Modulation of circulating cytokine production in alcoholic patients infected with Strongyloides stercoralis.

Strongyloidiasis control is associated with a Th2 immune response. However, alcohol ingestion plays an important role in modulating the immune system. The aim of this study is to evaluate the occurrence of Strongyloides stercoralis infection in alcoholic patients, the levels of circulating cytokines (IFN-γ, IL-2, IL-4, IL-5, IL-10, IL-15 and IL-17), and its correlation with modulation of parasitic load in alcoholic individuals infected with S. stercoralis. A total of 336 alcoholic patients, treated at the Alcoholic Care and Treatment Center were included in this study. The cytokine levels were measured by a commercial ELISA in 80 sera divided into four groups with 20 individuals each: alcoholics infected (ASs+) and not infected (ASs-) with S. stercoralis and non-alcoholics infected (NASs+) and not infected (NASs-) with the helminth. S. stercoralis frequency in alcoholic patients was 16.1% (54/336). The parasitic load varied from 1 to 546 larvae/g of faeces, median and interquartile range (IQR) of 9 and 1.0-62.5 larvae/g of faeces, while in non-alcoholic individuals the parasitic load was less than 10 larvae/g of faeces. Levels of circulating IL-4 were significantly higher in ASs+ when compared with NASs- group (p < .05). An inverse correlation between serum levels of IFN-γ and parasitic load in alcoholic patients infected with S. stercoralis was observed (r = -601; p < 0.01). These results suggest that modulation of IFN-γ production occurs in alcoholic individuals with high parasitic burden.

Ineffectiveness of TF-Test® and Coproplus® Methods in Strongyloides stercoralis Infection Diagnosis.

PURPOSE: S. stercoralis diagnosis is currently performed by parasitological methods, mainly by Baermann-Moraes (BM), although Agar Plate Culture (APC) presents a higher sensitivity. New techniques, such as TF-Test® and Coproplus® have been suggested as more practical alternatives. The aim of this study was to evaluate the sensitivity of TF-Test® and Coproplus®, compared with APC, BM and Spontaneous Sedimentation (SS) methods. METHODS: One-hundred and forty male alcoholic patients, who provided three stools samples collected on alternate days, were included in this study. The most frequently found parasite was S. stercoralis, 20% (28/140), and the most sensitive method was APC, 96.4% (27/28), followed by BM, 89.3% (25/28) and SS, 57.1% (16/28). TF-Test® and Coproplus® presented a sensitivity of 46.4 (13/28) and 39.3% (11/28), respectively. In samples with a parasitic load of 1-10 larvae/g of feces, which occurred in 39.3% (11/28) of the infected patients, both the TF-Test® and Coproplus® methods demonstrated sensitivities of 18.2% (2/11), while APC and BM methods reached a sensitivity of 100% (11/11) (p < 0.05). For other intestinal helminth infections, TF-Test® and Coproplus® sensitivities were 22.2 (4/18) and 11.1% (2/18), respectively, this being lower than the SS, 66.7% (12/18) (p < 0.05). On the other hand, for protozoa infection diagnosis, TF-Test® and Coproplus® presented the highest sensitivities, 62.2 (46/74) and 43.2% (32/74), respectively. CONCLUSION: TF-Test® and Coproplus® methods presented the lowest sensitivities for S. stercoralis and other helminth infection diagnosis; therefore, they can be indicated for use in parasitological diagnosis, only when associated with other more effective methods of helminth identification.

Alcohol consumption alters anti-Strongyloides stercoralis antibodies production.

Individuals infected with Strongyloides stercoralis have been reported to produce different immunoglobulins isotypes, yet few studies have evaluated their use in strongyloidiasis diagnosis. The aim of this work was to evaluate the immunoreactivity of different classes and subclasses of anti-S. stercoralis circulating antibodies in alcoholic patients by ELISA and to perform immunoblotting in samples with discordant results between parasitological and immunological methods. 345 male patients with a clinical diagnosis of alcoholism hospitalized at a reference center for alcoholics in Salvador, Bahia, Brazil, were included in this study. The fecal samples were examined by three different parasitological methods (spontaneous sedimentation, Baermann-Moraes and Agar Plate Culture methods). The ELISA was performed for the detection of IgG, IgG1, IgG4, IgE and IgA1 anti-S. stercoralis. Immunoblotting, for the detection of specific IgA1, was used to elucidate discordant results between parasitological and immunological methods. S. stercoralis infection frequency in alcoholic patients by parasitological methods was 21.4% (74/345). Although IgE-ELISA demonstrated a high sensitivity and specificity in non-alcoholic patients, about 30% (22/74) of alcoholics with larvae in feces were negative. IgG1-ELISA detected the lowest frequency of antibodies in alcoholic patients with larvae in feces, only 57% (42/74). IgG4-ELISA was the best assay for S. stercoralis infection immunodiagnosis. Immunoreactivity in the immunoblotting for IgA1 at 90, 75, 26 and/or 17 kDa bands was observed in 92% (33/36) of alcoholics with larvae excretion and negative ELISA for one or more antibody isotypes. In conclusion, IgG4-ELISA showed the highest sensitivity and specificity, thus demonstrating its superiority for strongyloidiasis immunodiagnosis in alcoholic and non-alcoholic individuals. Both, IgE and IgG1-ELISA presented high sensitivities and specificities for S. stercoralis infection diagnosis in non-alcoholics, however there was low reactivity in alcoholic individuals. This can be associated with an increased susceptibility to severe strongyloidiasis in these patients. IgA1-immunoblotting can be used to confirm S. stercoralis infection when there are discordant results between parasitological methods and ELISA.

Influence of parasite load on the diagnosis and occurrence of eosinophilia in alcoholic patients infected with Strongyloides stercoralis.

Alcoholic patients are more susceptible to Strongyloides stercoralis infection. The chronic use of alcohol raises the levels of endogenous corticosteroids, which regulates the development of larvae and stimulates the differentiation of rhabditiform into infective filariform larvae, thus inducing internal autoinfection. Therefore, early diagnosis is important to prevent severe strongyloidiasis. The aim of this study was to evaluate the efficacy of parasitological methods, according to the parasite load and the number of stool samples, for diagnosis of S. stercoralis infection, as well the peripheral blood eosinophil count in alcoholic patients. A total of 330 patients were included in this study. The diagnosis was established using three parasitological methods: agar plate culture, Baermann-Moraes method and spontaneous sedimentation. Peripheral eosinophilia was considered when the level was >600 eosinophils/mm3. The agar plate culture (APC) had the highest sensitivity (97.3%). However, the analysis of multiple samples increased the sensitivity of all parasitological methods. The sensitivities of the methods were influenced by the parasite load. When the larval number was above 10, the sensitivity of APC was 100%, while in spontaneous sedimentation the sensitivity reached 100% when the larval number was above 50. In the present study, 15.4% of alcoholic patients infected with S. stercoralis (12/78) had increased peripheral blood eosinophil count (above 600 eosinophils/mm3). For an efficient parasitological diagnosis of S. stercoralis infection in alcoholic patients, repeated examination by two parasitological methods must be recommended, including agar plate culture due to its higher sensitivity. Moreover, S. stercoralis infection was associated with eosinophilia, mostly in patients excreting up to 10 larvae/g faeces.

Peripheral blood CD4+/CD25+ regulatory T cells in alcoholic patients with Strongyloides stercoralis infection.

An increased number of regulatory T (Treg) cells has been reported in patients with HTLV-1 and Strongyloides stercoralis co-infection, suggesting the contribution of these cells to worm survival. As Strongyloides infections have been found to be highly prevalent in chronic alcoholics, we investigated the effect of abusive ethanol ingestion on the induction of Treg cells in alcoholic patients with Strongyloides infection. Treg cells were assessed by flow cytometry in the peripheral blood of 12 healthy non-alcoholic (control) and 14 alcoholic patients (alcoholic) without Strongyloides infection and five non-alcoholics (controlSs) and five chronic alcoholics (alcoholSs) with Strongyloides infection. The results showed significantly higher frequencies of Treg cells in the alcoholic, controlSs and alcoholSs group patients than in the control group patients. However, the frequencies of Treg cells did not differ between the alcoholSs and controlSs groups. In conclusion, our results demonstrate that ethanol consumption induced an increase in the number of circulating Treg cells in chronic alcoholics in this study but was unable to potentiate the induction of these cells in alcoholics with Strongyloides infection.

Strongyloides stercoralis Infection in Alcoholic Patients.

The course of Strongyloides stercoralis infection is usually asymptomatic with a low discharge of rhabditoid larva in feces. However, the deleterious effects of alcohol consumption seem to enhance the susceptibility to infection, as shown by a fivefold higher strongyloidiasis frequency in alcoholics than in nonalcoholics. Moreover, the association between S. stercoralis infection and alcoholism presents a risk for hyperinfection and severe strongyloidiasis. There are several possible mechanisms for the disruption of the host-parasite equilibrium in ethanol-addicted patients with chronic strongyloidiasis. One explanation is that chronic ethanol intake stimulates the hypothalamic-pituitary-adrenal (HPA) axis to produce excessive levels of endogenous cortisol, which in turn can lead to a deficiency in type 2 T helper cells (Th2) protective response, and also to mimic the parasite hormone ecdysone, which promotes the transformation of rhabditiform larvae to filariform larvae, leading to autoinfection. Therefore, when untreated, alcoholic patients are continuously infected by this autoinfection mechanism. Thus, the early diagnosis of strongyloidiasis and treatment can prevent serious forms of hyperinfection in ethanol abusers.

Face-to-face versus computer-delivered alcohol interventions for college drinkers: a meta-analytic review, 1998 to 2010.

Alcohol misuse occurs commonly on college campuses, necessitating prevention programs to help college drinkers reduce consumption and minimize harmful consequences. Computer-delivered interventions (CDIs) have been widely used due to their low cost and ease of dissemination but whether CDIs are efficacious and whether they produce benefits equivalent to face-to-face interventions (FTFIs) remain unclear. Therefore, we identified controlled trials of both CDIs and FTFIs and used meta-analysis (a) to determine the relative efficacy of these two approaches and (b) to test predictors of intervention efficacy. We included studies examining FTFIs (N=5237; 56% female; 87% White) and CDIs (N=32,243; 51% female; 81% White). Independent raters coded participant characteristics, design and methodological features, intervention content, and calculated weighted mean effect sizes using fixed and random-effects models. Analyses indicated that, compared to controls, FTFI participants drank less, drank less frequently, and reported fewer problems at short-term follow-up (d(+)s=0.15-0.19); they continued to consume lower quantities at intermediate (d(+)=0.23) and long-term (d(+)=0.14) follow-ups. Compared to controls, CDI participants reported lower quantities, frequency, and peak intoxication at short-term follow-up (d(+)s=0.13-0.29), but these effects were not maintained. Direct comparisons between FTFI and CDIs were infrequent, but these trials favored the FTFIs on both quantity and problem measures (d(+)s=0.12-0.20). Moderator analyses identified participant and intervention characteristics that influence intervention efficacy. Overall, we conclude that FTFIs provide the most effective and enduring effects.

Alcoholism and Strongyloides stercoralis: daily ethanol ingestion has a positive correlation with the frequency of Strongyloides larvae in the stools.

BACKGROUND: Significantly higher prevalence of Strongyloides stercoralis has been reported in chronic alcoholic patients. The aim of this investigation was to report the prevalence of Strongyloides larvae in stools of chronic alcoholic patients with known daily ethanol intake. METHODS: From January 2001 through December 2003 the results of fecal examinations and the daily ethanol intake were retrieved from the records of 263 chronic alcoholic and from 590 non-alcoholic male patients that sought health care at the outpatients unit of the University Hospital C A Moraes. Alcoholic patients were separated into four groups, with 150g intervals between the groups according to the daily ethanol intake. RESULTS: (a) The frequency of Strongyloides was significantly higher in alcoholic patients than in control group (overall prevalence in alcoholic 20.5% versus 4.4% in control group; p = 0.001). Even in the group with a daily intake of ethanol equal to or less than 150g the prevalence was higher than in control group, although non significant (9.5%, versus 4.4% in control group; p = 0,071); (b) the prevalence of Strongyloides in alcoholic patients rises with the increase of ethanol intake (Pearson's Correlation Coefficient = 0.956; p = 0.022), even in patients without liver cirrhosis (Pearson's Correlation Coefficient = 0.927; p = 0.037). CONCLUSION: These results confirm and reinforce the hypothesis that chronic alcoholism is associated with Strongyloides infection, which is in direct relationship with the severity of alcoholism, independently of the presence of liver cirrhosis.

[The protozoan-infected brain in alcohol abusers].

The paper gives the studying the brain in 57 male patients with different types of ethanol intoxication and in 14 control group subjects. The material has been examined by a complex of histological, histochemical, and morphometric studies. The different regions of the brains from those who have died and had signs of alcoholic intoxication exhibit large microorganisms that belong to protozoa, as judged from their structure are identified. They are most commonly oval in shape. The peripheral portions of the parasites' bodies are light and homogeneous and the middle ones are muddy and granular. Their cytoplasm frequently displays vacuoles and inclusions that most often looked like basophilic acicular crystals. One or two nuclei that have large hyperchromic nucleoli are located in the center of the described microorganisms or eccentrically. They are encapsulated in a number of cases. The signs of mitotic division can be seen in individual parasites. Some of them die and are prone to petrification. All these signs allow the described protozoa to be assigned to amoebas.

Neuropsychological performance of South African treatment-naïve adolescents with alcohol dependence.

BACKGROUND: Alcohol dependence (AD) in developmentally vulnerable adolescents is ubiquitous and confers a risk for long-term neurocognitive sequelae, yet comorbid substance use disorders and psychopathology can complicate interpretations. Here, we compare cognitive functioning in adolescents with and without AD, who are free from comorbid disorders. METHODS: English- and Afrikaans-speaking adolescents (13-15 years) of mixed ancestry and low socio-economic status were recruited from the Cape Town region of South Africa. Adolescents with psychiatric, developmental, or other substance use disorders (SUDs) were excluded. AD (n=26) and control (n=26) groups were matched on age, gender, language, and level of education. Neuropsychological testing in participants' home language followed detailed medical/psychiatric evaluation. RESULTS: Although our sample included participants who smoked tobacco, lifetime dosage of other drugs was negligible. When tobacco and other drug use as well as demographic variables were controlled, adolescents with AD performed more poorly on measures of Verbal Story Memory, Self-Monitoring, and Psychomotor Speed and Coordination. CONCLUSIONS: These preliminary results, although relatively subtle, suggest that adolescents with AD may be at increased risk for failure to reach optimal levels of neuromaturation, and may be susceptible to cognitive problems associated with protracted alcohol consumption.

[Infections in hospitalized patients with cirrhosis]. / Infecciones en pacientes hospitalizados por cirrosis.

We evaluated the prevalence and the clinical relevance of bacterial and nonbacterial infections in predominantly alcoholic cirrhotic patients, admitted to an intermediate complexity hospital, and we also compared the clinical characteristics, laboratory and evolution of these patients with and without bacterial infection in a prospective study of cohort. A total of 211 consecutive admissions in 132 cirrhotic patients, between April 2004 and July 2007, were included. The mean age was 51.8 (+/-8) years, being 84.8% male. The alcoholic etiology of cirrhosis was present in 95.4%. One hundred and twenty nine episodes of bacterial infections were diagnosed in 99/211 (46.9%) admissions, community-acquired in 79 (61.2%) and hospital-acquired in 50 (38.8%): spontaneous bacterial peritonitis (23.3%); urinary tract infection (21.7%); pneumonia (17.8%); infection of the skin and soft parts (17.1%), sepsis by spontaneous bacteremia (7.7%); other bacterial infections (12.4%). Gram-positive organisms were responsible for 52.2% of total bacterial infections documented cases. There were eight serious cases of tuberculosis, fungal and parasitic infections; the prevalence of tuberculosis was 6% with an annual mortality of 62.5%; 28.1% (9/32) of the coproparasitological examination had Strongyloides stercolaris. The in-hospital mortality was significantly higher in patients with bacterial infection than in non-infected patients (32.4% vs. 13.2%; p=0.02). The independent factors associated with mortality were bacterial infections, the score of Child-Pügh and creatininemia > 1.5 mg/dl. By the multivariate analysis, leukocytosis and hepatic encephalopathy degree III/IV were independent factors associated to bacterial infection. This study confirms that bacterial and nonbacterial infections are a frequent and severe complication in hospitalized cirrhotic patients, with an increase of in-hospital mortality.

Infecciones en pacientes hospitalizados por cirrosis / Infections in hospitalized patients with cirrhosis

Evaluamos la prevalecencia y relevancia clínica de las infecciones bacterianas y no bacterianas en pacientes cirróticos predominantemente alcohólicos internados en un hospital de mediana complejidad, y comparamos las características clínicas, de laboratorio y la evolución de pacientes con y sin infección bacteriana en un estudio prospectivo de cohorte. Se incluyeron 211 internaciones consecutivas de 132 pacientes con diagnóstico de cirrosis, de abril 2004 a julio 2007. El promedio de edad (±DS) fue 51.8 (±8) años, 112 fueron hombres (84.8%); etiología alcohólica 95.4%. Se diagnosticaron 129 episodios de infecciones bacterianas en 99/211 (46.9%) internaciones, adquiridos en la comunidad 79 (61.2%) y 50 (38.8%) intrahospitalarios: peritonitis bacteriana espontánea (23.3%); infección urinaria (21.7%); neumonías (17.8%); infecciones de piel y partes blandas (17.1%); sepsis por bacteriemia espontánea (7.7%); otras infecciones bacterianas (12.4%). El 52.2% fueron por gérmenes gram-positivos. Hubo ocho casos de tuberculosis e infecciones graves por hongos y parásitos. La prevalecencia de tuberculosis fue del 6% con una mortalidad anual de 62.5%. El 28.1% (9/32) de los exámenes coproparasitológicos tuvieron Strongyloides stercolaris. La mortalidad hospitalaria fue mayor en los pacientes con infección bacteriana (32.4% vs. 13.2%; p=0.02). Fueron identificados como predictores independientes de mortalidad: las infecciones bacterianas, el score de Child-Pügh y creatininemia > 1.5 mg/dl. En el análisis multivariado fueron factores independientes asociados a infección bacteriana la leucocitosis y la encefalopatía hepática grado III/IV. Este estudio confirma que las infecciones bacterianas y no bacterianas son una complicación frecuente y grave en pacientes cirróticos internados, con un aumento de la mortalidad hospitalaria.

We evaluated the prevalence and the clinical relevance of bacterial and nonbacterial infections in predominantly alcoholic cirrhotic patients, admitted to an intermediate complexity hospital, and we also compared the clinical characteristics, laboratory and evolution of these patients with and without bacterial infection in a prospective study of cohort. A total of 211 consecutive admissions in 132 cirrhotic patients, between April 2004 and July 2007, were included. The mean age was 51.8 (±8) years, being 84.8% male. The alcoholic etiology of cirrhosis was present in 95.4%. One hundred and twenty nine episodes of bacterial infections were diagnosed in 99/211 (46.9%) admissions, community- acquired in 79 (61.2%) and hospital-acquired in 50 (38.8%): spontaneous bacterial peritonitis (23.3%); urinary tract infection (21.7%); pneumonia (17.8%); infection of the skin and soft parts (17.1%), sepsis by spontaneous bacteremia (7.7%); other bacterial infections (12.4%). Gram-positive organisms were responsible for 52.2% of total bacterial infections documented cases. There were eight serious cases of tuberculosis, fungal and parasitic infections; the prevalence of tuberculosis was 6% with an annual mortality of 62.5%; 28.1% (9/32) of the coproparasitological examination had Strongyloides stercolaris. The in-hospital mortality was significantly higher in patients with bacterial infection than in non-infected patients (32.4% vs. 13.2%; p=0.02). The independent factors associated with mortality were bacterial infections, the score of Child-Pügh and creatininemia > 1.5 mg/dl. By the multivariate analysis, leukocytosis and hepatic encephalopathy degree III/IV were independent factors associated to bacterial infection. This study confirms that bacterial and nonbacterial infections are a frequent and severe complication in hospitalized cirrhotic patients, with an increase of in-hospital mortality.

Australian clinician attitudes towards contingency management: comparing down under with America.

BACKGROUND: Contingency management (CM) is an efficacious treatment intervention. Research from the US indicates that clinicians have both positive and negative attitudes towards CM. Concerns about the practicalities of implementation and potential philosophical differences have been identified in American samples. To date, no research has examined Australian clinicians attitudes towards CM nor assessed the extent to which Australian clinicians share the concerns of American clinicians. METHOD: The Provider Survey of Incentives was completed by 102 Australian drug and alcohol treatment providers. The survey assesses both positive and negative attitudes towards tangible and social incentives. Comparisons are made with published data on American samples. RESULTS: The proportion of respondents agreeing with positive opinions about CM in this Australian sample was lower than that reported in the American sample. The average percentage agreement for positive aspects of tangible rewards was 41% whereas the average percent agreement for social rewards was 51% indicating more positive views towards social rewards. Objections to CM were similar between the two samples, but American respondents more strongly agreed with the idea that it would not be right to give incentives when clients are still using drugs, whereas the Australian sample had much less difficulty with this concept. CONCLUSIONS: There appears to be broad support for CM from about half of the clinicians surveyed. The areas of concern were highly similar between the Australian sample and published American data. Many Australian clinicians expressed neutral views about CM, indicating that the environment may be ripe for implementation of programs.

Prevalence of intestinal nematodes in alcoholic patients

We report the results of a retrospective study on the frequency of intestinal nematodes among 198 alcoholic and 440 nonalcoholic patients at the University Hospital Cassiano Antonio Moraes in Vitória, ES, Brazil. The control sample included 194 nonalcoholic patients matched according to age, sex and neighborhood and a random sample of 296 adults admitted at the same hospital. Stool examination by sedimentation method (three samples) was performed in all patients. There was a significantly higher frequency of intestinal nematodes in alcoholics than in controls (35.3 percent and 19.2 percent, respectively), due to a higher frequency of Strongyloides stercoralis (21.7 percent and 4.1 percent, respectively). Disregarding this parasite, the frequency of the other nematodes was similar in both groups. The higher frequency of S. stercoralis infection in alcoholics could be explained by immune modulation and/or by some alteration in corticosteroid metabolism induced by chronic ethanol ingestion. Corticosteroid metabolites would mimic the worm ecdisteroids, that would in turn increase the fecundity of females in duodenum and survival of larvae. Consequently, the higher frequency of Strongyloides larvae in stool of alcoholics does not necessarily reflect an increased frequency of infection rate, but only an increased chance to present a positive stool examination using sedimentation methods

Frequency of Strongyloides stercoralis infection in alcoholics.

Several studies have shown that chronic alcoholics have increased susceptibility to infections due to higher exposure to infectious agents as well as breakdown in their immune defenses. As Strongyloides stercoralis infection is usually more relevant in immunocompromised patients, the aim of this study was to evaluate the frequency of S. stercoralis infection in alcoholics. Thus, coproparasitological examination was carried out in 145 subjects, from which 45 were chronic alcoholics (mean age of 45.7 +/- 11.0 years), 10 were nonalcoholic cirrhotic patients (mean age of 50.2 +/- 13.1 years), and 90 were asymptomatic nonalcoholic subjects (mean age of 46.7 +/- 10.1 years), which served as controls. From the alcoholics, 9 had hepatic cirrhosis, 9 had chronic pancreatitis and 27 had neither cirrhosis nor pancreatitis. For the diagnosis of strongyloidiasis, the Baermann-Moraes and Lutz methods were used in three fecal samples from each subject. Samples were collected at alternated days, and three slides of each sample were analyzed for each method, thus totalizing 2,610 slides examined. The frequency of strongloidiasis in the total alcoholic group (33.3%) and in the subgroups of alcoholics, i.e., patients with hepatic cirrhosis (44.4%), with chronic pancreatitis (33.3%), and those with no cirrhosis or pancreatitis (29.6%) was statistically higher than that found in the control group (5.5%). None of the individuals with nonalcoholic hepatic cirrhosis had S. stercoralis infection. Our results showed that the chronic alcoholism itself is an important factor that predisposes to strongyloidiasis.

Prevalence of intestinal nematodes in alcoholic patients.

We report the results of a retrospective study on the frequency of intestinal nematodes among 198 alcoholic and 440 nonalcoholic patients at the University Hospital Cassiano Antonio Moraes in Vit ria, ES, Brazil. The control sample included 194 nonalcoholic patients matched according to age, sex and neighborhood and a random sample of 296 adults admitted at the same hospital. Stool examination by sedimentation method (three samples) was performed in all patients. There was a significantly higher frequency of intestinal nematodes in alcoholics than in controls (35.3% and 19.2%, respectively), due to a higher frequency of Strongyloides stercoralis (21.7% and 4.1%, respectively). Disregarding this parasite, the frequency of the other nematodes was similar in both groups. The higher frequency of S. stercoralis infection in alcoholics could be explained by immune modulation and/or by some alteration in corticosteroid metabolism induced by chronic ethanol ingestion. Corticosteroid metabolites would mimic the worm ecdisteroids, that would in turn increase the fecundity of females in duodenum and survival of larvae. Consequently, the higher frequency of Strongyloides larvae in stool of alcoholics does not necessarily reflect an increased frequency of infection rate, but only an increased chance to present a positive stool examination using sedimentation methods.

Strongyloides stercoralis en pacientes alcohólicos / Strongyloides stercoralis infection in alcoholic patients

Se evaluó la infección con strongyloides stercoralis en 106 pacientes alcohólicos crónicos, usando el método de Baermann, el cultivo en plato de agar (CPA) y la observación microscópica de frotis de heces. El parásito fue observado en 6 (5,7 por ciento) casos. Todos diagnosticados por Baermann, 5 por CPA (sensibilidad = 83,3 por ciento), y solo 2 por el frotis directo (sensibilidad = 33,3 por ciento). Otros parásitos intestinales diagnosticados fueron endolimax nana (16 por ciento), giardia lamblia (7,3 por ciento), entamoeba coli (6,6 por ciento), entamoeba histolytica (4,7 por ciento), uncinarias (0,9 por ciento), hymenolepis nana (0,9 por ciento) y entamoeba hartmanni (0,9 por ciento). La prevalencia global de parásitos intestinales en los pacientes estudiados fue del 30 por ciento, un valor relativamente bajo; pero en concordancia con la prevalencia a nivelnacional que fue 21 por ciento o menor al 5 por ciento si sólo se consideran los helmintos intestinales. Además, es importante la comparación de las infecciones por uncinarias y S. stercoralis en pacientes alcohólicos, porque ambos parásitos tienen mecanismos de infección similares; pero nuestros datos muestran una mayor prevalencia para el último, lo que denota un posible incremento en el riesgo para esta infección en pacientes alcohólicos

Efeitos da intoxicaçäo crônica com o etanol na evoluçäo da Tripanosomíase cruzi experimental no camundongo / Effects of chronic ethanol intoxication on the evolution of experimental Trypanosomiasis cruzi in mice

Dois experimentos foram realizados para estudar o efeito da intoxicaçäo crônica com o etanol (soluçäo a 7% como única fonte de líquido) sobre a evoluçäo da infecçäo pelo T. cruzi em camundongos: (1) animais após 60 dias de infecçäo com cepa miotrópica do T. cruzi foram submetidos à intoxicaçäo crônica com o etanol durante 6 meses (2) animais cronicamente intoxicados com etanol durante 5 meses foram infectados com a mesma cepa do T. cruzi e, continuando a ingestäo do etanol, foram acompanhados até 45 dias após a infecçäo. Os animais infectados e tratados com etanol apresentram, relaçäo aos que näo ingeriram álcool etílico: (a) mortalidade semelhante nos dois experimentos; (b) parasitemia mais alta na fase aguda e parasitemia patente mais freqüente na fase crônica; (b) miocardite com exsudado inflamatório menos intenso e fibrose miocárdica mais extensa na fase crônica; (c) no músculo esquelético, miosite menos intensa e arterite com trombose hialina menos freqüente