RESUMO
Strongyloidiasis is a neglected tropical disease mainly caused by the nematode parasite Strongyloides stercoralis. Current treatment consists in the administration of ivermectin or, alternatively, albendazole (or analogues). Concerns regarding these drugs' irregular cure rates and side effects, raise a need for therapeutic alternatives. In this study, we tested the in vitro effect of Spondias mombin L. ethanolic extract against the laboratory model for strongyloidiasis, Strongyloides venezuelensis. The ethanolic extract was further fractionated and each fraction was also tested. Tested fractions were analyzed through thin layer chromatography and gas chromatography (GC/MS). Our results showed that S. mombin extract and fractions had a better in vitro effect than ivermectin, particularly fraction 4 which showed the better results causing 100% mortality in 4 h after exposure to an extract concentration of 400 µg/mL of RPMI medium and caused 100% mortality 12 h after exposure to an extract concentration of 50 µg/mL. Scanning electron microscopy showed that this fraction caused both wrinkling and peeling of the parasites cuticle, whilst ivermectin only caused wrinkling. GC/MS showed a high percentage of monoaromatic phenolic lipids (3-R phenol and 3-R1 phenol), which were likely responsible for the anti-Strongyloides effect. The use of polyvinylpyrrolidone reduced the efficiency, thus raising a need for alertness when using this excipient. Our results suggest that S. mombin is a potential source of compounds that could be used for stongyloidiasis treatment.
Assuntos
Anacardiaceae , Strongyloides stercoralis , Estrongiloidíase , Anacardiaceae/química , Animais , Humanos , Ivermectina/farmacologia , Ivermectina/uso terapêutico , Fenóis/farmacologia , Fenóis/uso terapêutico , Extratos Vegetais/farmacologia , Extratos Vegetais/uso terapêutico , Estrongiloidíase/tratamento farmacológicoRESUMO
INTRODUCTION: Strongyloidiasis, an infection caused by the soil-transmitted helminth Strongyloides stercoralis, can lead immunocompromised people to a life-threatening syndrome. We highlight here current and emerging pharmacotherapeutic strategies for strongyloidiasis and discuss treatment protocols according to patient cohort. We searched PubMed and Embase for papers published on this topic between 1990 and May 2022. AREAS COVERED: Ivermectin is the first-line drug, with an estimated efficacy of about 86% and excellent tolerability. Albendazole has a lower efficacy, with usage advised when ivermectin is not available or not recommended. Moxidectin might be a valid alternative to ivermectin, with the advantage of being a dose-independent formulation. EXPERT OPINION: The standard dose of ivermectin is 200 µg/kg single dose orally, but multiple doses might be needed in immunosuppressed patients. In the case of hyperinfection, repeated doses are recommended up to 2 weeks after clearance of larvae from biological fluids, with close monitoring and further dosing based on review. Subcutaneous ivermectin is used where there is impaired intestinal absorption/paralytic ileus. In pregnant or lactating women, studies have not identified increased risk with ivermectin use. However, with limited available data, a risk-benefit assessment should be considered for each case.
Assuntos
Estrongiloidíase , Humanos , Feminino , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/induzido quimicamente , Estrongiloidíase/complicações , Ivermectina/efeitos adversos , Albendazol/efeitos adversos , Lactação , SoloRESUMO
WHAT IS KNOWN AND OBJECTIVE: The rhabditid nematode Strongyloides stercoralis is the major causative agent of disseminated strongyloidiasis (DS). In rare cases, DS has caused enterococcal meningitis. If DS-associated vancomycin-resistant Enterococcus faecium (VRE) meningitis is suspected, combination antibiotic therapy should be considered. CASE SUMMARY: We present a case of a 61-year-old male who developed DS associated with vancomycin-resistant and linezolid-intermediate E. faecium meningitis after receiving corticosteroids. The VRE meningitis was treated with high-dose daptomycin 12 mg/kg, linezolid, tigecycline and quinupristin/dalfopristin. Despite negative cultures, the patient expired. WHAT IS NEW AND CONCLUSION: In patients with DS-associated VRE meningitis, early use of combination therapy may be warranted to improve patient outcomes.
Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Meningites Bacterianas/tratamento farmacológico , Estrongiloidíase/tratamento farmacológico , Corticosteroides/efeitos adversos , Antibacterianos/administração & dosagem , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Enterococcus faecium , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estrongiloidíase/induzido quimicamente , Resistência a VancomicinaRESUMO
BACKGROUND: Strongyloides stercoralis is a soil-transmitted helminth (STH) that affects approximately 600 million people worldwide. Interventions targeting S. stercoralis have not been implemented yet. Specific treatment (ivermectin) could be included in already ongoing preventive chemotherapy (PC) campaigns targeting other STHs. The aim of this study was to estimate the quantity of ivermectin needed for an integrated STH/S. stercoralis control program. METHODODOLOGY/PRINCIPAL FINDINGS: Our study estimates the number of school- age children (SAC) (the main focus of STH deworming campaigns) in need of PC with ivermectin. The normal approximation of the binomial distribution was adopted to calculate the hypothetical prevalence distribution in each endemic country. Considering prevalence thresholds for PC equal to 10%, 15%, and 20%, we estimated the number of SAC in need of treatment. We adjusted the estimates accounting for ivermectin distributed in lymphatic filariasis and onchocerciasis elimination programs and excluded from our calculation areas where Loa loa is endemic. The global number of SAC that should be targeted in PC campaigns was estimated at 283.9 M (95% CI: 163.4-368.8), 207.2 M (95% CI: 160.9-380.7), and 160.7 M (95% CI: 86.6-225.7) when the threshold for intervention was set to 10%, 15%, and 20%, respectively. India, China, Indonesia, Bangladesh, and Nigeria accounted for about 50% of the global SAC would have to be covered by PC intervention. CONCLUSIONS/SIGNIFICANCE: Our analysis may support endemic countries to evaluate the ivermectin quantity needed for integrating strongyloidiasis in the existing STH programs. These estimates might also show to generic drug manufacturers the size of the potential market for ivermectin and encourage its production.
Assuntos
Ivermectina/uso terapêutico , Solo/parasitologia , Strongyloides stercoralis/efeitos dos fármacos , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/epidemiologia , Adolescente , África/epidemiologia , Animais , Ásia/epidemiologia , Quimioprevenção , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Programas Nacionais de Saúde , Prevalência , Instituições Acadêmicas , Estrongiloidíase/prevenção & controle , Organização Mundial da SaúdeRESUMO
Strongyloidiasis is a parasitosis that represents a public health problem, in tropical regions. The present study aimed to investigate the anthelmintic effects of several extracts of Argemone mexicana, as well as its main component berberine (Ber) against the third-stage larvae (L3) of Strongyloides venezuelensis in-vitro experiments. Also, the anti-hemolytic activity of the extract, fractions, and Ber were tested in human erythrocytes. A dose-response anthelminthic bioassay demonstrated Ber as the most effective component, followed by methanolic subfraction (Fr3) and finally the crude extract of A. mexicana (Am) showing LC50 response values of 1.6, 19.5, and 92.1 µg/mL, at 96 h respectively. Also, Am, Fr3, and Ber did not produce significant hemolysis against human erythrocytes (p ≤ 0.05). Am and Fr3 showed erythrocyte protection effect capacity at the membrane level (p ≤ 0.05). Furthermore, Ber was found to have an antioxidant activity of 168.18 µg/mL. According to the results, the Fr3 of A. mexicana, and particularly Ber, exhibited potent in-vitro effects against L3 of S. venezuelensis, without hemolytic activity against human erythrocytes and presented good antioxidant capacity. In conclusion, the extracts of A. mexicana and the main component have activity against S. venezuelensis, nevertheless, further studies are required to elucidate the mechanism of action.
Assuntos
Anti-Helmínticos/farmacologia , Argemone/química , Berberina/farmacologia , Extratos Vegetais/farmacologia , Strongyloides/efeitos dos fármacos , Análise de Variância , Animais , Anti-Helmínticos/química , Anti-Helmínticos/uso terapêutico , Berberina/química , Berberina/uso terapêutico , Bioensaio , Relação Dose-Resposta a Droga , Eritrócitos/efeitos dos fármacos , Fezes/parasitologia , Hemólise/efeitos dos fármacos , Humanos , Larva/efeitos dos fármacos , Dose Letal Mediana , Masculino , Extratos Vegetais/química , Extratos Vegetais/uso terapêutico , Folhas de Planta/química , Caules de Planta/química , Ratos , Ratos Wistar , Estrongiloidíase/tratamento farmacológicoRESUMO
Most of the 30 to 100 million people infected with Strongyloides stercoralis have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. The use of corticosteroids and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses that are like other nematodes. Definitive diagnosis of S stercoralis infection is based on stool examinations for larvae. S stercoralis remains largely neglected.
Assuntos
Antiparasitários/uso terapêutico , Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/parasitologia , Estrongiloidíase/tratamento farmacológico , Animais , Infecções Assintomáticas , Ensaios Clínicos como Assunto , Gerenciamento Clínico , Humanos , Imunoensaio , Ivermectina/uso terapêutico , Técnicas de Diagnóstico Molecular , Doenças Negligenciadas/diagnóstico , Solo/parasitologia , Estrongiloidíase/diagnósticoRESUMO
OBJECTIVE: The aim of the present study was to evaluate in vitro the anthelmintic activity of Marrubium vulgare L. growing in Algeria against digestive strongyles in naturally infected bovine. METHODS: The anthelmintic activities of the extracts were evaluated using the egg hatch assay and larval mortality assay. Leaves powder of M. vulgare as extracted by maceration. Ethanolic (EE) and aqueous extracts (AE) were tested at 0.78, 1.55, 3.1, 6.2, 12.5, 25, and 50 mg/ml. Albendazole and dimethyl sulfoxide were used as positive and negative controls at concentrations20 mg/ml and 3%, respectively. RESULTS: The mean embryonation rate was maximum in AE and EE (48.4±3.47% and 54.2±2.87%, respectively) of M. vulgare leaves. The extracts of M. vulgare leaves high effects were observed with 50 mg/ml, but the lowest reduction on parasite eggs hatchability was observed in cultures exposed to 0.78 mg/ml to both extracts. The larval mortality rate of both AE and EE from M. vulgare showed that the extracts at 50 mg/ml exhibited 45.8±1.99% and 51±2.53%, respectively, at 24h. CONCLUSION: The findings of the present study showed that AE and EE of M. vulgare leaves have a potential anthelmintic activity on eggs and larvae of bovine strongyles parasites in vitro.
Assuntos
Anti-Helmínticos/farmacologia , Doenças dos Bovinos/tratamento farmacológico , Marrubium , Extratos Vegetais/farmacologia , Strongyloidea/efeitos dos fármacos , Estrongiloidíase/veterinária , Albendazol/farmacologia , Albendazol/uso terapêutico , Argélia , Animais , Anti-Helmínticos/uso terapêutico , Bovinos , Doenças dos Bovinos/parasitologia , Fitoterapia , Extratos Vegetais/uso terapêutico , Folhas de Planta , Estrongiloidíase/tratamento farmacológicoRESUMO
BACKGROUND: Recommendations for soil-transmitted helminth (STH) control give a key role to deworming of school and pre-school age children with albendazole or mebendazole; which might be insufficient to achieve adequate control, particularly against Strongyloides stercoralis. The impact of preventive chemotherapy (PC) against STH morbidity is still incompletely understood. The aim of this study was to assess the effectiveness of a community-based program with albendazole and ivermectin in a high transmission setting for S. stercoralis and hookworm. METHODOLOGY: Community-based pragmatic trial conducted in Tartagal, Argentina; from 2012 to 2015. Six communities (5070 people) were enrolled for community-based PC with albendazole and ivermectin. Two communities (2721 people) were re-treated for second and third rounds. STH prevalence, anemia and malnutrition were explored through consecutive surveys. Anthropometric assessment of children, stool analysis, complete blood count and NIE-ELISA serology for S. stercoralis were performed. PRINCIPAL FINDINGS: STH infection was associated with anemia and stunting in the baseline survey that included all communities and showed a STH prevalence of 47.6% (almost exclusively hookworm and S. stercoralis). Among communities with multiple interventions, STH prevalence decreased from 62% to 23% (p<0.001) after the first PC; anemia also diminished from 52% to 12% (p<0.001). After two interventions S. stercoralis seroprevalence declined, from 51% to 14% (p<0.001) and stunting prevalence decreased, from 19% to 12% (p = 0.009). CONCLUSIONS: Hookworm' infections are associated with anemia in the general population and nutritional impairment in children. S. stercoralis is also associated with anemia. Community-based deworming with albendazole and ivermectin is effective for the reduction of STH prevalence and morbidity in communities with high prevalence of hookworm and S. stercoralis.
Assuntos
Albendazol/uso terapêutico , Ancylostomatoidea , Infecções por Uncinaria/tratamento farmacológico , Ivermectina/uso terapêutico , Strongyloides stercoralis , Estrongiloidíase/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Anti-Helmínticos/uso terapêutico , Argentina/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Solo/parasitologia , Adulto JovemRESUMO
Methanol-water (4:1, v/v) crude extracts (50 mg mL(-1)) of 25 Jamaican medicinal plants were screened in vitro for anthelmintic activity using infective third-stage larvae of Strongyloides stercoralis. The most effective extract was further chemically scrutinized to isolate and identify the source of the bioactivity, and the efficacy of this compound was compared with ivermectin. Eosin exclusion (0.1 mg mL(-1)) served as the indicator of mortality in all bioassays. A crude extract of Eryngium foetidum (Apiaceae) was significantly (Probit Analysis, P<0.05) more potent than the other plant extracts, taking 18.9 h to kill 50% (LT50) of the larvae. Further, the petrol extract of E. foetidum was significantly more effective (Probit Analysis, P<0.05) at killing the larvae (LT50, 4.7 h) than either its methanol-water or dichloromethane extract. The latter two effected less than 1% larval mortality after 120 h. With bioassay-driven column chromatography of the petrol extract, trans-2-dodecenal (eryngial) was identified and chemically isolated as the main anthelmintic compound in E. foetidum. There was a significant difference between the 24 h LD50 values (mm) of trans-2-dodecenal (0.461) and ivermectin (2.251) but there was none between the 48 h LD50 values (mm): trans-2-dodecenal (0.411) and ivermectin (0.499) in vitro.
Assuntos
Aldeídos/farmacologia , Anti-Helmínticos/farmacologia , Eryngium/química , Ivermectina/farmacologia , Extratos Vegetais/farmacologia , Strongyloides stercoralis/efeitos dos fármacos , Estrongiloidíase/tratamento farmacológico , Aldeídos/química , Aldeídos/isolamento & purificação , Animais , Anti-Helmínticos/química , Anti-Helmínticos/isolamento & purificação , Bioensaio , Cães , Feminino , Flores/química , Humanos , Larva , Pessoa de Meia-Idade , Extratos Vegetais/química , Extratos Vegetais/isolamento & purificação , Folhas de Planta/química , Raízes de Plantas/química , Caules de Planta/química , Plantas Medicinais , Strongyloides stercoralis/fisiologia , Estrongiloidíase/parasitologiaRESUMO
Post-treatment soil-transmitted helminth re-infection patterns were studied as part of a randomized controlled trial among school-aged children from an ethnic minority group in Yunnan province, People's Republic of China. Children with a soil-transmitted helminth infection (N = 194) were randomly assigned to triple-dose albendazole or placebo and their infection status monitored over a 6-month period using the Kato-Katz and Baermann techniques. Baseline prevalence of Trichuris trichiura, Ascaris lumbricoides, hookworm, and Strongyloides stercoralis were 94.5%, 93.3%, 61.3%, and 3.1%, respectively, with more than half of the participants harboring triple-species infections. For the intervention group (N = 99), the 1-month post-treatment cure rates were 96.7%, 91.5%, and 19.6% for hookworm, A. lumbricoides, and T. trichiura, respectively. Egg reduction rates were above 88% for all three species. Rapid re-infection with A. lumbricoides was observed: the prevalence 4 and 6 months post-treatment was 75.8% and 83.8%, respectively. Re-infection with hookworm and T. trichiura was considerably slower.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Helmintíase/tratamento farmacológico , Albendazol/administração & dosagem , Ancylostomatoidea , Animais , Anti-Helmínticos/administração & dosagem , Ascaríase/tratamento farmacológico , Ascaríase/epidemiologia , Ascaris lumbricoides , Criança , China/epidemiologia , Método Duplo-Cego , Fezes/parasitologia , Feminino , Helmintíase/epidemiologia , Infecções por Uncinaria/tratamento farmacológico , Infecções por Uncinaria/epidemiologia , Humanos , Masculino , Contagem de Ovos de Parasitas , Prevalência , Solo/parasitologia , Strongyloides stercoralis , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/epidemiologia , Resultado do Tratamento , Tricuríase/tratamento farmacológico , Tricuríase/epidemiologia , TrichurisRESUMO
Strongyloides stercoralis is a disease of worldwide distribution particularly in the immunocompromized patients, especially who are receiving systemic steroids or immunosuppressant therapy, early diagnosis is the key for life safety. A fatal case of chronic strongyloidiasis is reported in an immunocompromized patient with complicated pulmonary infection.
Assuntos
Hospedeiro Imunocomprometido , Doença Pulmonar Obstrutiva Crônica/complicações , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/complicações , Superinfecção/complicações , Idoso , Animais , Doença Crônica , Commiphora , Evolução Fatal , Humanos , Hipertensão Pulmonar/complicações , Imunossupressores/uso terapêutico , Masculino , Extratos Vegetais/uso terapêutico , Policitemia/complicações , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Resinas Vegetais , Esquistossomicidas/uso terapêutico , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/imunologia , Superinfecção/tratamento farmacológico , Superinfecção/imunologiaRESUMO
BACKGROUND: Tribendimidine is an anthelminthic drug with a broad spectrum of activity. In 2004 the drug was approved by Chinese authorities for human use. The efficacy of tribendimidine against soil-transmitted helminths (Ascaris lumbricoides, hookworm, and Trichuris trichiura) has been established, and new laboratory investigations point to activity against cestodes and Strongyloides ratti. METHODOLOGY/PRINCIPAL FINDINGS: In an open-label randomized trial, the safety and efficacy of a single oral dose of albendazole or tribendimidine (both drugs administered at 200 mg for 5- to 14-year-old children, and 400 mg for individuals > or = 15 years) against soil-transmitted helminths, Strongyloides stercoralis, and Taenia spp. were assessed in a village in Yunnan province, People's Republic of China. The analysis was on a per-protocol basis and the trial is registered with controlled-trials.com (number ISRCTN01779485). Both albendazole and tribendimidine were highly efficacious against A. lumbricoides and, moderately, against hookworm. The efficacy against T. trichiura was low. Among 57 individuals who received tribendimidine, the prevalence of S. stercoralis was reduced from 19.3% to 8.8% (observed cure rate 54.5%, p = 0.107), and that of Taenia spp. from 26.3% to 8.8% (observed cure rate 66.7%, p = 0.014). Similar prevalence reductions were noted among the 66 albendazole recipients. Taking into account "new" infections discovered at treatment evaluation, which were most likely missed pre-treatment due to the lack of sensitivity of available diagnostic approaches, the difference between the drug-specific net Taenia spp. cure rates was highly significant in favor of tribendimidine (p = 0.001). No significant adverse events of either drug were observed. CONCLUSIONS/SIGNIFICANCE: Our results suggest that single-dose oral tribendimidine can be employed in settings with extensive intestinal polyparasitism, and its efficacy against A. lumbricoides and hookworm was confirmed. The promising results obtained with tribendimidine against S. stercoralis and Taenia spp. warrant further investigations. In a next step, multiple-dose schedules should be evaluated.
Assuntos
Albendazol/administração & dosagem , Anti-Helmínticos/administração & dosagem , Fenilenodiaminas/administração & dosagem , Estrongiloidíase/tratamento farmacológico , Teníase/tratamento farmacológico , Administração Oral , Adolescente , Animais , Criança , Pré-Escolar , China , Humanos , Masculino , Solo/parasitologia , Strongyloides stercoralis/efeitos dos fármacos , Estrongiloidíase/parasitologia , Taenia/efeitos dos fármacos , Teníase/parasitologia , Resultado do TratamentoRESUMO
We report a 49-year-old man who was a human T-cell leukemia virus type 1 (HTLV-1) carrier, born in Okinawa prefecture where both strongyloidiasis and HTLV-1 are endemic. He presented with fever, headache and urinary retention. On the basis of CSF examination and MRI findings, his condition was diagnosed as myelitis. He received methylprednisolone pulse therapy. He was transferred to our hospital due to severe paralytic ileus. Strongyloides stercoralis (S. stercoralis) was found in the duodenal stained tissue of a biopsy specimen. Ivermectin applied both orally and through enema were ineffective because of severe ileus and intestinal bleeding. Nine mg (200 microg/kg) of ivermectin solution was administered subcutaneously every other day for five days (total amount 45 mg). The S. stercoralis burden in the stool decreased and paralytic ileus gradually resolved. Three weeks after the resolution of S. stercoralis infection, purulent meningitis developed and acute obstructive hydrocephalus appeared. The hydrocephalus improved by ventricular drainage. Approximately three months after drainage, he died of incidental aspiratory pneumonia. Autopsy showed neither eggs nor larvae of S. stercoralis in the organs. In this case, the fourth reported case in the world, subcutaneous ivermectin injection was dramatically effective. We should consider a diagnosis of strongyloidiasis for any patient from Okinawa prefecture who was an HTLV-1 carrier presenting with unknown origin ileus after treatment of steroid therapy.
Assuntos
Antiparasitários/administração & dosagem , Ivermectina/administração & dosagem , Estrongiloidíase/tratamento farmacológico , Autopsia , Infecções por Deltaretrovirus/complicações , Evolução Fatal , Vírus Linfotrópico T Tipo 1 Humano , Humanos , Hidrocefalia/etiologia , Íleus/etiologia , Injeções Subcutâneas , Masculino , Meningites Bacterianas/etiologia , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Prednisolona/efeitos adversos , Índice de Gravidade de Doença , Estrongiloidíase/diagnóstico , Estrongiloidíase/etiologia , Estrongiloidíase/patologia , Resultado do TratamentoRESUMO
The anthelmintic effect of Khaya senegalensis is described. In vitro and in vivo studies were conducted to determine possible direct anthelmintic effects of ethanolic and aqueous extracts of K. senegalensis towards different ovine gastrointestinal nematode. A larval development assay was used to investigate in vitro, the effect of aqueous and ethanolic extracts towards larvae of strongyles. The LC50 values of the effects of both the aqueous and ethanolic extracts were calculated. Another study was conducted in vivo to evaluate the therapeutic efficacy of the extracts administered orally at a dose rate of 125, 250 and 500 mg/kg of sheep harbouring naturally acquired infection of gastrointestinal nematodes. The presence of K. senegalensis extracts in the cultures decreased the viability of larvae. The LC50 of the aqueous extract (0.69 mg/ml) is not significantly different (P >0.05, t-test) from the ethanolic extract (0.51 mg/ml). The activity of the extract is concentration dependent in vivo. Sheep drenched with 500 mg/kg K. senegalensis ethanolic extract had a mean faecal egg count (FEC) reduction of 88.82%. The extract of K. senegalensis could find application in anthelmintic therapy in veterinary practice.
Assuntos
Anti-Helmínticos/uso terapêutico , Gastroenteropatias/veterinária , Meliaceae/química , Doenças dos Ovinos/parasitologia , Strongyloidea/crescimento & desenvolvimento , Estrongiloidíase/veterinária , Animais , Temperatura Corporal/efeitos dos fármacos , Peso Corporal/efeitos dos fármacos , Fezes/parasitologia , Feminino , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/parasitologia , Modelos Lineares , Masculino , Nigéria , Contagem de Ovos de Parasitas/veterinária , Casca de Planta/química , Extratos Vegetais/uso terapêutico , Distribuição Aleatória , Ovinos , Doenças dos Ovinos/tratamento farmacológico , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/parasitologiaRESUMO
BACKGROUND: The frequency of Strongyloides stercoralis infestation and complication in patients with cancer in the United States is unknown. METHODS: The authors performed a retrospective analysis of S. stercoralis infection in patients who were undergoing cancer treatment at The University of Texas M. D. Anderson Cancer Center (Houston, TX). RESULTS: The overall S. stercoralis infection frequency was approximately 1.0 per 10,000 new cancer cases between 1971 and 2003. Twenty-two of 25 patients (88%) were U.S. residents (19 from Texas; 1 each from Mississippi, Tennessee, and Puerto Rico), and the remaining 3 (13%) were from Latin America. Thirteen (52%) had solid-organ malignancies, whereas 12 (48%) had hematologic malignancies (lymphoma or multiple myeloma, n=8; leukemia, n=3; aplastic anemia, n=1). Twelve patients (48%) received systemic corticosteroids, 9 (36%) received antineoplastic therapy, and 2 underwent hematopoietic stem cell transplantation (HSCT). Diarrhea was reported in 13 patients (57%), and eosinophilia was observed in 11 patients (48%); 4 patients (16%) had probable hyperinfection syndrome (in 3 cases of polymicrobial gram-negative bacteremia, 1 patient had Klebsiella pneumoniae pneumonia, whereas 1 patient presented with K. pneumoniae lung infection alone). Evidence of definite pulmonary hyperinfection syndrome was observed in 2 HSCT recipients (8%). Fourteen (74%) of 19 patients responded to thiabendazole therapy. Two patients with definite pulmonary hyperinfection syndrome developed fatal S. stercoralis hemorrhagic alveolitis despite receiving high-dose thiabendazole plus ivermectin therapy. CONCLUSIONS: In the current study, strongyloidiasis was uncommon in patients with cancer and remained localized in individuals with solid-organ malignancies. Definite pulmonary accelerated autoinfections were observed only in HSCT recipients. Therefore, pre-HSCT S. stercoralis screening in individuals from endemic regions of the United States warrants further study.
Assuntos
Neoplasias/complicações , Estrongiloidíase/epidemiologia , Adolescente , Adulto , Idoso , Antinematódeos/uso terapêutico , Lavagem Broncoalveolar , Criança , Fezes/parasitologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/parasitologia , Estudos Retrospectivos , Estrongiloidíase/complicações , Estrongiloidíase/tratamento farmacológico , Tiabendazol/uso terapêutico , Resultado do Tratamento , Estados UnidosRESUMO
Strongyloides hyperinfection syndrome may be complicated by paralytic ileus that interferes with the absorption of oral anti-helminthics. We report on the administration of ivermectin as a rectal enema preparation to a renal transplant recipient with Strongyloides hyperinfection syndrome and progressive ileus. Attempts at treatment using nasogastric albendazole and ivermectin were unsuccessful despite clamping the nasogastric tube after drug administration. Ivermectin tablets were ground to a powder, resuspended in a commercially available suspending agent, and administered per rectum. The suspending agent was chosen for its near-physiologic osmolality to allow longer retention, in contrast to many enema preparations that have a laxative effect. The patient improved markedly within 72 hours of initiation of the therapy per rectum and recovered fully. Ivermectin administered as an enema may be beneficial in patients with severe strongyloidiasis who are unable to absorb or tolerate oral therapy.
Assuntos
Antinematódeos/administração & dosagem , Pseudo-Obstrução Intestinal/etiologia , Ivermectina/administração & dosagem , Estrongiloidíase/tratamento farmacológico , Administração Retal , Enema , Feminino , Humanos , Hospedeiro Imunocomprometido , Pseudo-Obstrução Intestinal/fisiopatologia , Pessoa de Meia-Idade , Estrongiloidíase/complicações , Resultado do TratamentoRESUMO
Em modelo experimental, baseado na infecção de ratos pelo Strongyloides venezuelensis, foi avaliada a atividade terapêutica de duas preparações de ivermectina, para usos veterinário e humano. Houve interesse em verificar a efetividade em relação a vermes adultos e formas larvárias. A administração dos fármacos ocorreu sempre por via oral e a posologia correspondeu à dose única de 0,2mg/kg. Considerados os vermes adultos e as formas larvárias, o produto para emprego veterinário propiciou eliminações expressas pelas porcentagens de 98,0% e 84,2%; quanto à outra preparação, as taxas situaram-se em 59,3% e 73,0%, respectivamente. O estudo revelou, então, utilidade do anti-helmíntico quando usada a via oral e, também, mostrou significativa ação sobre as formas larvárias, certamente valiosa quando vigente a modalidade disseminada da estrongiloidíase.
Strongyloides venezuelensis experimental infection in rats was treated by two different oral preparations of ivermectin, 0.2 mg/kg. One was a human formula used by WHO in the treatment of onchocerciasis; the other was a veterinary preparation. Adult worms and larvae were evaluated. The human formulation cleared both forms in 59.3% (adult worms) and 73.0% (larvae), whereas the veterinary one cleared 98.0% and 84.2%, respectively. The antilarval action is very useful when treating systemic strongyloidiasis.
Assuntos
Animais , Feminino , Ratos , Antinematódeos/administração & dosagem , Estrongiloidíase/tratamento farmacológico , Ivermectina/administração & dosagem , Administração Oral , Avaliação Pré-Clínica de Medicamentos , Estrongiloidíase/parasitologia , Intestinos/parasitologia , Larva/efeitos dos fármacos , Ratos Wistar , Strongyloides/efeitos dos fármacos , Fatores de TempoRESUMO
Strongyloides venezuelensis experimental infection in rats was treated by two different oral preparations of ivermectin, 0.2 mg/kg. One was a human formula used by WHO in the treatment of onchocerciasis; the other was a veterinary preparation. Adult worms and larvae were evaluated. The human formulation cleared both forms in 59.3% (adult worms) and 73.0% (larvae), whereas the veterinary one cleared 98.0% and 84.2%, respectively. The antilarval action is very useful when treating systemic strongyloidiasis.
Assuntos
Antinematódeos/administração & dosagem , Ivermectina/administração & dosagem , Estrongiloidíase/tratamento farmacológico , Administração Oral , Animais , Avaliação Pré-Clínica de Medicamentos , Feminino , Intestinos/parasitologia , Larva/efeitos dos fármacos , Ratos , Ratos Wistar , Strongyloides/efeitos dos fármacos , Estrongiloidíase/parasitologia , Fatores de TempoRESUMO
This study evaluating Chenopodium ambrosioides (paico) as an antiparasitic agent was conducted in two villages near Tarapoto, San Martin. Extracts from leaves of "paico" were given to 72 patients (children and adults) with intestinal parasitic infections. Their stools were analized before and 8 days after the intake. We observed antiparasitary efficacy in 56% of the cases. With respect to the parasites tested for, the efficacy was 100% for Ancilostoma and Trichuris and 50% for Ascaris. We didn't observe any significant difference relative to age or sex.A review of other popular methods used in this region is done.
Assuntos
Anti-Helmínticos/uso terapêutico , Chenopodium ambrosioides , Enteropatias Parasitárias/tratamento farmacológico , Medicina Tradicional , Fitoterapia , Adulto , Ascaríase/tratamento farmacológico , Carica , Criança , Cocos , Cucurbita , Esquema de Medicação , Ficus , Infecções por Uncinaria/tratamento farmacológico , Humanos , Himenolepíase/tratamento farmacológico , Enteropatias Parasitárias/parasitologia , Lua , Cebolas , Peru , Extratos Vegetais/uso terapêutico , Folhas de Planta/química , Estrongiloidíase/tratamento farmacológico , Resultado do Tratamento , Tricuríase/tratamento farmacológicoRESUMO
In vitro bioassay of (a) aqueous methanol extracts (AME) of the green leaves of mimosa (Mimosa pudica), love weed (Cuscuta americana), vervine (Stachytarpheta jamaicensis), chicken weed (Salvia serotina) and breadfruit (Artocarpus altilis); (b) methanol-water fraction (MWF) of breadfruit leaves, and (c) commercially available drugs albendazole, thiabendazole and levamisole were assayed for nematode inactivating potential, using filariform larvae of Strongyloides stercoralis. Test larvae were obtained from a 10-day-old charcoal coproculture. Bioassays were conducted in Locke's solution, using 100 larvae in each of three replicates. Inactivation was recorded microscopically at 1, 2, 6 and 12 hours, then every 24 hours up to 5 days' incubation. It(50) (time for inactivation of 50 percent of larvae) values read: levamisole and mimosa extract < 1 hour; love weed extract, approximately 2 hours; breadfruit (MWF), 9.5 hours; chicken weed, 20 hours; albendazole, 35 hours; breadfruit (AME), 49 hours; thiabendazole, 74 hours and vervine extract, 81.5 hours. It(95) values followed a similar trend, and were approximately double the It(50) measures. A potential role for locally available natural products in the treatment of strongyloidiasis is highlighted (AU)