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[粪类圆线虫及其感染概述]

[An overview of Strongyloides stercoralis and its infections].

作者信息

Ardiç Nurittin

机构信息

GATA Haydarpaşa Eğitim Hastanesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Servisi, Istanbul.

出版信息

Mikrobiyol Bul. 2009 Jan;43(1):169-77.

Abstract

Strongyloidiasis which is an infection caused by Strongyloides stercoralis, has a cosmopolitan distribution in tropical and subtropical regions; whereas, it is sporadic in Turkey. It is estimated that 30-100 million people are infected with this agent worldwide. The infection is usually asymptomatic, however, eosinophilia may be the only sign. S. stercoralis have the ability to persist and replicate within the host for decades and it may lead to infections with high mortality especially in immunocompromised host. Humans are generally infected transcutaneously with filariform larvae. Infections with S. stercoralis usually lead to cutaneous, gastrointestinal, or pulmonary symptoms. Definitive diagnosis of strongyloidiasis is made on the basis of detection of larvae in the stool, sputum or duodenal fluid. Hovewer, strongyloidiasis is difficult to diagnose since the parasite load is low and the larval output is irregular in majority of the patients. This situation necessitates the collection of consecutive samples and the use of concentration techniques. The burden of Strongyloides may be overlooked in especially non-endemic regions. Strongyloidiasis should be considered before the application of immunosuppressive therapy in patients with unexplained eosinophilia, serpiginous skin lesions, or pulmonary or gastrointestinal symptoms. The goal of treatment is to eliminate the parasites and ivermectin is the drug of choice. Besides, albendazole or thiabendazole may used as alternative agents in the treatment. Improved human waste disposal services are considered to be the main requirement to reduce the high prevalence of this disease. In this review, it was aimed to withdraw attention to strongyloidiasis and to overview its prevalence, clinical manifestations, diagnosis, management and prevention strategies.

摘要

粪类圆线虫病是由粪类圆线虫引起的一种感染,在热带和亚热带地区呈世界性分布;而在土耳其则为散发病例。据估计,全球有3000万至1亿人感染这种病原体。该感染通常无症状,然而,嗜酸性粒细胞增多可能是唯一的体征。粪类圆线虫有能力在宿主体内持续存在并繁殖数十年,尤其在免疫功能低下的宿主中,可能导致高死亡率的感染。人类通常经皮肤感染丝状蚴。粪类圆线虫感染通常会导致皮肤、胃肠道或肺部症状。粪类圆线虫病的确诊基于在粪便、痰液或十二指肠液中检测到幼虫。然而,由于大多数患者的寄生虫负荷低且幼虫排出不规则,粪类圆线虫病难以诊断。这种情况需要采集连续样本并使用浓缩技术。在非流行地区,粪类圆线虫的负担可能被忽视。对于有不明原因嗜酸性粒细胞增多、匐行性皮肤病变或肺部或胃肠道症状的患者,在应用免疫抑制治疗前应考虑粪类圆线虫病。治疗的目标是消除寄生虫,伊维菌素是首选药物。此外,阿苯达唑或噻苯达唑可作为治疗的替代药物。改善人类废物处理服务被认为是降低该疾病高流行率的主要要求。在本综述中,旨在引起对粪类圆线虫病的关注,并概述其流行情况、临床表现、诊断、管理和预防策略。

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