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      Molecular diagnosis of strongyloidiasis in a population of an endemic area through nested-PCR

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          Abstract

          Aim:

          This study is aimed to diagnose and analyze strongyloidiasis in a population of an endemic area of Iran using nested-PCR, coupled with parasitological methods.

          Background:

          Screening of strongyloidiasis infected people using reliable diagnostic techniques are essential to decrease the mortality and morbidity associated with this infection. Molecular methods have been proved to be highly sensitive and specific for detection of Strongyloides stercoralis in stool samples.

          Methods:

          A total of 155 fresh single stool samples were randomly collected from residents of north and northwest of Khouzestan Province, Iran. All samples were examined by parasitological methods including formalin-ether concentration and nutrient agar plate culture, and molecular method of nested-PCR. Infections with S. stercoralis were analyzed according to demographic criteria.

          Results:

          Based on the results of nested-PCR method 15 cases (9.7%) were strongyloidiasis positive. Nested-PCR was more sensitive than parasitological techniques on single stool sampling. Elderly was the most important population index for higher infectivity with S. stercoralis.

          Conclusion:

          In endemic areas of S. stercoralis, old age should be considered as one of the most important risk factors of infection, especially among the immunosuppressed individuals.

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          Most cited references20

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          Strongyloides hyperinfection syndrome: an emerging global infectious disease.

          The hyperinfection syndrome (HS) caused by Strongyloides stercoralis has a high mortality rate (15% to 87%). A variety of risk factors and predisposing conditions have been described, including new immunosuppressive therapies; HTLV-1 infection; cadaveric transplantation; immune reconstitution syndrome; haematological malignancies (especially lymphoma); tuberculosis; malnutrition secondary to chronic Strongyloides diarrhoea; international travel and immigration. Inhibition of Th2 cell-mediated, humoral or mucosal immunity is associated with HS. HS is more frequently seen in HTLV-1 than HIV patients. In AIDS, there is an increase in Th2 cytokines, while in HTLV-1 infection there is a decrease in the Th2 response, leading to an increased risk of autoinfection. Corticosteroid use remains the most frequent risk factor for HS. A number of ELISAs are useful for diagnosis and post-treatment evaluation. Once diagnosed, the disease may be managed effectively with anthelminthic drugs, including ivermectin. HS causes diverse symptoms and signs, with unusual manifestations leading to misdiagnosis and medical errors related to healthcare providers' lack of familiarity with the condition. HS is an example of an emerging tropical infection migrating to developed countries and requiring greater clinician awareness.
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            Multiplex real-time PCR for the detection and quantification of Schistosoma mansoni and S. haematobium infection in stool samples collected in northern Senegal.

            A multiplex real-time PCR assay for the detection and quantification of Schistosoma mansoni and S. haematobium DNA in faecal samples was developed and evaluated as an alternative diagnostic method to study the epidemiology of schistosomiasis. Primers and probes targeting the cytochrome c oxidase gene were designed for species-specific amplification and were combined with an internal control. Using positive control DNA extracted from adult Schistosoma worms and negative control samples (n=150) with DNA from a wide range of intestinal microorganisms, the method proved to be sensitive and 100% specific. For further evaluation, duplicate stool specimens with varying S. mansoni egg loads were collected in northern Senegal from pre-selected individuals (n=88). The PCR cycle threshold values, reflecting parasite-specific DNA loads in faeces, showed significant correlation with microscopic egg counts both for S. mansoni in stool and S. haematobium in urine. The Schistosoma detection rate of PCR (84.1%) was similar to that of microscopy performed on duplicate stool samples (79.5%). The simple faecal sample collection procedure and the high throughput potential of the multiplex real-time PCR provide a powerful diagnostic tool for epidemiological studies on schistosomiasis in remote areas, with possibilities for extension to other helminths or protozoa using additional molecular targets.
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              Manifestations, diagnosis, and treatment of Strongyloides stercoralis infection.

              To summarize current literature on the manifestations, diagnosis, and treatment of Strongyloides stercoralis infection. A search was conducted of PubMed (1970-August 2007). Search terms included Strongyloides stercoralis, hyperinfection, prevention, and treatment. Reviews, studies, and recent case reports were included. Additional references were obtained from article bibliographies. All studies or review articles published in English from 1970 to August 2007 and case reports of hyperinfection or disseminated disease published since 2000 were evaluated. Strongyloidiasis is a parasitic infection endemic to tropical, subtropical, and temperate areas including the Appalachian region of the southern US. Prevalence rates vary widely. Patients may present with infection decades after original exposure. Diagnosis can be achieved by identifying the larvae in the stool; usually, more than one sample is needed. Most patients are asymptomatic. However, in immunosuppressed patients, a hyperinfection syndrome or disseminated disease may occur due to the ability of the parasite to reproduce within the host. The most common risk factors for these complications are immunosuppression caused by corticosteroids and infection with human T lymphotropic virus type 1. Treatment options for uncomplicated disease include thiabendazole, ivermectin, and albendazole. Thiabendazole has been replaced by ivermectin as treatment of choice due to better tolerance. These antihelminthics have been used to treat hyperinfection or disseminated disease alone or in combination, but data are limited to case reports or case series. Prevention of disease is mainly achieved by wearing shoes in endemic areas to avoid contact with infected soil. Strongyloides is a unique parasite that can cause a hyperinfection syndrome and disseminated infection several years after exposure. Treatment options include ivermectin, thiabendazole, or albendazole. Information on the best treatment for disseminated disease and hyperinfection is limited.
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                Author and article information

                Journal
                Gastroenterol Hepatol Bed Bench
                Gastroenterol Hepatol Bed Bench
                GHFBB
                Gastroenterology and Hepatology From Bed to Bench
                Shaheed Beheshti University of Medical Sciences (Tehran, Iran )
                2008-2258
                2008-4234
                Winter 2018
                : 11
                : 1
                : 68-74
                Affiliations
                [1 ] Department of Medical Parasitology and Mycology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
                [2 ] Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
                [3 ] Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                Reprint or Correspondence: Eshrat Beigom Kia, PhD. Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences. E-mail: keiaeshr@tums.ac.ir
                Article
                GHFBB-11-068
                5849121
                29564068
                721a78c3-a148-4871-a864-f19f298bbdb1
                ©2018 RIGLD, Research Institute for Gastroenterology and Liver Diseases

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 October 2017
                : 22 December 2017
                Categories
                Original Article

                elderly,molecular diagnosis,nested-pcr,strongyloides stercoralis

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