Osamu Zaha

Varioliform mucosal polypoid lesions in intestinal tract in a patient with adult T-cell leukemia.

We describe a case of adult T-cell leukemia (ATL) with intestinal infiltration. In the early clinical stage, the endoscopic findings for the intestine were similar to those of amebic enterocolitis, i.e., varioliform mucosal polypoid lesions, and amebic cyst was detected with stool examination. Although no specific pathological factor could be identified on biopsy, the patient was treated for amebiasis as a diagnostic therapy. the findings of varioliform mucosal polypoid lesions were detected in the duodenum on endoscopic examination, but the lesions eventually disappeared during the treatment for amebiasis. We then suspected lymphoma partially masked by, the amebiasis. Immunological staining of a specimen of the colonic mucosa revealed T cell invasion and Southern blotting demonstrated adult T-cell leukemia provirus invasion. Thus, ATL cell infiltration of the intestinal tract was confirmed It is suggested that systemic disease should also be considered when varioliform mucosal polypoid lesions are found on colonoscopic examination.

Ivermectin in Clinical Practice

Publisher Summary This chapter provides an overview of ivermectin in clinical practice. Ivermectin is a dihydro derivative of avermectin B1. It has an extremely broad-spectrum nematocidal activity. Ivermectin is extremely used in veterinary medicine against a wide range of parasites, including insects and nematodes, in cattle, sheep, and horses. Ivermectin exhibits potent microfilaricidal activity against the other major filarial parasites of humans. It also has excellent efficacy against human cutaneous larva migrans, for which good alternative treatments are not available. In context to human diseases, ivermectin is approved only for the treatment of onchocerciasis and strongyloidiasis. The anthelmintic effect of ivermectin for strongyloidiasis is excellent, the incidences of adverse effects are low and their severity is very mild. Therefore, ivermectin is considered as the most useful drug for strongyloidiasis in mass treatment. Owing to the broad potency of albendazole against intestinal helminths, combination therapy with ivermectin and albendazole carries the added advantage of reducing the prevalence and intensity of filarial parasites as well as of intestinal nematodes. This chapter describes the efficacy of ivermectin for human strongyloidiasis, the combination therapy of ivermectin and albendazole for bancroftian filariasis and finally the efficacy of ivermectin in the treatment of human scabies. The chapter also briefly summarizes the efficacy of ivermectin for human onchocerciasis.