DOCSLIB.ORG

Strongyloidiasis: a Review and Update by Case Example

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Strongyloidiasis: a Review and Update by Case Example CLINICAL PRACTICE Strongyloidiasis: A Review and Update by Case Example KATHERINE GREINER, JOSEPH BETTENCOURT, CAROLE SEMOLIC A 77-year-old female immigrant from South America Joseph Bettencourt PhD is associate professor, Department of presented with epigastric pain, diarrhea, gastrointestinal Biology (Parasitology, Immunology, Anatomy), Marist College, bleeding, malabsorption, and acid reflux disorder. A Poughkeepsie NY. gastroduodenoscopy, performed to assess for peptic ulcer disease, revealed parasitic larvae in the duodenal mucosa Carole Semolic MT is medical technologist, Microbiology which were subsequently identified as Strongyloides stercoralis Department, St. Luke’s Cornwall Hospital, Newburgh NY. Downloaded from rhabditiform larvae. Anti-helminthic therapy was initiated to resolve infection. Address for correspondence: Katherine Greiner MS MT (ASCP), associate professor, Department of Medical Laboratory OBJECTIVES: Review the pathogenesis, diagnosis and Sciences (Clinical Microbiology, Clinical Immunology/Immu- treatment of strongyloidiasis; alert laboratory professionals nohematology), Marist College, DN 228, 3399 North Road, http://hwmaint.clsjournal.ascls.org/ to the importance of early detection of Strongyloides stercoralis Poughkeepsie NY 12601. (845) 575-3000, ext. 2505, (845) in specimens from immigrants at risk and immunodeficient 575-3184 (fax). [email protected]. patients to reduce morbidity and mortality. CASE HISTORY ABBREVIATIONS: AIDS = acquired immunodeficiency A 77-year-old female immigrant from South America syndrome; EIA = enzyme immunoassay; HIV = human sought medical attention at a hospital clinic due to immunodeficiency virus; HTLV-1 = human T-cell lym- epigastric pain and diarrhea. She was diagnosed with photropic virus type 1; IgE = immunoglobulin E; IgG = gastrointestinal bleeding, malabsorption, and acid reflux immunoglobulin G. disorder coupled with possible ulceration of the esophagus. A gastroduodenoscopy was performed to determine if INDEX TERMS: hyperinfection; immunodeficiency disor- she had peptic ulcer disease. Recommendations for stool on September 28 2021 ders; rhabditiform larvae; strongyloidiasis. analysis were made based on the histopathology findings. Clin Lab Sci 2008;21(2):82 LABORATORY RESULTS Biopsies of the small intestine and esophageal-gastric junction Katherine Greiner MS MT (ASCP) is associate professor, were taken. The mucosa of the small intestine was hyperemic Department of Medical Laboratory Sciences (Clinical Micro- and characterized by areas of acute or chronic inflammation. biology, Clinical Immunology/Immunohematology), Marist The gastric mucosa of the fundus also was hyperemic and had College, Poughkeepsie NY. focal areas of mild, nonspecific, chronic inflammation. Focal metaplasia, suggestive of Barrett’s esophagus, was seen in the esophageal mucosa. There was no evidence of ulceration, granuloma formation, or malignancy. The peer-reviewed Clinical Practice Section seeks to publish case stud- Cross-sections of structures resembling parasitic larvae were ies, reports, and articles that are immediately useful, are of a practical prominent in the duodenal histologic preparations. Subse- nature, or contain information that could lead to improvement in the quent stool analysis confirmed that these forms in sectioned quality of the clinical laboratory’s contribution to patient care, includ- tissue were Strongyloides stercoralis larvae. The larvae were ing brief reviews of books, computer programs, audiovisual materials, observed in the mucosal region of the duodenum, within or other materials of interest to readers. Direct all inquiries to Berna- the lumen of the crypts of Lieberkuhn (Figure 1). Typically, dette Rodak MS CLS(NCA), Clin Lab Sci Clinical Practice Editor, the crypts are invaded by juvenile or adult forms of Stron- Clinical Laboratory Science Program, Indiana University, Clarian gyloides stercoralis. Pathology Laboratory, 350 West 11th Street, 6002F, Indianapolis IN 46202. [email protected] 82 VOL 21, NO 2 SPRING 2008 CLINICAL LABORATORY SCIENCE CLINICAL PRACTICE Three stools for ova and parasite studies were submitted movement from the lungs to the respiratory airways causes to the laboratory the following week. Trichrome stains on irritation. Juveniles are coughed up to the pharynx and then smears prepared from stool concentrates on all three speci- swallowed, eventually lodging in the intestine. Lung migra- mens were negative for protozoa but revealed Strongyloides tion is unnecessary if juveniles in food or water are directly stercoralis rhabditiform larvae. Two fecal smears had many swallowed and conveyed to the small intestine. larvae present while the third showed only a few. In the small intestine filariform larvae molt twice, developing A diagnosis of strongyloidiasis was made on the basis of into adult female parasites (2 mm-3 mm). Females anchor rhabditiform larval morphology. Larvae were characterized by into the intestinal mucosa with their mouths or thread their a short buccal cavity, a sharply pointed tail, and the presence anterior ends into the submucosa. They produce several of a noticeable midsection genital primordium. Strongyloides dozen, thin-shelled eggs per day through parthenogenesis. ova are a rare finding in fecal smears and were not seen on Downloaded from the slides reviewed. Eggs are released into the intestinal lumen or submucosa and hatch during transit through the gut or while in the LIFE CYCLE submucosa. Juveniles escaping from the eggs develop into Strongyloides stercoralis is a member of the order Rhabditida first stage larvae called rhabditiform larvae (300μm -380 μm) which includes tiny round worms which bridge the gap be- which are passed from feces to soil. The rhabditiform larvae http://hwmaint.clsjournal.ascls.org/ tween free-living and parasitic modes of life. Within this or- become infective third-stage filariform larvae after two more der, Strongyloides stercoralis is the most common, widespread stages of development in soil and are capable of infecting a species of medical importance in humans and other primates new host if directly contacted or ingested. but also infects other mammals like dogs and cats. Autoinfection can occur and represents a permutation of Humans acquire strongyloidiasis through soil, food, or water the life cycle. If first stage juveniles molt twice during transit contaminated with infectious larvae. Invasive third-stage, fi- down the intestinal tract, they become infective filariform lariform larvae (490μm-630 μm) can directly penetrate skin larvae that can penetrate the lower gut mucosa (internal from soil or be ingested in contaminated food or water (Figure autoinfection) or perianal skin (external autoinfection) 2).The site of skin entry is usually exposed areas on the hands, and begin migration to the lungs and up the respiratory feet, and buttocks. Invasive juveniles that burrow into the skin tree to the pharynx, ultimately returning to the small in- on September 28 2021 are transported to the lungs by the bloodstream, where they testine. Autoinfection occurs at a significant rate in states migrate from pulmonary capillaries to alveolar spaces. Upward of immunosupression and appears to contribute to the life-threatening hyperinfections seen in individuals with immunocompromising illness. Whether by continuance of adult worms in the small intestine or by autoinfection, some cases of strongyloidiasis have resulted in persistent infection Figure 1. Strongyloides stercoralis rhabditiform larva lasting for decades. in the lumen of a crypt of Lieberkuhn. 430X In the free-living life cycle of Strongyloides stercoralis, rhab- ditiform larvae can molt to the fourth stage of development in soil, maturing into free-living adult males and females. Adult worms mate, resulting in egg release from which new rhabditiform larvae emerge. These hatched larvae then either develop into free-living adult worms or into filariform larvae that infect humans. SYMPTOMS Disease severity varies in strongyloidiasis. Numerous cases originating in endemic areas are chronic and asymptomatic when immunocompetency exists. Some individuals are evalu- ated for parasitosis on the basis of unexplained eosinophilia VOL 21, NO 2 SPRING 2008 CLINICAL LABORATORY SCIENCE 83 CLINICAL PRACTICE only. The more complex cases are characterized by symptom- Pulmonary migration phases are associated with cough- atology resulting from higher numbers of parasites in skin, ing, wheezing, and shortness of breath, symptoms which lung, and gastrointestinal tissue. may lead to a diagnosis of asthma and treatment with steroid-based medications that potentiate more extensive Dermatologic involvement at filariform points of entry is parasite invasion. manifested by a migrating, urticarial, erythematous rash, termed larva currens. Larva currens occurs more often in Epigastric pain and abdominal tenderness, along with bloating, the skin of the buttocks, groin, and trunk than that of the nausea, anorexia, and diarrhea are general signs of gastrointes- extremities. Eruptions may be particularly prominent in tinal invasion. A potentially fatal outcome is associated with perianal sites where the external autoinfection cycle begins. massive hyperinfection due to autoinfection cycles. Compli- Downloaded from Figure 2. Life cycle of Strongyloides stercoralis http://hwmaint.clsjournal.ascls.org/ on September 28 2021 CDC Public Health Image Library, ID#: 3419. Available from http://phil.cdc.gov/phil/home.asp. Content providers: CDC/Alexander J. da Silva,
Load more

Recommended publications
  • CDC Overseas Parasite Guidelines
    Guidelines for Overseas Presumptive Treatment of Strongyloidiasis, Schistosomiasis, and Soil-Transmitted Helminth Infections for Refugees Resettling to the United States U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine February 6, 2019 Accessible version: https://www.cdc.gov/immigrantrefugeehealth/guidelines/overseas/intestinal- parasites-overseas.html 1 Guidelines for Overseas Presumptive Treatment of Strongyloidiasis, Schistosomiasis, and Soil-Transmitted Helminth Infections for Refugees Resettling to the United States UPDATES--the following are content updates from the previous version of the overseas guidance, which was posted in 2008 • Latin American and Caribbean refugees are now included, in addition to Asian, Middle Eastern, and African refugees. • Recommendations for management of Strongyloides in refugees from Loa loa endemic areas emphasize a screen-and-treat approach and de-emphasize a presumptive high-dose albendazole approach. • Presumptive use of albendazole during any trimester of pregnancy is no longer recommended. • Links to a new table for the Treatment Schedules for Presumptive Parasitic Infections for U.S.-Bound Refugees, administered by IOM. Contents • Summary of Recommendations • Background • Recommendations for overseas presumptive treatment of intestinal parasites o Refugees originating from the Middle East, Asia, North Africa, Latin America, and the Caribbean o Refugees
    [Show full text]
  • Presumptive Treatment and Screening for Stronglyoidiasis, Infections
    Presumptive Treatment and Screening for Strongyloidiasis, Infections Caused by Other Soil- Transmitted Helminths, and Schistosomiasis Among Newly Arrived Refugees U.S. Department of Health and Human Services Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases Division of Global Migration and Quarantine November 26, 2018 Accessible link: https://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/intestinal-parasites- domestic.html Introduction Strongyloides parasites, other soil-transmitted helminths (STH), and Schistosoma species are some of the most common infections among refugees [1, 2]. Among refugees resettled in North America, the prevalence of potentially pathogenic parasites ranges from 8% to 86% [1, 2]. This broad range may be explained by differences in geographic origin, age, previous living and environmental conditions, diet, occupational history, and education level. Although frequently asymptomatic or subclinical, some infections may cause significant morbidity and mortality. Parasites that infect humans represent a complex and broad category of organisms. This section of the guidelines will provide detailed information regarding the most commonly encountered parasitic infections. A summary table of current recommendations is included in Table 1. In addition, information on overseas pre-departure intervention programs can be accessed on the CDC Immigrant, Refugee, and Migrant Health website. Strongyloides Below is a brief summary of salient points about Strongyloides infection in refugees, especially in context of the presumptive treatment with ivermectin. Detailed information about Strongyloides for healthcare providers can be found at the CDC Parasitic Diseases website. Background • Ivermectin is the drug of choice for strongyloidiasis. CDC presumptive overseas ivermectin treatment was initiated in 2005. Epidemiology • Prevalence in serosurveys of refugee populations ranges from 25% to 46%, with a particularly high prevalence in Southeast Asian refugees [2-4].
    [Show full text]
  • Performance of Two Serodiagnostic Tests for Loiasis in A
    Performance of two serodiagnostic tests for loiasis in a Non-Endemic area Federico Gobbi, Dora Buonfrate, Michel Boussinesq, Cédric Chesnais, Sébastien Pion, Ronaldo Silva, Lucia Moro, Paola Rodari, Francesca Tamarozzi, Marco Biamonte, et al. To cite this version: Federico Gobbi, Dora Buonfrate, Michel Boussinesq, Cédric Chesnais, Sébastien Pion, et al.. Perfor- mance of two serodiagnostic tests for loiasis in a Non-Endemic area. PLoS Neglected Tropical Dis- eases, Public Library of Science, 2020, 14 (5), pp.e0008187. 10.1371/journal.pntd.0008187. inserm- 02911633 HAL Id: inserm-02911633 https://www.hal.inserm.fr/inserm-02911633 Submitted on 4 Aug 2020 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. PLOS NEGLECTED TROPICAL DISEASES RESEARCH ARTICLE Performance of two serodiagnostic tests for loiasis in a Non-Endemic area 1 1 2 2 Federico GobbiID *, Dora Buonfrate , Michel Boussinesq , Cedric B. Chesnais , 2 1 1 1 3 Sebastien D. Pion , Ronaldo Silva , Lucia Moro , Paola RodariID , Francesca Tamarozzi , Marco Biamonte4, Zeno Bisoffi1,5 1 IRCCS Sacro
    [Show full text]
  • Imaging Parasitic Diseases
    Insights Imaging (2017) 8:101–125 DOI 10.1007/s13244-016-0525-2 REVIEW Unexpected hosts: imaging parasitic diseases Pablo Rodríguez Carnero1 & Paula Hernández Mateo2 & Susana Martín-Garre2 & Ángela García Pérez3 & Lourdes del Campo1 Received: 8 June 2016 /Revised: 8 September 2016 /Accepted: 28 September 2016 /Published online: 23 November 2016 # The Author(s) 2016. This article is published with open access at Springerlink.com Abstract Radiologists seldom encounter parasitic dis- • Some parasitic diseases are still endemic in certain regions eases in their daily practice in most of Europe, although in Europe. the incidence of these diseases is increasing due to mi- • Parasitic diseases can have complex life cycles often involv- gration and tourism from/to endemic areas. Moreover, ing different hosts. some parasitic diseases are still endemic in certain • Prompt diagnosis and treatment is essential for patient man- European regions, and immunocompromised individuals agement in parasitic diseases. also pose a higher risk of developing these conditions. • Radiologists should be able to recognise and suspect the This article reviews and summarises the imaging find- most relevant parasitic diseases. ings of some of the most important and frequent human parasitic diseases, including information about the para- Keywords Parasitic diseases . Radiology . Ultrasound . site’s life cycle, pathophysiology, clinical findings, diag- Multidetector computed tomography . Magnetic resonance nosis, and treatment. We include malaria, amoebiasis, imaging toxoplasmosis, trypanosomiasis, leishmaniasis, echino- coccosis, cysticercosis, clonorchiasis, schistosomiasis, fascioliasis, ascariasis, anisakiasis, dracunculiasis, and Introduction strongyloidiasis. The aim of this review is to help radi- ologists when dealing with these diseases or in cases Parasites are organisms that live in another organism at the where they are suspected.
    [Show full text]
  • Eosinophilic Cellulitis Secondary to Occult Strongyloidiasis, Case Report
    6 Case Report Page 1 of 6 Eosinophilic cellulitis secondary to occult strongyloidiasis, case report Llewelyn Yi Chang Tan, Dingyuan Wang, Joyce Siong See Lee, Benjamin Wen Yang Ho, Joel Hua Liang Lim National Skin Centre, Singapore, Singapore Correspondence to: Llewelyn Yi Chang Tan, MBChB. National Skin Centre, Singapore, Singapore. Email: [email protected]. Abstract: Eosinophilic cellulitis (EC), also known as Wells syndrome, is a rare reactive inflammatory dermatosis which may masquerade as bacterial cellulitis. A 59-year-old gentleman who presented with an acute onset of pruritic rashes affecting the chest and abdomen, along with painful induration over bilateral lower limbs, in association with blistering on his right leg. He had peripheral blood eosinophilia ranging from 0.91 to 1.17×109/L with no biochemical evidence of sepsis. Skin biopsy revealed dermal interstitial lymphocytic infiltration with numerous eosinophils at various stages of degranulation, along with flame figures. EC causing pseudo-cellulitis was suspected. Three fecal samples were unyielding for ova and cysts, but Strongyloides immunoglobulin G serology was positive. The diagnosis of EC secondary to occult strongyloidiasis was made and the patient was treated with oral anti-helminthics and topical steroids with all the skin lesions resolving within 4 days. To our knowledge, this association has never been hitherto reported. This case showcases the following instructive points to the internist, namely (I) the low threshold to consider pseudo-cellulitis in apparent “bilateral lower limb cellulitis”; (II) the awareness of the entity of EC and the need to evaluate for underlying etiologies that cause this reactive dermatoses, such as including occult helminthic infections; (III) the correct way to perform a thorough evaluation for, and optimal treatment of helminthiasis.
    [Show full text]
  • Identifying Co-Endemic Areas for Major Filarial Infections in Sub-Saharan
    Cano et al. Parasites & Vectors (2018) 11:70 DOI 10.1186/s13071-018-2655-5 SHORTREPORT Open Access Identifying co-endemic areas for major filarial infections in sub-Saharan Africa: seeking synergies and preventing severe adverse events during mass drug administration campaigns Jorge Cano1* , Maria-Gloria Basáñez2, Simon J. O’Hanlon2, Afework H. Tekle4, Samuel Wanji3,4, Honorat G. Zouré5, Maria P. Rebollo6 and Rachel L. Pullan1 Abstract Background: Onchocerciasis and lymphatic filariasis (LF) are major filarial infections targeted for elimination in most endemic sub-Saharan Africa (SSA) countries by 2020/2025. The current control strategies are built upon community-directed mass administration of ivermectin (CDTI) for onchocerciasis, and ivermectin plus albendazole for LF, with evidence pointing towards the potential for novel drug regimens. When distributing microfilaricides however, considerable care is needed to minimise the risk of severe adverse events (SAEs) in areas that are co-endemic for onchocerciasis or LF and loiasis. This work aims to combine previously published predictive risk maps for onchocerciasis, LF and loiasis to (i) explore the scale of spatial heterogeneity in co-distributions, (ii) delineate target populations for different treatment strategies, and (iii) quantify populations at risk of SAEs across the continent. Methods: Geographical co-endemicity of filarial infections prior to the implementation of large-scale mass treatment interventions was analysed by combining a contemporary LF endemicity map with predictive prevalence maps of onchocerciasis and loiasis. Potential treatment strategies were geographically delineated according to the level of co-endemicity and estimated transmission intensity. Results: In total, an estimated 251 million people live in areas of LF and/or onchocerciasis transmission in SSA, based on 2015 population estimates.
    [Show full text]
  • Chronic Symptomatic and Microfilaremic Loiasis in a Returned Traveller
    CMAJ Practice Clinical images Chronic symptomatic and microfilaremic loiasis in a returned traveller Courtney Thompson BSc MD, Ajith Cy MBBS MD, Andrea K. Boggild MSc MD 24-year-old woman presented for eval- Competing interests: None uation of eosinophilia (4.3 [normal declared. 0.04–0.4] × 109/L), generalized pruritis This article has been peer A reviewed. and recurrent migratory swelling of the wrists. Her symptoms had begun six months after her The authors have obtained return from a three-week stay in rural Camer- patient consent. oon, and had been ongoing for three years. Affiliations:Department of Owing to the epidemiologic and clinical history Medicine (Thompson, Cy, Boggild), University of compatible with loiasis, a blood smear was sub- Toronto; Public Health mitted for microscopic examination, which con- Figure 1: Adult stage of the filarial nematode Loa loa Ontario Laboratories firmed the presence of Loa loa microfilariae migrating in the conjunctiva of the left eye of a (Boggild), Public Health (microfilaremia). 24-year-old woman who had travelled to Cameroon. Ontario; Tropical Disease Unit, Division of Infectious While waiting for treatment with medications Diseases (Boggild), available only through the Special Access Pro- tomatic disease is more common among short- University Health Network- gramme of Health Canada, the patient presented term travellers, the presence of microfilaremia is Toronto General Hospital, to the emergency department with the sensation more consistently seen in patients from endemic Toronto, Ont. of a foreign body in her left eye (Figure 1), and areas who often show no symptoms. Microfilare- Correspondence to: was found to have a nemotode migrating in the mia is not commonly seen in expatriates or trav- Andrea Boggild, andrea [email protected] conjunctiva.
    [Show full text]
  • Strongyloidiasis: the Most Neglected Tropical Disease in Ethiopia Abebaw Tiruneh*, Endalew Zemene and Zeleke Mekonnen
    Tiruneh et al. Infect Dis Poverty (2021) 10:65 https://doi.org/10.1186/s40249-021-00851-2 COMMENTARY Open Access Strongyloidiasis: the most neglected tropical disease in Ethiopia Abebaw Tiruneh*, Endalew Zemene and Zeleke Mekonnen Abstract Background: Strongyloidiasis is the most neglected of the neglected tropical diseases (NTDs). The aim of this com- mentary is to describe the possible reasons why strongyloidiasis is so overlooked in Ethiopia, and shed light on better ways of control and elimination of the disease. Main body: This commentary highlights three points why strongyloidiasis is the most neglected of the NTDs in Ethiopia. Firstly, lack of clear category within the NTDs resulted in omission of the disease from reports, intervention programs, and preventive chemotherapy guidelines. Secondly, magnitude of the disease is underestimated due to paucity of studies and low sensitivity of diagnostic methods coupled with asymptomatic nature of most of the infec- tions. Finally, ivermectin (the drug of choice for treatment of strongyloidiasis) is not in use for control of the other soil- transmitted helminthiasis, nor is there ivermectin mass drug administration for control of strongyloidiasis. This might have created gap in control and elimination of the disease in Ethiopia and possibly elsewhere. Conclusion: Strongyloidiasis appears to be the most neglected of the NTDs mainly due to nature of the infection, low sensitivity of the routine diagnostic tools and it’s exclusion from strategic plans and intervention programs. Moreover, studies on strongyloidiasis should use sensitive diagnostic tools. Strongyloidiasis control and elimination programs should be based on reliable evidence of epidemiology of the disease in Ethiopia.
    [Show full text]
  • Serodiagnosis of Fasciolosis by Fast Protein Liquid Chromatography-Fractionated Excretory/Secretory Antigens
    Parasitol Res (2016) 115:2957–2965 DOI 10.1007/s00436-016-5049-7 ORIGINAL PAPER Serodiagnosis of fasciolosis by fast protein liquid chromatography-fractionated excretory/secretory antigens Kobra Mokhtarian1 & Lame Akhlaghi1 & Ahmad Reza Meamar1 & Elham Razmjou1 & Kourosh Manouchehri Naeini2 & Samaneh Gholami3 & Masoomeh Najafi Samei3,4 & Reza Falak3,4 Received: 14 March 2016 /Accepted: 7 April 2016 /Published online: 30 April 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract In several studies, different antigenic preparations exchange chromatography on a Sepharose CL-6B column and and diverse immunological tests were applied for then tested the serodiagnostic values of the fractions. We used serodiagnosis of Fasciola hepatica infections. Most of these sera from F. hepatica-infected human and sheep as positive preparations showed cross-reactivity with proteins of other controls. Sera from patients with hydatidosis and strongyloi- parasites. Application of purified antigens might reduce these diasis were used for cross-reactivity studies. Enzyme-linked cross-reactivities. Here, we used fast protein liquid chroma- immunosorbent assays (ELISA) of the second FPLC peak, tography (FPLC)-fractionated extracts of F. hepatica containing 20, 25, and 70 kDa proteins, discriminated be- excretory/secretory antigens (E/S Ags) for serodiagnosis of tween F. hepatica-infected and uninfected human and sheep human and sheep fasciolosis. To develop an improved diag- samples. Fractionation of F. hepatica E/S Ags by FPLC is a nostic method, we fractionated F. hepatica E/S Ags by anion fast and reproducible way of obtaining antigens useful for Highlights • Fasciola hepatica antigens were fractionated by FPLC anion exchange chromatography. • Fractions containing the 17-, 48-, and 50-kDa proteins cross-reacted with sera from hydatidosis patients.
    [Show full text]
  • Common Helminthic Infections in the Middle East ESCMID Online Lecture Library © by Author
    ESCMID PGTW PARASITIC INFECTIONS OF THE ARABIAN PENINSULA AL AIN, UAE 17-19 MARCH 2016 Common Helminthic Infections in the Middle East Míriam J. Álvarez-Martínez M.D., Ph.D. Microbiology Department Hospital Clinic, Barcelona (Spain) ISGlobal (Barcelona© by Institute author for Global Health) Faculty of Medicine-University of Barcelona [email protected] ESCMID Online Lecture Library © by author LAS FALLAS- VALENCIA, SPAIN ESCMID Online Lecture Library © by author ESCMID Online Lecture Library OUTLINE • Helminthic Infections – yesterday, today & always? Global Burden • Coinfections & Immunity • Strongyloides: Infection & Hyperinfection • Lymphatic Filariais© by author • Conclusions ESCMID Online Lecture Library 2008 © by author Three generalESCMID migration routes ofOnline humans in prehistory Lecture hypothesized fromLibrary Asia to the Americas. (a) Represents the longest-standing hypothesis of a migration route through Beringia and into North America at the time of low sea level and glacial maximum (b) Parasite probe data are consistent with a Coastal migration or (c) Trans-Pacific migration © by author ESCMID Online Lecture Library PHOTOGRAPH COURTESY DENNIS VAN GERVEN Metazoa PlatyhelmintosPlatyhelminths NematohelmintosNematodes gusanosFlatworms planos gusanosRoundworms redondos Soil CestodosCestodes TrematodosTrematodes Nematodos Filarial © by authorTransmitted Tapeworms Flukes worms tape worms flukes roundHelminths worms ESCMID Online Lecture Library GLOBAL BURDEN • It is estimated that approximately one-third of the 3 billion people that live on less than 2 US dollars per day in developing regions of sub-Saharan Africa, Asia, and the Americas are infected with one or more helminths. • Human helminthic infections have both direct and indirect effects on malaria and HIV/AIDS in developing countries, where are frequenty© by author coendemic. • Coinfections have additive effects, such as severe anemia,synergisticESCMID Online effects, such Lecture as increased Library transmission of the malaria, HIV, and/or increased susceptibility to infection.
    [Show full text]
  • Strongyloides Stercoralis
    CLOSE ENCOUNTERS WITH THE ENVIRONMENT What’s Eating You? Strongyloides stercoralis COL Dirk M. Elston, MC, USA; MAJ Katherine Czarnik, MC, USA; Lt Col Royce Brockett, USAF, BSC; James H. Keeling, MD trongyloides stercoralis (Figure 1) is endemic to Southeast Asia, the southern United States S (especially Kentucky and Tennessee), central Africa, and warmer areas of South America (espe- cially Brazil).1 Among immigrants from Southeast Asia, the prevalence of infection may be as high as 38%.2 The most characteristic skin lesion associ- ated with Strongyloides infection is larva currens (Figures 2 and 3), a rapidly moving urticarial form of cutaneous larva migrans. These linear or serpigi- nous urticarial streaks are typically noted on the buttocks or lower trunk. Larva currens may migrate up to 10 cm in a matter of hours, unlike the slow Figure 1. Strongyloides larva. progression of cutaneous larva migrans. Although lesions of cutaneous larva migrans persist for days, larva currens is fleeting and may vanish a few hours after onset. Thumbprint purpura also may be lichen simplex chronicus.5 The larval worm in noted, especially on the lower trunk and buttocks. Figure 4 was isolated from the feces of a patient In one study of patients with disseminated strongy- with urticaria and prurigo nodularis. She had loidiasis, skin biopsy results of purpuric lesions recently been treated with a course of prednisone. demonstrated the parasite in 10 of 12 biopsy spec- Complete blood count results revealed peripheral imens.3 Recognition of the characteristic skin eosinophilia, which prompted examination of lesions can be crucial for early diagnosis and treat- stool samples for ova and parasites.
    [Show full text]
  • Prevalence and Intensity of Infection of Soil-Transmitted Helminths in Latin America and the Caribbean Countries Mapping at Second Administrative Level 2000-2010
    2011 Prevalence and intensity of infection of Soil-transmitted Helminths in Latin America and the Caribbean Countries Mapping at second administrative level 2000-2010 0 March 18/2011 PAHO NTD Team Pan American Health Organization Communicable Disease Prevention and Control Project “Prevalence and intensity of infection of Soil-transmitted Helminths in Latin America and the Caribbean Countries: Mapping at second administrative level 2000-2010” Washington, D.C.: PAHO © 2011 1. Background 2. Objectives 3. Methodology 4. Outcomes 5. Discussion 6. Conclusions All rights reserved. This document may be reviewed, summarized, cited, reproduced, or translated freely, in part or in its entirety with credit given to the Pan American Health Organization. It cannot be sold or used for commercial purposes. The electronic version of this document can be downloaded from: www.paho.org. The ideas presented in this document are solely the responsibility of the authors. Requests for further information on this publication and other publications produced by Neglected and Parasitic Diseases Group, Communicable Disease Prevention and Control Project, HSD/CD should contact: Parasitic and Neglected Diseases Pan American Health Organization 525 Twenty-third Street, N.W. Washington, DC 20037-2895 www.paho.org. Recommended citation: Saboyá MI, Catalá L, Ault SK, Nicholls RS. Prevalence and intensity of infection of Soil-transmitted Helminths in Latin America and the Caribbean Countries: Mapping at second administrative level 2000-2010. Pan American Health Organization: Washington D.C., 2011. 1 March 18/2011 PAHO NTD Team Acknowledgments The Pan-American Health Organization (PAHO) would like to express special thanks to authors who contributed with copies of their papers directly, when free access was not available.
    [Show full text]