Risk factors for acquiring Strongyloides stercoralis infection among patients attending a tertiary hospital in south India.

Purpose: Strongyloides stercoralis causes persistent and fatal disseminated infections in immunocompromised hosts. In this study, we aimed to determine the risk factors for acquiring strongyloidiasis and the associated morbidity in south India. Materials and Methods: The study was carried out in two parts. This included a 6-month chart review of cases with strongyloidiasis and randomly selected controls conducted to determine the association with immunocompromised states. Secondly, a cross-sectional study was conducted to investigate hyperinfection in human immunodeficiency virus (HIV)-infected adults where the stool and sputum samples were examined by microscopy for Strongyloides larvae. Results: In the chart review, 118 cases were compared with 240 controls. A higher proportion of patients on corticosteroids [8 (53.3%)] and with HIV infection [3 (60%)] had the risk of acquiring strongyloidiasis than not, although the difference was not statistically significant in this population. In the cross-sectional study, 14/239 HIV-positive individuals had Strongyloides larvae in the stool samples but none had Strongyloides detectable in their sputum samples. The CD4 cell counts were significantly lower in cases with Strongyloides compared with HIV-infected individuals with no parasites in their stool samples (P < 0.001). Conclusions: In this setting, strongyloidiasis was seen more often in patients on corticosteroid therapy and with HIV infection. In HIV, an association with lower CD4 counts indicates the need for inclusion of Strongyloides as an opportunistic parasite. Gram negative sepsis was an important complication of strongyloidiasis hyperinfection in both HIV and steroid therapy. Further prospective studies on the risk of developing complicated Strongyloides infection are required.

Hepato-pulmonary amebiasis: a case report

Infections with Entamoeba histolytica are seen worldwide and are more prevalent in the tropics. About 90 percent of infections are asymptomatic, and the remaining 10 percent produce a spectrum of clinical syndromes, ranging from dysentery to abscesses of the liver or other organs. Extra-intestinal infection by E. histolytica most often involves liver. Pleuro-pulmonary involvement, seen as the second most common extra-intestinal pattern of infection, is frequently associated with amebic liver abscess. Pulmonary amebiasis occurs in about 2-3 percent of patients with invasive amebiasis. We report herein the case of a 45-year-old male presenting with hepato-pulmonary amebiasis. The diagnosis was established from direct examination of sputum, in which trophozoites of E. histolytica were detected, and by serology. Following treatment with metronidazole and chloroquine, the clinical evolution improved significantly. On regular follow-up visits, the patient was asymptomatic. This case report reiterates the need for collaboration between clinicians and microbiologists for timely diagnosis of such infections.

Paragonimiasis prevalences in Saraburi Province, Thailand, measured 20 years apart.

Saraburi Province, Central Thailand has been a paragonimiasis-endemic area since 1956. This study compared the prevalences of human paragonimiasis in two villages near Chet Khot Waterfall, Kaeng Khoi District, investigated in 1984-1985 and 2005. The results from the 1980s showed 6.3% and 1% of villagers were positive for Paragonimus eggs in sputum and stool, respectively. In 2005, Paragonimus eggs were not found in feces or sputum. An IgG-ELISA for paragonimiasis was conducted on 33 serum samples collected in the 1980s, 23 collected in 2005 and 25 diagnosed with other parasitic infections. Ninety percent of the samples from the eighties were positive for paragoimiasis, and 43% from 2005 were positive, equivalent to 10.9% and 4.9% of the total population examined in the 1980s and 2005, respectively. Serodiagnosis is currently the best method for detecting paragonimiasis. The positive cases in the 1980s were age 10-60 years and in 2005 were age 34- 67-years-old. The prevalence and intensity of Paragonimus metacercariae in fresh Waterfall crabs collected from Chet Khot Waterfall were significantly lower in the 1980s than in 2005. The prevalence of paragonimiasis in this endemic area has decreased to the level that no egg-producing cases were detected. No infections were found in villagers age < 30 years, despite the high density of metacercariae in the crabs, indicating a change in the habit of eating raw food among the younger people.

continuing dilemma of hyperinvasive strongyloidiasis syndrome: a case report and review of literature

A 28-year-old man from Bangladesh was admitted to Al-Jahra Hospital in Kuwait with an Addison's crisis after suddenly stopping steroids prescribed for uveitis. His hospital stay was further complicated by severe gastritis, peritonitis and meningitis. Investigations revealed Strongyloides stercoralis in the sputum, stomach aspirate and duodenal mucosa. The patient died in spite of intensive treatment. The problem of hyperinvasive strongyloidiasis syndrome is reviewed

Paragonimiasis in Nan Province, northern Thailand.

Two cases of paragonimiasis were identified within the hill-tribe population living on the Thai-Laotian border of Nan Province, northern Thailand, where information on Paragonimus was then still limited. The patients were in the habit of eating improperly cooked crabs and freshwater prawns. A survey for natural intermediate hosts to complete the life cycle was in progress at that time, and the detection of paragonimiasis cases indicated that there was persistence of paragonimiasis in the endemic area of Nan Province.

Pleuropulmonary paragonimiasis mimicking pulmonary tuberculosis--a report of three cases.

Paragonimiasis is an important cause of pulmonary disease worldwide. Infection in humans mainly occurs by ingestion of raw or undercooked freshwater crabs or crayfish. The disease is well known in endemic regions of Asian countries, where culturally based methods of food preparation foster human transmission. Three patients with clinical and radiological features compatible with pulmonary tuberculosis had been treated for tuberculosis without remedy despite an inability to demonstrate acid fast bacilli in sputum smears. All patients had history of ingestion of raw crabs and crayfish. The confirmed diagnosis of pleuropulmonary paragonimiasis was made based on the demonstration of Paragonimus eggs in the sputum, and high absolute eosinophilia in their peripheral blood and pleural fluid. All the patients had been treated with praziquantel successfully.

Cyclospora cayetanensis oocysts in sputum of a patient with active pulmonary tuberculosis, case report in Ismailia, Egypt

Observation of acid fast C. cayetanensis oocysts were proved in a sputum sample of a 45 years-old male HIV negative patient who was admitted to Chest Hospital due to loss of weight, cough with expectoration of purulent sputum and dyspnea. The radiological picture suggested active pulmonary tuberculosis [TB]. Sputum samples which were positive for acid fast bacilli as proved by Ziehl-Neelsen stain technique showed large [8-10 pm] spherical acid-fast C. cayetanensis oocysts and their identification was confirmed by molecular techniques [Nested PCR]. The patient was successfully treated for TB since 4 years. However, this was the second time to report C. cayetanensis oocysts in human sputum. The first one was in Argentina. So, C. cayetanensis is a new respiratory system pathogen which must be considered in the differential diagnosis

A human case of house dust mite Tarsonemus floricolus collected from sputum

A 23-year-old medical student showed a positive reaction on a skin test for Paragonimus westermani, and two Tarsonemus floricolus mites were subsequently found by sputum examination and identified morphologically. Our report is the first human case of Tarsonemus floricolus in Korea.

The present situation of paragonimiasis in endemic area in Phitsanulok Province.

A cross-sectional survey and evaluation of paragonimiasis situation from endemic area in Phitsanulok Province was studied. Studies on the species and prevalence of parasites which infected people in Noen Maprang, Phitsanulok Province were also conducted during October 1999-March 2000. The sputum specimens were collected and examined to identify Paragonimus heterotremus eggs. In addition fecal samples were collected and examined for parasites by the formalin-ethyl acetate concentration technique. P. heterotremus eggs were detected in 2 out of 391 sputum specimens; a prevalence of 0.51%. A total of 584 stool specimens were obtained and examined. It was found that the prevalence of parasitic infection was 36.30%. Opisthorchis viverrini infection was the most prevalent (10.78%), followed by Strongyloides stercoralis (9.59%), hookworm (8.22%), Echinostoma spp (2.23%), minute intestinal flukes (1.54%), Taenia species (1.37%), Enterobius vermicularis (0.68%), Entamoeba coli (1.03%) and Giardia lamblia (0.86%). The prevalent rate of paragonimiasis in this endemic area in Phitsanulok Province has decreased during the past decade. However, there were other important parasite infections, especially opisthorchiasis and strongylodiasis and these should be studied further.

Clinical features and parasite-specific IgM/IgG antibodies of paragonimiasis patients recently found in Japan.

Clinical features of a total of 30 paragonimiasis westermani patients referred to and diagnosed in our laboratory in 1999 were analyzed retrospectively. Most patients were middle-aged (average: 48 years, range: 13-72 years) with the male/female ratio of 19/11. Over 70% of the patients had respiratory symptom and over 80% had peripheral blood eosinophilia and high serum IgE level. All but two cases had radiologic abnormalities on the chest X-ray. Only in 3 cases were Paragonimus eggs detected in the sputum smear. We classified the patients into two groups depending on the chest X-ray findings: patients having pleurisy alone and those having nodular/cavitating lesions in the lung parenchyma. We measured parasite specific IgM/IgG antibodies in all patients sera by microplate ELISA. The mean parasite-specific IgM/IgG antibody ratio was significantly higher in the parenchymatous lesion group than in the pleurisy group. While IgM antibody titer had a strong positive correlation with the degree of eosinophilia in peripheral blood, IgG antibody titer had an inverse correlation. Although the degree of eosinophilia in peripheral blood was higher in the pleurisy group than in the parenchymatous lesion group, total IgE level in serum was comparable between the two groups. The present results indicate that pleurisy with eosinophilia and dominant IgM antibody are the characteristic features of the early stage of paragonimiasis, whereas parenchymatous lesions in lungs with low grade eosinophilia and dominant IgG antibody are of the late stage. These results suggest that detection of IgM antibody should always be considered for the immunodiagnosis for paragonimiasis-suspected patients with pleurisy.

Paragonimosis in the Cajabamba and Condebamba districts, Cajamarca, Peru

Stool samples from 409 pre-school and school students, living in six villages of the Cajabamba and Condebamba districts, Cajamarca, Perú, were examined using wet preparations and Lumbreras' method, looking for Paragonimus eggs. Fecal and sputum samples from two children (0.5 percent) of 6 and 8 year-old showed eggs of Paragonimus. One hundred and twenty freshwater crabs, Hypolobocera chilensis eigenmanni, were collected from the Condebamba valley and 21 (17.5 percent) of them were infected with P. mexicanus (syn. P. peruvianus) metacercariae. Our results show the persistence of Paragonimus in human beings and in the main source of infection, the crabs

Cyclospora cayetanensis in sputum and stool samples

We report the observation of acid-fast Cyclospora cayetanensis oocysts in a sputum sample. The patient, a 60 year-old, HIV negative man, was successfully treated for pulmonary tuberculosis during 1997. On February 1998, he was admitted to our center due to loss of weight, cough with purulent expectoration, dysphonia and a radiological picture of pulmonary fibrosis. Bacilloscopic study of sputum (negative for acid-fast bacilli) stained with Ziehl-Neelsen technique showed large (8-10 µm) spherical, acid-fast Cyclospora cayetanensis oocysts. No other pathogens were isolated on cultures from this sample or from laryngeal biopsy. Serial parasitologic studies showed C. cayetanensis and also eggs of Trichuris trichiura, Ascaris lumbricoides and Hymenolepis nana and of Entamoeba coli cysts. The patient lives in the outskirts of Buenos Aires in a brick-made house with potable water and works as builder of sewers. He travelled in several occasions to the rural area of province of Tucumán which has poor sanitary conditions. C. cayetanensis is an emergent agent of diarrhea and as far as we know this is the first time the parasite is observed in respiratory samples.

Hallazgos de parásitos en pacientes HIV seropositivos / Parasites found in HIV seropositive patients

Durante 41 meses se investigó la presencia de parásitos en una población HIV seropositiva con las características clínicas de los estadíos 3 y 4 según la clasificación de la OMS. Se analizaron 212 muestras fecales de 135 pacientes y 53,33 por ciento de ellos presentaban enteroparásitos. A las heces recolectadas en formol 10 por ciento se les realizó un examen parasitológico directo, una concentración por Ritchie y la tinción de 2 frotis con Safranina 1 por ciento y 2 con Ziehl-Neelsen modificada para identificar Cryptosporidium sp. Las frecuencias detectadas fueron: Cryptosporidium sp. 11,11 por ciento; I. belli 2,96 por ciento; G. lamblia 11,85 por ciento; B. hominis 26,66 por ciento; A. lumbricoides 2,96 por ciento; E. vermicularis 1,48 por ciento; H. nana 0,74 por ciento; E. coli 13,33 por ciento por ciento; E. nana 5,93 por ciento; Ch. mesnilii 2,22 por ciento e I. butschlii 0,74 por ciento; resultando 46 pacientes monoparasitados, 19 b, 5 tri y 2 tetraparasitados. Se procesaron 17 lavados broncoalveolares (LBA) y 194 esputos, recolectados en formal 10 por ciento y centrifugados hasta agotamiento. Con el sedimento se realizaron 10 frotis y se colorearon con azul de toluidina O. La tinción de Groccot Gomori se usó para confirmar los casos dudosos. En el 47 por ciento de los LBA y en 22,68 por ciento de los esputos (E) se diagnosticó P. carinii. Esto representa el 34,68 por ciento. El porcentaje de positividad fue: 30,88 por ciento para los pacientes que remitieron un único esputo; 36,84 por ciento más de uno y 27,276 por ciento para LBA. Por último 7 pacientes enviaron LBA y E, siendo 2 positivos y 2 negativos en ambos materiales, mientras que en 3 pacientes se diagnosticó P. carinii sólo en LBA

Recent trends of paragonimiasis westermani in Miyazaki Prefecture, Japan.

Miyazaki Prefecture has long been known as one of the endemic areas of paragonimiasis westermani. The prevalence of this disease peaked around 1956 and then drastically decreased. A few sporadic cases are still occasionally found in Miyazaki Prefecture; however, the number of new cases has gradually increased during the last 5 years. One important point to be noted is the change of clinical manifestations in the patients. A classically known form of paragonimiasis westermani is characterized by persisting cough, bloody sputum, and nodular or ring shadows in the lung field by chest x-ray. However, the patients recently found in Miyazaki Prefecture rarely showed such typical symptoms. Only four of 13 cases were found to have pulmonary infiltration and nine cases showed massive pleural effusion without pulmonary infiltration. Such atypical cases may be caused by low intensity of infection or, alternatively, be due to the earlier diagnosis.

Paragonimiasis in Mae Hong Son Province northern Thailand: case report.

Two cases of paragonimiasis have been reported from Srisangval Hospital, Mae Hong Son Province, Thailand. These two patients (Thai-Karen) resided in Nam-Piang-Din, Mae Hong Son. The preliminary survey for epidemiological data in Nam-Piang-Din, Mae Hong Son revealed that most of Thai-Karen villagers had the habit of eating raw crabs and fresh water prawns. A survey for intermediate and reservoir hosts are still in progress and this area can be considered as an additional area for paragonimiasis in Thailand.

a case of pulmonary paragonimiasis in Mindanao, Philippines.

A case of pulmonary paragonmiasis was diagnosed in a woman of the Manobo tribe in Marilog, Calinan, in the Davao region of Mindanao, the second-largest island in the Phillippine Archipelago. She had the first case of this disease reported in Mindanao. The patient was initially mis-diagnosed as having pulmonary tuberculosis, but failure of the standard triad regimen led to microscopic identification of Paragonimus westermani eggs in sputum. Therapy with Bithionol was successful in this case. One additional case was confirmed, and several more suspected, among members of this population group. From an epidemiologic standpoint, careful examination of chest x-rays will allow early differentiation between pulmonary paragonimiasis and tuberculosis, in areas where both conditions are endemic.