肠道菌群与绝经综合征的研究前景

绝经综合征是指女性绝经前后因雌激素水平波动或下降所引起的一系列生理及心理的短期、中期和长期的临床症状,严重影响老年女性的生活质量。目前激素替代治疗（HRT）被认为是治疗绝经综合征最有效的方法。但是,由于HRT相关的健康风险以及人群对HRT的担忧,很多女性不能或者不选择HRT治疗。因此,随着全球老龄化社会的到来,以绝经期女性为中心的综合治疗,包括共同决策替代药物成为当务之急。本文旨在阐述肠道菌群与绝经综合征临床症状的关系并分析治疗效果,探讨肠道菌群在绝经综合征治疗中的研究前景。

     

A case of fatal malabsorption syndrome caused by strongyloidiasis complicated with isosporiasis and human cytomegalovirus infection]

This 54-year-old Korean coal miner suffered from continuous watery diarrhea and weight loss after corticosteroid treatment (beta-methasone, 4 mg daily for 1 week) due to hip-bone fracture in January 1991. Except for the short therapy of steroid, no other histories were contributory. The malabsorption syndrome was aggravated while the case was treated under the impression of amebiasis or intestinal tuberculosis. AIDS antibody test by EIA was negative and quantitative analysis of serum immunoglobulins was in normal ranges. Nine months after the onset of symptoms, the case was diagnosed as malabsorption syndrome caused by complexed and aggravated infection by Strongyloides stercoralis, Isospora and cytomegalovirus in the small intestine, which were proved by stool examination and duodenal biopsy. His clinical course became worse even after high-dosed and prolonged albendazole treatment for strongyloidiasis with supportive fluid therapy. The patient was discharged in hopeless status in November, 1991 and died after one week at home.     

Epidemiological aspects of strongyloidiasis in Brazil

The objective of this review was to outline an epidemiological profile of Strongyloides stercoralis by parasitological and serological diagnosis in inhabitants, and to associate this profile with different immunosupression situations, in Brazil, over 20 years (1990-2009). The occurrence of S. stercoralis using parasitological methods was 5·5%, being 4·8% in rural and 5·0% in urban areas, characterizing the country as hyperendemic. There was a diversity of techniques used as a diagnostic tool and only 39·1% of the studies presented results based on at least 1 specific method. The occurrence increased with age, being 12·1%, for those over 60 that suggests an epidemiological condition of concern for the elderly population. Of the seroepidemiological studies in the general population the mean positivity in serum samples was 21·7% and 29·2%, using an immunofluorescence antibody test and enzyme-linked immunosorbent assay (ELISA), respectively. The occurrence of strongyloidiasis in immunosuppressed individuals was 11·8% by parasitological methods and 19·5% using immunological methods. Considering that Brazil is a tropical country and that the character of chronicity and autoinfection of the parasite that can result in severe forms of hyperinfection or dissemination makes strongyloidiasis an important medically and socially neglected problem.     

多囊卵巢综合征患者与健康人群肠道菌群差异性分析

目的 比较多囊卵巢综合征(PCOS)患者与健康人群间肠道菌群的差异,为后续研究提供参考.方法 采用16SrDNA扩增子测序法对30例PCOS患者(PCOS组)和20例健康人(健康组)粪便标本中菌群结构进行分析,并比较两组之间的区别.结果 与健康组相比,PCOS组患者肠道菌群α多样性降低.PCOS组患者肠道厚壁菌门(Fi...     

Strongyloides stercoralis hyperinfection syndrome presenting as mechanical ileus after short-course oral steroids for chronic obstructive pulmonary disease (COPD) exacerbation

We report a case of a fatal Strongyloides stercoralis hyperinfection syndrome (SHS) in a migrant from Kenya, who had been living in Germany for three decades. A short-course oral steroid treatment for Chronic Obstructive Pulmonary Disease (COPD) exacerbation had been administered four weeks prior to the presentation. The initial clinical and radiological findings suggested a mechanical small bowel obstruction as a cause of ileus. Our case highlights the importance of maintaining a high index of suspicion for strongyloidiasis in patients from endemic areas even years after they left the country of origin. It demonstrates that even a five-day course of prednisolone is able to trigger SHS in patients with underlying strongyloidiasis. History of frequent previous administration of oral prednisolone for COPD exacerbations in our case raises the question why and how the last steroid regimen provoked SHS. SHS can present with multiple gastrointestinal symptoms including ileus and the absence of eosinophilia during the whole course of the disease should not lower the level of suspicion in the appropriate clinical setting.     

Endemic institutional strongyloidiasis in British Columbia.

The incidental finding in 1984 of Strongyloides stercoralis larvae in a resident of a chronic care institution who had a vague clinical illness prompted a review of the other residents. Five other cases were identified after exhaustive laboratory investigations. Fecal-oral spread was considered the most likely manner of the spread of infection. The possibility of endemic strongyloidiasis in institutions should be considered, even in temperate climates, when there is unexplained persistent illness or high eosinophil counts. Serologic testing is a useful adjunct to fecal examination in such situations.     

Seroepidemiology of strongyloidiasis in a Thai village

Strongyloidiasis is a potentially fatal disease for which existing methods of diagnosis lack sensitivity. A recently developed ELISA for IgG antibodies against the infective larval stage was used to screen a leprosy resettlement village in an area endemic for strongyloidiasis. The results of the ELISA were compared with the results of stool examination for 177 villagers. Eleven per cent of the village had S. stercoralis present on stool examination and 45% had antibodies detected by ELISA. Eighteen of 21 (85%) villagers with S. stercoralis infection proven by stool examination had positive ELISA values. No cross reactivity with intraluminal parasites was present. Linear correlation between per cent eosinophils and the ELISA revealed a correlation coefficient of 0.402 (P < 0.001). Forty-two days after sucessful treatment in 14 villagers, the IgG antibody levels had decreased (P < 0.001). Leprosy did not affect the sensitivity of the assay. These results suggest that ELISA is a simple, sensitive and specific method for surveying exposure to S. stercoralis in an endemic area.     

Strongyloides stercoralis hyperinfection in an immunocompetent patient with extreme eosinophilia

This report examines an unusual case of Srongyloides stercoralis hyperinfection in a 63-yr-old man. The patient had a history of vitamin B deficiency, on and off diarrhea, and clinical pellagra for a decade and a half. There was also evidence of extreme eosinophilia. The patient did not have any associated illness suggestive of immunosuppression. Treatment with ivermectin resulted in remarkable clinical improvement and reversion of eosinophil count to normal.     

Callithrix penicillata as a nonhuman primate model for strongyloidiasis

In order to better understand experimental strongyloidiasis in small New World primates, and to evaluate aspects of reinfection and immunosuppression induced by glucocorticoids, nine specimens of Callithrix penicillata (Primates: Cebidae) were administered (by subcutaneous injection, sc) 3000 infective larvae of a strain of Strongyloides venezuelensis (Rhabditida: Strongyloididae) that had been maintained in successive passages through AKR/J mice since 1987. The mean prepatent period was 5.6 ± 0.7 days post-infection (DPI). The mean patent period of infection among the untreated animals (marmosets 1-7) was 123.4 ± 61.4 DPI. Two animals (marmosets 8 and 9) received dexamethasone (2.5 mg/kg, sc) for five consecutive days starting on the 20th day after infection, but this treatment did not alter the course of the infection, and the patent period for these animals was 100.5 ± 58.7 DPI (59 and 142, respectively). Stool examination showed that the highest quantities of parasite eggs were expelled between the 8th and 19th days after inoculation of the larvae. Thereafter, there was a gradual reduction in the number of parasite eggs in feces of all marmosets. During the chronic phase of the infection, before completely negative parasitological findings were obtained, the parasitological examinations were intermittently positive. Reinfection of three of these animals did not result in new positive examinations. However, given the receptiveness of these animals to initial infection with S. venezuelensis and their similarities to human beings, it is proposed that C. penicillata could be used as a nonhuman primate model for experimental strongyloidiasis.     

Intestinal endotoxin as a universal factor of adaptation and pathogenesis of general adaptation syndrome

Intestinal endotoxin is an obligate adaptive and pathogenetic factor of general adaptation syndrome. In athletes, systemic blood endotoxin levels, regulated by the sympathoadrenal system, increase as the athletic performance is enhanced and the exercise tolerance depends on the ability of the body to consume this endotoxin and on the extent to which it is absorbed in the intestine.