The kinetic profile of clinical and laboratory findings and treatment outcome of patients with toxocariasis.

OBJECTIVES: Human toxocariasis is a widespread zoonosis for which a chemotherapy decision and therapy effectiveness are difficult to determine. We aimed to investigate the kinetic profile of clinical and laboratory findings and treatment outcome of patients with toxocariasis in Vietnam. METHODS: The prospective study was conducted between October 2017 and June 2019. The diagnosis of toxocariasis was established based on clinical, laboratory (eosinophilia, raised IgE concentration) and serological (positive Toxocara IgG ELISA) evaluation as well as the exclusion of another helminthic co-infection. The patients were followed up after seven days, then one, three and six months after chemotherapy by thiabendazole. RESULTS: The study involved 80 patients with a mean age of 41.6 ± 15.2 years of whom 58.8% were female. At three and six months after chemotherapy, most patients demonstrated resolution of clinical signs and symptoms, eosinophil count and IgE concentration but not in the proportion of IgG seropositivity. Skin lesions and eosinophilia resolved earlier than the other symptoms (one month after treatment). About four-fifths of the patients were "cured" after three and six months of follow-up; 33.8% showed side effects to thiabendazole therapy but no severe events were reported. The most common adverse reaction was neurologic symptoms followed by gastrointestinal or skin manifestations which lasted as long as 4 days. CONCLUSIONS: In toxocariasis patients, cutaneous manifestations and eosinophilia resolve more rapidly than other clinical and laboratory findings while IgG titre has a very slow kinetic after therapy. Thiabendazole seems to be a potential alternative for the treatment of human toxocariasis.

Clinical interventions for tungiasis (sand flea disease): a systematic review.

Tungiasis (sand flea disease) is an epidermal parasitic skin disease occurring in resource-limited communities. There is no standard treatment for tungiasis, and available treatment options are scarce. To our knowledge, this is the first systematic review aimed to assess randomised controlled trials (RCTs) investigating interventions for tungiasis. We systematically searched databases including MEDLINE (EBSCOhost), CENTRAL, CINAHL, PubMed, Web of Science, SciELO, LILACS and Embase (Scopus) for RCTs in any language, from inception of the databases until June 12, 2021. RCTs exploring preventive and therapeutic interventions for tungiasis were eligible. We used the revised Cochrane Collaboration's risk of bias tool to assess the risk of bias and Jadad scale to quantify the methodological quality of the RCTs. Of the 1839 identified records, only eight RCTs involving 808 participants were included, and several methodological deficiencies were identified in most of the trials. Trial interventions included: oral drugs niridazole and ivermectin and topical interventions of ivermectin lotion, metrifonate lotion, thiabendazole lotion, thiabendazole ointment, dimeticones (NYDA), and a neem seed and coconut oils-based mixture for treatment and coconut oil-based lotion (Zanzarin) for prevention. The coconut oil-based lotion for prevention and dimeticones for treatment of tungiasis have displayed the most promise. Most of the RCTs included in this study had low methodological quality. There is a clear unmet need for high-quality RCTs examining safe and effective prevention and treatment alternatives of tungiasis in endemic settings.

Modulation of immune functions, inflammatory response, and cytokine production following long-term oral exposure to three food additives; thiabendazole, monosodium glutamate, and brilliant blue in rats.

The food additives thiabendazole (TBZ), monosodium glutamate (MSG), and brilliant blue (BB) are commonly used in many daily-consumed food products worldwide. They are widely used in major agricultural and industrial applications. Yet, many of its toxicological aspects are still unclear, especially immune modulation. This research was therefore intended to investigate the effects of male Wistar rats' daily oral exposure for 90 days to TBZ (10 mg/kg b.wt), MSG (20 mg/kg b.wt), or BB (1.2 mg/kg b.wt) on the blood cells, immunity, and inflammatory indicators. The three tested food additives showed varying degrees of hematological alterations. Initially, megaloblastic anemia and thrombocytopenia were evident with the three tested food additives. At the same time, TBZ showed no significant changes in the leukogram element except eosinopenia. MSG induced leukopenia, lymphocytopenia, neutrophilia, and eosinophilia. BB evoked neutrophilia and lymphopenia. The immunoglobins M (IgM) and IgG were significantly reduced with the three tested food additives. In contrast, lysozyme and nitric oxide levels were elevated. A reduced considerably lymphocyte proliferation was detected with TBZ and MSG exposure without affecting the phagocytic activity. Various pathologic disturbances in splenic tissues have been detected. An obvious increase in CD4+ but a lessening in CD8+ immunolabeling was evident in TBZ and MSG groups. The cytokines, including interferon-gamma, tumor necrosis factor-alpha, and interleukin 1ß, 6, 10, and 13, were significantly upregulated in the spleen of rats exposed to TBZ, MSG, and BB. These results concluded that TBZ, MSG, and BB negatively affect hematological parameters, innate and humoral immune functions together with inflammatory responses. TBZ achieved the maximal negative impacts followed by MSG and finally with BB. Given the prevalence of these food additives, TBZ and MSG should be limited to a minimal volume use, or natural food additives should be used instead.

Efeito combinado de carvacrol e tiabendazol contra Colletotrichum gloesporioides, Fusarium solani e Alternaria alternata / Combined effect of carvacrol and thiabendazole against Colletotrichum gloesporioides, Fusarium solani and Alternaria alternata

O objetivo deste trabalho foi determinar a atividade antimicrobiana do carvacrol e sua combinação com tiabendazol no controle de fungos patogênicos deteriorantes de frutas (Colletotrichum gloesporioides, Fusarium solani e Alternaria alternata). O carvacrol apresentou uma concentração inibitória mínima (CIM) de 282 a 563 μg mL-1 para os fungos testados. Quando avaliado em conjunto com o tiabendazol apresentou efeito aditivo contra C. gloesporioides e F. solani (FICI 0,5 e 1,0, respectivamente) e sinérgico contra a A.alternata (FICI 0,1). Houve redução da CIM do carvacrol de 50 a 88%. Este estudo mostra o potencial do uso.

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.

Infestación masiva por larva migrans / Massive infestation with larva migrans

No disponible

The first reported case of resistance of gastrointestinal nematodes to benzimidazole anthelmintic in goats in Poland

Fecal egg count reduction (FECR) test with albendazole and egg hatch test (EHT) with thiabendazole (TBZ) were performed in a dairy goat herd suspected of anthelmintic resistance to benzimidazoles. The herd had been regularly dewormed with fenbendazole for 5 previous years and despite that it remained infected with several species of gastrointestinal nematodes (Trichostrongylus colubriformis, Teladorsagia circumcincta, and Haemonchus contortus). Albendazole was administered per os at dose of 20 mg/kg to 10 goats (treated group), while 10 other goats remained untreated (control group). Fecal egg count (FEC) was determined using McMaster egg counting method before and 7 days after the treatment in the treated group, and once (at the latter moment) in the control group. EHT was performed on the pooled rectal sample collected from treated goats. EHT comprised the negative control and 7 consecutive concentrations of TBZ (0.05, 0.1, 0.2, 0.3, 0.5, 1.0, 2.0 µg/ml) according to the standard procedure. Two hundred eggs/larvae were counted to determine percentage of unhatched eggs, which was adjusted by the natural mortality. TBZ dose effective in preventing hatching of 50% of eggs (ED50) was determined using the log-probit transformation. Median FEC (range) before the treatment was 1000 (250­3450) epg in the treated group and dropped to 150 (50­500) epg after the treatment (p=0.005). Median FEC (range) after the treatment was also significantly lower in the treated than in control group (p=0.009), where it was 725 (0­5050) epg. FECR between the treated and control group was 81% (95% CI: 49%, 93%). FECR in the treated group was 83% and 74% based on average and individual approach, respectively. ED50 value of TBZ was 0.78 µg/ml. Only H. contortus persisted in the treated group after treatment. The results indicate resistance of H. contortus to a benzimidazole anthelmintic, which is the first such case reported in Polish goats.

Five cases of recurrent meningitis associated with chronic strongyloidiasis.

Although meningitis secondary to chronic strongyloidiasis is a rare complication, it is associated with a high mortality rate. Recurrent meningitis can occur if the underlying parasitic infection is left untreated. We report five cases of recurrent meningitis related to chronic strongyloidiasis that were associated with human T-lymphotropic virus type 1 (HTLV-1) infection. Common causative organisms are Escherichia coli, Streptococcus bovis, and Klebsiella pneumonia. One patient died during the second episode of meningitis. Three patients showed significant gastrointestinal and respiratory symptoms before developing headache and fever. In four cases, patients developed multiple recurrences even with the treatment of thiabendazol. Ivermectin seems to be a better agent compared with thiabendazol to achieve eradication of strongyloidiasis.

Tungíase atualidades clínicas / Tungiase clinical news

O objetivo deste artigo é revisar as características clínicas da tungíase. A Tunga penetrans é a menor das pulgas conhecidas, alcançando 1 milímetro de comprimento quando atinge a fase adulta. Os relatos antigos de surtos de tungíase são escassos em relação aos registros epidemiológicos. O diagnóstico da doença é realizado através da história epidemiológica e dos achados clínicos, aliados ao exame direto com visualização do parasita, após abertura da lesão com agulha estéril. A retirada da pulga é o tratamento preconizado, sendo a profilaxia a melhor alternativa para controlar o parasita. Os profissionais de saúde devem atentar para a importância de se orientar as populações de áreas endêmicas em relação à doença, a fim de reduzir o número de casos e de complicações.

The purpose of this article is to review the clinical features of tungiasis. Tunga penetrans is the smallest known flea, reaching a millimeter in length when fully grown. The earliest accounts of outbreaks of tungiasis are scarce in relation to epidemiological records. The diagnosis is made by history and clinical epidemiological findings, coupled with the direct examination with visualization of the parasite after opening the wound with a sterile needle. The removal of the flea is the recommended treatment, and prophylaxis the best way to control the parasite. Healthcare professionals should be aware as to the importance of educating the public in endemic areas for the disease in order to reduce the number of cases and complications.

Analysis of putative inhibitors of anthelmintic resistance mechanisms in cattle gastrointestinal nematodes.

Effects of the cytochrome P450 inhibitor piperonyl butoxide and the P-glycoprotein inhibitor verapamil on the efficacy of ivermectin and thiabendazole were studied in vitro in susceptible and resistant isolates of the cattle parasitic nematodes Cooperia oncophora and Ostertagia ostertagi. The effects of combined use of drug and piperonyl butoxide/verapamil, respectively, were investigated in the Egg Hatch Assay, the Larval Development Assay and the Larval Migration Inhibition Assay. The effects of piperonyl butoxide and verapamil as inhibitors of thiabendazole and ivermectin responses were particularly marked for larval development, where both inhibitors were able to completely eliminate all differences between susceptible and resistant isolates. Even the lowest concentrations of anthelmintics used in combination with inhibitors caused complete inhibition of development. Differences and/or similarities among responses in different isolates were only obtained in the two other assays: in the Egg Hatch Assay piperonyl butoxide caused a shift in concentration-response curves obtained with thiabendazole to the left for all isolates tested, changing relative differences between isolates. In contrast, an effect of verapamil in the Egg Hatch Assay was only apparent for benzimidazole-resistant isolates. In the Larval Migration Inhibition Assay only ivermectin was tested and piperonyl butoxide shifted the concentration-response curves for all isolates to the left, again eliminating differences in EC50 values between susceptible and resistant isolates. This was not the case using verapamil as an inhibitor, where curves for both susceptible and benzimidazole-resistant isolates shifted to the left in Ostertagia isolates. In Cooperia the picture was more complex with ivermectin-resistant isolates showing a larger shift than the susceptible isolate. Single nucleotide polymorphisms in the ß-tubulin isotype 1 gene were investigated. Significantly increased frequencies of resistance-associated alleles were observed for the codons 167 and 200 in one benzimidazole-resistant isolate but not in an isolate selected for benzimidazole resistance at an early stage of selection.

Comparisons of metabolic and physiological changes in rats following short term oral dosing with pesticides commonly found in food.

¹H Nuclear Magnetic Resonance spectroscopy has been used to profile urinary metabolites in male Fischer F344 rats in order to assess the metabolic changes induced by oral exposure to two benzimidazole fungicides (carbendazim and thiabendazole) and two bipyridyllium herbicides (chlormequat and mepiquat). Exposure levels were selected to be lower than those expected to cause overt signs of toxicity. We then compared the sensitivity of the metabolomics approach to more traditional methods of toxicity assessment such as the measurement of growth and organ weights. Separate, acute exposure experiments were conducted for each pesticide to identify potential metabolic markers of exposure across four doses (and a control). Growth, organ weights and feeding/drinking rates were not significantly affected by any compounds at any dose levels tested. In contrast, metabolic responses were detected within 8 and 24h for chlormequat and mepiquat, and after 24h for carbendazim and thiabendazole. These results demonstrate the potential for the use of metabolomics in food toxicity testing.

[Distribution and elimination of thiabendazole and its metabolite residue in laying hens].

OBJECTIVE: To explore the distribution and elimination of thiabendazole and its metabolite 5-hydrothiabendazole residues in the hens tissues including liver, muscle, heart, fat, as well as in eggs. METHODS: Laying hens were orally administred thiabendazole for 5 consecutive days (100mg per hen daily) and then the hens were sacrificed at the times of 1 day, 3 days, 5 days and 7 days after the end of treatment. Eggs, liver,muscle,fat and heart tissues were collected and homogenized. The samples were extracted by acetonitrile, further concentrated and purified by an Oasis MCX cartridge, and then the contents of thiabendazole and 5-hydrothiabendazole in tissue homogenates determinated by liquid chromatography electrospray ionisation tandem mass spectrometry (UPLC-ESI-MS/MS). RESULTS: The major residues in the tissue homogenates was 5-hydroxythiabendazole, with more higher concentrations than thiabendazole. Egg samples presented the large majority of both drug residues. For the tissue homogenates,the total concentrations of thiabendazole and 5-hydrothiabendazole residues followed the order of liver > heart > muscle > fat at 1 day after the treatment. The withdrawal period of thiabendazole for eggs was about 7 days. CONCLUSION: Distribution and elimination of thiabendazole and its metabolite residues in laying hens were primarily studied in this study.

Testing intra-hemocelic injection of antimicrobials against Encephalitozoon sp. (Microsporidia) in an insect host.

Encephalitozoon spp. are the primary microsporidial pathogens of humans and domesticated animals. In this experiment, we test the efficacy of four commercial antimicrobials against an Encephalitozoon sp. in an insect host by intra-hemocelic injection. All four antimicrobials, viz., thiabendazole, quinine, albendazole, and fumagillin, significantly reduced but did not eliminate microsporidia spore counts in the grasshopper host. Among these four drugs, thiabendazole was most effective in reducing the microsporidia spore level up to 90%, followed by quinine (70%), albendazole (62%), and fumagillin (59%). No control or quinine-treated animals died, whereas 45% of albendazole animals died. Despite the high mortality induced by albendazole, this drug significantly reduced spore counts, a result not seen in previous per os trials. Among the treatment groups, grasshoppers injected with thiabendazole lost a significant mass. Our study suggests that quinine and related alkaloids should be further examined for antimicrosporidial activity.

Factors affecting the synergy of thiabendazole, sodium bicarbonate, and heat to control postharvest green mold of citrus fruit.

The efficacy of thiabendazole (TBZ) to control postharvest decay caused by Penicillium digitatum of citrus fruit can be enhanced by co-application with sodium bicarbonate (SBC) and/or heat treatment. The impact of these treatments was investigated in citrus fruit, as a function of TBZ and SBC concentration and temperature, and were related to the amount of TBZ residues in fruit (total residues), in fruit surface, in the cuticular wax, and in the inner fruit. The residue levels of TBZ were determined in 'Valencia' oranges following a 1 min dip in an aqueous mixture of SBC at 0.5, 1, or 2 wt %/vol and TBZ at 600 or 400 mg/L (active ingredient, a.i.) at 20 or 40 degrees C and after 0 and 20 days at 17 degrees C and 90% relative humidity. The influence of SBC and heat on the TBZ residue concentration on the fruit surface, in cuticular wax, and on the inner cuticle tissue was determined in 'Salustiana' oranges after a 1 or 3 min dip in TBZ alone at 600 mg/L and 20 or 50 degrees C or for 1 min in TBZ at 600 mg/L and SBC at 2% and 20 degrees C. The efficacy of heat treatments with water, SBC, and TBZ, applied separately or in combination, was investigated on artificially inoculated 'Nova' mandarins and 'Valencia' oranges for the control of postharvest green mold caused by a TBZ-sensitive (TBZ-s) or TBZ-resistant (TBZ-r) isolate of P. digitatum. The residue levels of TBZ in fruit, evaluated as total residues, were not affected by the co-application of SBC in most samples. While TBZ residues in the fruit surface were not significantly affected by the dip temperature or by co-application of SBC, the rates of diffusion and penetration of TBZ into cuticular wax markedly increased in the presence of SBC or when TBZ was applied in combination with heat. TBZ residues in the inner tissue of fruits treated at 20 degrees C were not dependent upon the dip time or by the presence of SBC and were similar to those found in fruit treated with TBZ at 50 degrees C for 1 min, whereas significantly higher values were recorded in samples treated with TBZ at 50 degrees C for 3 min. When TBZ at 600 mg/L and 20 degrees C was applied in the presence of SBC at concentrations of 1-2 or 0.5-2%, it effectively reduced decay caused by the TBZ-resistant isolate of green mold in 'Nova' mandarins and 'Valencia' oranges. This treatment was also significantly more effective than TBZ alone to control green mold caused by a TBZ-s isolate in 'Valencia' oranges. The combination with SBC and mild heat (40 degrees C) and TBZ at 400 mg/L generally improved the control of a TBZ-r isolate of green mold with respect to the combined treatment at 20 degrees C. TBZ efficacy was also improved when applied at reduced rates (200 mg/L) and 50 degrees C, significantly suppressing green mold caused by a TBZ-s isolate of P. digitatum and effectively controlling a TBZ-r isolate. The rate of weight loss of 'Valencia' oranges was significantly increased by SBC treatment and was positively dependent upon the concentration of SBC used in the treatment, while the temperature of the treatment solution had little influence on later weight loss.

Infecção pulmonar por Strongyloides stercoralis em paciente tratado com imunosupressores / Case report: Pulmonary infection by Strongyloides stercoralis in a patient treated with immunosupressors

Strongyloides stercoralis é um parasito predominantemente intestinal. Nos casos graves, pode evoluir para a forma disseminada, principalmente se houver utilização prolongada de glicocorticóides, medicamentos imunodepressores ou radioterapia. Relata-se, neste estudo, o caso de P.F.C.S., do sexo feminino, 16 anos, proveniente da comunidade Menino de Deus na ilha de Pratari, município de Manacapuru, estado do Amazonas, Brasil, com diagnóstico de anemia hemolítica auto-imune desde agosto de 2005. Nenhum dos exames parasitológicos de fezes apresentou positividade para Strongyloides stercoralis, tendo sido detectado apenas no exame de escarro. Foi tratada com tiabendazol, via oral, sem resultado favorável e evoluiu para óbito. Ficou evidenciada a importância da realização de exames complementares, como o parasitológico de fezes, antes da utilização de medicamentos indicados para o tratamento de anemia hemolítica.

Effect of four antimicrobials against an Encephalitozoon sp. (Microsporidia) in a grasshopper host.

Encephalitozoon spp. are the primary microsporidial pathogens of humans and domesticated animals. In this experiment, we test the efficacy of 4 commercial antimicrobials against an Encephalitozoon sp. infecting a grasshopper (Romalea microptera) host. Oral treatment with fumagillin or thiabendazole significantly reduced pathogen spore counts (93% and 88% respectively), whereas spore counts of grasshoppers fed quinine produced a non-significant 53% reduction in spores, and those fed streptomycin a non-significant 29% increase in spores, compared to the control. We observed a moderate dose-response effect for thiabendazole, whereby spore count decreased as drug consumption increased. No thiabendazole-treated animals died, whereas 27% of streptomycin-treated animals died, suggesting that thiabendazole was not toxic at the doses administered. The deaths among streptomycin-treated animals may have been caused by drug toxicity, parasite burden, or both. Although fumagillin and thiabendazole significantly reduced spore counts, in no individual was the pathogen totally eliminated. Our data confirm that microsporidia are difficult to control and that fumagillin and thiabendazole are partially effective antimicrobials against this group. Our study suggests that quinine and related alkaloids should be further examined for antimicrosporidial activity, and streptomycin should be examined as a possible enhancer of microsporidiosis.

Comparison of various anthelmintic therapies for the treatment of Trypanoxyuris microon infection in owl monkeys (Aotus nancymae).

Trypanoxyuris microon is a pinworm that infects New World nonhuman primates, including Aotus nancymae. Although it typically is clinically insignificant, infection may serve as a significant variable during experimental data analysis. In this study we sought to determine the most effective anthelmintic therapy for eradication of T. microon infection in A. nancymae. Animals confirmed to be infected with T. microon by perianal tape test were treated twice (on days 0 and 14) with pyrantel pamoate, ivermectin, or thiabendazole and evaluated for eggs by daily perianal tape test throughout the entire 28-d period. Successful clearance of eggs was defined as 5 consecutive negative perianal tape tests. Pyrantel pamoate and ivermectin were significantly more effective at egg clearance than were thiabendazole and no treatment. Overall, 100% of the pyrantel pamoate and ivermectin treatment groups were cleared of infection after 2 treatments, whereas only 60% of the thiabendazole group became negative for pinworm eggs. In addition, the time after treatment until clearance was 1 to 2 d for pyrantel pamoate, 2 to 4 d for thiabendazole, and 4 to 6.5 d for ivermectin. These results indicate that pyrantel pamoate was the most effective and rapidly acting anthelmintic for the treatment of adult T. microon infection, with ivermectin as a suitable alternative. However because of the potential for continued development of immature stages or reinfection, anthelmintic doses should be repeated after 1 to 2 wk, in combination with effective environmental sanitation.