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what he describes as an itchy rash on the lower ab- monary infiltrates. A transbronchial lung biopsy dominal wall. The patient s physical examination showed eosinophilic granulomatous inflammation revealed a thin man in mild distress with a temper- of the bronchial epithelium. Bronchoalveolar lavage ature of 100°F (37.8°C), blood pressure 124/70 revealed S. stercoralis filariform larvae. Microscopic mmHg, pulse 120, and respiratory rate 25 per examination of the stool revealed rhabditiform lar- minute. Rales were heard throughout his lung fields. vae of S. stercoralis. Based on the knowledge of S. His abdomen was soft and flat, with hypoactive stercoralis hyperinfection syndrome, which agent or bowel sounds. There was marked tenderness with- agents would be a logical choice for treatment of out rebound noted on palpation of the epigastric this life-threatening disease? 54 Anthelmintic Drugs 629 Case Study An Extensive History: Always Useful ANSWER: Until recently thiabendazole was the drug treatment can be lifesaving, as hyperinfection syn- of choice to treat strongyloidiasis. Parasite eradica- drome is associated with mortality rates up to 86%. tion in uncomplicated infections is approximately Steroids may suppress the eosinophil response nor- 90% or higher. However, S. stercoralis is a signifi- mally seen in this disease, so an appropriate history cant health risk in many developing countries and must be taken and characteristic intestinal and skin even in parts of eastern Kentucky and rural findings examined, and a high index of suspicion is Tennessee. It presents a serious potential for severe needed to make a timely diagnosis of patients who disease in the many military servicemen who were spent time in endemic areas. In immunocompro- stationed in Southeast Asia during World War II mised hosts, persistent infection and relapse may and the Vietnam era. In fact, it was first described in complicate therapy with thiabendazole (even when 1876 as diarrhea of China in French colonial given over 7 to 10 days). Alternative therapy with troops in Indochina by Louis Alexis Norman, physi- ivermectin appears as effective (64 100% cure cian first class in the French Navy. It is acquired by rates) as thiabendazole with fewer side effects. infective larvae that penetrate the skin and fre- Other drug choices are albendazole (cure rates of quently maintain a low level of autoinfection 38 81%) and mebendazole, but these have not been asymptomatically for many decades. Hyperinfection approved by the FDA for this indication. and widespread dissemination may occur following immunosuppression or chronic disease. Prompt [ Pobierz caÅ‚ość w formacie PDF ] |