title: The prevalence and response to therapy of Strongyloides stercoralis in patients with asthma from endemic areas.
abstract: OBJECTIVE
  To evaluate the prevalence and response to therapy of Strongyloides stercoralis infection in immigrant patients with asthma from areas endemic for Strongyloides.
  
  
  METHODS
  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.
  
  
  METHODS
  Ambulatory and hospitalized patients who were referred to the respiratory medicine clinic of a general hospital for the evaluation and treatment of asthma.
  
  
  METHODS
  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.
authors.affiliation: Santa Clara Valley Medical Center, Division of Respiratory and Critical Care Medicine, San Jose, Calif 95128.
authors.forename: J H
authors.initials: JH
authors.lastname: Wehner
authors.forename: C M
authors.initials: CM
authors.lastname: Kirsch
authors.forename: F T
authors.initials: FT
authors.lastname: Kagawa
authors.forename: W A
authors.initials: WA
authors.lastname: Jensen
authors.forename: A C
authors.initials: AC
authors.lastname: Campagna
authors.forename: M
authors.initials: M
authors.lastname: Wilson
mesh_terms: D000328:Adult; D000818:Animals; D000909:Antibodies, Helminth / Q000097:blood; D001249:Asthma / Q000188:drug therapy* / Q000208:ethnology* / Q000276:immunology / Q000469:parasitology; D002140:California / Q000453:epidemiology; D016009:Chi-Square Distribution; D004197:Disease Reservoirs; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D016036:Seroepidemiologic Studies; D017171:Strongyloides stercoralis / Q000276:immunology / Q000302:isolation & purification; D013322:Strongyloidiasis / Q000188:drug therapy* / Q000208:ethnology* / Q000276:immunology / Q000469:parasitology
chemical_list: D000909:Antibodies, Helminth; D007074:Immunoglobulin G