A new technique for sampling duodenal contents: demonstration of upper small-bowel pathogens.
01 Mar 1970-American Journal of Tropical Medicine and Hygiene (The American Society of Tropical Medicine and Hygiene)-Vol. 19, Iss: 2, pp 349-352
TL;DR: The technique was demonstrated to be reliable in obtaining duodenal contents and provided the means for diagnosis of Strongyloides stercoralis infection in 51 of 56 persons thought to be infected and may be the best procedure available for the detection of this parasite.
Abstract: A simple and convenient method for obtaining a small quantity of duodenal contents has been developed: a length of nylon yarn is coiled inside a weighted gelatin pharmaceutical capsule lined inside with rubber. One end of the line protrudes through a hole in the capsule so that when this end is grasped and the capsule swallowed, the line is delivered to the stomach and then to the duodenum. When the line is pulled back up, bilestained duodenal mucus adhering to it may be removed for examination. The technique was demonstrated to be reliable in obtaining duodenal contents and provided the means for diagnosis of Strongyloides stercoralis infection in 51 of 56 persons thought to be infected. The method may be the best procedure available for the detection of this parasite. Other parasites frequently found in the duodenum were also encountered. The value of the procedure for microbiologic, enzyme, and cytologic sampling is yet to be determined.
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TL;DR: The clinical manifestations of strongyloidiasis are described as well as various diagnostic tests and treatment strategies, and several immunodiagnostic assays have been found ineffective in detecting disseminated infections and show extensive cross-reactivity with hookworms, filariae, and schistosomes.
Abstract: Strongyloides stercoralis infects 30 million people in 70 countries. Infection usually results in asymptomatic chronic disease of the gut, which can remain undetected for decades. However, in patients receiving long-term corticosteroid therapy, hyperinfection can occur, resulting in high mortality rates (up to 87%). Strongyloidiasis is difficult to diagnose because the parasite load is low and the larval output is irregular. Results of a single stool examination by use of conventional techniques fail to detect larvae in up to 70% of cases. Several immunodiagnostic assays have been found ineffective in detecting disseminated infections and show extensive cross-reactivity with hookworms, filariae, and schistosomes. Although it is important to detect latent S. stercoralis infections before administering chemotherapy or before the onset of immunosuppression in patients at risk, a specific and sensitive diagnostic test is lacking. This review describes the clinical manifestations of strongyloidiasis, as well as various diagnostic tests and treatment strategies.
817 citations
Cites background from "A new technique for sampling duoden..."
...a string that is swallowed by the patient and retrieved after a few hours—enjoyed a brief period of popularity, but currently it is used infrequently [58]....
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TL;DR: The intention here is to give an up-to-date overview of Giardia and giardiasis and provide an insight into the enormous wealth of literature on the subject, as well as highlight the most important recent developments and unresolved questions.
Abstract: It is over 10 years since Meyer and Radulescu (1979) reviewed Giardia and giardiasis in Advances in Parasitology. In their introduction, they emphasized that "despite their ubiquity and antiquity, the Giardia have, until recently, been little studied". In the intervening years, Giardia has been extensively studied. The number of papers published has increased enormously, two books on the parasite have been produced (Erlandsen and Meyer, 1984; Meyer, 1990a), and an international conference on Giardia has been organized (Wallis and Hammond, 1988). Yet it is still very difficult to keep up with developments in this productive field of research and, despite all these research efforts, several fundamental questions concerning Giardia and giardiasis remain unresolved (Table 1), particularly with respect to the relationship of Giardia and disease, and the role of zoonotic transmission. Indeed, it is only recently that we have started to appreciate the clinical significance of Giardia infections in developing countries and among disadvantaged groups. Giardia is now recognized as one of the 10 major parasites of humans, being equal to ascariasis as a cause of death in the developing world (Warren, 1989; Meyer, 1990b). In developed countries, Giardia has the distinction of being the most commonly reported human intestinal parasite (Acha and Szyfres, 1987; Thompson et al., 1990a; Schantz, 1991). Regrettably, however, the range of drugs available to treat giardiasis is limited and their efficacy leaves much to be desired. There is an urgent need for new antigiardial agents, yet this search is hampered by our lack of understanding of many fundamental aspects of Giardia biochemistry and metabolism. In addition, although the application of molecular biological techniques to research on Giardia has revealed new avenues of investigation, it has also given rise to many new questions about this intriguing organism concerning its phylogenetic position, reproductive behaviour and genetic diversity.
To review Giardia and giardiasis in detail would require at least an entire volume of Advances in Parasitology. Such treatment in depth is not warranted at this time in view of the excellent book recently edited by Meyer (1990a). Our intention here is to give an up-to-date overview of Giardia and giardiasis and provide an insight into the enormous wealth of literature on the subject, as well as highlight the most important recent developments and unresolved questions.
262 citations
TL;DR: Giardia is a protozoan flagellate that was first observed by Van Leeuwenhoek in 1681 and more fully described by Lamb in 1859 and is now clearly recognized as a common cause of diarrhea and malabsorption.
Abstract: Giardia is a protozoan flagellate that was first observed by Van Leeuwenhoek in 1681 and more fully described by Lamb in 1859. It was initially thought to be a commensal in humans, but it is now clearly recognized as a common cause of diarrhea and malabsorption. Giardia infects millions of people throughout the world in both epidemic and sporadic forms. It is transmitted through ingestion of contaminated water and food, person-to-person contact in child care centers, and male homosexual activity.
257 citations
Cites methods from "A new technique for sampling duoden..."
...This can be done with the string test (EnteroTest; Hedeco Corporation, Mountain View, CA) [18], for which a patient swallows a capsule on the end of a string....
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TL;DR: New developments to help meet the clinical challenges of Strongyloides stercoralis are reviewed, including clinical clues to the diagnosis, new diagnostic methods, including stool culture and serological assays, new drugs such as albendazole and ivermectin, and difficult treatment issues.
209 citations
TL;DR: Strongyloidiasis is considered a neglected tropical disease and is probably an underdiagnosed parasitic disease due to its low parasitic load and uncertain clinical symptoms and increased infectivity rates in many developed countries and nonendemic regions nearing those in the most prevalent endemic regions are indications for initiating an integrated approach towards prompt diagnosis and control of this parasitic disease.
Abstract: Background: Strongyloides stercoralis, an intestinal parasitic nematode, infects more than 100 million people worldwide. Strongyloides are unique in their ability to exist as a free-living and autoinfective cycle. Strongyloidiasis can occur without any symptoms or as a potentially fatal hyperinfection or disseminated infection. The most common risk factors for these complications are immunosuppression caused by corticosteroids and infection with human T-lymphotropic virus or human immunodeficiency virus. Even though the diagnosis of strongyloidiasis is improved by advanced instrumentation techniques in isolated and complicated cases of hyperinfection or dissemination, efficient guidelines for screening the population in epidemiological surveys are lacking. Methodology and Results: In this review, we have discussed various conventional methods for the diagnosis and management of this disease, with an emphasis on recently developed molecular and serological methods that could be implemented to establish guidelines for precise diagnosis of infection in patients and screening in epidemiological surveys. A comprehensive analysis of various cases reported worldwide from different endemic and nonendemic foci of the disease for the last 40 years was evaluated in an effort to delineate the global prevalence of this disease. We also updated the current knowledge of the various clinical spectrum of this parasitic disease, with an emphasis on newer molecular diagnostic methods, treatment, and management of cases in immunosuppressed patients. Conclusion: Strongyloidiasis is considered a neglected tropical disease and is probably an underdiagnosed parasitic disease due to its low parasitic load and uncertain clinical symptoms. Increased infectivity rates in many developed countries and nonendemic regions nearing those in the most prevalent endemic regions of this parasite and the increasing transmission potential to immigrants, travelers, and immunosuppressed populations are indications for initiating an integrated approach towards prompt diagnosis and control of this parasitic disease.
207 citations
Cites background from "A new technique for sampling duoden..."
...String test (Entero test), once popular, is seldom used for collection of larvae from the patient’s duodenum [55]....
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