1/192. mortality associated with concurrent strongyloidosis and cytomegalovirus infection in a patient on steroid therapy.Disseminated strongyloidosis has been recognized with increasing frequency, often in patients who are immunocompromised or have received steroid therapy. In addition, disease due to cytomegalovirus (CMV) is noted in immunodeficient hosts. We report on a 55-year-old Puerto Rican man who received steroid treatment for orpharyngeal pemphigus vulgaris and developed abdominal symptoms with alternating constipation and diarrhea. The clinical work-up did not reveal specific abnormalities, but the patient died of cardiopulmonary failure. At the postmortem examination, the patient had evidence of strongyloidosis and CMV disease. This report reviews both this case and the literature, and discusses the overlapping infections of strongyloidosis and CMV disease in this patient who had received steroid therapy.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
2/192. A case of strongyloides stercoralis infection.strongyloidiasis has been recognized as one of the life-threatening parasitic infections in the immunocompromised patients. We report an intestinal infection case of strongyloides stercoralis in a 61-year-old man. Rhabditiform larvae were detected in the stool examination and developed to filariform larvae having a notched tail through the Harada-Mori filter paper culture. The patient received five courses of albendazole therapy but not cured of strongyloidiasis.- - - - - - - - - - ranking = 1.2keywords = infection (Clic here for more details about this article) |
3/192. Case studies in international medicine.family physicians in the united states are increasingly called on to manage the complex clinical problems of newly arrived immigrants and refugees. Case studies and discussions are provided in this article to update physicians on the diagnosis and management of potentially unfamiliar ailments, including strongyloidiasis, hookworm infection, cysticercosis, clonorchiasis and tropical pancreatitis. albendazole and ivermectin, two important drugs in the treatment of some worm infections, are now available in the united states.- - - - - - - - - - ranking = 0.4keywords = infection (Clic here for more details about this article) |
4/192. Bacterial complications of strongyloidiasis: streptococcus bovis meningitis.We report the case of a 64-year-old veteran who had streptococcus bovis meningitis as a result of a long latent Strongyloides infection that became acute when he was treated with prednisone. We reviewed 38 reported cases of serious bacterial infections associated with strongyloidiasis. patients most frequently had nonspecific gastrointestinal symptoms. Of these 38 patients, 21 (55%) had meningitis, and 28 (73%) had bacteremia that was polymicrobial in 3 cases (8%). Other sites of infection included lung, bone marrow, ascites, mitral valve, and lymph node. Most infections were due to enteric gram-negative bacteria. There is one previously reported case of S bovis meningitis. Thirty-four of the patients (89%) were immunosuppressed; 21 of these (55%) were taking pharmacologic doses of adrenal corticosteroids. Thirty-three of the 38 (87%) patients died. patients with enteric bacterial infection without an obvious cause should be tested for the presence of strongyloidiasis.- - - - - - - - - - ranking = 1.6848979546927keywords = bacterial infection, infection (Clic here for more details about this article) |
5/192. strongyloides stercoralis infection presenting as generalized prurigo nodularis and lichen simplex chronicus.strongyloides stercoralis is a parasitic nematode that develops an autoinfective life cycle within the gastrointestinal tract of its human host. The infection produces peripheral eosinophilia and cutaneous eruptions, as well as gastrointestinal or respiratory symptoms. Detection of S stercoralis is difficult through stool examination, but may be demonstrated by ELISA for IgG antibody against the parasite. We describe a patient with chronic S stercoralis infection initially presenting with generalized prurigo nodularis and lichen simplex chronicus.- - - - - - - - - - ranking = 1.2keywords = infection (Clic here for more details about this article) |
6/192. Fatal strongyloidosis following corticosteroid therapy in a patient with chronic idiopathic thrombocytopenia.A patient with chronic idiopathic thrombocytopenia and fatal strongyloides hyperinfection syndrome following prolonged corticosteroid therapy is briefly described. Diagnosis was difficult to perform due to absence of eosinophilia and diarrhea at presentation, as well as to the negativity of multiple stool specimens examined by direct microscopy of saline smear, formol-ether concentration techniques, and Baermann's test. The striking hypoalbuminemia in the setting of the normal results of liver function tests and prothrombin time was assumed to be due to enteropathy. Therefore, an upper endoscopy was undertaken, revealing strongyloides stercoralis (SS) larvae in the biopsy specimens of the gastric and duodenal mucosa. The SS larvae were also demonstrated in the multiple specimens of the concentrated sputum. Despite thiabendazol treatment, death ensued. On autopsy, SS larvae were recovered in the gastrointestinal tract and lungs. The importance of early diagnosis and of ruling out strongyloidosis prior to administration of corticosteroids are discussed, as well as the pathogenetic aspects of strongyloidosis in the patient under corticosteroids.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
7/192. Mistaken diagnosis of eosinophilic colitis.A 69-year-old male chronic alcohol abuser suffering from diarrhoea and with a number of discrete pruriginous and erythematous lesions of the trunk was referred to our Unit with a diagnosis of idiopathic eosinophilic colitis in order that we might determine corticosteroid treatment. Diagnosis was based on the presence of marked peripheral eosinophilia and massive eosinophilic infiltration at colonic biopsy, and the exclusion of parasitic infection by means of two different microscopic stool examinations of five samples. However, repeated stool examinations of ten samples collected on separate days and evidence of impaired cell-mediated immunity allowed a definite diagnosis of strongyloides stercoralis autoinfection or hyperinfection. Due to the poor sensitivity of stool examination in the diagnosis of strongyloides stercoralis infection, a careful search for this parasite should be made in all patients with comparable clinical findings before formulating a diagnosis of idiopathic eosinophilic colitis, because consequent steroid treatment may have a fatal outcome by inducing widespread dissemination of the parasite.- - - - - - - - - - ranking = 0.8keywords = infection (Clic here for more details about this article) |
8/192. Parenteral ivermectin in Strongyloides hyperinfection.Strongyloides hyperinfection, unresponsive to oral ivermectin and oral albendazole, was controlled by subcutaneous administration of a veterinary preparation of ivermectin.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
9/192. Disseminated strongyloidiasis arising from a single dose of dexamethasone before stereotactic radiosurgery.A fatal case of disseminated strongyloidiasis is described, abruptly following a single high dose of dexamethasone before stereotactic radiosurgery. The mechanism of steroid-induced dysregulation of Strongyloides infection is unclear. treatment failure and the use of rectal thiabendazole in the presence of bowel obstruction is discussed. This case reinforces the need to screen selected patients for strongyloidiasis before any high-dose steroid therapy, particularly in the presence of persistent eosinophilia.- - - - - - - - - - ranking = 0.2keywords = infection (Clic here for more details about this article) |
10/192. Severe strongyloidiasis during interferon plus ribavirin therapy for chronic HCV infection.ribavirin is a nucleoside analogue, recently introduced in hepatitis c virus (HCV) therapy, that has postulated immunomodulatory and immunosuppressive action. strongyloidiasis is an helmintic infection caused by strongyloides stercoralis, endemic in tropical countries. Severe strongyloidiasis has been demonstrated after immunosuppression by corticosteroids evolving some fatal cases. Here, we describe two cases of severe strongyloidiasis coincident with ribavirin plus interferon therapy for treating HCV infection. The review of our monotherapy protocol with interferon did not disclose any case of symptomatic strongyloidiasis pointing to a possible role of ribavirin in modifying immune response to S. stercoralis. We propose a careful screening for S. stercoralis before initiating ribavirin therapy or even empiric antihelmintic treatment.- - - - - - - - - - ranking = 1.2keywords = infection (Clic here for more details about this article) |
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