Resumen La Estrongiloidiasis humana producida por el nemбtodo Strongyloides stercoralis, representa todavнa un problema de diagnуstico y el tratamiento, a pesar de los avances alcanzados con el uso de nuevas drogas, no se puede afirmar que es totalmente satisfactorio. El sнndrome de hiperinfecciуn, la forma mбs grave de esta helmintiasis, continъa siendo un reto al tratamiento y su mortalidad es aъn alta. En adiciуn, la existencia de vacнos en nuestro conocimiento sobre la inmunobiologнa del parбsito y de la relaciуn huйsped-parбsito, impiden la comprensiуn total de la fenomenologнa sintomбtica y evolutiva de la enfermedad. En el presente artнculo, se hace una extensa revisiуn de los diferentes tуpicos, involucrados en la estrongiloidiasis humana. Summary Human Strongyloidiasis due to nematode strongyloides stercoralis, represents a diagnostic problem, and its treatment with new drugs is better than before but no completely successful. Hyperinfection syndrome, the most severe clinical form of this helminthiasis, represents a challenge for treatment, and has a very high mortality index.
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Strongyloidiasis is a chronic parasitic infection of humans caused by Strongyloides stercoralis. Transmission occurs mainly in tropical and subtropical regions but also in countries with temperate climates. An estimated 30— million people are infected worldwide; precise data on prevalence are unknown in endemic countries.
Infection is acquired through direct contact with contaminated soil during agricultural, domestic and recreational activities. Like other soil-transmitted helminthiases, the risk of infection is associated with hygiene, making children especially vulnerable to infection. Strongyloidiasis is frequently underdiagnosed because many cases are asymptomatic; moreover, diagnostic methods lack sensitivity. Without appropriate therapy, the infection does not resolve and may persist for life.
Infection may be severe and even life-threatening in cases of immunodeficiency. No public health strategies for controlling the disease are active at the global level.
Some 30— million people are estimated to be infected worldwide probably an underestimate. Transmission cycle Strongyloidiasis is transmitted through direct penetration of human skin by infective larvae when in contact with soil; walking barefoot is therefore a major risk factor for acquiring the infection. Strongyloides spp. Symptoms Strongyloidiasis may cause intermittent symptoms that mostly affect the intestine abdominal pain and intermittent or persistent diarrhoea , the lungs cough, wheezing, chronic bronchitis or skin pruritus, urticaria.
Asymptomatic cases may host the parasites for years unaware of the infection. Although strongyloidiasis has usually mild manifestations, the infection may be severe and life-threatening in cases of immunodeficiency haematological diseases, immunosuppressive therapies.
For this reason it is extremely important to suspect, diagnose and treat the infection. Diagnosis and therapy Diagnosis of strongyloidiasis is not standardized. Alternative tests serology and polymerase chain reaction are more efficient. Ivermectin, thiabendazole and albendazole are the most effective medicines for treating the infection. Albendazole is considered the least effective.
Ivermectin, the drug of choice, is not available in all endemic countries. Moreover, the optimal schedule has yet to be defined. Prevention and control No public health strategy has been developed to control strongyloidiasis. Strongyloidiasis has almost disappeared in countries where sanitation and human waste disposal have improved.
In areas where mass treatment with ivermectin has been used to control onchocerciasis or lymphatic filariasis, the prevalence of strongyloidiasis is probably reduced, but further investigation is needed.
Summary More detailed epidemiological data on the global distribution of strongyloidiasis are needed. Health-care providers should be made aware of this parasite, and particularly about the risk of disseminated infections. Control of the parasite through preventive chemotherapy and evaluation of existing campaigns for lymphatic filariasis control based on the distribution of ivermectin and albendazole may provide important indications for developing a public health strategy.
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In the case of Strongyloidesautoinfection may explain the possibility of persistent infections for many years in persons who have not been in an endemic area and of hyperinfections in immunodepressed individuals. Physical examination revealed a slightly distended abdomen and no other abnormalities. Image taken at x magnification. Upper and lower endoscopy was performed and revealed mild duodenal atrophy and colonic erythema. Notice the short buccal canal and the genital primordium red arrows. The principal aim of the journal is to publish original work in the broad field of Gastroenterology, as well as to provide information on the specialty estrongiloldiasis related areas that is up-to-date and relevant.
Signs and symptoms[ edit ] Strongyloides life cycle Strongyloides infection occurs in five forms. The infection may then become chronic with mainly digestive symptoms. On reinfection when larvae migrate through the body from the skin to the lungs and finally to the small intestine, there may be respiratory, skin and digestive symptoms. Finally, the hyperinfection syndrome causes symptoms in many organ systems, including the central nervous system. Pulmonary infiltrate may be present through radiological investigation.
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