11/192. Pigmented nails and strongyloides stercoralis infestation causing clinical worsening in a patient treated for immunoproliferative small intestinal disease: two unusual observations.immunoproliferative small intestinal disease (IPSID) is commonly reported from developing countries with poor socioeconomic conditions, hygiene, and high frequency of gastrointestinal infections and infestations. The disease requires anti-malignant chemotherapy in lymphomatous stage. Reported here is a 20-year old man with IPSID lymphoma who responded to anti-malignant chemotherapy initially, but later deteriorated due to strongyloides stercoralis infestation, which was treated successfully with mebendazole. Importance of an early recognition and adequate treatment for gastrointestinal infections and infestations before anti-malignant chemotherapy for this disease is highlighted considering the occurrence of this disease in the developing world. The patient developed alternate brown black and white lines in the finger nails after combination chemotherapy, which has not been reported earlier in this disease; the nail changes disappeared 6 months after the withdrawal of doxorubicin suggesting this drug as the cause for such nail changes during anti-malignant combination chemotherapy.- - - - - - - - - - ranking = 1keywords = infection (Clic here for more details about this article) |
12/192. Pulmonary strongyloidiasis--case report of 2 cases.strongyloidiasis is a benign gastrointestinal infection. It can pass through the lungs and induce pulmonary strongyloidiasis. The suspicion of pulmonary involvement begins with clinical and chest radiographic features in the patients at risk. They are as follows: chronic lung diseases, age was 65 years, altered cellular immunity, and use of corticosteroids. Definitive diagnosis is made by identification of strongyloides in the secretion or tissue of the respiratory tract. We present 2 patients with pulmonary strongyloidiasis in this research. These 2 cases were patients with chronic obstructive pulmonary disease; both patients were more than 65 years old. They had the risk factors for severe strongyloides infection (advanced age, use of corticosteroids, an high serum cortisol level), worsening of pulmonary symptoms (e.g., dyspnea, cough, sputum production) and abnormal radiographic findings. strongyloides stercoralis was found in the sputum and stool, and pulmonary strongyloidiasis was diagnosed. mebendazole 100 mg twice daily was used and this eliminated the parasite from the stool in case 1, and from the sputum in case 2. Unfortunately, there was a relapse of parasite infection in case 1 and it also induced pulmonary strongyloidiasis. Finally, he died of respiratory failure. Since this disorder has a high relapse rate (15%), serial follow-up of stool and sputum is very important.- - - - - - - - - - ranking = 1.5keywords = infection (Clic here for more details about this article) |
13/192. Transmission of Strongyloides steracolis person to person.A case of presumed person-to-person transmission of Strongyloides steracolis is described. The index case was immunocompromised following high dose glucocorticosteroid therapy for myelodysplasia, which resulted in reactivation of latent strongyloides infection with the hyperinfestation syndrome. physicians unfamiliar with this disease should realize that a history of foreign travel is unnecessary to acquire this parasite, and that transmission to persons in close proximity to the index case does occur and warrants treatment.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
14/192. Natural killer-cell lymphocytosis and strongyloides infection.We report a case of strongyloides infection in a 72-year-old man presenting with acute angio-oedema and urticaria. He was also found to have natural killer cell (NK) large granular lymphocytosis (LGL). We discuss the possible relationship between the strongyloides infection and the NK-LGL lymphocytosis.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
15/192. Strongyloides hyperinfection syndrome--an unappreciated opportunistic infection.A case of respiratory hyperinfection syndrome which occurred in a patient on long term corticosteroid therapy is reported here for it's rarity. Intestinal infection with this parasite should be looked for and treated before the initiation of immunosuppressive therapy.- - - - - - - - - - ranking = 5keywords = infection (Clic here for more details about this article) |
16/192. Pseudoparasitic pneumonia after bone marrow transplantation.We present a female patient from somalia with an acute lymphoblastic leukemia, who received an allogeneic bone marrow transplantation (BMT) and developed several periods of moderate to severe pulmonary symptoms that were accompanied by pulmonary infiltrates and peripheral blood eosinophilia. After several recurrences an open lung biopsy was performed, which initially gave rise to the diagnosis parasitic infection. Later on this diagnosis was questioned and it was suggested that the structures were artifacts that might have been aspirated. Nevertheless, after the immediately given antihelminthic treatment no peripheral blood eosinophilia occurred anymore, but at that point of time pulmonary function was already severely hampered and eventually led to a lethal complication. With the worldwide increasing migration from Third World countries with a high prevalence of parasitic infections, more patients will receive immunosuppressive therapies in countries less familiar with parasites. This may complicate diagnostic procedures, prevent early recognition and delay adequate treatment. Specific screening for opportunistic parasitic infections of the population at risk before BMT and a great awareness for these infections is strongly recommended.- - - - - - - - - - ranking = 2keywords = infection (Clic here for more details about this article) |
17/192. Case study: Fatal strongyloidiasis associated with human T-cell lymphotropic virus type 1 infection.A case of fatal strongyloidiasis associated with human T-cell lymphotropic virus type 1 (HTLV-1) infection is described in a 45-year-old West Indian man living in an area endemic for both strongyloidiasis and HTLV-1 infection. Clinical presentation was typical with severe diarrhea, vomiting, and progressive weight loss. Stool microscopy revealed strongyloides stercoralis rhabditiform larvae. Despite treatment with thiabendazole, the patient died. autopsy findings revealed severe ileocolitis due to Strongyloides larvae, right subdiaphragmatic pyogenic abscess, and severe pleuritis of the right lower lobe of the lung. This case illustrates that despite effective antihelmintic therapy, mortality is still high in patients with the hyperinfective state of S. stercoralis. Thus, in patients in areas endemic for both Strongyloides infection and HTLV-1, or in immigrants from these areas, repeated stool microscopy is indicated in patients positive for HTLV-1.- - - - - - - - - - ranking = 3.5keywords = infection (Clic here for more details about this article) |
18/192. Clinical manifestations of strongyloidiasis in southern taiwan.The diagnosis and management of strongyloidiasis present a continuous challenge in developing countries including taiwan. In this study, the clinical characteristics and microbiological findings of 27 patients with strongyloides stercoralis infection were retrospectively analyzed. Intestinal infection was identified in 17 patients and hyperinfection syndrome or disseminated disease in 10 (including 2 autopsy cases). The most frequent clinical findings were diarrhea (74%), fever (70%), abdominal pain (59%), cough (37%), dyspnea (33%), and constipation (26%). The common initial laboratory abnormalities were leukocytosis (81%), anemia (67%), liver function impairment (52%), and eosinophilia (44%). Most of the 27 patients had comorbid conditions, including malnutrition in 20 (74%), corticosteroid dependence in 15 (55%), chronic obstructive pulmonary disease in 9 (33%), chronic liver disease or cirrhosis in 8 (30%), and peptic ulcer disease in 7 (26%). There was no difference in the time interval from symptom onset to diagnosis between the intestinal infection group and the hyperinfection/disseminated group (22 /- 15 vs 17 /- 9 days). Larvae of S. stercoralis were identified in the stool of 24 patients, in the sputum smear of 5, in the gastric biopsy of one, and on histology of autopsy specimens in 2. Twenty-six patients received antiparasitic drug therapy of variable duration (mebendazole in 24, albendazole in 2, combined therapy in one). The overall cure rate was 52% (14/27). Relapse occurred in 4 patients. The overall mortality was 26% (7/27). There was a high mortality (up to 50%) in the hyperinfection/disseminated disease group. In conclusion, diagnosis of strongyloidiasis is often delayed and overlooked because of nonspecific symptoms. physicians in endemic regions should include strongyloidiasis in the differential diagnosis when patients present with gastrointestinal and/or pulmonary symptoms with peripheral eosinophilia.- - - - - - - - - - ranking = 3keywords = infection (Clic here for more details about this article) |
19/192. Disseminated strongyloidiasis in nephrotic syndrome.strongyloides stercoralis is endemic in the southwestern islands Amami and Ryukyu in japan. Systemic strongyloidiasis occurs in immunocompromised hosts. We report here on a 60-year-old patient with minimal-change nephrotic syndrome (MCNS) without eosinophilia or HTLV-I infection. She was treated with corticosteroid for MCNS and died of disseminated strongyloidiasis. The patient developed systemic purpura, ileus, respiratory distress, malabsorption, pancytopenia, pulmonary hemorrhage and sepsis due to escherichia coli before death. Massive infestation with strongyloides stercoralis was disclosed by autopsy, and the larvae was considered as a pathomechanism or exacerbating agent of nephrotic syndrome in endemic areas.- - - - - - - - - - ranking = 0.5keywords = infection (Clic here for more details about this article) |
20/192. Mesenteric arteriographic findings in a patient with strongyloides stercoralis hyperinfection.The authors present a case of a Latin American patient with systemic lupus erythematosus who was referred for a mesenteric arteriogram because of acute lower gastrointestinal bleeding. Multiple segments of dilation alternating with stenosis or spasm were noted in the superior mesenteric artery/inferior mesenteric artery distributions. At the time, these irregularities were thought to be representative of lupus vasculitis. Despite appropriate treatment for vasculitis, the patient continued to have bleeding episodes and ultimately died of multiple organ failure. autopsy demonstrated no evidence of vasculitis, but did demonstrate the unexpected finding of strongyloides stercoralis hyperinfection with vessel invasion.- - - - - - - - - - ranking = 2.5keywords = infection (Clic here for more details about this article) |
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