THE PREVALENCE AND RESPONSE TO THERAPY OF STRONGYLOIDES-STERCORALIS IN PATIENTS WITH ASTHMA FROM ENDEMIC AREAS

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 al l patients, we performed a complete history and physical examination, complete blood cell counts (CBC), S stercoralis serologic tests, spiro metry, and evaluated three stool samples for ova and parasites. Patien ts treated for S stercoralis infection had follow-up CBC, spirometry, serologic tests, and at least three additional stool examinations to c onfirm eradication of the parasite. Setting: Ambulatory and hospitaliz ed 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, rangi ng in age from 20 to 76 years, were prospectively evaluated. Results: Six of 45 patients were infected with S stercoralis, which yielded a p revalence of 13 percent. The patients. with asthma and S stercoralis i nfection had higher blood eosinophil counts (p=0.006) and were younger (p=0.006) compared with patients with only asthma. There was no diffe rence in the duration of asthma, spirometry, or steroid use between th e two groups. Patients with S stercoralis and asthma tended to be more recent immigrants (p=0.05). Five of the six patients with S stercoral is agreed to be treated with thiabendazole but only four returned for follow-up evaluation. All four patients had eradication of S stercoral is 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 (2,4 76+/-832 cells per cubic millimeter vs 551+/-138 cells per cubic milli meter, p=0.03) without a clinical improvement in asthma. Conclusions: Our data suggest that patients with asthma from areas endemic for S st ercoralis, who have elevated peripheral blood eosinophil counts, shoul d be screened for S stercoralis infection. Successful eradication of S stercoralis, however, may not result in a clinical improvement of ast hma.