STRONGYLOIDIASISETIOLOGY: STRONGYLOIDES STERCORALIS

PATHOGENESIS

ABILITY OF S. S. TO REPLICATE WITHIN THE HOST IN CHRONIC STRONGYLOIDIASIS:* BALANCE BETWEEN HOST PARASITE

WHERE WORMS RESTRICTED IN NUMBER

HOST DEFENSES BREAK DOWN

WORMS MULTIPLY RAPIDLY & DISSEMINATE THROUGHOUT THE BODY

CUTANEOUS LESION HYPERSENSITIVITY Rx WORMS PRODUCTS ENTERITIS:DIRECT MECHANICAL TRAUMAINFLAMMTORY RxSECONDARY BACTERIAL COLONIZATION

CLINICAL MANIFESTATIONS (1)

ACUTE STRONGYIDIASIS

LARVAE THROUGHT THE LUNGSLOEFFLERS SYNDROM, COUGH, SHORTNESS OF BREATH, WHEEZING, FEVER, IN THE GUTABDOMINAL PAIN, DIARRHEA, EPIGASTRIC PAIN, MALABSORPSION

CHRONIC STRONGYLOIDIASIS- S.S. INFECTIONS > 35 YEARS * ASYMPTOMATIC * CUTANEOUS SYMP. * GASTROINTESTINAL SYMP. - THE CLASSIC TRIAD: ABDOMINAL PAIN DIARRHEA URTICARIA - CREEPING ERUPTION CLINICAL MAAANIFESTATIONS (2)

DISSEMINATED STRONGYLOIDIASIS (1) - OVERWHELMING STRONGYLOIDIASIS - IMMUNOSUPRESSED RESULT OF DISEASES - IMMUNOSUPRESSIVE AGENTS - MALNUTRITION - PATIENTS WITH BURN - CHRONIC INFECTION - IRRADIATION - LYMPHOMAS - AIDS - SYSTEMIC CORTICOSTEROID THERAPY

DISSEMINATED STRONGYLOIDIASIS (2) - SEVERE, GENERALIZED ABDOMINAL PAIN - ABDOMINAL DISTENTION - SHOCK - ILEUS EDEMA SMALL-BOWEL OBSTRUCTION FATAL NECROTIZING JEJUNITIS - JAUNDICE

- MASSIVE LARVAL INVATION OF THE LUNG: * COUGH * WHEEZING * DYSPNEA - CEREBRAL INVOLMENT: * CHANGE IN MENTAL STATUS * COMA - HIGH FEVER DISSEMINATED STRONGYLOIDIASIS (3)

CLINICAL FINDINGS (1)1. CUTANEOUS MANIFESTATIONS - FOCAL EDEMA - INFLAMMATION - PETECHIAE - SERPIGIOUS OR URTICARIAL TRACT, AND INTENSE ICTHING - CREEPING ERUPTIONS CHRONIC

2. INTESTINAL MANIFESTATIONS: MILD SEVERE - ANOREXIA - VOMITING - EPIGASTRIC TENDERNESS MIMIC DUODENAL ULCER - DIARRHEA DIARRGEA CONSTIPATION - ABDOMINAL PAIN - FLATULENCE - PRURITUS ANI - FECES CONTAIN MUCUS AND BLOOD - MALABSORPTION

CLINICAL FINDINGS (2)

3. PULMONAL MANIFESTATIONS - DRY COUGH - THROAT IRRITATION OR LOW-GRADE FEVER - DYSPNEA - WHEEZING - HEMOPTYSIS - ASTHMA CLINICAL FINDINGS (3)

CLINICAL FINDINGS (4) - BRONCHOPNEUMONIA - BRONCHITIS - PLEURAL EFFUSION - PROGRESSIVE DYSPNEA - MILIARY ABSCESSES - COUGH: * PRODUCTIVE OF AN ODORLESS * MUCOPURULENT SPUTUM

COMPLICATION: HYPERINFECTION (1)

1. PLEURAL EFFUSION2. MYOCARDITIS3. HEPATIC GRANULOMAS4. CHOLECYSTITIS5. PURPURA6. ULCERATING LESIONS OF THE GI. TRACT7. CNS INVOLVEMENT

COMPLICATION: HYPERINFECTION (2)

8. PARALYTIC ILEUS9. PERFORATION-PERITONITIS10. GRAM-NEGATIVE SEPTICEMIA11. MENINGITIS12. CACHEXIA13. SHOCK ABD DEATH14. NEPHROTIC SYNDROME

MANAGEMENT (1)

* UNCOMPLICATED STRONGYLOIDIASIS- IVERMECTIN, 200 G/KG FOR 2 DAYS- THIABENDAZOLE, 25 MG/KGBW, TWICE DAYLY FOR 3 DAYS (MAX. 1,5 G PER DOSE), REPEAT IN 2 WEEKS- MEBENDAZOLE- CAMBENDAZOLE- ALBENDAZOLE, 2 X 400 MG FOR 3-7 DAYS, REPEATED IN 1 WEEK

* DISSEMINATED STRONGYLOIDIASIS - THIABENDAZOLE, 25 MG/KGBWTWICE DAYLY FOR 1 WEEK - REPEATED 25 MG/KGBW TWICE DAYLY FOR 2 DAYS AT MONTHLY INTERVALS

MANAGEMENT (2)

PRGONOSIS

PROGNOSIS IS FAVORABLE EXCEPT: * IN THE HYPERINFECTION * ASSOCITED WITH EMACIATON * ADVANCED LIVER DISEASE * CANCER * IMMUNOLOGIC DISORDERS * THE USE OFI MMUNOSUPPRESSIVE DRUGS