疗,比较2组患者经治疗后的近期及远期疗效差异。结果近期疗效：治疗组的发热、气喘、哮鸣音等症状的消退时间及住院时间比较,均显著短于对照组,差异有统计学意义（P〈0．05）;治疗总有效率为91.2％,显著高于对照组的70．6％,差异有统计学意义（P〈0．05）。远期疗效：治疗组治疗3个月及6个月的再次复发率分别为4.4％、7.4％,均显著低于对照组20.6％、27.9％,差异有统计学意义（P〈0.05）,治疗组未出现不良反应,对照组出现皮疹1例、上消化道不良反应1例。结论孟鲁司特钠联合干扰素α1b具有一定的预防喘息性支气管炎患儿气道高反应性的疗效作用,安全可靠,值得临床推广应用。     

喘息患儿血清1,25-二羟维生素D_3和总IgE的变化及孟鲁司特的干预研究

目的：探讨血清1,25-二羟维生素D3和总免疫球蛋白E（Ig E）在喘息患儿体内的含量变化,以及孟鲁司特对两种物质的干预作用。方法：选取我院收治的60例6个月~3岁的喘息患儿,分为非干预组和孟鲁司特干预组各30例,同时选取同年龄段的健康体检儿童30例作为对照组。采用放射免疫法测定血清1,25-二羟维生素D3,酶联免疫法测定血清总Ig E水平,观察三组儿童血清1,25-二羟维生素D3和Ig E的差异,以及喘息患儿治疗前后两种物质的变化,并比较非干预组和孟鲁司特干预组的临床疗效。结果：喘息患儿血清1,25-二羟维生素D3明显低于健康儿童（P〈0.05）,血清总Ig E水平明显高于健康儿童（P〈0.05）,孟鲁司特干预组临床疗效优于非干预组（P〈0.01）,孟鲁司特可以降低喘息患儿血清总Ig E水平（t=22.496,P〈0.01）。结论：1,25-二羟维生素D3和血清总Ig E均参与喘息患儿的免疫调节机制,孟鲁司特是治疗喘息患儿一种安全有效的药物,并且通过降低血清总Ig E减轻过敏性喘息。     

Prenatal paracetamol exposure and risk of wheeze at preschool age*

Aim: To analyse the association between prenatal paracetamol exposure and preschool wheeze. Methods: Data were obtained from a prospective, longitudinal study of a cohort of children born in the region of western Sweden in 2003; 8176 families were randomly selected. The parents answered questionnaires at 6 and 12 months and at 4.5 years of age. The response rate was 55%, i.e. 4496 of the 5398 questionnaires distributed at 4.5 years (83%). Inhaled corticosteroid (ICS) treated wheeze during the last year was regarded as a proxy for doctor‐diagnosed asthma. Episodic viral wheeze was defined as wheezing only with viral infections and multiple‐trigger wheeze as wheezing also in between infections. Results: In the multivariate analysis, the risk of ICS‐treated wheeze was increased by paracetamol (OR 1.6; 95% CI 1.01–2.6). Within the ICS‐treated group, the effect was significant for multiple‐trigger wheeze (OR 2.4; 1.2–4.8) but not for episodic viral wheeze (OR 1.1; 0.5–2.3). Conclusion: Prenatal paracetamol exposure was an independent risk factor for ICS‐treated wheeze at preschool age, especially among children with ICS‐treated multiple‐trigger wheeze. Although the analysis adjusted for e.g. maternal asthma and antibiotic use, the possibility of residual confounding by maternal indication (respiratory illness) should be acknowledged.