exudates and Strongyloidiasis

Strongyloides stercoralis is an intestinal nematode infecting humans. The actual prevalence of infestation with this parasite in our setting is not well established. Thus, this study was conducted to determine the age, sex and co-morbid conditions among patients with S. stercoralis infestation as well as to study the common manifestations of strongyloidiasis in our patients. Records of patients with positive S. stercoralis larvae from January 2000 to December 2012 in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan were reviewed. Ten patients were male and two were female. Their ages ranged from 19 to 78 years old. The majority (92%) of cases, presented with intestinal symptoms and 50% with moderate to severe anaemia. Thirty percent of cases had extraintestinal manifestations such as cough, sepsis and pleural effusion. Ninety-two percent of the patients had a comorbid illness. Most patients were immunocompromised, with underlying diabetes mellitus, retroviral disease, lymphoma and steroid therapy contributing to about 58% of cases. Only 58% were treated with anti-helminthic drugs. Strongyloidiasis is present in our local setting, though the prevalence could be underestimated.

Topics: Adult; Aged; Animals; Comorbidity; Female; Hospitals, Teaching; Humans; Malaysia; Male; Prevalence; Strongyloides stercoralis; Strongyloidiasis; Tertiary Care Centers; Young Adult

Strongyloides stercoralis infection can persist in the host for several decades, and patients with cancer and other clinical conditions who are exposed to immunosuppressive therapy are at risk of developing hyperinfection.. This is a case of angioimmunoblastic T-cell lymphoma (AITL) in a patient with lymphadenopathy and bulky neck mass. Severe sepsis and episodes of diarrhea were observed upon the first cycle of cyclophosphamide, doxorubicin, oncovin (vincristine) and prednisone (CHOP) regime chemotherapy preceded by high dose of dexamethasone. There was Klebsiella pneumoniae bacteremia and moderate eosinophilia. Rhabditiform S. stercoralis larvae were observed in the stool, and this was confirmed by real-time PCR. Strongyloides-specific IgG and IgG4 were also positive. The patient was treated with oral albendazole (400mg/day) for 3 days and intravenous tazocin (4.5gm/6 hours) for 5 days; however he succumbed following multi-organ failure.. This is likely a case of Strongyloides hyperinfection with secondary bacteremia.

Topics: Aged; Animals; Cyclophosphamide; Diarrhea; Doxorubicin; Fatal Outcome; Humans; Immunoblastic Lymphadenopathy; Injections, Intravenous; Malaysia; Male; Prednisone; Shock, Septic; Strongyloides stercoralis; Strongyloidiasis; Treatment Outcome; Vincristine

A lateral flow rapid test for strongyloidiasis will greatly facilitate the control and elimination of the disease. Previously SsRapid prototype rapid test showed high diagnostic specificity to detect Strongyloides infection, determined using non-Strongyloides sera negative by IgG-ELISAs. Since high specificity is crucial before a test is used for public health control activities, further validation of its specificity is needed. Also, it needs to be ascertained whether non-Strongyloides sera positive by IgG-ELISAs and SsRapid are truly positive for Strongyloides or are cases of cross-reactivity. We performed 84 rapid tests (two types of dipsticks and cassettes) using 34 serum samples. They were divided into four groups based on Strongyloides infection and coinfection with other parasites and the availability of recombinant proteins and rapid tests for the latter. Sera was adsorbed using polystyrene microspheres beads separately coated with four recombinant parasite proteins. The small sample size is a limitation of this study; however, the overall results showed that the sera adsorption procedure was successful, and the SsRapid test is specific.

Topics: Adsorption; Animals; Antibodies, Helminth; Humans; Immunoglobulin G; Malaysia; Sensitivity and Specificity; Serologic Tests; Strongyloides stercoralis; Strongyloidiasis

This cross-sectional study aimed to determine the prevalence and risk factors of S. stercoralis infection among 1142 Orang Asli primary schoolchildren in six different states of Peninsular Malaysia. Fecal samples were examined using direct smear, formalin-ether sedimentation (FES), agar plate culture (APC) and PCR techniques. Overall, 15.8% of the children were found to be infected with S. stercoralis. The prevalence was 0.2, 1.3, 15.2 and 13.7% by direct smear, FES, APC and PCR, respectively. Multivariate analysis showed that an age of >10 years, being male, belonging to a Proto-Malay tribe, belonging to the Senoi tribe, indiscriminate defecation, using an unimproved water source for drinking water and not wearing shoes when outside were the significant risk factors of infection among these children. In conclusion, we provide new evidence on the occurrence of S. stercoralis in Malaysia to show that there is a relatively high prevalence of infection among Orang Asli schoolchildren. Therefore, the use of specific methods for detecting S. stercoralis should be considered when screening these children for intestinal parasites. Moreover, prevention and control measures specific to S. stercoralis should be integrated into the intestinal parasitic infections control programme in Malaysia.

Topics: Animals; Child; Cross-Sectional Studies; Female; Humans; Malaysia; Male; Prevalence; Risk Factors; Strongyloides stercoralis; Strongyloidiasis

Understanding determinants shaping infection risk of endangered wildlife is a major topic in conservation medicine. The proboscis monkey, Nasalis larvatus, an endemic primate flagship species for conservation in Borneo, is endangered through habitat loss, but can still be found in riparian lowland and mangrove forests, and in some protected areas. To assess socioecological and anthropogenic influence on intestinal helminth infections in N. larvatus, 724 fecal samples of harem and bachelor groups, varying in size and the number of juveniles, were collected between June and October 2012 from two study sites in Malaysian Borneo: 634 samples were obtained from groups inhabiting the Lower Kinabatangan Wildlife Sanctuary (LKWS), 90 samples were collected from groups of the Labuk Bay Proboscis Monkey Sanctuary (LBPMS), where monkeys are fed on stationary feeding platforms. Parasite risk was quantified by intestinal helminth prevalence, host parasite species richness (PSR), and eggs per gram feces (epg). Generalized linear mixed effect models were applied to explore whether study site, group type, group size, the number of juveniles per group, and sampling month predict parasite risk. At the LBPMS, prevalence and epg of Trichuris spp., strongylids, and Strongyloides spp. but not Ascaris spp., as well as host PSR were significantly elevated. Only for Strongyloides spp., prevalence showed significant changes between months; at both sites, the beginning rainy season with increased precipitation was linked to higher prevalence, suggesting the external life cycle of Strongyloides spp. to benefit from humidity. Higher prevalence, epgs, and PSR within the LBPMS suggest that anthropogenic factors shape host infection risk more than socioecological factors, most likely via higher re-infection rates and chronic stress. Noninvasive measurement of fecal parasite stages is an important tool for assessing transmission dynamics and infection risks for endangered tropical wildlife. Findings will contribute to healthcare management in nature and in anthropogenically managed environments.

Topics: Animals; Borneo; Colobinae; Conservation of Natural Resources; Feces; Female; Forests; Helminthiasis; Host-Parasite Interactions; Intestinal Diseases, Parasitic; Malaysia; Male; Monkey Diseases; Rainforest; Risk Factors; Strongyloidiasis; Trichuriasis

Strongyloidiasis is one of the most commonly neglected but clinically important parasitic infections worldwide, especially among immunocompromised patients. Evidence of infection among immunocompromised patients in Malaysia is, however, lacking. In this study, microscopy, real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assays (ELISAs) were used to detect Strongyloides stercoralis (S. stercoralis) infection among cancer patients in a Malaysian hospital.. A total of 192 stool and serum samples were collected from cancer patients who were receiving chemotherapy with or without steroid treatment at a hospital in northeastern Malaysia. Stool samples were examined for S. stercoralis using parasitological methods and real-time PCR. Serology by ELISA was performed to detect parasite-specific immunoglobulin G (IgG), IgG4 and immunoglobulin E (IgE) antibodies. For comparison, IgG4- and IgG-ELISAs were also performed on the sera of 150 healthy individuals from the same area.. Of the 192 samples examined, 1 (0.5%) sample was positive for S. stercoralis by microscopy, 3 (1.6%) by real-time PCR, 8 (4.2%) by IgG-ELISA, 6 (3.1%) by IgG4-ELISA, and none was positive by IgE-ELISA. In comparison, healthy blood donors had significantly lower prevalence of parasite-specific IgG (2.67%, p < 0.05) and IgG4 (2.67%, p < 0.05) responses.. This study showed that laboratory testing may be considered as a diagnostic investigation for S. stercoralis among immunocompromised cancer patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Animals; Antibodies, Helminth; Child; Child, Preschool; Cross-Sectional Studies; Enzyme-Linked Immunosorbent Assay; Female; Healthy Volunteers; Hospitalization; Humans; Immunocompromised Host; Immunoglobulin E; Immunoglobulin G; Malaysia; Male; Middle Aged; Neoplasms; Real-Time Polymerase Chain Reaction; Strongyloides stercoralis; Strongyloidiasis; Young Adult

Detection of Strongyloides stercoralis infection particularly in asymptomatic individuals is often hampered due to the lack of standard diagnostic tools. In this study, the use of serological and molecular approaches were investigated for the detection of S. stercoralis infection among an Orang Asli (indigenous) community following a preliminary detection by microscopic examination of faecal samples. Out of 54 individuals studied, 17/54 (31.5%) were detected to be positive for S. stercoralis infection by enzyme-linked immunosorbent assay (ELISA), compared to 0/54 (0%) by faecal examination. Further confirmation performed by a nested polymerase chain reaction (PCR) using DNA extracted from faecal samples of these 17 individuals yielded 3/17 (17.6%) positives for S. stercoralis DNA amplification. No amplification was seen with the other 37 faecal samples, which were negative by microscopy and ELISA. As the high ELISA positive results were suspected to be false-positives, ELISA is not recommended for use as a detection tool but may be beneficial for evaluating the effectiveness of anti-Strongyloides drugs. The present finding indicated that PCR should be considered as an alternative diagnostic tool for the detection of S. stercoralis infection.

Topics: Adolescent; Adult; Animals; Child; Child, Preschool; Feces; Female; Humans; Infant; Malaysia; Male; Serologic Tests; Strongyloides stercoralis; Strongyloidiasis; Young Adult

Intestinal parasitic infection among five interior communities at Bakun Valley, upper Rejang River, Sarawak, Malaysia, was investigated as part of a public health impact assessment of the proposed US$ 3 billion Bakun Hydroelectric Project. Coproparasitological examination of 355 stool samples from 7 of 16 villages representing 5 of 7 tribes in the area revealed infection rate of 41%. A higher infection rate was found among the settled Kayans (56%) than the seminomadic Penans (29%). Infection rate was high (68%) among children less than 14 years old. Trichuris trichiura accounted for more than 90% of all infections; less common were Ascaris lumbricoides, hookworms and Strongyloides stercoralis. Polyparasitism was found in 8% of the individuals surveyed with dual infection due to T. trichiura and A. lumbricoides being more common than dual infection with T. trichiura and hookworm. Women had higher infection rates (57%) than men (33%).

Topics: Adolescent; Animals; Ascariasis; Ascaris lumbricoides; Child; Female; Humans; Intestinal Diseases, Parasitic; Malaysia; Male; Prevalence; Strongyloides stercoralis; Strongyloidiasis; Trichuriasis; Trichuris

Topics: Aged; Animals; Enteritis; Female; Gastritis; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Malaysia; Strongyloides stercoralis; Strongyloidiasis

Topics: Animals; Ascariasis; Child; Ethnology; Helminthiasis; Helminths; Hospitals, General; Humans; Infant; Infant, Newborn; Malaysia; Prevalence; Statistics as Topic; Strongyloidiasis; Trichinellosis