Chest
Volume 106, Issue 3, September 1994, Pages 762-766
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Clinical Investigations: Bronchial Reactivity
The Prevalence and Response to Therapy of Strongyloides stercoralis in Patients With Asthma From Endemic Areas

https://doi.org/10.1378/chest.106.3.762Get rights and content

Study objective

To evaluate the prevalence and response to therapy of Strongyloides stercoralis infection in immigrant patients with asthma from areas endemic for Strongyloides.

Design and interventions

In all patients, we performed a complete history and physical examination, complete blood cell counts (CBC), S stercoralis serologic tests, spirometry, and evaluated three stool samples for ova and parasites. Patients treated for S stercoralis infection had follow-up CBC, spirometry, serologic tests, and at least three additional stool examinations to confirm eradication of the parasite.

Setting

Ambulatory and hospitalized patients who were referred to the respiratory medicine clinic of a general hospital for the evaluation and treatment of asthma.

Patients

Forty-five asthmatic adults, representing 12 endemic countries, ranging in age from 20 to 76 years, were prospectively evaluated.

Results

Six of 45 patients were infected with S stercoralis, which yielded a prevalence of 13 percent. The patients with asthma and S stercoralis infection had higher blood eosinophil counts (p=0.006) and were younger (p=0.006) compared with patients with only asthma. There was no difference in the duration of asthma, spirometry, or steroid use between the two groups. Patients with S stercoralis and asthma tended to be more recent immigrants (p=0.05). Five of the six patients with S stercoralis agreed to be treated with thiabendazole but only four returned for follow-up evaluation. All four patients had eradication of S stercoralis infection confirmed by negative stool examinations and a decline in S stercoralis serology (160 ± 25 percent vs 13 ± 13 percent, p=0.03). All four patients had a decline in total blood eosinophil counts (2,476 ±832 cells per cubic millimeter vs 551 ± 138 cells per cubic millimeter, p=0.03) without a clinical improvement in asthma.

Conclusions

Our data suggest that patients with asthma from areas endemic for S stercoralis, who have elevated peripheral blood eosinophil counts, should be screened for S stercoralis infection. Successful eradication of S stercoralis, however, may not result in a clinical improvement of asthma.

Section snippets

Methods

The study was approved by the Santa Clara Valley Medical Center Research and Human Subjects Review Committee. From February 1992 through May 1993, we prospectively evaluated ambulatory and hospitalized patients referred to the Division of Respiratory Medicine for the management of asthma. All patients underwent a complete history and physical examination. The history focused on the country of origin, date of immigration to the United States, onset of asthma, history of corticosteroid treatment,

Results

A total of 45 patients, whose ages ranged from 20 to 76 years, were studied. Patient characteristics are listed in Table 1. Five patients (11 percent), including one eventually proved to have S stercoralis were previously intubated for status asthmaticus. Five patients (11 percent), all without S stercoralis smoked at least 10 pack-years. Table 2 shows the region of origin for all patients.

Fecal examination revealed the presence of S stercoralis larvae in five patients (11 percent). Two of

Discussion

Sporadic reports have linked the presence of S stercoralis infection with asthma.6, 7, 8, 9 Furthermore, corticosteroid-induced immunosuppression has led to overwhelming disseminated S stercoralis infection, bacterial superinfections, and death in patients with airflow obstruction and in patients who have received organ transplants with active S stercoralis infection.10, 11, 12, 13, 14 To design appropriate treatment and avoid disastrous consequences of corticosteroid-induced immunosuppression,

ACKNOWLEDGMENT

The authors thank Dr. John Hamilton and the staff in the Clinical Microbiology Lab at the Santa Clara Valley Medical Center and Janet Fried at the Centers for Disease Control and Prevention for their technical assistance.

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