1/8. 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 = 1keywords = physician (Clic here for more details about this article) |
2/8. Fatal meningoencephalitis caused by disseminated strongyloidiasis.A middle-aged aboriginal man with a history of alcoholism and gastrectomy was diagnosed as having bacterial meningoencephalitis based on the typical clinical manifestations, laboratory findings, and treatment responses. During the recovery stage, he developed consciousness disturbance, seizures, severe diarrhea, and respiratory failure that led us to search for other possibility of the diagnosis. The eosinophilia and repeated stool examinations helped us to make the diagnosis of disseminated strongyloidiasis. In this patient the initial bacterial meningitis was followed by S. stercoralis hyperinfection. Despite treatment with strong antimicrobial agents, the patient died. This case could serve as a reminder to physicians to be alert for strongyloidiasis superimposed on bacterial meningitis.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/8. Exposure of medical staff to Strongyloides stercolaris from a patient with disseminated strongyloidiasis.We examined whether medical staff were infected with Strongyloides stercolaris through exposure to the body substances of a patient with disseminated strongyloidiasis. The patient excreted a large number of S. stercolaris organisms in respiratory secretions and stool-like excretions from a nasogastric tube. blood tests in six physicians and three nurses, who were highly suspected of having had contact with the substances without appropriate protection during medical care of the patient for about 1 week, showed no increase of eosinophiles or IgG antibodies against S. stercolaris. We conclude that adherence to the standard precautions is sufficient for preventing the nosocomial transmission of this organism.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/8. Opportunistic strongyloidiasis in renal transplant recipients.Eight patients with severe strongyloidiasis complicating renal transplantation are reported. Twenty-one additional cases from the English-language literature are reviewed. In this setting, systemic strongyloidiasis is an often baffling illness involving multiple organ systems that is frequently complicated by serious bacterial infection. bacteremia, meningitis, urinary tract infection, and pneumonia resulting from enteric organisms are common. In order to make the diagnosis, larvae must be sought by direct microscopy of stool, upper intestinal fluid, sputum, urine, or biopsy specimens. Treatment with oral thiabendazole in prolonged or repeated courses is recommended. Effective parenteral therapy is not available. Following treatment, previously parasitized patients must be tested at regular intervals to detect therapeutic failure or reinfection. Screening of patients awaiting renal transplantation for chronic intestinal strongyloidiasis is suggested. Improvement of the observed 52% mortality will depend upon heightened awareness by physicians caring for renal transplant candidates, and upon improved therapeutic regimens.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/8. Chronic strongyloidiasis in vietnam veterans.Chronic strongyloides stercoralis infections can produce intermittent urticarial skin eruptions and gastrointestinal discomfort for years. Three cases of symptomatic infection acquired by united states military personnel in vietnam are presented as examples of chronic parasitic disease unrecognized by physicians despite clear histories of geographic exposure, classic creeping skin eruptions, and eosinophilia. More attention needs to be paid to the possible long-term sequela from military service in tropical climates by both military and civilian physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. strongyloides stercoralis.strongyloides stercoralis, a nematode not well known to many Canadian physicians, infects 35% of some tropical populations. Larvae can be isolated from the stools in 25% of cases and from duodenal aspirates in 95%. Treatment is with thiabendazole given twice daily in a dose of 25 mg/kg up to a maximum of 1.5 g/d. Frenquently an individual with a previously asymptomatic infection presents with hyperinfection and death rapidly ensues, but usually classical symptoms are present. Such a case is described. immunosuppression is frequently associated with the hyperinfective state.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/8. strongyloidiasis. When to suspect the wily nematode.strongyloidiasis is a tenacious soil-transmitted nematode infestation endemic in the south-eastern united states. Thirty-three cases were diagnosed in a series of 1,290 stool examinations in 971 patients at veterans Administration Medical Center, Mountain Home, tennessee. Most patients had a concurrent major illness, such as chronic lung disease, serious bacterial infection, or cancer. A minority presented with gastrointestinal symptoms alone. skin rash was uncommon. eosinophilia, IgE elevation, and skin anergy were common. Atypical presentations included severe proctitis, colitis, and exacerbation of inflammatory bowel disease. In a patient with the hyperinfection syndrome, the diagnosis was made only at autopsy. Since strongyloidiasis seems to present like an opportunistic illness, all physicians, not just those in endemic areas, should consider its presence in the appropriate setting.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/8. superinfection: another look.superinfection in the compromised host often poses a diagnostic and therapeutic dilemma for the physician who is concerned that a perplexing array of microorganisms might be involved. We believe that the differential diagnosis list can often be narrowed considerably by separating superinfection in the compromised host into five convenient categories: (1) infections due to the underlying disease itself; (2) infections due to the underlying disease plus therapy for that disease; (3) infections due solely to medicaments, operations, or procedures; (4) infections increased in severity but probably not in incidence; and (5) societally related infections. Use of this or a similar categorization should result in a more rational approach to differential diagnosis, should encourage a more focused diagnostic work-up, whould reduce the necessity for invasive procedures, should provide the microbiology laboratory information about specific organisms that should be sought sedulously, and should permit the selection of a more rational antimicrobial regimen prior to the availability of definitive microbiologic information.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |