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1/10. strongyloides stercoralis: ultrastructural study of newly hatched larvae within human duodenal mucosa.

    AIM: To investigate the ultrastructural features of the newly hatched larvae of strongyloides stercoralis in human duodenal mucosa. methods: Duodenal biopsies from an AIDS patient were studied by transmission electron microscopy to investigate morphology, location, and host-worm relations of newly hatched larvae. RESULTS: Newly hatched larvae were found in the Lieberkuhn crypts within the tunnels formed by migration of parthenogenic females. Delimiting enterocytes were compressed. Release of larvae into the gut lumen was also documented. It was shown that both a thin and a thick membrane surrounded the eggs and larvae, as a tegument derived respectively from parasite and host. Segmentary spike-like waves, caused by contractures of worm body musculature, were observed on the surface of newly hatched larvae, and their intestinal lumen was closed and empty, with no budding microvilli. Immaturity of the cuticle and some degree immaturity of amphidial neurones were found, but there was no evidence of either immaturity or signs of damage to other structures. CONCLUSIONS: Newly hatched larvae of S stercoralis appear to be a non-feeding immature stage capable of active movement through the epithelium, causing mechanical damage. The tegument resulting from the thin and the thick membrane may protect the parasite and reduce any disadvantage caused by immaturity.
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2/10. myxobolus sp., another opportunistic parasite in immunosuppressed patients?

    During a study of intestinal parasitic infections in human immunodeficiency virus-positive patients, a parasite belonging to the phylum myxozoa, recently described from human samples, was identified in one sample. When this parasite was stained by the modified Ziehl-Neelsen staining method, the features of the spores were identified: they were pyriform in shape, had thick walls, and had one suture and two polar capsules, with each one having four or five coils. The suture and two polar capsules were observed with the chromotrope-modified stain. The number of stools passed was more than 30 per day, but oocysts of isospora belli were also found. Upon reexamination of some formalin- or merthiolate-iodine-formaldehyde-preserved samples an identical parasite was found in another sample from a patient presenting with diarrhea. strongyloides stercoralis larvae and eggs of hymenolepis nana and ascaris lumbricoides were also found in this sample. Given that both patients were also infected with other pathogens that cause diarrhea, the possible pathogenic role of this parasite could not be established. The probable route of infection also could not be established.
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3/10. strongyloides stercoralis infection as a cause of acute granulomatous appendicitis in an hiv-positive patient in Athens, greece.

    A case of acute granulomatous appendicitis due to strongyloides stercoralis infection in an hiv-positive patient is described. To our knowledge this is the first case presented in the literature.
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4/10. diagnosis of strongyloides stercoralis in a peritoneal effusion from an hiv-seropositive man. A case report.

    BACKGROUND: strongyloides stercoralis, a nematode parasite in humans with free-living and autoinfective cycles, is often an asymptomatic infection of the upper small intestine. If the host becomes immunocompromised, autoinfection may increase the intestinal worm burden and lead to disseminated strongyloidiasis. The parthenogenetic adult female larvae can remain embedded in the mucosa of the small intestine for years, producing eggs that develop into either rhabditiform, noninfective larvae or filariform, infective larvae. Manifestations of dissemination occur when the filariform larvae penetrate the intestinal wall and migrate into the blood. Pulmonary involvement is common, and the central nervous system may be affected. blood eosinophilia is typical, and gram-negative sepsis from enteric bacteria may occur. Much less commonly described is invasion of the peritoneal cavity with peritoneal effusion. CASE: A 49-year-old man who came to the united states from liberia 4 years earlier presented with sudden onset of severe abdominal distention, generalized weakness and marked pedal edema. Diagnostic paracentesis showed numerous filariform larvae of S stercoralis. Stool examination confirmed the presence of both rhabditiform and filariform larvae. Subsequently the patient was found to be hiv seropositive, with a CD4 lymphocyte count of 59. CONCLUSION: Early detection of S stercoralis may alter the often-fatal course of infection. The present case is the second reported one in the English-language literature of the diagnosis of S stercoralis in ascitic fluid.
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5/10. strongyloidiasis in a patient with acquired immunodeficiency syndrome.

    Rhabditiform larvae, transforming larvae from rhabditiform to filariform, and eggs of strongyloides stercoralis were identified in the sputum of a Thai woman with acquired immunodeficiency syndrome (AIDS), and stool microscopy also showed a heavy load of rhabditiform larvae of S. stercoralis. She was treated with 12 mg ivermectin once a day for 2 days for the strongyloidiasis, with good therapeutic results being obtained. strongyloidiasis may be a curable disease through the use of an appropriate therapy, even in a patient with AIDS.
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6/10. hiv infection associated with strongyloides stercoralis colitis resulting in streptococcus bovis bacteraemia and meningitis.

    We report the case of an hiv infected patient with streptococcus bovis bacteraemia and meningitis associated with gastrointestinal strongyloides stercoralis infection. To our knowledge, this has been reported once previously and serves as a reminder to actively exclude asymptomatic S stercoralis infection in hiv infected individuals presenting with bacteraemia.
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7/10. Disseminated strongyloides stercoralis in AIDS: a report from india.

    We report a fatal case of disseminated strongyloidiasis masquerading clinically as stage IV caecal malignancy diagnosed at post mortem by needle necropsy. The parasite was seen in the smears from CSF, pleural fluid, ascitic fluid, splenic aspirate, lung aspirate and aspirates from caecal area. Enteric organisms like Group D streptococci and candida sp were also associated. We believe that this is the first report of widespread dissemination of S. stercoralis in AIDS from india.
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8/10. Detection of strongyloides stercoralis in the cerebrospinal fluid of a patient with acquired immunodeficiency syndrome.

    We report a case of strongyloides stercoralis hyperinfection syndrome in a patient with acquired immunodeficiency syndrome with CNS involvement who died despite prompt institution of thiabendazole.
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9/10. Systemic strongyloidiasis in patients infected with the human immunodeficiency virus. A report of 3 cases and review of the literature.

    We report 3 cases of systemic strongyloidiasis in hiv-infected individuals and review 11 additional cases reported in the English-language literature. Systemic strongloidiasis is a rare and potentially fatal complication of late-stage hiv disease. A combination of gastrointestinal and respiratory symptoms in an hiv-infected patient who has been to an endemic area should prompt the clinician to search for S. stercoralis in stool and sputum specimens. Treatment failures occur commonly, and careful follow-up is warranted. New antihelminthic drugs (such as ivermectin) seem promising and need to be evaluated in controlled studies.
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10/10. streptococcus bovis bacteremia and meningitis associated with strongyloides stercoralis colitis in a patient infected with human immunodeficiency virus.

    We present a case of human immunodeficiency virus (hiv) infection complicated by streptococcus bovis meningitis and bacteremia and severe strongyloides stercoralis colitis. The association between S. bovis infection and strongyloidiasis has not been described previously. This case highlights the importance of searching for larvae of S. stercoralis as part of the evaluation of the gastrointestinal tract of patients with bacteremia or meningitis due to certain enteric organisms. The role of hiv infection in the development of severe S. stercoralis colitis in association with S. bovis bacteremia and meningitis is unclear.
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