Anteriomesenteric duodenal compression syndrome

We report the case of a 48 year old man presented with a 4 month history of vomiting and weight loss. Barium studies and upper gastrointestinal endoscopy demonstrated anteriomesenteric duodenal occlusion. We discuss the possible aetiology and significance of his investigation findings and subsequent management.(AU)

Cutaneous larva migrans infection in the pediatric foot: a review and two case reports

Cutaneous larva migrans is the result of infestation of human skin by helminth larvae, which burrow through the epidermis. This route of infestation makes the foot a typical site for origination of this infection. Children, who frequently play barefoot in locations where the most common the helminth larvae, the dog and cat hookworms, are endemic, are at particular risk of this disorder. This article reviews the differential diagnosis of cutaneous larva migrans and current concepts in management. Two cases of related children who presented to their pediatricians with this condition are reported(AU)

Coincidental HTLV-I infection influences outcome of treatment of strongyloidiasis - abstract

It is uncertain whether HTLV-I infection and Strongyloidiasis are related other than by chance. A consecutive series of Jamaican patients and controls have been analysed retrospectively for anti-Strongyloides and HTLV-1 antibodies to determine whether either influences the outcome of anti-helminthic therapy. Twenty-seven Jamaicans (16 M, 11F) mean age 50.2 years (range 16-85), who were found to have Strongyloides stercoralis infection were studied at the University Hospital of the West Indies. At the same time, a parasite-negative group of 13 patients (6M, 7F) of mean age 37.6 years, (range 23-53), with minor or no gastrointestinal disease served as controls. Pretreatment blood samples were taken from the Strongyloides group and controls. Serum was subsequently tested for IgG antibodies to filariform Strongyloides stercoralis larval antigens by ELISA and to HTLV-1 by ELISA and Western Blot. Outcome of the treatment of Strongyloidiasis with thiabendazole (25 -mg/kg b.d. orally for 10 days was determined at 2 months. Strongyloides reciprocal antibody titre was considerably higher in patients than controls, mean 870 vs 167; median 1,024 vs 8 (p<0.001). The sensitivity of the antibody test was 93 percent, but the specificity was 69 percent at best. There was no correlation with the anti-Strongyloides antibody titre and outcome with anti-helminthic therapy. HTLV-1 antibodies were found only in the Strongyloides patients, 12 of 27 (44 percent); antibody titres were high and positive with both test used: only one patient was known beforehand to have a disease associated with HTLV-1 infection. Of those 12 with HTLV-1 antibodies, 3 (25 percent) were cured, 7 still had the infection at 2 months, a further 2 had died or defaulted from follow-up. Of the 15 patients without HTLV-1 antibodies, 9 (60 percent) were cured, 3 still had the infection and 3 had died or defaulted. By chi-square analysis, the difference is significant whether one includes all the deaths and defaulters on an intention-to-treat basis or just those who were available at 2 months post-therapy. However, since none of the deaths were related to Stongyloidiasis or HTLV-1 injection, it is probably justifiable to exclude the deaths from the computation. These results show that the association of Strongyloidiasis and HTLV-1 is more than chance clustering. Not only is the prevalence of HTLV-1 antibodies far higher in the patients with Strongyloidiasis than in the normal Jamaican population, but that concurrent asymptomatic HTLV-1 infection interferes with anti-helminthic treatment (AU)

Psuedo-obstruction and a sprue-like syndrome from stronglyloidiasis

Symptomatic diseases from Strongyloides stercoralis has been recognized for the first time in Trinidad. Five cases are reported, all showing clinical features suggestive of a sprue-like syndrome. Subtotal jejunal villous atrophy was seen in one case and partial villous atrophy in two. Three patients had laparotomies bacause of suspected partial intestinal obstruction. A sprue-like syndrome in certain Caribbean immigrants should arouse a suspicion of S. stercoralis (Summary)

Hyperinfection syndrome with Strongyloides stercoralis in malignant lymphoma

Hyperinfection with Strongyloides stercoralis occurred in three patients with malignant lymphoma. The probable cause was alteration of the immune responses either as a result of the malignant lymphoma or by the treatment given. Though thiabendazole (Mintezol) has produced reasonable results in the treatment of the hyperinfection syndrome, preliminary data suggest that the new broad-spectrum antihelmintic levamisole (Ketrax) is more effective. All patients who live or have lived in an area where strongyloidiasis is endemic should be investigated to detect the presence of the nematode before and during treatment with drugs with immunosuppressive properties. In view of the high mortality with S. stercoralis hyperinfection, vigorous therapy should be instituted before the use of immunosuppressive drugs (Summary)

Laboratory and field studies on the Jamaican strain of human Strongyloides

Laboratory and field studies were done on the Jamaican strain of human Strongyloides. In the laboratory, optimal conditions for propagations of the free-living cycle were investigated. The mongrel puppy was employed as a model for the exploration of various aspects of host-strongyloid relationships. The histological reaction to normal skin to penetrating larvae, and of sensitised skin to larvae, excretory-secretory ("ES") and somatic ("S") antigen, was determined. Enzymatic activities of falariform larvae were assayed in vitro. Several factors predisposing to autoinfection were examined. The anthelmintic activity of levamisole and thiabendazole was compared. In the field, a follow-up study was done and pilot surveys for prevalence were conducted throughout Jamaica in areas contrasting in climatic and physiographic features. The results indicated that optimal conditions for propagation of the heterogonic cycle existed at a temperature range of 26§C to 30§C, a pH range of 7.5 to 8.0, and a stool consistency equal to that of a very thick paste. The reaction of normal skin to invading larvae was essentially a non-specific, acute inflammatory response; with sensitised skin, there was significant degranulation of mast cells in the presence of larvae, "ES" and "S" antigen. Collagenase, galatinase, fibrinase, lipase and hyaluronidase activity of falariform larvae were demonstrated. Autoinfection was experimentally induced by constipation, by vincristine therapy, by ileal ligation and by simulation of ileal volvulus. A general hypothesis was advanced to explain the etiology of autoinfection. Levamisole possessed statistically significantly greater anthelmintic activity than thiabendazole against Strongyloides in vitro, but not in vivo in puppies. It was unable to eradicate the parasite completely from the stools of five out of six infected patients. Preliminary data suggest that the chronicity of strongyloidiasis in Jamaican patients is due to internal autoinfection rather than external reinfection. The low prevalence of the infection in the general population is very low (30 out of 1,555 persons positive, or 1.9 percent)(AU)

Thiabendazole therapy of lagochilascaris minor infection in Surinam: report of a case

A 15-year-old Negro boy, a native of Surinam, was admitted to the University Hospital in Paramaribo because of a small, slowly growing, painful tumor on the left side of the neck below the jaw. Tissue taken at biopsy of the tumor contained structures that suggested worm eggs and cross sections of worms. The patient was discharged without treatment. About 2 months later, his physician sent in a specimen of pus from a fistula that had developed in the tumor. The pus contained adult worms identified as Lagochilascaris minor, also eggs, larvae, and immature worms of this ascarid. The patient was readmitted to hospital and treated with 50 mg of thiabendazole per kg of body weight per day for 5 days. This treatment was repeated 1 week after completion of the first course of therapy, because treatment of another patient with L. minor infection, with smaller doses of thiabendazole, had not been succesful. During the next 8 months the tumor decreased in size and the fistula closed. Despite this favorable result, it is not certain that the infection with L. minor was destroyed.(AU)

Lagochilascaris minor infection in Surinam: report of a case

In 1965 a 10-year-old Bushnegro girl was hospitalized in Paramaribo for a tumor of the neck. The disease began with a small pustule on the neck, accompanied by fever, approximately 6 months before the patient was hospitalized. The pustule was the size of a hen's egg when she came to the hospital and it developed into an abcess without much discharge. Four months later the diagnosis, Lagochilascaris minor infection, was made. The patient was then treated with thiabendazole, without success. Irradiation by x-ray to kill the eggs was unsuccessful. After a short period of dyspnea the girl died. This happened about a year after the first onset of the symptoms