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      Strongyloidiasis: Epidemiology, clinical manifestations and new methods for diagnosis and treatment

      review-article
      , MD, PhD
      Journal of Infection and Chemotherapy
      Springer-Verlag
      strongyloidiasis, Strongyloides stercoralis, culture method, ivermectin

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          Conclusion

          Strongyloidosis is a parasitic disease of the intestines, seen mainly in tropical areas. It is quite likely that, because its manifestations are milder than those of other tropical diseases, it may be overlooked in regions where parasitic diseases such as hookworms and roundworms are endemic. With future improvements in hygiene and the resulting decreases in parasitic diseases, increasing attention will be focused on strongyloidiasis in tropical regions — a phenomenon currently being observed in Okinawa.

          Studies on the diagnosis and treatment of apparently healthy Strongyloides carriers have only just started. These studies can be expected to play a major role in improving the near-future health and welfare of people in tropical regions of the world. Parasitic diseases in Japan have a strong local character; a long-term eradication program, with due consideration to HTLV-1 infection, must be instituted.

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          Most cited references45

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          Efficacy of agar-plate culture in detection of Strongyloides stercoralis infection.

          Agar-plate culture of feces using a modified petri dish proved to be highly efficient in the detection of Strongyloides stercoralis infection. Furrows left by S. stercoralis on the agar plate were distinguished readily in size from those left by Necator americanus.
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            Syndrome of hyperinfection with Strongyloides stercoralis.

            Two patients hyperinfected with Strongyloides stercoralis (an intestinal nematode) are described. Both were both in Puerto Rico and had left the island six to 15 years previously; both were receiving adrenal steroids (one for Hodgkin's disease and the other for Goodpasture's syndrome). One died shortly after diagnosis, but the other survived the hyperinfection syndrome and complicating bacterial sepsis and meningitis. In addition to our case reports, 103 previously described cases of presumed strongyloides hyperinfection are reviewed. Among 89 patients immunocompromised by therapy or disease, the mortality rate was 86%; bacterial sepsis often contributed to the fatal outcome. In most cases, infection was acquired in an endemic area, sometimes long before the hyperinfection syndrome occurred. The few patients who had never been to an endemic area had a history of prolonged contact with highly soiled material, an observation suggesting cross infection from a contaminated person. When administered in time, thiabendazole, the drug of choice for strongyloidiasis, was effective in 70% of cases. If intestinal infection with S. stercoralis is detected and treated before immunosuppressive therapy is initiated and if a high index of suspicion for the hyperinfection syndrome is maintained while immunosuppressive therapy is given, the mortality from this disease should decrease.
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              Monoclonal integration of HTLV-I proviral DNA in patients with strongyloidiasis.

              The relationship between strongyloidiasis and HTLV-I was investigated in Okinawa, an area where both conditions are endemic. Thirty-six patients with strongyloidiasis were seropositive for HTLV-I and suffered from several related clinical complications. Fourteen of these patients (39%) were shown to have monoclonal integration of HTLV-I proviral DNA in their blood lymphocytes, a condition designated as "smouldering" adult T-cell leukaemia (ATL). Monoclonal integration of proviral DNA correlated with an increased CD4/CD8 ratio and the presence of abnormal lymphocytes in the peripheral blood, and with a trend for greater severity of the parasitic infection. Although the immunodeficiency caused by HTLV-I could predispose to hyperinfestation by Strongyloides, it is also possible that both the parasitic and the retroviral infestations are important co-factors leading to the development of ATL.
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                Author and article information

                Journal
                J Infect Chemother
                J. Infect. Chemother
                Journal of Infection and Chemotherapy
                Springer-Verlag (Tokyo )
                1341-321X
                1437-7780
                1995
                : 1
                : 2
                : 98-106
                Affiliations
                GRID grid.267625.2, ISNI 0000000106855104, First Department of Internal Medicine, Faculty of Medicine, , University of the Ryukyus, ; Okinawa, Japan
                Article
                BF02348752
                10.1007/BF02348752
                7102270
                6913ca37-253c-4077-9b79-58855a6ff4e9
                © Japan Society of Chemotherapy/Churchill Livingstone Japan 1995

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 6 September 1995
                : 9 October 1995
                Categories
                Review Article
                Custom metadata
                © Japan Society of Chemotherapy 1995

                Oncology & Radiotherapy
                strongyloidiasis,strongyloides stercoralis,culture method,ivermectin
                Oncology & Radiotherapy
                strongyloidiasis, strongyloides stercoralis, culture method, ivermectin

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