DOCSLIB.ORG

Update on Strongyloidiasis in the Immunocompromised Host

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Update on Strongyloidiasis in the Immunocompromised Host Curr Infect Dis Rep (2011) 13:35–46 DOI 10.1007/s11908-010-0150-z Update on Strongyloidiasis in the Immunocompromised Host Luis A. Marcos & Angélica Terashima & Marco Canales & Eduardo Gotuzzo Published online: 1 December 2010 # Springer Science+Business Media, LLC 2010 Abstract Immunocompromised persons are the most vul- minthic therapy. Highly sensitive screening tests are still nerable population at risk for developing life-threatening not available in the major tertiary medical centers. clinical syndromes associated with strongyloidiasis, such as Parenteral ivermectin has been used in some severe cases. hyperinfection syndrome (HS) or dissemination. This Further therapy developments and improving diagnostic review focuses on describing Strongyloides infection in tools are warranted. the immunocompromised host, including immune response against this infection, analyzing the cases with HS Keywords Strongyloides stercoralis . Strongyloidiasis . published during the past 4 years in the United States, Immunocompromised host . Hyperinfection syndrome . and describing the most sensitive diagnostic tools and the Dissemination . Autoinfection . Transplant population . most effective treatment for each clinical syndrome. Immigrant . Agar plate . Anthelminthic . Ivermectin . Strongyloidiasis is becoming an important parasitic disease Parenteral . USA in the United States, especially in the immunocompromised immigrant population. Because the transplant population is particularly at risk for developing HS, both recipients and Introduction donors should be screened for Strongyloides. Clinicians should also be aware that the development of HS can Strongyloides stercoralis and Strongyloides fuelleborni follow unexpectedly a few days after appropriate anthel- (genus: Strongyloides) are two intestinal nematodes that cause the disease strongyloidiasis, which affects an esti- mates 30–100 million people around the world [1]. An increased number of cases seen in developed countries are * L. A. Marcos ( ) related to the increased numbers of immigrants, refugees, Infectious Diseases Division, Internal Medicine Department, Washington University School of Medicine, and travelers. Without an adequate control program, this 660 South Euclid Avenue, infection might be a potential emerging global infectious St. Louis, MO 63110, USA disease [2•]. The unique life cycle in Strongyloides has e-mail: [email protected] severe clinical consequences in humans. Both the free- L. A. Marcos : A. Terashima : M. Canales : E. Gotuzzo living cycle (environment) and the parasitic cycle (in Institute of Tropical Medicine Alexander von Humboldt, humans) can develop adult worms. The adult worms can Universidad Peruana Cayetano Heredia, survive in humans permanently for years, in a process Lima, Peru better known as autoinfection. Nonetheless, a dysregulation A. Terashima of the host’s immune response during this latent infection e-mail: [email protected] may be lethal, because multiple infective larvae can E. Gotuzzo develop and invade other organs than the intestines, causing e-mail: [email protected] sepsis and death. This increase in the number of larvae with A. Terashima : M. Canales : E. Gotuzzo invasion to other organs is called hyperinfection syndrome PO. Box 4314, Lima 100, Peru (HS) with dissemination [3]. 36 Curr Infect Dis Rep (2011) 13:35–46 Strongyloidiasis is highly prevalent in some developing (IL)-4, IL-5, IL-10, and IL-13, and IgA, IgE, and IgG1 are countries. However, it has been seen more frequently in produced [5]. Immune responses elicited by nematode developed countries, especially where immigrants are present. infections in normal subjects are Th2 type, characterized A recent study reported 347 deaths related to strongyloidiasis by production of high levels of IL-3, IL-4, IL-5, and IL-13, (0.79 per 10 million deaths, 14–29 deaths per year) from 1991 and eosinophils and specific IgA [6, 7]. to 2006 in the United States [4••]. Lack of strategic control During Strongyloides infection, two Th2-dependent programs, the increased number of infected humans’ deaths mechanisms have been proposed for killing the penetrating reported in developed countries, and the lack of readily infective larvae: mast cell degranulation and direct killing available treatment are some of the major issues related to this of the parasite by eosinophils. Mast cells are activated by neglected disease. This review describes the immunology IL-4 and their degranulation depends on the presence of interaction between Strongyloides and some immunodeficient IgE against parasite antigens. The IgE, IgG1, and IL-4 conditions; collects the available US cases of disseminated cytokines are elicited by Strongyloides infection [8]. At an strongyloidiasis reported between 2006 and 2010; and intestinal level, a strong Th2 response is present by intense updates the most available and sensitive diagnostic tests and mast cell activation through IL-3 pathway, and eosinophil treatment of strongyloidiasis described in the literature. production against the parasite [9–11]. Expansion and activation of eosinophils for parasite killing depends on IL-5; when IL-5 suppressors are used (decreasing Th-2 Overview of the Pathogenesis and Immune Response response), levels of larva killing decreased significantly of Strongyloides Infection [12]. Likewise, corticosteroids suppress Th2 response directly by binding the glucocorticoid receptors of the + A fine balance between the T helper 1 (Th1) and 2 (Th2) CD4 Th2 cell membrane, causing apoptosis and T-cell response plays a key role in the host’s response against dysfunction. Corticosteroids may also increase ecdysteroid- Strongyloides infection (Fig. 1). CD4/T cells are composed like substances, which act as molting signals for eggs and of Th1 and Th2 subpopulations based on the type of rhabditiform larvae, leading to increased number of filari- cytokine secretion. In general, the cytokine production of form larvae and dissemination [13]. If the immune response the Th1-type T-cell subpopulation can down-regulate the is manipulated to Th1, for example, providing IL-12 (Th-1 Th2-type cytokines profile, and vice versa. In the Th1 immune response modulating cytokine), eosinophils levels response, there is production of interferon (IFN)-γ, activa- are decreased and protective immunity can be lost [14]. tion of macrophages, CD8+ cytotoxic T cells, and genera- Furthermore, the innate immune response (early response tion of IgG2a; whereas in the Th2 response, interleukin mainly by macrophages, dendritic cells, neutrophils) and the Filariform Strongyloides Th1 cell larva HTLV-1 has a stronger Strongyloides Th1 response promotes HTLV-1 Low IgE cell replication High IgG4 by IL-2 Intestine CD4 Mast cell Antigen-presenting cell T cell activation (neutrophils mainly) IL-4 effector IL-13 HIV has a predominant Th2 response IL-5 Eosinophil Innate immune response eliminates Inhibit Corticosteroids the larvae IL-4 IgE (C3, lgM, and neutrophils) IL-13 Th2 cell B cell Innate immunity Adaptive immunity Fig. 1 Immune response of Strongyloides infection. HTLV human T-cell lymphotrophic virus; IL interleukin; Th helper T cell. Curr Infect Dis Rep (2011) 13:35–46 37 adaptive protective immune response (B and T lymphocytes) prognosis [32]. Finally, immune response in humans against are activated during the initial Strongyloides infection [15]. Strongyloides infection is difficult to study because of time, Killing of the infective S. stercoralis larvae by immunized age, and intensity of infection; previous or current co- mice is dependent on the interaction among C3 (common parasite infections; previous Strongyloides infections; and factor of the complement system), IgM, and neutrophils. A immunodeficiencies related to viruses, malignancies, and probable immune induction of specific antibodies and iatrogenic or congenital conditions. granulocytes may be implicated on parasite clearance. A mouse model infected with live filariform larvae (L3) elicited high levels both on tissues and peripheral blood of Clinical Syndromes in Strongyloides Infection IgG1, IgM, IgA, and eosinophils [16]. Likewise, IgM, C3, and eosinophils were found either attached to the outer The clinical presentation of strongyloidiasis can range from surface of L3 larva or nearby [17]. IgM and IgG antibodies an indolent to a life-threatening condition. These are are both protective against larval S. stercoralis, but they grouped in five major clinical syndromes: 1) acute infection recognize different antigens and use different killing mech- (with Loeffler’s syndrome or transient eosinophilic pulmo- anisms which, in turn, together synergize efficiently to kill nary infiltrates); 2) chronic intestinal infection; 3) oligo- the worm [18]. Filariform larvae, the infective larvae present asymptomatic autoinfection; 4) symptomatic autoinfection; during HS, can modify their body and evade the host and 5) hyperinfection syndrome (HS) with dissemination immune response [19]. B-cell immune response is also [2, 33, 34]. important during the infection. When T-cell and B-cell– It is extremely uncommon to see the acute infection in mediated responses are suppressed in mice, S. stercoralis clinical practice; reports are mainly in volunteers [35]. attack was attributable mainly to deficiencies in B-cell– Chronic intestinal infection (latent) occurs mainly in mediated immunity [20]. endemic countries and occasionally is seen in travelers, Immunity in Strongyloides infection is possible. A immigrants, and refugees [36,
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]
  • Visceral and Cutaneous Larva Migrans PAUL C
    Visceral and Cutaneous Larva Migrans PAUL C. BEAVER, Ph.D. AMONG ANIMALS in general there is a In the development of our concepts of larva II. wide variety of parasitic infections in migrans there have been four major steps. The which larval stages migrate through and some¬ first, of course, was the discovery by Kirby- times later reside in the tissues of the host with¬ Smith and his associates some 30 years ago of out developing into fully mature adults. When nematode larvae in the skin of patients with such parasites are found in human hosts, the creeping eruption in Jacksonville, Fla. (6). infection may be referred to as larva migrans This was followed immediately by experi¬ although definition of this term is becoming mental proof by numerous workers that the increasingly difficult. The organisms impli¬ larvae of A. braziliense readily penetrate the cated in infections of this type include certain human skin and produce severe, typical creep¬ species of arthropods, flatworms, and nema¬ ing eruption. todes, but more especially the nematodes. From a practical point of view these demon¬ As generally used, the term larva migrans strations were perhaps too conclusive in that refers particularly to the migration of dog and they encouraged the impression that A. brazil¬ cat hookworm larvae in the human skin (cu¬ iense was the only cause of creeping eruption, taneous larva migrans or creeping eruption) and detracted from equally conclusive demon¬ and the migration of dog and cat ascarids in strations that other species of nematode larvae the viscera (visceral larva migrans). In a still have the ability to produce similarly the pro¬ more restricted sense, the terms cutaneous larva gressive linear lesions characteristic of creep¬ migrans and visceral larva migrans are some¬ ing eruption.
    [Show full text]
  • Public Health Significance of Intestinal Parasitic Infections*
    Articles in the Update series Les articles de la rubrique give a concise, authoritative, Le pointfournissent un bilan and up-to-date survey of concis et fiable de la situa- the present position in the tion actuelle dans les do- Update selectedfields, coveringmany maines consideres, couvrant different aspects of the de nombreux aspects des biomedical sciences and sciences biomedicales et de la , po n t , , public health. Most of santepublique. Laplupartde the articles are written by ces articles auront donc ete acknowledged experts on the redigeis par les specialistes subject. les plus autorises. Bulletin of the World Health Organization, 65 (5): 575-588 (1987) © World Health Organization 1987 Public health significance of intestinal parasitic infections* WHO EXPERT COMMITTEE' Intestinal parasitic infections are distributed virtually throughout the world, with high prevalence rates in many regions. Amoebiasis, ascariasis, hookworm infection and trichuriasis are among the ten most common infections in the world. Other parasitic infections such as abdominal angiostrongyliasis, intestinal capil- lariasis, and strongyloidiasis are of local or regional public health concern. The prevention and control of these infections are now more feasible than ever before owing to the discovery of safe and efficacious drugs, the improvement and sim- plification of some diagnostic procedures, and advances in parasite population biology. METHODS OF ASSESSMENT The amount of harm caused by intestinal parasitic infections to the health and welfare of individuals and communities depends on: (a) the parasite species; (b) the intensity and course of the infection; (c) the nature of the interactions between the parasite species and concurrent infections; (d) the nutritional and immunological status of the population; and (e) numerous socioeconomic factors.
    [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]
  • Dracunculiasis in Oral and Maxillofacial Surgery
    http://dx.doi.org/10.5125/jkaoms.2016.42.2.67 INVITED SPECIAL ARTICLE pISSN 2234-7550·eISSN 2234-5930 Dracunculiasis in oral and maxillofacial surgery Soung Min Kim1,2 1Oral and Maxillofacial Microvascular Reconstruction Lab, Sunyani Regional Hospital, Sunyani, Brong Ahafo, Ghana, 2Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea Abstract (J Korean Assoc Oral Maxillofac Surg 2016;42:67-76) Dracunculiasis, otherwise known as guinea worm disease (GWD), is caused by infection with the nematode Dracunculus medinensis. This nematode is transmitted to humans exclusively via contaminated drinking water. The transmitting vectors are Cyclops copepods (water fleas), which are tiny free- swimming crustaceans usually found abundantly in freshwater ponds. Humans can acquire GWD by drinking water that contains vectors infected with guinea worm larvae. This disease is prevalent in some of the most deprived areas of the world, and no vaccine or medicine is currently available. Inter- national efforts to eradicate dracunculiasis began in the early 1980s. Most dentists and maxillofacial surgeons have neglected this kind of parasite infec- tion. However, when performing charitable work in developing countries near the tropic lines or other regions where GWD is endemic, it is important to consider GWD in cases of swelling or tumors of unknown origin. This paper reviews the pathogenesis, epidemiology, clinical criteria, diagnostic criteria, treatment, and prevention of dracunculiasis. It also summarizes important factors for maxillofacial surgeons to consider. Key words: Dracunculiasis, Dracunculus medinensis, Guinea worm disease, Neglected tropical diseases, Swelling of unknown origin [paper submitted 2016. 3. 24 / accepted 2016.
    [Show full text]