Whole gut irrigation in strongyloidiasis - abstract

ABSTRACT

Two patients with chronic Strongyloidiasis, refractory to conventional therapy, were studied by whole gut irrigation and high-dose antihelminthic therapy. Saline (0.9 percent) was given via naso-gastric tube at 50 ml per minute. After solid material was cleared, the gut effluent was collected in 10-minute samples. After one hour baseline collection, mebendazole (1,800 mg in patient 1) or levamisole (1,100 mg in patient 2) was given. Irrigation and collection continued for a further 140 and 170 minutes respectively. Parasitic forms were collected and counted in each sample. In the mebendazole treated patient the spontaneous egg- and larval-shedding rate was 1,501/minute. This was not affected by mebendazole treatment. Adults first appeared in the effluent at 1 hour after treatment and the numbers were increasing at the termination of the infusion. Nineteen adults were recovered. Follow-up showed no diminution in the intensity of infection, demonstrating that only a small proportion of the available adults had been recovered or expelled. In the levamisole treated patient, the pre-treatment effluent contained 49,041 larvae/minute and no adult forms. In contrast to mebendazole, after treatment with levamisole, there was a massive efflux of adults which had not returned to baseline after 3 hours; 88,729 adults were recovered. The post-treatment infection level was reduced dramatically and a further 15,000 adults were recovered within 24 hours. There was no increase in larval output with levamisole. It is concluded that neither mebendazole nor levamisole has a direct on Strongyloides larvae. However, they are both active against the adult forms, with the potency of levamisole appearing to be greater than that of mebendazole. Treatment with these drugs may have to continue for longer than the full maturation time of endogenous larvae. This may be in excess of 4 weeks (AU)