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The natural components ofThe experiment found that 13The investigation shows that components of

Hymenolepis nana, a parasitic tapeworm distributed worldwide, is very prevalent in countries with poor sanitary conditions. Garlic is widely used as a seasoning and medicinal plant all over the world, and its derivatives have proven anti-microbial and anti-inflammatory effects. Our study explored the cestocidal and therapeutic effects of allicin derivatives against H. nana in vitro and in vivo. Worms taken from a host were cultured in vitro, and the effects of allyl sulfide (DAS), allyl disulfide (DADS) and dimethyl sulfoxide (DMSO) treatments were observed. Male BALB/c mice were then fed eggs to produce infection, given drugs for ten days and dissected. The results of this study showed that DADS in garlic exhibited good cestocidal effects in vitro and in vivo. DADS and DATS reduced motility, induced mortality and damaged body segments of worms in vitro. In vivo, the number of worms in the low-dose and high-dose DADS groups was significantly less than the infected control group. DADS effected cytokine changes in BALB/c mice after infection. IFN-γ increased, IL-2, 4, 6 and 13 decreased, and IL-5, 10 and IL-12 p70 did not change significantly. As a medicinal plant, garlic has many active ingredients that can developed as anti-microbial or parasite-related drugs.

Background/Purpose: Hymenolepis nana is globally distributed. Leucaena leucocephala has been studied as a treatment, including the nematodes and protozoa, but no research results are related to cestodes. Therefore, the aim of this study was to target H. nana. Methods: The natural components of L. leucocephala were isolated and added to H. nana, which was cultured in vitro, to observe changes in the mortality, motility, and morphology. BALB/c male mice infected with H. nana were treated with effective components of L. leucocephala for 10 days, and the changes were recorded. After the mice were sacrificed, the spleen weight was measured, and a primary culture was performed for the subsequent cytokine and chemokine testing. Results: The experiment found that 132-hydroxy-(132-S)-pheophytin a and aristophyll-C have clear cestocidal effects in vitro. 132-hydroxy-(132-S)-pheophytin a has been shown to be effective at reducing parasite populations and eliciting host immune responses in vivo. IL-2, IL-4, IL-5, IL-6, IL-10, IL-13, IL-17, MCP-1, IFN-γ, TNF-α, MIP-1α, and GM-CSF in 132-hydroxy-(132-S)-pheophytin a were significantly increased after stimulation, while IL-1α, IL-1β, IL-3, IL-12p70, and RANTES were unchanged. Conclusions: The investigation shows that components of L. leucocephala have actual cestocidal activity against H. nana.

Infections by soil-transmitted helminths are a major public health problem worldwide, especially among schoolchildren in low-income countries. Little information is described about their prevalence in the Solomon Islands. From 2017 to 2018, a school-based soil-transmitted helminths survey in the Guadalcanal Province was conducted. A total of 454 schoolchildren were selected; the Merthiolate–iodine–formaldehyde concentration and stain was used. The prevalence was 17% of one or more parasites, including hookworm (8.8%), Strongyloides stercoralis (5.7%), Ascaris lumbricoides (4.2%) and Trichuris trichiura (3.5%). STH infection was significantly correlated with parents' occupations, hand washing, shoe wearing as well as gastrointestinal symptoms. To prevent STH transmission for schoolchildren in the Solomon Islands completely, combined preventive strategies seem necessary.

Steroids are commonly used in patients with eosinophilic meningitis caused by A. cantonensis infections. The mechanism steroids act on eosinophilic meningitis remains unclear. In this mouse experiments, expressions of 14-3-3 isoform β and γ proteins significantly increased in the CSF 2-3 weeks after the infection, but not increasedin the dexamethasone-treated group. Expression of 14-3-3 β, γ, e, and θ isoforms increased in brain meninges over the 3-week period after infection and decreased due to dexamethasone treatment. In conclusion, administration of dexamethasone in mice with eosinophilic meningitis decreased expressions of 14-3-3 isoform proteins in the CSF and in brain meninges.

The 14-3-3 proteins are cerebrospinal fluid (CSF) markers of neuronal damage during infectious meningitis and Creutzfeldt-Jakob disease. Little is known about dynamic changes in the individual isoforms in response to parasitic eosinophilic meningitis. The purposes of this study were to determine the 14-3-3 protein isoform patterns, examine the kinetics and correlate the severity of blood brain barrier (BBB) damage with the expressions of these markers in mice with eosinophilic meningitis. Mice were orally infected with 50 A. cantonensis L3 via an oro-gastric tube and sacrificed every week for 3 consecutive weeks after infection. The Evans blue method and BBB junctional protein expressions were used to measure changes in the BBB. Hematoxylin and eosin staining was used to analyze pathological changes in the mice brains following 1-3 weeks of infection with A. cantonensis. The levels of 14-3-3 protein isoforms in serum/CSF and brain homogenates were analyzed by Western blot, and immunohistochemistry (IHC) was used to explore the different isoform distributions of 14-3-3 proteins and changes in BBB junctional proteins in the mice brain meninges. Dexamethasone was injected intraperitoneally from the seventh day post infection (dpi) until the end of the study (21 dpi) to study the changes in BBB junctional proteins. The amounts of Evans blue, tight junction and 14-3-3 protein isoforms in the different groups of mice were compared using the nonparametric Kruskal-Wallis test. There were significant increases in 14-3-3 protein isoforms β and γ in the CSF in the second and third weeks after infection compared to the controls and first week of infection, which were correlated with the severity of BBB damage in brain histology, and Evans blue extravasation. Using IHC to assess the distribution of 14-3-3 protein isoforms and changes in BBB junctional proteins in the mice brain meninges, the expressions of isoforms β, γ, e, and θ and junctional proteins occludin and claudin-5 in the brain meninges increased over a 3-week period after infection compared to the controls and 1 week after infection. The administration of dexamethasone decreased the expressions of BBB junctional proteins occludin and claudin-5 in the mice brain meninges. Our findings support that 14-3-3 proteins β and γ can potentially be used as a CSF marker of neuronal damage in parasitic eosinophilic meningitis caused by A. cantonensis.

Angiostrongylus cantonensis is an important zoonotic parasite causing eosinophilic meningitis and eosinophilic meningoencephalitis in humans. In this study, the protein expression profiles of the infective third- and pathogenic fifth-stage larvae (L3 and L5) of this parasite were compared by proteomic techniques. Isolated protein samples were separated by two-dimensional gel electrophoresis (2-DE), stained with silver nitrate, and analyzed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). Proteins from L5 were mainly at pH 5-7 and with molecular weight (MW) 40-100 kDa, whereas those from L3 were at pH 5-6 and with 5-35 kDa. Of 100 protein spots identified, 33 were from L3 whereas 67 from L5 and 63 had known identities, whereas 37 were hypothetical proteins. There were 15 spots of stress proteins, and HSP60 was the most frequently found heat stress proteins in L5. More binding and protein transport-related proteins were found in L5 including peptidylprolyl isomerase (cyclophilin)-like 2, serum albumin, preproalbumin precursor, and dilute class unconventional myosin. L3 had a higher expression of cytoskeleton and membrane proteins than L5. In addition, four protein spots were identified in the sera of the rat host by Western blot analysis. The present proteomic study revealed different protein expression profiles in L3 and L5 of A. cantonensis. These changes may reflect the development of L3 from the poikilothermic snails to L5 in the homoeothemic rats. This information may be useful for the finding of stage-specific proteins and biomarker for diagnosis of angiostrongyliasis.

Angiostrongylus cantonensis is the most common infectious agent causing eosinophilic meningitis and is present in Taiwan, Thailand and the Pacific islands. Clinical symptoms vary within different endemic regions, and their severity is probably dependent on the number of ingested parasites and the diversity among strains. The experimentally definitive host is the rat, and non-permissive hosts are certain mammals such as humans and mice. In this study, the partial gene sequences of two A. cantonensis strains isolated from five different regions in Taiwan were selected and molecularly analyzed. The internal transcribed spacer gene and cytochrome-c oxidase subunit I gene sequences of the Hualien (H) strain of A. cantonensis differed from those of the Pingtung (P) strain and the other three strains by 19% and 11%, respectively. We analyzed the infectivity, fecundity, and development of the H and P strain in rats and host pathogenicity in mice inoculated with both strains. The number of the emerged first-stage larvae, adult recovery, and average length of adults in Sprague-Dawley rats significantly differed between rats inoculated with the H and P strain. Young adult recovery, average length of young adults, eosinophil counts in the cerebrospinal fluid (CSF), glutathione peroxidase concentration, levels of reactive oxygen species as well as malondialdehyde concentration in the CSF, and the survival of mice significantly differed between BALB/c mice inoculated with the H and P strain. The H strain of A. cantonensis had lower infectivity, delayed fecundity, and poor development in rats, and caused milder pathology and lower mortality in mice than the P strain. These data clearly indicate that the H strain of A. cantonensis is a pathogenically distinct strain with lower infectivity to its definitive host, and causing mild pathogenic symptoms to its non-permissive host.

Angiostrongylus cantonensis is the main causative agent of human eosinophilic meningitis in Southeast Asia and the Pacific Islands. A previous study demonstrated that the 14-3-3β protein is a neuropathological marker in monitoring neuronal damage in meningitis. Steroids are commonly used in patients with eosinophilic meningitis caused by A. cantonensis infection. However, the mechanism by which steroids act in eosinophilic meningitis is unknown. We hypothesized that the beneficial effect of steroids on eosinophilic meningitis is partially mediated by the down-regulation of 14-3-3β protein expression in the cerebrospinal fluid (CSF). In this animal study, we determined the dynamic changes of 14-3-3β protein in mice with eosinophilic meningitis. The 14-3-3β protein in serum and CSF was increased in week 2 and 3 after infections. Dexamethasone administration significantly decreased the amounts of CSF 14-3-3β protein. By developing an in-house ELISA to measure 14-3-3β protein, it was found that the amounts of 14-3-3β protein in the CSF and serum increased over a three-week period after infection. There was a remarkable reduction of 14-3-3β protein in the CSF after 2 weeks of dexamethasone treatment. In conclusion, the administration of corticosteroids in mice with eosinophilic meningitis decreased the expression of 14-3-3β protein in the CSF.

Angiostrongylus cantonensis also known as the rat lungworm, is prevalent in the Pacific Islands and southeast Asia and is the most common cause of eosinophilic meningitis in humans. Although frogs and toads are known as paratenic hosts of A. cantonensis, they are rarely reported as the infectious source of human angiostrongyliasis. We report a case of encephalitis caused by Angiostrongylus cantonensis after eating raw frogs mixed with wine as a health supplement. Prednisolone at a dose of 1 mg/kg/day was prescribed for 14 days successfully. We advise that travelers and residents of endemic areas should avoid eating raw frogs and a public caution on the danger of eating raw wild animal products or the whole animal is recommended to alleviate such accidental infection.

This study aimed to estimate reactive oxygen species (ROS) production, antioxidants activity, and biomarkers level of oxidative damage to protein and DNA in the cerebrospinal fluid (CSF) of C57BL/6 mice infected with Angiostrongylus cantonensis. The mean ROS concentration in the CSF of infected mice increased gradually, and the increase in ROS in CSF became statistical significance at days 12-30 post-infection compared to that before infection (P

In this study, we investigated the anthelmintic activity of [10]-shogaol, [6]-shogaol, [10]-gingerol and [6]-gingerol, compounds isolated from the roots of Zingiber officinale L., Zingiberaceae (ginger), against Anisakis simplex. The above compounds kill or reduce spontaneous movement in A. simplex larvae. The maximum lethal efficacy of [10]-shogaol and [10]-gingerol was approximately 80% and 100%, respectively. We further examined the time course of compound-induced loss of mobility in A. simplex. The results showed that various concentrations of [10]-shogaol, [6]-shogaol, [10]-gingerol and [6]-gingerol have maximum effects on loss of spontaneous movement from 24 to 72 h. In addition, the time course of mortality and the percentage of loss of spontaneous movements were ascertained to determine the minimum effective doses of [10]-gingerol and [10]-shogaol. [10]-Gingerol exhibited a larger maximum larvicidal effect and greater loss of spontaneous movement than [10]-shogaol and albendazole. In addition, these constituents of Zingiber officinale showed effects against 2,2-diphenyl-1-picrylhydrazyl (DPPH) and peroxyl radicals. These constituents of Zingiber officinale are responsible for its larvicidal activity against A. simplex.

The cerebrospinal fluid (CSF) of C57BL/6 mice infected with Angiostrongylus cantonensis was examined for kinetic changes in oxidative stress parameters, including reactive oxygen species (ROS), superoxide dismutase (SOD), catalase, malondialdehyde (MDA), 8-isoprostane, and 8-hydroxy-2′-deoxyguanosine (8-OHdG). The ROS increased gradually in the early stage of infection. During days 12–30 post-infection, the infected mice revealed ROS levels significantly higher than that in uninfected controls (P < 0.001). The ROS levels peaked at day 24 and then returned to that observed in uninfected controls at day 45 post-infection. The kinetics of MDA, 8-isoprostane, and 8-OHdG concentration changes observed in the CSF of the infected mice corresponded with kinetic changes in ROS levels. Thus, the excess ROS caused lipid peroxidation and DNA damage to cells in the central nervous system (CNS) of mice infected with A. cantonensis despite the increased antioxidant SOD and catalase enzyme activities during post-infection days 12–30. The oxidative stress in the CNS of C57BL/6 mice was apparently increased by diseases associated with A. cantonensis infection.

To quantitate cerebrospinal fluid (CSF) concentrations of matrix metalloproteinase 9 (MMP-9) in adult patients with Klebsiella pneumoniae meningitis and to correlate levels of MMP-9 with parameters of intrathecal inflammation and analyze the kinetic changes of MMP-9. In a prospective cohort study, levels of MMP-9 and tissue inhibitor of matrix metalloproteinase (TIMP-1) concentrations were measured in the CSF of six adult patients with meningitis and 11 controls. MMP-9 and TIMP-1 were detected in all of the six patients at presentation and follow up lumbar puncture. CSF levels of MMP-9 (6.71+/-7.29 ng/ml) and TIMP-1(454.3+/-242.9 ng/ml) were higher in patients than in the control group (0.07+/-0.11 ng/ml and 27.14+/-39.34 ng/ml, respectively). Levels of MMP-9 correlated with CSF concentrations of protein, cell count and lactate. Repeated lumbar punctures showed that levels of MMP-9 decrease during clinical recovery, although the levels of MMP-9 in the CSF are variable because of the small number of cases. The relative change in gelatin zymography is comparable to the changes of MMP-9 levels found in ELISA. MMP-9 levels in CSF may be a useful tool in follow-up in patients with K. pneumoniae meningitis.

Vascular endothelial growth factor (VEGF) is a potent vascular permeability factor and a mediator of brain edema. To assess the role of vascular endothelial growth factor in eosinophilic meningitis, vascular endothelial growth factor was measured in the cerebrospinal fluid (CSF) and blood of 9 patients with eosinophilic meningitis in a cohort study. VEGFCSF was detected in 8 (90%) of 9 eosinophilic meningitis patients (range, 45-2190 pg/mL) at presentation. The mean VEGFCSF at presentation, 1 week, and 2 weeks after admission was 568 pg/mL, 751 pg/mL, and 1031 pg/mL, respectively. There was an association between VEGFCSF, CSF protein, white cell count, and eosinophil counts. The VEGFSERUM fluctuated during the 6-month follow-up period. These results indicate that vascular endothelial growth factor may be associated with blood-brain barrier disruption in patients with eosinophilic meningitis.

Angiostrongylus cantonensis is the most common cause of eosinophilic meningitis in humans after ingestion of raw or inadequately cooked intermediate hosts or food contaminated with infective third-stage larvae. Frogs are known to be a paratenic host of A. cantonensis, but have never been reported as the infectious source of human angiostrongyliasis in Taiwan. We report the first case of eosinophilic meningitis caused by A. cantonensis after ingestion of raw frogs (Rana plancyi).

Diphyllobothriasis latum is an intestinal parasitosis caused by the ingestion of mostly raw fresh-water fish containing plerocercoids of Diphyllobothrium latum. We report an 8-year-old boy who came to our hospital with the complaint of a tapeworm hanging from the anus after defecation. The other symptom was mild abdominal cramping for a period of 1 year. The laboratory examination did not reveal anemia or vitamin B12 deficiency. Examination of gravid proglottids with rosette-like central uterus and typically operculated eggs of D. latum confirmed the diagnosis. The morphologic characters of proglottids and eggs size are compatible with D. latum. The patient had a history of eating uncooked fish for 1 year. Salmonids may be the infection source. He was treated with two doses of praziquantel and passed about 183 cm in length of all proglottids. There is a high prevalence of diphyllobothriasis latum in the northern temperate areas, but it is very rare in children. This patient is the first child case reported in Taiwan.

Plasmid DNA encoding the flagella protein (flagellin) was used as a vaccination candidate for the evaluation of its immunogenicity and for protection against infection with Burkholderia pseudomallei . Firstly, flagellin encoding plasmid DNA was injected into Balb/c mice intramuscularly and this elicited both a humoral and a cellular immune response. Total IgG production and the clonal expansion of the spleen cells increased in response to flagellin. The IgG subclass response exhibited a dominance of IgG2a over IgG1 in the sera. In addition, IFN-γ-secreting cells in the spleen were substantially increased. Furthermore, the anti- B. pseudomallei activity of the peritoneal exudate cells was evaluated by a Transwell tissue-culture plate system where the macrophage-activating related cytokines in upper chamber were allowed to cross the plate's membrane and stimulate the activation of peritoneal exudate cells in lower chamber. Our results indicated that the activated peritoneal exudate cells were able to restrict the growth of B. pseudomallei in vitro. Indeed, subsequent intravenous challenge of the vaccinated Balb/c mice with 10 5 CFU of B. pseudomallei resulted in the number of bacterial cells detected in liver and/or spleen being significantly reduced in the flagellin plasmid DNA vaccinated mice. At 7 days subsequent to infection of B. pseudomallei , 5/6 (83%) of flagellin plasmid DNA vaccinated mice had survived. We suggest that plasmid DNA-encoding flagellin might be useful as a potential immunization route for the future development of a vaccine against melioidosis in related animals.

Several indices were used to assess whether blood-brain barrier (BBB) damage occurs in neurological disorders. Dysfunction of the BBB was surmised to be involved in the pathological changes of eosinophilic meningitis caused by the infection of Angiostrongylus cantonensis. The mean concentration of protein and albumin in the cerebrospinal fluid (CSF) of infected mice gradually increased from days 0 to 18 after infection and then rapidly increased 21 days after infection. The concentrations of protein and albumin in the CSF of infected mice 15 days after infection were all significantly higher than those in uninfected mice (all P-values at least

Background and Aim: The relation of helminthic infestation to hepatolithiasis is a subject of dispute. This case–control study was undertaken to evaluate the prevalence of helminthiasis in hepatolithiasis patients and to compare the clinicopathological features of hepatolithiasis between patients with and without helminthiasis. Methods: The prevalence of ascariasis or clonorchiasis was evaluated using ELISA in 131 patients with hepatolithiasis who were treated at Show-Chwan Memorial Hospital and 121 subjects who constituted a control group. The patients’ detailed histories and medical charts were reviewed. Results: The prevalence of positive immunodiagnosis of ascariasis and clonorchiasis was higher in patients with hepatolithiasis than in control subjects (33.6%, 44/131 vs 17.4%, 21/121, odds ratio [OR] = 2.41, 95% confidence interval [CI] = 1.28–4.56, P = 0.005; and 6.9%, 9/131 v 0.8%, 1/121, OR = 8.85, 95% CI = 1.12–188.69, P = 0.02). Patients with helminthiasis rarely had concurrent gallbladder stones (26%, 12/47 vs 55%, 46/84, OR = 0.28, 95% CI = 0.12–0.66, P = 0.002). Prior to the diagnosis of hepatolithiasis in adulthood, most of the patients with helminthiasis tended to have a history of recurrent abdominal pain in their childhood and an asymptomatic ‘lucid interval’ during their teenage years (70.2%, 33/47 vs 39.3%, 33/84, OR = 3.64, 95% CI = 1.59–8.42, P = 0.0005). However, the prevalence of intrahepatic duct stricture (38.3%, 18/47 vs 40.5%, 34/84, OR = 0.91, 95% CI = 0.41–2.02, P > 0.05), secondary biliary cirrhosis (6.4%, 3/47 vs 3.6%, 3/84, OR = 1.84, 95% CI = 0.28–12.03, P > 0.05), cholangiocarcinoma (2.1%, 1/47 vs 0%, 0/84, OR = ∼, P > 0.05), and stone recurrence (54.8%, 24/42 vs 50.0%, 38/76, OR = 1.33, 95% CI = 0.58–3.06, P > 0.05) did not significantly increase. Conclusions: Helminthiasis is a possible risk factor for hepatolithiasis, although it is unlikely to increase the incidence of complications, including bile duct stricture, secondary biliary cirrhosis, and cholangiocarcinoma. Patients with helminthiasis tend to have a history of an asymptomatic ‘lucid interval’ between the periods of recurrent abdominal pain in their childhood and the diagnosis of hepatolithiasis in their adulthood.

The most common cause of eosinophilic meningitis is the rat lungworm Angiostrongylus cantonensis a parasite that is endemic in the southeast Asian and Pacific regions. Outbreaks of eosinophilic meningitis associated with drinking raw vegetable juice are rarely reported, even in regions of endemic infection. We performed a cohort study among Taiwanese with eosinophilic meningitis who drank raw vegetable juice within three months of the onset of the outbreak. Clinical manifestations, laboratory examinations, and outcomes were prospectively followed. Five native Taiwanese met the case definition of eosinophilic meningitis. Specific antibodies to A. cantonensis were detected in the serum of five of the patients and in the cerebrospinal fluid (CSF) of four of the patients. Central nervous system manifestations included headache (n = 5 [100%]), Brudzinski's sign/stiff neck (n = 5 [100%]), hyperesthesia/paresthesias (n = 5 [100%]), and cranial nerve palsy (n = 1 [20%]). Laboratory findings included peripheral (n = 5 [100%]) and CSF eosinophilia (n = 4 [80%]), transient increases in the white blood cell count (n = 1 [20%]), and in serum levels of creatine kinase (n = 1 [20%]). Meningeal enhancement, as well as high signal intensity, at the subcortical white matter on T2 weighted and fluid attenuated inversion recovery images were observed on magnetic resonance imaging in four patients. There were three episodes of relapse during treatment and all resolved with after a lumbar puncture and/or administration of steroids. At the 12-month follow up, all five patients had recovered without neurologic sequelae. Risk factors identification showed that consumption of raw vegetable juice was associated with illness (Pearson correlation test r = 0.867, P = 0.01). There was association between the presence of raw vegetable juice and CSF eosinophilia (Spearman's correlation test r = 0.816, P = 0.004).

Suspensions of fertilized eggs of Toxocara canis were mixed with 2% neutral formalin and preserved at 4 degrees C. When, after storage for 0, 12, 18, 21 and 24 months, samples of the eggs were incubated at 30 degrees C for 12 days, 96.8%, 92.6%, 74.1%, 51.0% and 19.3% of the eggs in the samples were found to embryonate. The embryonated eggs produced from the fertilized eggs preserved (in 2% neutral formalin at 4 degrees C) for 0, 12, 18 and 21 months were then tested for their infectivity to BALB/c mice, each mouse being given 800 embryonated eggs. The numbers of larvae recovered from the mice and the sites from which they were recovered, 2 or 14 days post-infection, appeared unaffected by the length of storage of the eggs. The infected mice all had similar eosinophil counts in their peripheral blood and similar serum titres of Toxocara-specific IgM and IgG antibodies, and cultures of their spleen cells produced similar amounts of interleukin-4, interleukin-5 and interferon-gamma when stimulated with concanavalin A. The results of SDS-PAGE indicated that egg preservation for at least 21 months had no effect on the excretory-secretory antigens in samples of medium from cultures of infective larvae released from the eggs. In summary, at least 50% of the fertilized eggs preserved in 2% neutral formalin at 4 degrees C for 21 months could fully embryonate and then had the same infectivity and antigenicity as embryonated fresh eggs.

Background: Definitive diagnosis of infestation with Angiostrongylus cantonensis is difficult because the parasitic nematode is undetectable in the cerebrospinal fluid (CSF) of one-half of afflicted patients and the diagnostic sensitivity of ELISA for circulating worm antigens in patient sera is low. We studied immuno-PCR as a diagnostic tool. Methods: We studied 30 controls and 60 afflicted patients (30 confirmed by parasitologic analysis of CSF). We used a monoclonal antibody to capture circulating A. cantonensis antigens in serum samples. A DNA label generated by PCR amplification with biotinylated primer was bound by use of streptavidin to a biotinylated third antibody. Circulating antigens sandwiched by monoclonal antibody were detected by PCR amplification of the DNA label. Results: The detection limit of the ELISA was 100–1000 times higher than that of the immuno-PCR. The concentrations of circulating antigens in patients were markedly higher than those in controls (Wilcoxon rank-sum test, P Conclusions: Immuno-PCR is a promising technique for diagnosis of A. cantonensis infestation.

The kinetics of changes in the eotaxin concentration in the serum and cerebrospinal fluid (CSF) of BALB/c mice after infection with Angiostrongylus cantonensis and the correlation between the concentration of eotaxin and worm recovery were investigated. The mean concentration of eotaxin in serum of infected mice gradually increased from 46.3+/-6.5 pg/ml at week 0 to 104.9+/-44.8 pg/ml at week 3 after infection, while the mean eotaxin level in the CSF of infected mice rapidly increased from 18.7+/-2.1 pg/ml to 193.2+/-23.6 pg/ml 1 week after infection and then increased further to 507.8+/-167.9 pg/ml at week 3. The concentrations of eotaxin in the CSF of infected mice each week after infection were all significantly higher than those in serum ( P0.0001). In parallel with the increase in eotaxin in the CSF, infected mice showed gradual increases in CSF eosinophilia and a reduction in intracranial worm recovery. The concentration of eotaxin in CSF was higher in infected mice with more worms in the brain, except when the number of worms in the brain was30. In addition, when the worm counts in the brains of infected mice were30, eotaxin concentrations in the CSF were positively correlated with worm counts in the brain ( P0.001). Thus, the release of eotaxin in the CSF of mice infected with A. cantonensis observed in this study was time dependent and worm-load dependent, and in parallel with the increase in eotaxin in the CSF, and gradual decreases in worm counts in the brains of infected mice.

This study investigated the anthelmintic activity of gingerenone A, [6]-dehydrogingerdione, [4]-shogaol, 5-hydroxy-[6]-gingerol, [6]-shogaol, [6]-gingerol, [10]-shogaol, [10]-gingerol, hexahydrocurcumin, 3R,5S-[6]-gingerdiol and 3S,5S-[6]-gingerdiol, a constituent isolate from the roots of ginger, for the parasite Hymenolepis nana. The cestocidal activity or ability to halt spontaneous parasite movement (oscillation/peristalsis) in H. nana of above constituents was reached from 24 to 72 h in a time- and dose-dependent manner, respectively. The [10]-shogaol and [10]-gingero1 have maximum lethal efficacy and loss of spontaneous movement than the others at 24–72 h. In addition, worms treated with 1 and 10 μM [10]-gingero1, more than 30% had spontaneous movement of oscillation at 72 h but [10]-shogaol at 72 h only about 15–20% of oscillation. This showing that [10]-gingero1 had less loss of spontaneous movement efficacy than [10]-shogaol. After exposure to 200 μM [10]-shogaol, 100% of H. nana had died at 12 h rather than died at 24 h for [10]-gingerol, showing that [10]-gingero1 had less lethal efficacy than [10]-shogaol. In addition, these constituents of ginger showed effects against peroxyl radical under cestocidal activity. In order to evaluate the cestocidal activity and cytokine production caused by ginger's extract R0 in the H. nana infected mice, we carried out in vivo examination about H. nana infected mice BALB/c mice were inoculated orally with 500 eggs. After post-inoculation, R0 (1 g/kg/day) was administered orally for 10 days. The R0 exhibited cestocidal activity in vivo of significantly reduced worms number and cytokines production by in vitro Con A-stimulated spleen cells showed that INF-γ and IL-2 were significantly increases by R0. IL-4, IL-5, IL-6, IL-10 and IL-13 were significantly decreases and Murine KC and IL-12 were not significantly changes by R0. Together, these findings first suggest that these constituents of ginger might be used as cestocidal agents against H. nana.

Purpose To describe two outbreaks of Angiostrongylus cantonensis infection that occurred in Kaohsiung, Taiwan, during 1998 and 1999, and to characterize the source of the outbreaks and the clinical manifestations of the disease. Subjects and methods We performed a retrospective cohort study among Thai laborers with eosinophilic meningitis who ate raw snails ( Ampullarium canaliculatus ), as well as an environmental surveillance of larvae in snails. Results We enrolled 17 Thai laborers in whom severe headache and eosinophilia developed within 4 to 23 days after eating raw snails. Twelve (71%) developed eosinophilic meningitis. Third-stage larvae were found in the cerebrospinal fluids of 2 patients and in all 12 tested snails. Specific antibodies to A. cantonensis were detected in serum from 16 of the patients and in cerebrospinal fluid from 5 of the patients. Central nervous system manifestations included headache (n = 17 [100%]), fever (n = 11 [65%]), Brudzinski's sign/stiff neck (n = 11 [65%]), hyperesthesia (n = 3 [18%]), cranial nerve palsy (n = 2 [12%]), diplopia (n = 2 [12%]), and ataxia (n = 1 [6%]). Laboratory findings included peripheral eosinophilia (n = 15 [88%]) and cerebrospinal fluid eosinophilia (n = 12 [71%]); elevated immunoglobulin (Ig) E levels (n = 13 [100%]); and transient increases in white blood cell count (n = 7 [41%]) and in serum levels of creatine kinase (n = 7 [41%]), transaminase (n = 3 [18%]), and lactate dehydrogenase (n = 2 [12%]). The severity of illness and eosinophilia were correlated with the number of ingested snails. Meningeal and basal ganglion enhancement was noted on magnetic resonance imaging in several patients. Treatment with mebendazole combined with glucocorticosteroids appeared to shorten the course of the infection, but not the number of relapses. The eosinophil count fell to normal within 3 months, but IgE levels remained elevated for as long as 6 months. All patients recovered with minimal neurologic sequelae. Conclusion Eosinophilic meningitis caused by A. cantonensis should be considered in patients who have headache or central nervous system manifestations after eating raw snails.

Hepatocyte growth factor (HGF) is a member of the angiogenic growth factor family, which exerts a variety of effects on epithelial, endothelial, and neuronal cells by binding to the c-MET receptor tyrosine kinase. It was reported that HGF attenuates cerebral ischemia-induced increase in permeability of the blood-brain barrier (BBB) and decreases in expression of tight junction proteins in cerebral vessels of rats. Studies on the localization of the c-Met/HGF receptor in the rat brain and the interaction with HGF after brain injuries show that HGF plays an important role as a neurotrophic factor in the brain. To assess the role of HGF in patients with eosinophilic meningitis, a retrospective, cohort study was conducted to measure the dynamic changes of HGF in the cerebrospinal fluid (CSF) and blood of nine patients with eosinophilic meningitis. The mean HGF(CSF) at presentation, 1 week, 2 weeks, and 3 weeks after admission was 539 pg/mL, 540 pg/mL, 376 pg/mL, and 279 pg/mL, respectively. The mean level of HGF(CSF) at presentation (539 +/- 242 pg/mL) and 1 week after admission (540 +/- 213 pg/mL) was significantly higher than in controls (162 +/- 207 pg/mL)(P = 0.02 and P = 0.01, respectively). The CSF/blood ratio of HGF at presentation (0.61) was higher when compared with physiologic situations in uninfected individuals (0.51). The levels of HGF in CSF were not correlated with the amount of CSF cells or proteins. All patients recovered without neurologic sequelae. These results indicate that high concentrations of HGF in the CSF occur in eosinophilic meningitis, and may have a role in protecting against endothelial injury and reducing BBB dysfunction.

Although there have been some advances in the cryopreservation of Angiostrongylus cantonensis, the degrees of viability and infectivity of the cryopreserved developmental stages have not been high. A two-step freezing protocol using a programmable freezer was determined to be effective in improving the infectivity of the cryopreserved third-stage larvae of this parasite. After washing steps and suspension in 10% (v/v) dimethylsulfoxide and equilibrium at room temperature the larvae were placed into the freezer. The temperature was lowered first at 0.8 degrees C/min from room temperature to -40 degrees C and then at 10 degrees C/min to -70 degrees C. The samples were plunged into liquid nitrogen. After storage in liquid nitrogen for 7-15 days the larvae were thawed rapidly in 37 degrees C water and 27.6% were found to show vigorous "S-shape" movement without significant changes in appearance. These larvae (50/rodent) could develop to the fifth stage in mice (42.6%) and establish patent infection in rats (40.4%). Moreover, there was no significant difference in the recovery rates of cryopreserved worms and their unfrozen counterparts. These findings indicate that steady precooling conditions may decrease damage with regard to the infectivity of cryptopreserved third-stage larvae of A. cantonensis.

Nelumbo nucifera Gaertn. cv. Rosa-plena (Nelumbonaceae), commonly known as lotus, is a perennial aquatic plant grown and consumed throughout Asia. All parts of N. nucifera have been used for various medicinal purposes in oriental medicine. From the leaves of Nelumbo nucifera Gaertn. cv. Rosa-plena (an aquatic plant), liriodenine (1), lysicamine (2), (-)-anonaine (3), (-)-asimilobine (4), (-)-caaverine (5), (-)-N-methylasimilobine (6), (-)-nuciferine (7), (-)-nornuciferine (8), (-)-roemerine (9), 7-hydroxydehydronuciferine (10) and cepharadione B (11) were isolated and identification and anthelmintic activities of aporphine was evaluated against Anisakis simplex and Hymenolepis nana. This study found that the above constituents killed H. nana or reduced their spontaneous movements (oscillation/peristalsis). However, the above constituents at various concentrations demonstrated no larvicidal effect or ability to halt spontaneous parasite movement for 72 h against A. simplex, respectively. In addition, according to an assay of cestocidal activity against H. nana and nematocidal activity against A. simplex, we found that the above compounds showed greater lethal efficacy on H. nana than against A. simplex. Further investigation showed that these above constituents have effects against peroxyl radicals under cestocidal effect. Together, these findings suggest that these constituents of Nelumbo nucifera Gaertn. cv. Rosa-plena might be used as anthelmintic agents against H. nana.

The major cause of eosinophilic meningitis in Taiwan is Angiostrongylus cantonensis. Humans are infected by ingesting terrestrial and freshwater snails and slugs. In 1998 and 1999, two outbreaks of eosinophilic meningitis caused by A. cantonensis infection were reported among 17 adult male immigrant Thai laborers who had eaten raw golden apple snails (Pomacea canaliculata). Another outbreak associated with consuming a health drink consisting of raw vegetable juice was reported in 2001. These adult cases differed from reports in the 1970s and 1980s, in which most of the cases were in children. With improvements in public health and education of foreign laborers, there have since been only sporadic cases in Taiwan. Review of clinical research indicates inconsistent association of Magnetic Resonance Imaging (MRI) results with clinical features of eosinophilic meningitis. MRI features were nonspecific but there was an association between the presence of high brain MRI signal intensities and severity of peripheral and cerebrospinal fluid (CSF) eosinophilia. Inflammatory markers have been identified in the CSF of patients with eosinophilic meningitis caused by A. cantonensis infection, and vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), and the matrix metalloproteinase system may be associated with blood-brain barrier disruption. Eosinophilic meningitis caused by A. cantonensis infection is not a reportable disease in Taiwan. It is important that a public advisory and education program be developed to reduce future accidental infection.

Background Angiostrongylus cantonensis is a parasite endemic in the Southeast Asian and Pacific regions. Humans are incidentally infected either by eating uncooked intermediate hosts or by consuming vegetables containing the living third-stage larvae. The 14-3-3β protein is a cerebrospinal fluid (CSF) marker of neuronal damage during the development of Creutzfeldt-Jakob disease. In addition, increased 14-3-3β protein is also found in CSF from patients with a variety of neurological disorders. The goal of this study is to determine the roles of serum/CSF14-3-3β protein in patients with eosinophilic meningitis. Methods In a cohort study among nine Thai laborers with eosinophilic meningitis due to eating raw snails (Pomacea canaliculata), we examined the CSF weekly while patients were still hospitalized and followed up the serum for 6 months. The levels of 14-3-3β protein in CSF were analyzed by western blot and an in-house 14-3-3β enzyme-linked immunosorbent assay (ELISA) measurement was established and tested in an animal model of eosinophilic meningitis. Results The elevated 14-3-3β level was detected in the CSF from eight out of nine (81%) patients After 2 weeks of treatment, all patients showed a declined level or cleared of 14-3-3β protein in the CSF. By developing an in-house ELISA for measurement of 14-3-3β protein, it was found that the serum 14-3-3β level was significantly increased in patients during initial visit. . This finding was consistent to the animal experiment result in which there was severe blood brain barrier damage three weeks after infection and increased 14-3-3β protein expression in the CSF and serum by western blot and in house ELISA. After treatment, the serum 14-3-3β level in meningitis patients was rapidly returned to normal threshold. There was a correlation between initial CSF 14-3-3β level with severity of headache (r = 0.692, p = 0.039), CSF pleocytosis (r = 0.807, p = 0.009) and eosinophilia (r = 0.798, p = 0.01) in the CSF of patients with eosinophilic meningitis (Spearman’s correlation test). Conclusions The serum 14-3-3β concentrations may constitute a useful marker for blood brain barrier damage severity and follow up in patients with eosinophilic meningitis caused by A. cantonensis.

When C57BL/6 mice were infected with Angiostrongylus cantonensis, the percentage of T helper (CD4+) cells and T supressor (CD8+) cells in peripheral blood increased weekly until the third and seventh week respectively, and then gradually decreased. C57BL/6 mice were depleted of CD4+ and CD8+ T cells by in vivo injection of anti-CD4 and anti-CD8 monoclonal antibodies, respectively, and then infected with A. cantonensis. There were significantly more and less worms recovered in the mice depleted of CD4+ and CD8+ T cells respectively than in undepleted mice. Discrete subpopulations of T cells from mice exposed to A. cantonensis for 3 weeks or 7 weeks were adoptively transferred to syngeneic recipients which were then given a challenge infection. Protection was mediated by a CD4+ T cell population present in mice after 3 weeks of infection but was not demonstrable with cells taken 7 weeks after infection. When CD4+ T cells obtained from 3-week infected mice were mixed with 5% CD8+ T cells obtained from mice infected for 7 weeks, no significant transfer of resistance was observed. Thus, immune responses to A. cantonensis in mice were regulated by discrete subpopulations of T lymphocytes.

The saikosaponins -a(SSa), -d(SSd), -f(SSf), crude saponin mixture (CSM) and H 2 O-layer components (HLC) which were isolated from the root of Bupleurum kaoi Liu, Chao et Chuang (Umbelliferae), demonstrated an immunomodulatory effect. Mice of the BALB/c strain were injected peritoneally with drugs to assess immune responses weekly over a 4 week period. The results showed that the mean ratio of thymus weight to body weight increased during week 1 but declined gradually thereafter; the ratio of helper T-cells to suppressor T-cells (Th/ Ts) from mice treated with SSf and HLC gradually increased; however, in mice treated with SSa, SSd and CSM, the ratio rose to a maximum at week 3 and then decreased; the IL-2 level of treated mice was significantly higher than that of the control group throughout the test period; the ratio of spleen weight to body weight in all drug treated groups increased weekly; the activity of B-cell stimulation in mice was promoted week by week; levels of IgA, IgG and IgM in serum of SSd and SSa treated animals increased. An in vitro study, involving stimulation of IL-1 demonstrated the following order of potency: SSd > SSa, 23-O-AcSSa and CSM > SSf and HLC.

This study was designed to determine the effects of age and the role of spleen in rats with heavy Angiostrongylus cantonensis infection. Young rats (8 weeks) infected with 100 larvae were found to have significantly higher worm recovery rate (75.0 ± 6.6%) than the adult (6 months) (55.7 ± 1.5%) and the aging ones (13 months) (57.6 ± 4.0%). Moreover, the recovery rate in adult rats with 400 larvae (33.6 ± 10.67%) was significantly lower than those with 100 larvae (55.7 ± 1.53%) or 200 larvae (53.3 ± 5.4%). The splenectomized young rats with 100 larvae had a significantly higher recovery rate (84.3 ± 2.5%) than the intact (75.0 ± 6.6%) or sham splenectomized ones (74.4 ± 3.8%). Although titers of antibody against A. cantonensis increased with time, those against young adults were significantly higher before week 4 whereas those against adult worms become significantly higher since week 4. Titers in the splenectomized rats were also found to be significantly lower than those in the intact ones. These finding indicate that young rats are more susceptible to A. cantonensis. Crowding effect may occur in rats with heavy infections. The effects of splenectomy on the host are independent of the intensity of infection.

Angiostrongylus cantonensis is a parasite endemic in the Southeast Asian and Pacific regions. Humans are incidentally infected either by eating uncooked intermediate hosts or by consuming vegetables containing the living third-stage larvae. Reports on brain magnetic resonance imaging (MRI) findings and how they correlate with clinical features are limited in the literature. In this retrospective study, we investigated the brain MR features of eosinophilic meningitis caused by human infection with A. cantonensis. A detailed clinical study of 26 of these patients was conducted. The brain MRI findings were nonspecific, ranging from normal (n=1), leptomeningeal enhancement (n=21), hyperintense signal lesions (n=11) on T2-weighted MRI and nodular enhancing lesions in gadolinium-enhanced T1W1 (n=1). There was an association between the presence of brain MRI high signal intensities with peripheral eosinophilia (p=0.02), cerebrospinal fluid (CSF), eosinophil count ≥10%, and the presence of CSF antibodies to A. cantonensis (p=0.01). The patients with leptomeningeal enhancement in brain MRI tended to be younger and predominantly men (p=0.03). The time from onset of symptom to spinal tapping or brain MRI studies did not have an effect on the presence of brain MRI abnormalities. The brain MRI findings did not add any additional importance to the clinical evaluation of patients with eosinophilic meningitis in this series. Further studies are required to clarify the role of brain MRI in eosinophilic meningitis.

In this study, we investigated the anthelmintic activity of [6]-gingerol, [10]-shogaol, [10]-gingerol, [6]-shogaol and hexahydrocurcumin, a constituent isolate from the roots of ginger (Zingiber officinale), for the parasite Angiostrongylus cantonensis. This study found that the above constituents killed A. cantonensis larvae or reduced their spontaneous movements in a time- and dose-dependent manner. The larvicidal effect or ability to halt spontaneous parasite movement of [10]-shogaol, [6]-gingerol, [10]-gingerol, [6]-shogaol and hexahydrocurcumin at various concentrations was reached from 24 to 72 h, respectively. Further investigation to determine minimal effective doses of [10]-gingerol and hexahydrocurcumin revealed [10]-gingerol to have a greater maximum larvicidal effect and loss of spontaneous movements than hexahydrocurcumin, mebendazole and albendazole. These constituents of ginger showed effects against DPPH and peroxyl radical under larvicidal effect. Together, these findings suggest that these constituents of ginger might be used as larvicidal agents against A. cantonensis.

In this study, we investigate the anticancer effect of isoobtusilactone A (IOA), a constituent isolated from the leaves of Cinnamomum kotoense, on human non-small cell lung cancer (NSCLC) A549 cells. IOA was found to induce the arrest of G2-M phase, induce apoptosis, increase sub-G1, and inhibit the growth of these cells. Further investigation revealed that IOA's blockade of the cell cycle was associated with increased levels of p21/WAF1, p27 (kip1), and p53. In addition, IOA triggered the mitochondrial apoptotic pathway, as indicated by an increase in Bax/Bcl-2 ratios, resulting in a loss of mitochondrial membrane potential, release of cytochrome c, activation of caspase-9 and caspase-3, and cleavage of PARP. We also found the generation of reactive oxygen species (ROS) to be a critical mediator in IOA-induced inhibition of A549 cell growth. In antioxidant and NO inhibitor studies, we found that by pretreating A549 cells with either N-acetylcystenine (NAC), catalase, mannitol, dexamethasone, trolox, or L-NAME we could significantly decrease IOA production of ROS. Moreover, using NAC to block ROS, we could significantly suppress IOA-induced antiproliferation, antimigration, and anti-invasion. Finally, we found that IOA inhibited the migration and invasion of A549 cell migration and invasion. Taken together, these results suggest that IOA has anticancer effects on A549 cells.

Three IgG1 and one IgG2a monoclonal antibodies were obtained by fusion of NS-1 cells with spleen cells of BALB/C mice immunized with young-adult worm antigen of A. cantonensis. These 4 monoclonal antibodies were specific to A. cantonensis without cross-reactivity to any antigens of Toxocara canis, Ascaris suum, Clonorchis sinensis, Dirofilaria immitis, Paragonimus westermani, Gnathostoma spinigerum, Strongyloides stercoralis and Anisakis spp. detected by ELISA. The affinity constants of monoclonal antibodies specific to young-adult worms antigen of A. cantonensis were in the range of 10(7) M-1 to 10(9) M-1. The immunoblots showed that the 4 monoclonal antibodies recognized epitope on molecular weight of 204 kiloDaltons. They will be utilized to purify their corresponding antigen by an immunoaffinity column for the specific immunodiagnosis.

Invasive amoebiasis is rarely seen in human immunodeficiency virus (HIV)-infected individuals, even in endemic areas. By contrast, cytomegalovirus (CMV) disease is recognized as a major clinical problem in acquired immunodeficiency syndrome patients. A 34-year-old HIV-infected man with amoeba colitis, disseminated Mycobacterium avian complex and CMV infection with cecum perforation, presented with the initial symptoms of fever, shortness of breath and painful sensation when swallowing. He was treated with fluconazole, trimethoprim-sulfamethoxazole and hydrocortisone under the impression of esophageal candidiasis and Pneumocystis jiroveci pneumonia. However, diarrhea and abdominal pain developed on day 6 of hospitalization. Invasive amoebiasis and CMV colitis was diagnosed after examination of colon pathological specimens. Emergent laparotomy was performed. Right hemicolectomy with double barrel ileostomy and colostomy was done due to perforation of the cecum. Iodoquinol was given, followed by metronidazole 14 days afterwards. He underwent closure of double barrel ileostomy and colostomy 5 months later. This case illustrates the diagnostic challenge of caring for acquired immunodeficiency syndrome persons with multiple illnesses and medication use. CMV infection, amoebic colitis and possibly corticosteroid may have played a role in colon perforation in our patient.

The infective third-stage larvae of Angiostrongylus cantonensis secrete a proteolytic enzyme that is thought to be essential for both larval penetration into the intestinal wall of the host and full development. Protease activity in these larvae during culture in vitro was determined by zymography, pH optimum, and substrate and inhibitor specificity. Excretory-secretory (ES) products of the third-stage larvae showed protease activity as three bands with molecular masses of 66, 30, and 23 kD by gelatin zymography. The optimal pH value for this protease activity was 10.0. The protease was found to have collagenolytic as well as elastinolytic activity, but these activities were inhibited by serine protease or metalloprotease inhibitors. The importance of this protease in larval penetration of the intestinal wall and entering the blood stream was observed in vitro by cocultured third-stage larvae of A. cantonensis with specific protease inhibitors in the intestines of BALB/c mice. The penetration rates of larvae significantly decreased when serine protease or metalloprotease inhibitors were added to the intestines. These results showed that serine protease and metalloprotease in ES products of A. cantonensis third-stage larvae are associated with larval penetration of the intestinal walls of mice.

BALB/cByJ mice were divided into zinc-deficient (ZD), high zinc-supplemented (ZH), adequately zinc-replete (ZA) and normal control groups by daily dietary control. The body weight in ZD and ZH mice became significantly less than that of normal control mice from 4 weeks (P

Snails and freshwater fish were examined from four ponds in the Meinung township in which Clonorchis sinensis was known to be endemic 18 years ago. No metacercariae were found in 478 Tilapia nilotica, whereas of 451 Ctenopharyngodon idellus examined, 16.2%, 3.3% and 0.9% were found to be infected with Haplorchis pumilio, H. taichui and Clonorchis sinensis, respectively. In addition, there were some unidentified metacercariae in 12.0% of Ctenopharyngodon idellus examined. Overall, no positive correlation between infection rates and sizes of infected fish was shown. Six species of snails were collected in this survey and two frequently-occurring snails, Melanoides tuberculata and Thiara granifera were commonly infected with H. pumilio. Reasons for the prevalence of Haplorchis species and the absence of Clonorchis sinensis in fish and snail hosts in a previously reported endemic area for human clonorchiasis are discussed.

The diagnosis and management of strongyloidiasis present a continuous challenge in developing countries including Taiwan. In this study, the clinical characteristics and microbiological findings of 27 patients with Strongyloides stercoralis infection were retrospectively analyzed. Intestinal infection was identified in 17 patients and hyperinfection syndrome or disseminated disease in 10 (including 2 autopsy cases). The most frequent clinical findings were diarrhea (74%), fever (70%), abdominal pain (59%), cough (37%), dyspnea (33%), and constipation (26%). The common initial laboratory abnormalities were leukocytosis (81%), anemia (67%), liver function impairment (52%), and eosinophilia (44%). Most of the 27 patients had comorbid conditions, including malnutrition in 20 (74%), corticosteroid dependence in 15 (55%), chronic obstructive pulmonary disease in 9 (33%), chronic liver disease or cirrhosis in 8 (30%), and peptic ulcer disease in 7 (26%). There was no difference in the time interval from symptom onset to diagnosis between the intestinal infection group and the hyperinfection/disseminated group (22 +/- 15 vs 17 +/- 9 days). Larvae of S. stercoralis were identified in the stool of 24 patients, in the sputum smear of 5, in the gastric biopsy of one, and on histology of autopsy specimens in 2. Twenty-six patients received antiparasitic drug therapy of variable duration (mebendazole in 24, albendazole in 2, combined therapy in one). The overall cure rate was 52% (14/27). Relapse occurred in 4 patients. The overall mortality was 26% (7/27). There was a high mortality (up to 50%) in the hyperinfection/disseminated disease group. In conclusion, diagnosis of strongyloidiasis is often delayed and overlooked because of nonspecific symptoms. Physicians in endemic regions should include strongyloidiasis in the differential diagnosis when patients present with gastrointestinal and/or pulmonary symptoms with peripheral eosinophilia.

An antigen from Angiostrongylus cantonensis fifth-stage larvae was purified by immuno-affinity chromatography with a specific monoclonal antibody. The purified antigen showed only a single band with a molecular weight of 204 kD in SDS-PAGE, and no cross-reactivity to antibodies induced by several other species of helminths were observed in ELISA. When the purified antigen was used to examine serum and cerebrospinal fluid (CSF) specimens by ELISA, the antibody levels in patients with eosinophilic meningitis or meningoencephalitis (EME) were significantly higher than those of control subjects. The antibody levels in serum were slightly higher than those in CSF, and the levels in serum were positively correlated with the levels in CSF. The reliability in detection of antibodies in serum was slightly higher than that in the detection of antibodies in CSF specimens. The purification of a specific A. cantonensis antigen and its subsequent use in the development of an ELISA for detection of A. cantonensis specific antibodies in serum specimens constitute an important step towards improvement in the accuracy of diagnosis for A. cantonensis infections.

Specimens of serum and bile from patients were assayed by an enzyme-linked immunosorbent assay to reveal antibodies specific to antigens from adult Clonorchis sinensis. Antibodies of the IgG isotype showed the greatest elevation during infection (Student's t-test, P < 0.001), whereas serum IgA and IgE and secretory IgA in bile were moderately elevated (P < 0.05). Major differences in the distribution of antibodies among the IgG subclasses were observed between patients who were and those who were not infected. IgG4 antibody levels were elevated in the serum and bile of infected patients, and there were significant correlations between the levels of IgG and IgG4 antibodies and the intensity of infection.