A Gata3 enhancer necessary for ILC2 development and function.

The type 2 helper effector program is driven by the master transcription factor GATA3 and can be expressed by subsets of both innate lymphoid cells (ILCs) and adaptive CD4+ T helper (Th) cells. While ILC2s and Th2 cells acquire their type 2 differentiation program under very different contexts, the distinct regulatory mechanisms governing this common program are only partially understood. Here we show that the differentiation of ILC2s, and their concomitant high level of GATA3 expression, are controlled by a Gata3 enhancer, Gata3 +674/762, that plays only a minimal role in Th2 cell differentiation. Mice lacking this enhancer exhibited defects in several but not all type 2 inflammatory responses, depending on the respective degree of ILC2 and Th2 cell involvement. Our study provides molecular insights into the different gene regulatory pathways leading to the acquisition of the GATA3-driven type 2 helper effector program in innate and adaptive lymphocytes.

Resistance mesenteric arteries display hypercontractility in the resolution time of Strongyloides venezuelensis infection.

The blood flow in the mesenteric region is crucial for nutrient absorption and immune response in the gastrointestinal tract. The presence of nematodes or their excreted/secreted products seems to provoke vascular dysfunction. However, it is unclear whether and how the intestinal nematodes with habitat in the intestinal niche could affect the mesenteric vascular resistance. In this study, male Wistar rats were infected with 2000 larvae of S. venezuelensis, and experiments were conducted at 0 (non-infected control), 10 or 30 days post-infection (DPI). Eggs were counted in rats' feces and adult worms recovered from the small intestine. Second- or third-order mesenteric arteries were extracted for concentration-response curves (CRC) to phenylephrine [PE; in the presence or absence of L-NAME or indomethacin] and acetylcholine. The number of eggs and adult worms were significantly higher in the 10 DPI group than those of 30 DPI group. Augmented PE-induced contraction was seen after 30 DPI compared to 10 DPI or control group. Hypercontractility to PE was partially prevented by L-NAME and wholly abolished by indomethacin incubation. Endothelium-dependent relaxation and endothelial nitric oxide synthase expression were unchanged among groups. COX-1 and COX-2 display a different pattern of expression over the infection. Hypercontractility observed in mesenteric resistance arteries in the resolution time of S. venezuelensis infection may represent systemic damage, which can generate significant cardiovascular and gastrointestinal repercussions.

Age range implications of rats over Strongyloides venezuelensis infection.

OBJECTIVE: To evaluate the dynamics of S. venezuelensis infection in Wistar rats of different age ranges. DESIGN: Thirty-five (n = 35, 7 per group) male Wistar rats were distributed according to age into five groups: 2, 3, 6, 12 and 18 months old (mo). The rats were infected by S. venezuelensis and eggs per gram of feces (EPG) were measured at 3, 9, 15 and 21 days post-infection (dpi). All animals were killed at 21 dpi, thymus, lungs and small intestines were removed, and relative weight calculated. The adult worms recovered from the small intestines and blood cells were counted. RESULTS: Rats in advanced age presented higher parasite oviposition at 9 dpi and posterior reduction of EPG, while young rats still showed higher oviposition at 15 dpi and 21 dpi. At 12 and 18 mo, the rats had greater number of adult worms, which with low fecundity, eosinophilia and least concentration of monocytes. The fecundity of worms was more expressive in young rats. A strong correlation was observed between age and EPG at 9 dpi (R = 0.72, p < 0.0001), at 15 (R = -0.66, p < 0.0001) and at 21 dpi (R = -0.65, p < 0.0001), as well as age and numbers of worms at 21 dpi (R = 0.74, p < 0.0001). The relative weight of the thymus, lungs and small intestines were higher in rats at 2 and 3 mo in comparison to the older groups of rats. CONCLUSIONS: Aging process interfered on host-parasite relationship and changed the dynamics of infection of S. venezuelensis in Wistar rats.

[Strongyloides stercoralis as uncommon cause of ascitic fluid infection in cirrhosis]. / Strongyloides stercoralis como causa infrecuente de infección de líquido ascítico en cirrosis.

Male patient, with a history of alcoholic cirrhosis frequent user of anti-inflammatory drugs including corticosteroids. He consulted for digestive bleeding secondary to a bulbar ulcer. During the admission, he had fever and antibiotic treatment with ceftriaxone is started, for a urinary infection. Fever persisted for 48 hours, so a diagnostic paracentesis was made: Strongyloides stercoralis larvae were seen in the direct microscopic exam. The patient started antiparasitic treatment with ivermectin. He was discharged and did not returned for follow up. Although infection with S. stercoralis is relatively common in patients with alcoholic liver cirrhosis, ascites infected with Strongyloides corresponds to an infrequent form of presentation. This case shows the importance of diagnostic paracentesis in every cirrhotic patient. It is important to consider atypical presentation of Strongyloides infection in the immunocompromised host, considering it could be fatal without treatment.

The Strongyloides stercoralis-hookworms association as a path to the estimation of the global burden of strongyloidiasis: A systematic review.

TRIAL REGISTRATION: PROSPERO (registration code CRD42019131127).

Regulatory T cell expansion resolves after effective strongyloidiasis treatment in subjects with HTLV-1 co-infection.

BACKGROUND: Regulatory T-cells (Tregs) are increased in patients with HTLV-1/Strongyloides stercoralis co-infection, and they may modify otherwise protective antigen-specific cytokine production. We hypothesized that effective anti-helminthic treatment would decrease Tregs and restore antigen-specific cytokine responses. METHODS/RESULTS: We enrolled 19 patients with Strongyloides larvae in their stool by Baerman's test. Six were positive and 13 negative for antibody to HTLV-1 by ELISA, with positive tests confirmed by immunoblot. Before treatment, co-infected subjects had higher Tregs percentages and lower antigen-stimulated IL-5 levels compared to subjects with Strongyloides without HTLV-1. All patients were treated with ivermectin. After effective treatment, Tregs percentages decreased in patients with HTLV-1; however, antigen-specific IL-5 production remained blunted in co-infected subjects. CONCLUSION: These results suggest that treating strongyloidiasis infection decreases circulating Tregs, but antigen-specific cytokine remains altered. This may reflect blunting of sensitization by Tregs.

Strongyloides stercoralis como causa infrecuente de infección de líquido ascítico en cirrosis / Strongyloides stercoralis as uncommon cause of ascitic fluid infection in cirrhosis

Resumen Se comunica el caso clínico de un varón, con antecedentes de una cirrosis hepática alcohólica y gota, usuario crónico de antiinflamatorios, incluyendo corticoesteroides. Consultó por una melena secundaria a una úlcera bulbar. Durante su internación presentó fiebre, tratándose con ceftriaxona por un probable foco urinario. Por persistir febril, se realizó una paracentesis diagnóstica. En la muestra de líquido ascítico se observaron larvas de Strongyloides stercoralis. Recibió tratamiento antiparasitario con ivermectina, con buena respuesta clínica. Aunque la infección por S. stercoralis es relativamente frecuente en pacientes con cirrosis hepática alcohólica, la ascitis infectada por Strongyloides corresponde a una forma de presentación infrecuente. Este caso muestra la importancia de la paracentesis diagnóstica en todo paciente con ascitis secundaria a una cirrosis. Es importante considerar la presentación atípica de la infestación por Strongyloides en el contexto del paciente inmunocomprometido, ya que sin tratamiento puede tener una alta mortalidad.

Abstract Male patient, with a history of alcoholic cirrhosis frequent user of anti-inflammatory drugs including corticosteroids. He consulted for digestive bleeding secondary to a bulbar ulcer. During the admission, he had fever and antibiotic treatment with ceftriaxone is started, for a urinary infection. Fever persisted for 48 hours, so a diagnostic paracentesis was made: Strongyloides stercoralis larvae were seen in the direct microscopic exam. The patient started antiparasitic treatment with ivermectin. He was discharged and did not returned for follow up. Although infection with S. stercoralis is relatively common in patients with alcoholic liver cirrhosis, ascites infected with Strongyloides corresponds to an infrequent form of presentation. This case shows the importance of diagnostic paracentesis in every cirrhotic patient. It is important to consider atypical presentation of Strongyloides infection in the immunocompromised host, considering it could be fatal without treatment.

Detection of classic and cryptic Strongyloides genotypes by deep amplicon sequencing: A preliminary survey of dog and human specimens collected from remote Australian communities.

Strongyloidiasis is caused by the human infective nematodes Strongyloides stercoralis, Strongyloides fuelleborni subsp. fuelleborni and Strongyloides fuelleborni subsp. kellyi. The zoonotic potential of S. stercoralis and the potential role of dogs in the maintenance of strongyloidiasis transmission has been a topic of interest and discussion for many years. In Australia, strongyloidiasis is prevalent in remote socioeconomically disadvantaged communities in the north of the continent. Being an isolated continent that has been separated from other regions for a long geological period, description of diversity of Australian Strongyloides genotypes adds to our understanding of the genetic diversity within the genus. Using PCR and amplicon sequencing (Illumina sequencing technology), we sequenced the Strongyloides SSU rDNA hyper-variable I and hyper-variable IV regions using Strongyloides-specific primers, and a fragment of the mtDNA cox1 gene using primers that are broadly specific for Strongyloides sp. and hookworms. These loci were amplified from DNA extracted from Australian human and dog faeces, and one human sputum sample. Using this approach, we confirm for the first time that potentially zoonotic S. stercoralis populations are present in Australia, suggesting that dogs represent a potential reservoir of human strongyloidiasis in remote Australian communities.

Morbidity Associated with Chronic Strongyloides stercoralis Infection: A Systematic Review and Meta-Analysis.

Strongyloides stercoralis, a worldwide-distributed soil-transmitted helminth, causes chronic infection which may be life threatening. Limitations of diagnostic tests and nonspecificity of symptoms have hampered the estimation of the global morbidity due to strongyloidiasis. This work aimed at assessing S. stercoralis-associated morbidity through a systematic review and meta-analysis of the available literature. MEDLINE, Embase, CENTRAL, LILACS, and trial registries (WHO portal) were searched. The study quality was assessed using the Newcastle-Ottawa scale. Odds ratios (ORs) of the association between symptoms and infection status and frequency of infection-associated symptoms were calculated. Six articles from five countries, including 6,014 individuals, were included in the meta-analysis-three were of low quality, one of high quality, and two of very high quality. Abdominal pain (OR 1.74 [CI 1.07-2.94]), diarrhea (OR 1.66 [CI 1.09-2.55]), and urticaria (OR 1.73 [CI 1.22-2.44]) were associated with infection. In 17 eligible studies, these symptoms were reported by a large proportion of the individuals with strongyloidiasis-abdominal pain by 53.1% individuals, diarrhea by 41.6%, and urticaria by 27.8%. After removing the low-quality studies, urticaria remained the only symptom significantly associated with S. stercoralis infection (OR 1.42 [CI 1.24-1.61]). Limitations of evidence included the low number and quality of studies. Our findings especially highlight the appalling knowledge gap about clinical manifestations of this common yet neglected soil-transmitted helminthiasis. Further studies focusing on morbidity and risk factors for dissemination and mortality due to strongyloidiasis are absolutely needed to quantify the burden of S. stercoralis infection and inform public health policies.

Gastrointestinal effects of ivermectin treatment in rats infected with Strongyloides venezuelensis.

We aimed to evaluate the effects of ivermectin treatment on gastrointestinal morphology and function after Strongyloides venezuelensis infection. Male rats composed Control (C), Parasitized (Sv), Ivermectin (IVM) and Parasitized and treated with Ivermectin (Sv/IVM) groups. IVM and Sv/IVM groups were subdivided according to IVM: single dose of 200 µg/kg (IVM1 and Sv/IVM1) or three repeated doses of 200 µg/kg at 24 h intervals (IVM3 and Sv/IVM3). First dose of IVM was administered after peak of infection. Eggs per gram (EPG), mean gastric emptying time (MGET), mean cecum arrival time (MCAT) and mean small intestinal transit time (MSITT) were evaluated. Measurements were performed before drug and at peak of infection, first day post peak of infection and 30 days post infection. Same time intervals were simulated for uninfected animals. Number of recovered worms and intestinal morphometry were also rated. Data were analyzed by ANOVA and correlated by Dunnett and Pearson (p < 0.05). Sv/IVM1 and Sv/IVM3 showed reduction of EPG and worms, although only group SV/IVM3 eradicate them. Hastened gastric emptying and slowed intestinal transit provoked by S. venezuelensis infection can be reverted by a single administration of IVM after peak of infection, even without total parasite elimination. Although three consecutive doses of IVM were more efficient to eradicate the parasite, drug administration impaired gastrointestinal function and morphology. IVM alone affected gastrointestinal parameters in uninfected animals for prolonged periods, especially in high doses. In control, there were strong negative correlations between MSITT and muscle layers. Strongyloides venezuelensis infection abolishes such correlations. Longitudinal muscle was thinner in IVM3 and Sv/IVM3 groups and circular thicker in Sv group. Revisiting the action of traditional drugs broadens knowledge in the parasite-host interface and may result in the development of more accurate therapeutic strategies.

Hemorragia digestiva ocasional em criança por estrongiloidíase: importância do exame parasitológico / Occasional digestive hemorrhage in children due to strongyloidiasis: importance of parasitologic testing

RESUMO Objetivo: Descrever um caso incomum de infecção por Strongyloides stercoralis (S. stercoralis) em paciente de quatro meses de idade e ressaltar a importância do diagnóstico precoce. Descrição do caso: Paciente masculino, procedente e residente de Videira, Santa Catarina, Brasil, nasceu pré-termo, parto cesárea, peso de nascimento 1.655 g, e permaneceu na Unidade de Terapia Intensiva neonatal e intermediária por 20 dias. Aos quatro meses de idade, começou a evacuar fezes sanguinolentas e foi feita hipótese de alergia à proteína do leite de vaca, em razão da sintomatologia e do uso da fórmula infantil para o primeiro semestre, para o qual foi indicada a substituição por fórmula infantil com proteína hidrolisada. Foram solicitados a pesquisa de leucócitos e o exame parasitológico das fezes). Ambos se mostraram positivos e o parasitológico revelou a presença de larva rabditoide de S. stercoralis. O clínico manteve a hipótese inicial e a dieta, mas solicitou a coleta de três amostras de fezes, que resultaram em uma amostra para larvas rabditoide, em muda, de S. stercoralis. Como a criança apresentava dor abdominal, vômito e as fezes permaneciam sanguinolentas, foi iniciado o tratamento com tiabendazol - duas vezes/dia por dois dias -, repetido após sete dias, e, em seguida, realizado o exame parasitológico de fezes, tendo sido negativo. Comentários: A estrongiloidíase, apesar de ser uma infecção parasitária frequentemente leve, em pacientes imunocomprometidos pode se apresentar de forma grave e disseminada. Deve-se suspeitar desse agente em pacientes que vivem em áreas endêmicas, sendo o diagnóstico estabelecido por meio da pesquisa das larvas do S. stercoralis na secreção traqueal e nas fezes.

ABSTRACT Objective: To describe an uncommon case of infection by Strongyloides stercoralis (S. stercoralis) in a 4-month-old child and to highlight the importance of early diagnosis. Case description: The patient was a male child from the city of Videira, State of Santa Catarina, Southern Brazil, who was born preterm by Cesarean-section, weighing 1,655 g, and stayed in the neonatal intensive care unit for 20 days. At four months of age, the child started presenting blood in stools and the possibility of cow's milk protein allergy was considered, given the symptoms and the use of infant formula in his 1st semester of life, which was then replaced by infant formula with hydrolyzed protein. White blood cell count and a parasitological stool sample were requested. Both tested positive and the stool ova and parasite examination showed a rhabditoid larva of S. stercoralis. The clinician maintained the initial hypothesis and diet, but requested three new stool samples, which tested positive for rhabditoid larvae of S. stercoralis. Since the child presented abdominal pain and vomiting, and there was still blood in stools, treatment with thiabendazole was initiated twice a day for two days. Treatment was repeated after seven days along with a new parasitological examination, which was then negative. Comments: Although strongyloidiasis is usually a mild parasitic infection, it may be severe and disseminated in immunocompromised patients. This agent must be considered in patients who live in endemic areas, and the diagnosis should be established by searching S. stercoralis larvae in tracheal secretions and in stools.

OCCASIONAL DIGESTIVE HEMORRHAGE IN CHILDREN DUE TO STRONGYLOIDIASIS: IMPORTANCE OF PARASITOLOGIC TESTING. / HEMORRAGIA DIGESTIVA OCASIONAL EM CRIANÇA POR ESTRONGILOIDÍASE: IMPORTÂNCIA DO EXAME PARASITOLÓGICO.

OBJECTIVE: To describe an uncommon case of infection by Strongyloides stercoralis (S. stercoralis) in a 4-month-old child and to highlight the importance of early diagnosis. CASE DESCRIPTION: The patient was a male child from the city of Videira, State of Santa Catarina, Southern Brazil, who was born preterm by Cesarean-section, weighing 1,655 g, and stayed in the neonatal intensive care unit for 20 days. At four months of age, the child started presenting blood in stools and the possibility of cow's milk protein allergy was considered, given the symptoms and the use of infant formula in his 1st semester of life, which was then replaced by infant formula with hydrolyzed protein. White blood cell count and a parasitological stool sample were requested. Both tested positive and the stool ova and parasite examination showed a rhabditoid larva of S. stercoralis. The clinician maintained the initial hypothesis and diet, but requested three new stool samples, which tested positive for rhabditoid larvae of S. stercoralis. Since the child presented abdominal pain and vomiting, and there was still blood in stools, treatment with thiabendazole was initiated twice a day for two days. Treatment was repeated after seven days along with a new parasitological examination, which was then negative. COMMENTS: Although strongyloidiasis is usually a mild parasitic infection, it may be severe and disseminated in immunocompromised patients. This agent must be considered in patients who live in endemic areas, and the diagnosis should be established by searching S. stercoralis larvae in tracheal secretions and in stools.

OBJETIVO: Descrever um caso incomum de infecção por Strongyloides stercoralis (S. stercoralis) em paciente de quatro meses de idade e ressaltar a importância do diagnóstico precoce. DESCRIÇÃO DO CASO: Paciente masculino, procedente e residente de Videira, Santa Catarina, Brasil, nasceu pré-termo, parto cesárea, peso de nascimento 1.655 g, e permaneceu na Unidade de Terapia Intensiva neonatal e intermediária por 20 dias. Aos quatro meses de idade, começou a evacuar fezes sanguinolentas e foi feita hipótese de alergia à proteína do leite de vaca, em razão da sintomatologia e do uso da fórmula infantil para o primeiro semestre, para o qual foi indicada a substituição por fórmula infantil com proteína hidrolisada. Foram solicitados a pesquisa de leucócitos e o exame parasitológico das fezes). Ambos se mostraram positivos e o parasitológico revelou a presença de larva rabditoide de S. stercoralis. O clínico manteve a hipótese inicial e a dieta, mas solicitou a coleta de três amostras de fezes, que resultaram em uma amostra para larvas rabditoide, em muda, de S. stercoralis. Como a criança apresentava dor abdominal, vômito e as fezes permaneciam sanguinolentas, foi iniciado o tratamento com tiabendazol - duas vezes/dia por dois dias -, repetido após sete dias, e, em seguida, realizado o exame parasitológico de fezes, tendo sido negativo. COMENTÁRIOS: A estrongiloidíase, apesar de ser uma infecção parasitária frequentemente leve, em pacientes imunocomprometidos pode se apresentar de forma grave e disseminada. Deve-se suspeitar desse agente em pacientes que vivem em áreas endêmicas, sendo o diagnóstico estabelecido por meio da pesquisa das larvas do S. stercoralis na secreção traqueal e nas fezes.

Strongyloides venezuelensis infection augments arterial blood pressure in male wistar rats.

Strongyloidiasis is an intestinal parasitosis that occurs in humans infected by Strongyloides stercoralis mostly. At its acute phase, symptoms like constipation, diarrhea and abdominal pain can be observed, but become asymptomatic for a long time, until an immunosuppression will start a hyperinfection and the dissemination of the disease, prevalent on the elderly population in tropical countries. Ivermectina treatment is the currently choice for this disease, due to its great efficacy and the results reported. It is expected that around one hundred million individuals have been infected around the world. Strongyloides venezuelensis is an intestinal helminth utilized on Strongyloidiasis investigations, in rodents. As the parasites reach the blood stream after subcutaneous infection, the larvae migrate to the lung by systemic circulation, but the effects of S. venezuelensis in the circulation remain widely unknown. Moreover, the role played by S. venezuelensis in the cardiovascular function has been understudied. Thus, the aim of this study is to determine whether acute infection with S. venezuelensis alters systemic blood pressure or not. Male wistar rats were infected subcutaneously with 2000 L3 larvae of S. venezuelensis and monitored during 21 days (Infected group), compared to a Healthy group, no infected. Oviposition, body and faeces weight, water and food intake were determined every 3 days. Moreover, systemic blood pressure was assessed by tail cuff plethysmography. At the end of experiments, the animals were euthanized and the number of worms, ventricles, lung and thymus and small intestine weight were registered. It was possible to observe that systolic blood pressure (126.86 ± 2.74 vs 155.08 ± 7.61 at 9°-day post infection - dpi - and 134.44 ± 5.22 vs 157.77 ± 9.55 at 21° dpi) and mean arterial pressure (71.72 ± 1.59 vs 80.51 ± 2.32 at 21° dpi) were markedly higher (P < 0.001) in infected group in comparison to the Healthy group. Those changes occurred after larvae passes through the circulation and demonstrated a late response to the presence of this parasite. These results suggest that host circulatory system reacts to this infection resulting in a significant increase in blood pressure.

Streptococcus pyogenes bacteremia and toxic shock syndrome related to Strongyloides stercoralis hyperinfection: a case report.

BACKGROUND: We describe a patient with Strongyloides stercoralis hyperinfection associated with Streptococcus pyogenes and with streptococcal toxic shock syndrome. To the best of our knowledge this association has not been previously described. CASE PRESENTATION: A 78 year-old Israeli man, who was born in Iraq but lived in Israel for 66 years, presented with multi-organ failure including acute kidney and hepatic injury, coagulopathy, and lactic acidosis. He had a medical history including aortic valve replacement, diabetes mellitus, spinal stenosis, and low back pain treated with repeated local steroid injections. Blood cultures were positive for Streptococcus pyogenes and antibiotic treatment was switched to penicillin G, clindamycin, and intravenous immunoglobulins. Repeated physical examinations failed to identify the source of the bacteremia. On day 12 of hospitalization the serology results for Strongyloides stercoralis sent on admission, because of chronic eosinophilia, came back positive. A microscopic stool examination and stool polymerase chain reaction were positive for Strongyloides stercoralis. Ivermectin therapy was commenced and continued for a total of 4 weeks. He was discharged for rehabilitation after 25 days. He had no exposure to endemic countries or to immigrants. During many years he had multiple gastrointestinal symptoms, respiratory symptoms, cutaneous symptoms, chronic eosinophilia, and high immunoglobulin E levels. He underwent several operative procedures and numerous hospitalizations and medical encounters with different experts but a parasitic infection was not considered. His asymptomatic daughter was also found to be serologically positive. CONCLUSIONS: Strongyloides stercoralis hyperinfection associated with Streptococcus pyogenes bacteremia and toxic shock is described for the first time. The case also highlights the importance of history taking and reviewing past laboratory results, the utility of serological tests for Strongyloides stercoralis, and the importance of screening asymptomatic family members of an infected patient. Strongyloides stercoralis hyperinfection must be considered in the differential diagnosis of any patient with Streptococcus pyogenes bacteremia or toxic shock of no clear source as well as in symptomatic patients with chronic or intermittent eosinophilia, even without any epidemiological risk factors.

Electroacupuncture in rats infected with Strongyloides venezuelensis: effects on gastrointestinal transit and parasitological measurements.

OBJECTIVE: To investigate the effects of electroacupuncture (EA) at ST36 and CV12 on gastrointestinal transit and parasitological measurements during Strongyloides venezuelensis infection in rats. DESIGN: Rats were infected with S. venezuelensis and allocated to one of three groups that were infected and remained untreated (SV group, n=8), infected and treated with EA at CV12 (SV+CV12 group, n=8) or infected and treated with EA at ST36 (SV+ST36 group, n=8). EA was performed every 3 days over a 21-day period, at 4 mA intensity and 15 Hz frequency for 20 min. At 2 and 20 days post-infection (dpi), body weight, food and water intake, and faecal characteristics were monitored over a 24-hour period. Gastric emptying, caecal arrival time, small intestinal transit and eggs per gram (EPG) of faeces were calculated at 3, 9, 15 and 21 dpi. At 21 dpi, intestinal worm recovery was counted. RESULTS: EA at ST36 and CV12 slowed gastric emptying over the course of infection time. An accelerated intestinal transit was observed in the ST36 group, and after CV12 treatment the same effect was observed at 9 and 15 dpi. At 9 dpi, EPG was increased in the CV12 group. ST36 treatment decreased EPG at 9 and 15 dpi. At 21 dpi, both the ST36 and CV12 groups had increased EPG and worm numbers. No changes were observed in the other parameters analysed. CONCLUSIONS: EA at ST36 and CV12 provoked changes in gastrointestinal transit that may be beneficial to the host during S. venezuelensis infection; however, based on the number of worms and EPG at 21 dpi, the indication for EA in the treatment of strongyloidiasis needs to be carefully assessed.

Strongyloides stercoralis is associated with significant morbidity in rural Cambodia, including stunting in children.

BACKGROUND: Strongyloides stercoralis is a soil-transmitted nematode that can replicate within its host, leading to long-lasting and potentially fatal infections. It is ubiquitous and highly prevalent in Cambodia. The extent of morbidity associated with S. stercoralis infection is difficult to assess due to the broad spectrum of symptoms and, thus, remains uncertain. METHODOLOGY/PRINCIPAL FINDINGS: Clinical signs were compared among S. stercoralis infected vs. non-infected participants in a cross-sectional survey conducted in 2012 in eight villages of Northern Cambodia, and before and after treatment with a single oral dose of ivermectin (200µg/kg BW) among participants harboring S. stercoralis. Growth retardation among schoolchildren and adolescents was assessed using height-for-age and thinness using body mass index-for-age. S. stercoralis prevalence was 31.1% among 2,744 participants. Urticaria (55% vs. 47%, OR: 1.4, 95% CI: 1.1-1.6) and itching (52% vs. 48%, OR: 1.2, 95% CI: 1.0-1.4) were more frequently reported by infected participants. Gastrointestinal, dermatological, and respiratory symptoms were less prevalent in 103 mono-infected participants after treatment. Urticaria (66% vs. 11%, OR: 0.03, 95% CI: 0.01-0.1) and abdominal pain (81 vs. 27%, OR: 0.07, 95% CI: 0.02-0.2) mostly resolved by treatment. S. stercoralis infection was associated with stunting, with 2.5-fold higher odds in case of heavy infection. CONCLUSIONS/SIGNIFICANCE: The morbidity associated with S. stercoralis confirmed the importance of gastrointestinal and dermatological symptoms unrelated to parasite load, and long-term chronic effects when associated with malnutrition. The combination of high prevalence and morbidity calls for the integration of S. stercoralis into ongoing STH control measures in Cambodia.

Estrongiloidiasis autóctona en Asturias / Strongyloidiasis native to Asturias

No disponible