The diagnosis and treatment of human strongyloidiasis: a prospective study - abstract

ABSTRACT

A prospective hospital-based study evaluating the accuracy of diagnostic instruments in human strongyloidiasis is reported together with a reassessment of standard anti-helminthic therapy by strict criteria for cure. Eleven patients, 7 men and 4 women, whose ages ranged from 16 to 70 (median 53) years were studied before treatment. Four (1 man, 3 women) were assessed before 2 consecutive courses of treatment. The following tests were done (1) formol-ether stool concentration, (2) Harada-Mori stool culture for 24 and 48 hours, direct microscopy of (3) duodenal aspirate and (4) duodenal mucosal biopsy, (5) duodenal mucosal biopsy histology, (6) examination for parsitic adults in stools collected over 48 hours after beginning treatment with thiabendazole (25 mg/kg twice daily) for 10 days. The results are given in the Table. Tests (1) - (5) were repeated 2 months after treatment, but Harada-Mori culture was continued for 7 days. Post-treatment assessment was completed in 9 of 11 patients (1 died, 1 default) and in 3 who were treated and assessed twice. Of 12 treatments, 9 failed (75 percent), although the number of parasites appeared reduced in all but 2 (17 percent). Results that was shown in the table as follows TECHINQUE (n) are - Harada-Mori, Formol-ether, Duodenal aspirate, Mucosal Biopsy(a) Microscopy, (b) Histology; SENSITIVITY ( percent) - PRE-TREATMENT (15)- 93, 87, 73, 53, 33 respectively; POST-TREATMENT (12)- 100, 67, 44, 33, 11 respectively. The Harada-Mori stool culture technique appears to be the single, most sensitive, diagnostic test. Although it may need to be supplemented with other tests to achive maximun diagnostic accuracym it is recommended that where strongyloidiasis is suspected, it becomes a standard diagnostic method. Formol-ether concentration is less sensitive in low-intensity infection. Previous studies from Jamaica have reported similarly low cure rate in contrast to those achieved in developed countries. Failure of treatment may indicate interaction between nutritional status and immuno-competence (AU)