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Bureaucrats, bureaucrats, nocaptcha, Administrators
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Bureaucrats, bureaucrats, nocaptcha, Administrators
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==Medical therapy==
==Historical Perspective==
===Uncomplicated strongylidiasis===
*The term "metabolic syndrome" dates back to at least the late 1950s, but came into common usage in the late 1970s to describe various associations of risk factors with diabetes, that had been noted as early as the 1920s.<ref>Joslin EP. The prevention of diabetes mellitus. ''JAMA'' 1921;76:79–84.</ref><ref>Kylin E. [Studies of the hypertension-hyperglycemia-hyperuricemia syndrome] (German). ''Zentralbl Inn Med'' 1923;44: 105-27.</ref>
*''Strongyloides stercoralis''
* The Marseilles physician in 1947, made the interesting observation that upper body obesity appeared to predispose to [[diabetes]], [[atherosclerosis]], [[gout]], and [[calculi]].<ref>Vague J. La diffférenciacion sexuelle, facteur déterminant des formes de l'obésité. Presse Med 1947;30:339-40.</ref>
:* Preferred regimen (1): [[Ivermectin]] 200 μg/kg/day PO q24h for 2 days
* Avogaro, Crepaldi and co-workers described six moderately obese patients with diabetes, [[hypercholesterolemia]], and marked [[hypertriglyceridemia]] all of which improved when the patients were put on a hypocaloric, low carbohydrate diet.<ref>Avogaro P, Crepaldi G, Enzi G, Tiengo A. Associazione di iperlipidemia, diabete mellito e obesità di medio grado. ''Acta Diabetol Lat'' 1967;4:572-590.</ref>
:** Note: For immunocompromised patients several treatment courses at 2-week intervals is recommended.
* In 1977, Haller used the term "metabolic syndrome" for associations of obesity, diabetes mellitus, [[hyperlipoproteinemia]], [[hyperuricemia]] and steatosis hepatis when describing the additive effects of risk factors on atherosclerosis.<ref>Haller H. [Epidemiology and associated risk factors of hyperlipoproteinemia] (German). ''Z Gesamte Inn Med'' 1977;32(8):124-8. PMID 883354.</ref>
:* Alternative regimen (1): [[Thiabendazole]] 1.5 g PO q24h for 2 consecutive days.
* The same year, Singer used the term for associations of obesity, gout, diabetes mellitus, and hypertension with hyperlipoprotenemia.<ref>Singer P. [Diagnosis of primary hyperlipoproteinemias] (German). ''Z Gesamte Inn Med'' 1977;32(9):129-33. PMID 906591.</ref>
:** Note: The maximum dosage is 3 g/d every 2 days (this dosage is likely to be toxic and needs to be reduced)
* In 1977 and 1978, Gerald B. Phillips developed the concept that risk factors for myocardial infarction concur to form a "constellation of abnormalities" (i.e., [[glucose intolerance]], [[hyperinsulinemia]], hyperlipidemia (hypercholesterolemia and hypertriglyceridemia) and [[hypertension]]) that is associated not only with heart disease, but also with [[aging]], obesity and other clinical states. He suggested there must be an underlying linking factor, the identification of which could lead to the prevention of cardiovascular disease; he hypothesized that this factor was sex hormones.<ref>Phillips GB. Sex hormones, risk factors and cardiovascular disease. ''Am J Med'' 1978;65:7-11. PMID 356599.</ref><ref>Phillips GB. Relationship between serum sex hormones and glucose, insulin, and lipid abnormalities in men with myocardial infarction. ''Proc Natl Acad Sci U S A'' 1977;74:1729-1733. PMID 193114.</ref>
:** Note: Cure rates are as high as 87% to 94%, but the drug may not be effective in the disease that is disseminated beyond the gastrointestinal tract.
* In 1988, in his Banting lecture, Gerald M. Reaven proposed [[insulin resistance]] as the underlying factor and named the constellation of abnormalities Syndrome X. Reaven did not include abdominal obesity, which has also been hypothesized as the underlying factor, as part of the condition.<ref>Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988;37:1595-607. PMID 3056758.</ref>
:** Note: Many patients have gastrointestinal adverse effects, it is used rarely in the U.S. because of adverse effects
:* Alternative regimen (2): [[Albendazole]] 400 mg PO bid for 3 days


===Complicated strongyloidiasis (Disseminated or hyper-infection syndrome)===
The terms "metabolic syndrome," "insulin resistance syndrome," and "syndrome X" are now used specifically to define a constellation of abnormalities that is associated with increased risk for the development of type 2 diabetes and atherosclerotic vascular disease (e.g. heart disease and stroke).
:* Preferred regimen (1): [[Ivermectin]] 200 μg/kg/d PO q24h orally for at least 7 to 10 days (until larvae are no longer detected in stool, sputum, or urine)
:** Note: For hyper-infection and disseminated disease, adding albendazole (400 mg PO bid for 7 days) to ivermectin may be warranted.
==Overview==
Above all, schistosomiasis is a [[chronic disease]].  Pathology of ''S. mansoni'' and  ''S. japonicum'' schistosomiasis includes: [[Katayama fever]], hepatic perisinusoidal egg [[granulomas]], Symmers’ pipe stem periportal fibrosis, [[portal hypertension]], and occasional [[embolism|embolic]] egg granulomas in [[brain]] or [[spinal cord]].  Pathology of ''S. haematobium'' schistosomiasis includes: [[hematuria]], [[scar]]ring, [[calcification]], [[squamous cell carcinoma]], and occasional embolic egg granulomas in brain or spinal cord.  [[Bladder cancer]] diagnosis and mortality are generally elevated in affected areas.
 
==Natural History and Complications==
Occasionally [[central nervous system]] lesions occur: cerebral granulomatous disease may be caused by ectopic ''S. japonicum'' eggs in the [[brain]], and granulomatous lesions around ectopic eggs in the [[spinal cord]] from ''S. mansoni'' and ''S. haematobium'' infections may result in a transverse [[myelitis]] with flaccid [[paraplegia]].  Continuing infection may cause granulomatous reactions and [[fibrosis]] in the affected organs, which may result in manifestations that include:
 
* Colonic [[polyposis]] with bloody diarrhea (''Schistosoma mansoni'' mostly);
* [[Portal hypertension]] with [[hematemesis]] and [[splenomegaly]] (''S. mansoni'', ''S. japonicum'');
* [[Cystitis]] and ureteritis (''S. haematobium'') with [[hematuria]], which can progress to [[bladder cancer]];
* [[Pulmonary hypertension]] (''S. mansoni'', ''S. japonicum'', more rarely ''S. haematobium'');
* [[Glomerulonephritis]]; and central nervous system lesions.
 
==Prognosis==
Treatment before significant damage or severe complications occur usually produces good results.

Revision as of 15:00, 14 August 2017

Historical Perspective

  • The term "metabolic syndrome" dates back to at least the late 1950s, but came into common usage in the late 1970s to describe various associations of risk factors with diabetes, that had been noted as early as the 1920s.[1][2]
  • The Marseilles physician in 1947, made the interesting observation that upper body obesity appeared to predispose to diabetes, atherosclerosis, gout, and calculi.[3]
  • Avogaro, Crepaldi and co-workers described six moderately obese patients with diabetes, hypercholesterolemia, and marked hypertriglyceridemia all of which improved when the patients were put on a hypocaloric, low carbohydrate diet.[4]
  • In 1977, Haller used the term "metabolic syndrome" for associations of obesity, diabetes mellitus, hyperlipoproteinemia, hyperuricemia and steatosis hepatis when describing the additive effects of risk factors on atherosclerosis.[5]
  • The same year, Singer used the term for associations of obesity, gout, diabetes mellitus, and hypertension with hyperlipoprotenemia.[6]
  • In 1977 and 1978, Gerald B. Phillips developed the concept that risk factors for myocardial infarction concur to form a "constellation of abnormalities" (i.e., glucose intolerance, hyperinsulinemia, hyperlipidemia (hypercholesterolemia and hypertriglyceridemia) and hypertension) that is associated not only with heart disease, but also with aging, obesity and other clinical states. He suggested there must be an underlying linking factor, the identification of which could lead to the prevention of cardiovascular disease; he hypothesized that this factor was sex hormones.[7][8]
  • In 1988, in his Banting lecture, Gerald M. Reaven proposed insulin resistance as the underlying factor and named the constellation of abnormalities Syndrome X. Reaven did not include abdominal obesity, which has also been hypothesized as the underlying factor, as part of the condition.[9]

The terms "metabolic syndrome," "insulin resistance syndrome," and "syndrome X" are now used specifically to define a constellation of abnormalities that is associated with increased risk for the development of type 2 diabetes and atherosclerotic vascular disease (e.g. heart disease and stroke).

  1. ↑ Joslin EP. The prevention of diabetes mellitus. JAMA 1921;76:79–84.
  2. ↑ Kylin E. [Studies of the hypertension-hyperglycemia-hyperuricemia syndrome] (German). Zentralbl Inn Med 1923;44: 105-27.
  3. ↑ Vague J. La diffférenciacion sexuelle, facteur déterminant des formes de l'obésité. Presse Med 1947;30:339-40.
  4. ↑ Avogaro P, Crepaldi G, Enzi G, Tiengo A. Associazione di iperlipidemia, diabete mellito e obesità di medio grado. Acta Diabetol Lat 1967;4:572-590.
  5. ↑ Haller H. [Epidemiology and associated risk factors of hyperlipoproteinemia] (German). Z Gesamte Inn Med 1977;32(8):124-8. PMID 883354.
  6. ↑ Singer P. [Diagnosis of primary hyperlipoproteinemias] (German). Z Gesamte Inn Med 1977;32(9):129-33. PMID 906591.
  7. ↑ Phillips GB. Sex hormones, risk factors and cardiovascular disease. Am J Med 1978;65:7-11. PMID 356599.
  8. ↑ Phillips GB. Relationship between serum sex hormones and glucose, insulin, and lipid abnormalities in men with myocardial infarction. Proc Natl Acad Sci U S A 1977;74:1729-1733. PMID 193114.
  9. ↑ Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988;37:1595-607. PMID 3056758.
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