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Fernandez-Gonzalez P, Torres-Tienza S, Collantes-Rodríguez C, Sáez-García MÁ, Fonda-Pascual P. Cytology and dermatological findings: key diagnostic tools in Strongyloides stercoralis hyperinfestation. Int J Dermatol 2024. [PMID: 38822581 DOI: 10.1111/ijd.17280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 06/03/2024]
Affiliation(s)
| | | | | | - Miguel Á Sáez-García
- Servicio de Anatomía Patológica, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
| | - Pablo Fonda-Pascual
- Servicio de Dermatología, Hospital Central de la Defensa Gómez Ulla, Madrid, Spain
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Rodrigues JGM, Miranda GS, Camelo GMA, Rodrigues VF, Silva JKAO, Gouveia CBG, Porto WJN, Wanderley FS, Geiger SM, Negrão-Corrêa DA. Modifications to the parasitological technique of Rugai increase the diagnostic sensitivity for strongyloidiasis. Parasitol Res 2024; 123:101. [PMID: 38233532 DOI: 10.1007/s00436-023-08111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
Strongyloidiasis is a neglected tropical disease caused mainly by Strongyloides stercoralis, a nematode that can persist for decades in the human host with a very low parasitic burden and without specific symptoms. Hence, it is difficult to diagnose and control. Larval concentration and culture methods with fecal samples show higher sensitivity for the diagnosis of Strongyloides-infected individuals; however, these techniques are not routinely used, primarily due to the challenges associated with processing a substantial volume of fecal samples. In the current study, we comparatively evaluated the sensitivity and applicability of modifications made to the Rugai parasitological method for the diagnosis of strongyloidiasis in fecal samples of experimentally infected rats and in 68 individuals from an urban community close to Maceió, Brazil. The presence and quantity of parasite larvae in the feces were comparatively evaluated using different parasitological techniques. In the experimental model, we demonstrated that the modified Rugai technique (RMOD) allowed for significantly higher recovery of larvae than the original Rugai technique (RO). Moreover, the sediment was cleaner and easier to evaluate using optical microscopy. Compared to other parasitological techniques, such as agar-plate culture (A-PC) and spontaneous sedimentation (SS), the RMOD technique showed higher sensitivity in the detection of larvae in all infected groups and presented comparatively better performance, especially in rats with a low parasite burden. In the human population, among the 68 stool samples evaluated, Strongyloides larvae were detected in the feces of six individuals with an estimated prevalence of 8.82%. However, the performance of each parasitological method was remarkably different. SS identified Strongyloides larvae in only two individuals and A-PC in three, whereas RMOD was able to identify six infected individuals, resulting in sensitivities of 33.3%, 50%, and 100%, respectively. In conclusion, the modifications introduced to the Rugai technique resulted in improved sensitivity for the detection of Strongyloides spp. infections, especially in stool samples with a low parasite burden, in comparison with other routinely used parasitological techniques.
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Affiliation(s)
- João Gustavo Mendes Rodrigues
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Guilherme Silva Miranda
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Biology, Federal Institute of Education, Science and Technology of Maranhão, São Raimundo das Mangabeiras, Brazil
| | - Genil Mororó Araújo Camelo
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vanessa Fernandes Rodrigues
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Caio Brandão Goes Gouveia
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Flaviana Santos Wanderley
- Laboratory of Parasitic Infectious Diseases, State University of Health Sciences of Alagoas, Maceió, Brazil
| | - Stefan Michael Geiger
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Gryschek RCB, Corral MA, Sitta RB, Gottardi M, Pierrotti LC, Costa SF, Abdala E, Chieffi PP, de Paula FM. Strongyloides infection screening in transplant candidates: What is the best strategy? Transpl Infect Dis 2023; 25:e14153. [PMID: 37750481 DOI: 10.1111/tid.14153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The potential that Strongyloides stercoralis infection has to cause major morbidity and high mortality when the disseminated form occurs in transplant patients is of particular concern. METHODS In this study, the objective was to observe S. stercoralis infection in patients who are candidates for transplantation by using parasitological, serological, and molecular techniques and to propose an algorithm for the detection of that infection in transplant candidates. RESULTS By parasitological techniques, 10% of fecal samples were positive. Anti-Strongyloides antibodies immunoglobulin G were detected in 19.3% and 20.7% of patients by immunofluorescence assay and enzyme-linked immunosorbent assay, respectively. S. stercoralis DNA was observed in 17.3% of samples by conventional polymerase chain reaction and 32.7% of samples by quantitative polymerase chain reaction (qPCR). CONCLUSION The set of results allows us to reinforce that a positive result by parasitological techniques and/or qPCR indicates that the specific treatment should be applied. However, the improvement of diagnostic techniques may suggest changes in the screening for strongyloidiasis in these patients.
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Affiliation(s)
- Ronaldo Cesar Borges Gryschek
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Marcelo Andreetta Corral
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Renata Barnabé Sitta
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Maiara Gottardi
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Ligia Camera Pierrotti
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Silvia Figueiredo Costa
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Edson Abdala
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Pedro Paulo Chieffi
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Sao Paulo, Brazil
| | - Fabiana Martins de Paula
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
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Gouveia-Eufrasio L, de Freitas GJC, Costa MC, Peres-Emidio EC, Carmo PHF, Rodrigues JGM, de Rezende MC, Rodrigues VF, de Brito CB, Miranda GS, de Lima PA, da Silva LMV, Oliveira JBS, da Paixão TA, da Glória de Souza D, Fagundes CT, Peres NTDA, Negrão-Correa DA, Santos DA. The Th2 Response and Alternative Activation of Macrophages Triggered by Strongyloides venezuelensis Is Linked to Increased Morbidity and Mortality Due to Cryptococcosis in Mice. J Fungi (Basel) 2023; 9:968. [PMID: 37888224 PMCID: PMC10607621 DOI: 10.3390/jof9100968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Cryptococcosis is a systemic mycosis that causes pneumonia and meningoencephalitis. Strongyloidiasis is a chronic gastrointestinal infection caused by parasites of the genus Strongyloides. Cryptococcosis and strongyloidiasis affect the lungs and are more prevalent in the same world regions, i.e., Africa and tropical countries such as Brazil. It is undeniable that those coincidences may lead to the occurrence of coinfections. However, there are no studies focused on the interaction between Cryptococcus spp. and Strongyloides spp. In this work, we aimed to investigate the interaction between Strongyloides venezuelensis (Sv) and Cryptococcus gattii (Cg) in a murine coinfection model. Murine macrophage exposure to Sv antigens reduced their ability to engulf Cg and produce reactive oxygen species, increasing the ability of fungal growth intracellularly. We then infected mice with both pathogens. Sv infection skewed the host's response to fungal infection, increasing lethality in a murine coinfection model. In addition to increased NO levels and arginase activity, coinfected mice presented a classic Th2 anti-Sv response: eosinophilia, higher levels of alternate activated macrophages (M2), increased concentrations of CCL24 and IL-4, and lower levels of IL-1β. This milieu favored fungal growth in the lungs with prominent translocation to the brain, increasing the host's tissue damage. In conclusion, our data shows that primary Sv infection promotes Th2 bias of the pulmonary response to Cg-infection and worsens its pathological outcomes.
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Affiliation(s)
- Ludmila Gouveia-Eufrasio
- Departamento de Microbiologia, Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (L.G.-E.); (N.T.d.A.P.)
| | - Gustavo José Cota de Freitas
- Departamento de Microbiologia, Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (L.G.-E.); (N.T.d.A.P.)
| | - Marliete Carvalho Costa
- Departamento de Microbiologia, Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (L.G.-E.); (N.T.d.A.P.)
| | - Eluzia Castro Peres-Emidio
- Departamento de Microbiologia, Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (L.G.-E.); (N.T.d.A.P.)
| | - Paulo Henrique Fonseca Carmo
- Departamento de Microbiologia, Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (L.G.-E.); (N.T.d.A.P.)
| | - João Gustavo Mendes Rodrigues
- Departamento de Parasitologia, Laboratório de Esquistossomose, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (D.A.N.-C.)
| | - Michelle Carvalho de Rezende
- Departamento de Parasitologia, Laboratório de Esquistossomose, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (D.A.N.-C.)
| | - Vanessa Fernandes Rodrigues
- Departamento de Parasitologia, Laboratório de Esquistossomose, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (D.A.N.-C.)
| | - Camila Bernardo de Brito
- Departamento de Microbiologia, Laboratório de Interação Microrganismo-Hospedeiro, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (D.d.G.d.S.); (C.T.F.)
| | - Guilherme Silva Miranda
- Departamento de Parasitologia, Laboratório de Esquistossomose, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (D.A.N.-C.)
| | - Pâmela Aparecida de Lima
- Departamento de Patologia, Laboratório de Patologia Celular e Molecular, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (T.A.d.P.)
| | - Lívia Mara Vitorino da Silva
- Departamento de Microbiologia, Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (L.G.-E.); (N.T.d.A.P.)
| | - Jefferson Bruno Soares Oliveira
- Departamento de Patologia, Laboratório de Patologia Celular e Molecular, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (T.A.d.P.)
| | - Tatiane Alves da Paixão
- Departamento de Patologia, Laboratório de Patologia Celular e Molecular, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (T.A.d.P.)
| | - Daniele da Glória de Souza
- Departamento de Microbiologia, Laboratório de Interação Microrganismo-Hospedeiro, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (D.d.G.d.S.); (C.T.F.)
| | - Caio Tavares Fagundes
- Departamento de Microbiologia, Laboratório de Interação Microrganismo-Hospedeiro, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (D.d.G.d.S.); (C.T.F.)
| | - Nalu Teixeira de Aguiar Peres
- Departamento de Microbiologia, Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (L.G.-E.); (N.T.d.A.P.)
| | - Deborah Aparecida Negrão-Correa
- Departamento de Parasitologia, Laboratório de Esquistossomose, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil (D.A.N.-C.)
| | - Daniel Assis Santos
- Departamento de Microbiologia, Laboratório de Micologia, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil; (L.G.-E.); (N.T.d.A.P.)
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Soleymani E, Davoodi L, Shayesteh Azar S, Mirbadiei SR, Parandin F, Azimi A, Mizani A, Khorshidvand Z, Fakhar M. Fatal Disseminated Strongyloidiasis in an Immunosuppressed Patient During COVID-19 Pandemic. Acta Parasitol 2023; 68:711-717. [PMID: 37532918 DOI: 10.1007/s11686-023-00705-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION This report presents a fatal case of disseminated strongyloidiasis in a patient with myasthenia gravis and diabetes mellitus who had received corticosteroid therapy. CASE REPORT The patient was a 67-year-old woman living in a rural area endemic for Strongyloides stercoralis in northern Iran. Disseminated strongyloidiasis was diagnosed in the advanced stage of the disease, with enormous numbers of larvae demonstrated in direct smears prepared from stool samples and stomach biopsy. Despite treatment with ivermectin and antibiotics, the patient succumbed to the severity of the infection. CONCLUSION Clinicians working in endemic areas should be mindful of the possibility of gastric involvement in strongyloidiasis, even if symptoms are nonspecific. We recommend that high-risk individuals be screened for S. stercoralis prior to immunosuppressive therapy in endemic regions to raise awareness and prevent similar cases.
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Affiliation(s)
- Eissa Soleymani
- Department of Infectious Diseases, Faculty of Medicine, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Lotfollah Davoodi
- Department of Infectious Diseases, Faculty of Medicine, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shadi Shayesteh Azar
- Department of Infectious Diseases, Faculty of Medicine, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Reza Mirbadiei
- Department of Parasitology and Mycology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Parandin
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Afshin Azimi
- Department of Parasitology and Mycology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Azadeh Mizani
- Department of Parasitology, Pasteur Institute of Iran, Tehran, Iran
| | - Zohreh Khorshidvand
- Department of Parasitology and Mycology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahdi Fakhar
- Iranian National Registry Centre for Lophomoniasis and Toxoplasmosis, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, P.O Box: 48166-33131, Sari, Iran.
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Singh A, Prasad P, Singh A. A case of strongyloidiasis with aplastic anaemia: A common disease with an uncommon presentation. IDCases 2023; 33:e01883. [PMID: 37663134 PMCID: PMC10474063 DOI: 10.1016/j.idcr.2023.e01883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023] Open
Abstract
Strongyloidiasis is an opportunistic infection caused by the nematode helminth Strongyloides stercoralis and transmitted mostly via soil. The disease is usually asymptomatic, limited, and long-standing. Herein, we report a case of strongyloidiasis in a patient who seemed to be immunocompetent despite his malnourished appearance. He was presented with pancytopenia and aplastic anaemia and well responded to albendazole therapy with complete resolution of symptoms within three months. We recommend, prior to beginning of immunosuppressive regimens, it may be prudent to examine all patients presenting with abdominal discomfort along with pancytopenia for a possible worm infestation. Bone marrow suppression induced by worm infestation is an extremely rare but potentially comorbid condition that can lead to pancytopenia and severe aplastic anaemia.
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Affiliation(s)
- Alka Singh
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Pallavi Prasad
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anurag Singh
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Sinhorin GH, Carneiro ACG, Farias BES, de Almeida P, Medeiros-Sousa AR, Melchior LAK, Brilhante AF. Intestinal parasite infections associated with sociodemographic and seasonal factors in the Western Amazon. Parasitol Res 2023; 122:419-423. [PMID: 36416950 DOI: 10.1007/s00436-022-07736-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/14/2022] [Indexed: 11/24/2022]
Abstract
Intestinal parasites are a constant public health problem in the Amazon region, with a high prevalence of cases related to poor sanitary conditions. We investigated the sociodemographic and seasonal factors associated with human intestinal parasite infections in an area of the Western Amazon, Brazil, from September 2017 to August 2019. Data were collected using a database available at the Diagnostic Support Centre (Centro de Apoio ao Diagnóstico, CAD) of the Municipality of Rio Branco, on positive diagnoses for intestinal parasites. Among the 53,200 samples analysed, 18.3% (n = 9712) were positive. Of these, 96.4% (n = 9363) and 3.6% (n = 349) were protozoan and helminthic infections, respectively. Males showed higher odds ratio (OR) for Enterobius vermicularis infection (OR: 2.3) and giardiasis (OR: 1.9) and lower OR for Endolimax nana (OR: 0.9) and Entamoeba coli (OR: 0.9) infections. Individuals aged ≥ 15 presented higher OR for Strongyloides stercoralis (OR: 3.4), hookworms (OR: 2.3), and almost all protozoan infections than younger individuals. In the dry season, the OR for hookworms (OR: 1.5), Iodamoeba butschlii (OR: 1.4), and Endolimax nana (OR: 1.3) infections was higher than that in the rainy season, including a high chance of polyparasitism (OR: 1.6). We concluded that there was a significant difference between the different types of intestinal parasites, particularly protozoa, with high OR in the dry season and for certain groups.
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Affiliation(s)
| | | | | | - Patrícia de Almeida
- Center for Health and Sport Sciences, Federal University of Acre, Rio Branco, Acre, Brazil
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8
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Fatal Case of Autochthonous Strongyloides stercoralis Hyperinfection in an Immunosuppressed Calabrian Patient. REPORTS 2022. [DOI: 10.3390/reports5040047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Strongyloides stercoralis is an intestinal nematode that can induce disseminated infection in immunocompromised patients. It is most commonly acquired in tropical and subtropical countries; however, foci of the infection have also been reported in temperate geographic areas. In non-endemic areas, the diagnosis of an S. stercoralis infection is challenging due to the variety of clinical symptoms. Herein, we report the case of a patient, born and raised in the Calabria region of Southern Italy, who presented with melanoma and S. stercoralis hyperinfection, which is characterized by dyspnea, productive cough, inappetence, marked asthenia, weight loss, and Klebsiella pneumoniae bacteremia. He worked as a farmer and never traveled to another country known to be endemic for S. stercoralis. Despite the prompt identification of the parasite with sputum microscopy and the initiation of therapy with ivermectin and piperacillin–tazobactam, the patient later died. This case underscores the continued risk for S. stercoralis infection even in geographic areas that were previously considered non-endemic for the nematode and indicates that the geographic distribution of S. stercoralis may be expanding in Italy.
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A Rare Presentation of Strongyloides stercoralis Infection from an Immunocompetent Individual in a Tertiary Care Center in South India. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.3.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Strongyloidiasis is a neglected parasitic disease caused by the intestinal parasite, Strongyloides stercoralis. Most patients with strongyloidiasis are asymptomatic, but few present with varied clinical manifestations such as cutaneous, gastrointestinal, pulmonary, and disseminated disease. It creates a diagnostic dilemma and undue delay in the diagnosis of patients. We report the case of a 79-year-old male who presented with fever and abdominal pain due to strongyloidiasis with no history of immunosuppression. The infection resolved entirely on treatment with ivermectin.
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Herbert DR, Stoltzfus JDC, Rossi HL, Abraham D. Is Strongyloides stercoralis hyperinfection induced by glucocorticoids a result of both suppressed host immunity and altered parasite genetics? Mol Biochem Parasitol 2022; 251:111511. [PMID: 36007683 DOI: 10.1016/j.molbiopara.2022.111511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/01/2022] [Accepted: 08/18/2022] [Indexed: 11/19/2022]
Abstract
The gastrointestinal (GI) nematode Strongyloides stercoralis (S.s.) causes human strongyloidiasis, a potentially life-threatening disease that currently affects over 600 million people globally. The uniquely pernicious aspect of S.s. infection, as compared to all other GI nematodes, is its autoinfective larval stage (L3a) that maintains a low-grade chronic infection, allowing undetectable persistence for decades. Infected individuals who are administered glucocorticoid therapy can develop a rapid and often lethal hyperinfection syndrome within days. Hyperinfection patients often present with dramatic increases in first- and second-stage larvae and L3a in their GI tract, with L3a widely disseminating throughout host organs leading to sepsis. How glucocorticoid administration drives hyperinfection remains a critical unanswered question; specifically, it is unknown whether these steroids promote hyperinfection through eliminating essential host protective mechanisms and/or through dysregulating parasite development. This current deficiency in understanding is largely due to the previous absence of a genetically defined mouse model that would support all S.s. life-cycle stages and the lack of successful approaches for S.s. genetic manipulation. However, there are currently new possibilities through the recent demonstration that immunodeficient NOD.Cg-PrkdcscidIl2rgtm1Wjl/SzJ (NSG) mice support sub-clinical infections that can be transformed to lethal hyperinfection syndrome following glucocorticoid administration. This is coupled with advances in transcriptomics, transgenesis, and gene inactivation strategies that now allow rigorous scientific inquiry into S.s. biology. We propose that combining in vivo manipulation of host immunity and deep immunoprofiling strategies with the latest advances in S.s. transcriptomics, piggyBac transposon-mediated transgene insertion, and CRISPR/Cas-9-mediated gene inactivation will facilitate new insights into the mechanisms that could be targeted to block lethality in humans with S.s. hyperinfection.
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Affiliation(s)
- De'Broski R Herbert
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce St., Philadelphia, PA 10104, USA.
| | - Jonathan D C Stoltzfus
- Department of Biology, Millersville University of Pennsylvania, 50 E. Frederick St., Millersville, PA 17551, USA.
| | - Heather L Rossi
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, 3800 Spruce St., Philadelphia, PA 10104, USA.
| | - David Abraham
- Department of Microbiology and Immunology, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St., Philadelphia, PA 19107, USA.
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Munisankar S, Rajamanickam A, Balasubramanian S, Muthusamy S, Dolla CK, Menon PA, Chinnayan P, Whalen C, Gumne P, Kaur I, Nadimpalli V, Deverakonda A, Chen Z, David Otto J, Habitegiyorgis T, Kandaswamy H, Nutman TB, Babu S. Seroprevalence of Strongyloides stercoralis infection in a South Indian adult population. PLoS Negl Trop Dis 2022; 16:e0010561. [PMID: 35857754 PMCID: PMC9299326 DOI: 10.1371/journal.pntd.0010561] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The prevalence of Strongyloides stercoralis infection is estimated to be 30–100 million worldwide, although this an underestimate. Most cases remain undiagnosed due to the asymptomatic nature of the infection. We wanted to estimate the seroprevalence of S. stercoralis infection in a South Indian adult population.
Methods
To this end, we performed community-based screening of 2351 individuals (aged 18–65) in Kanchipuram District of Tamil Nadu between 2013 and 2020. Serological testing for S. stercoralis was performed using the NIE ELISA.
Results
Our data shows a seroprevalence of 33% (768/2351) for S. stercoralis infection which had a higher prevalence among males 36% (386/1069) than among females 29.8% (382/1282). Adults aged ≥55 (aOR = 1.65, 95% CI: 1.25–2.18) showed higher adjusted odds of association compared with other age groups. Eosinophil levels (39%) (aOR = 1.43, 95% CI: 1.19–1.74) and hemoglobin levels (24%) (aOR = 1.25, 95% CI: 1.11–1.53) were significantly associated with S. stercoralis infection. In contrast, low BMI (aOR = 1.15, 95% CI: 0.82–1.61) or the presence of diabetes mellitus (OR = 1.18, 95% CI: 0.83–1.69) was not associated with S. stercoralis seropositivity.
Conclusions
Our study provides evidence for a very high baseline prevalence of S. stercoralis infection in South Indian communities and this information could provide realistic and concrete planning of control measures.
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Affiliation(s)
- Saravanan Munisankar
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
- * E-mail:
| | - Anuradha Rajamanickam
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | - Suganthi Balasubramanian
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | - Satishwaran Muthusamy
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | | | | | | | - Christopher Whalen
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Paschaline Gumne
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Inderdeep Kaur
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Varma Nadimpalli
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Akshay Deverakonda
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Zhenhao Chen
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - John David Otto
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Tesfalidet Habitegiyorgis
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Harish Kandaswamy
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Subash Babu
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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12
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De Liberato C, Iatta R, Scarito MA, Grifoni G, Dante G, Otranto D. Strongyloides stercoralis in a dog litter: Evidence suggesting a transmammary transmission. Acta Trop 2022; 231:106465. [PMID: 35427536 DOI: 10.1016/j.actatropica.2022.106465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Strongyloides stercoralis is a soil-transmitted helminth with an unusual life cycle, causing canine and human strongyloidiasis, mainly endemic in tropical and subtropical areas. Following percutaneous or oral transmission of infective third-stage larvae in the vertebrate host, the parasite can cause autoinfection, leading to life-long infection. At present, the transmammary transmission was only assessed in experimentally infested dogs. Here, we provide observational evidence of S. stercoralis transmammary transmission in puppies suckling from a truffle dog from Central Italy, from where its presence was neglected.
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Affiliation(s)
- Claudio De Liberato
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy.
| | - Roberta Iatta
- Dipartimento Interdisciplinare di Medicina, Università di Bari, Piazza Giulio Cesare 11, Bari 70124, Italy
| | - Maria Alessia Scarito
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy
| | - Goffredo Grifoni
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy
| | - Giampiero Dante
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy
| | - Domenico Otranto
- Dipartimento di Medicina Veterinaria, Università di Bari, Str. prov. per Casamassima km 3, Valenzano 70010, Italy
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13
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Muelas-Fernandez M, Lerida-Urteaga A, Paules-Villar MJ, Vidal-Bel A, Ruiz-Pombo M. Strongyloides hyperinfection in a patient from Venezuela with lower gastrointestinal bleeding. J Travel Med 2022; 29:6287697. [PMID: 34050370 DOI: 10.1093/jtm/taab084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 01/25/2023]
Abstract
We herein present a case of unsuspected Strongyloides stercoralis (Ss) hyperinfection diagnosis. No screening due to origin or immunosuppressed condition had been done and treatment was presumably prescribed lately, with subsequent vital risk for the patient.
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14
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Mazzaro MC, Santos ÉAD, Melo GBD, Marques PD, Souza LV, Elias-Oliveira J, Silva BCD, Gryschek RCB, Paula FMD, Rodrigues RM. Importance of detection of Strongyloides stercoralis DNA in fecal samples from patients with type 2 diabetes mellitus. Clinics (Sao Paulo) 2022; 77:100060. [PMID: 35834919 PMCID: PMC9283877 DOI: 10.1016/j.clinsp.2022.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/21/2022] [Accepted: 05/30/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The association between diabetes and Strongyloides infection remains controversial. This study aimed to detect Strongyloides stercoralis DNA in the feces of patients with Diabetes Mellitus type 2 (DM2). METHODS Fecal samples were analyzed via the Lutz, Rugai, and agar plate culture methods. PCR amplification was performed using two targets (PCR-genus and PCR-species) located on the S. stercoralis 18S ribosomal. RESULTS The positivity for S. stercoralis using parasitological methods was 1.1%. PCR-genus (14.13%) demonstrated a higher positivity than PCR-species (9.78%). CONCLUSION The results confirm the greater positivity of the molecular diagnosis in relation to parasitological methods, reinforcing its use as an additional tool for the diagnosis of S. stercoralis infection in patients with DM2 living in endemic areas for this helminthiasis.
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Affiliation(s)
| | | | - Gessica Baptista de Melo
- Laboratório de Investigação Médica, Hospital de Clínicase Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Priscila Duarte Marques
- Laboratório de Investigação Médica, Hospital de Clínicase Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Laura Vilela Souza
- Laboratório de Parasitologia, Universidade Federal de Jataí, Jataí, GO, Brazil
| | | | | | - Ronaldo César Borges Gryschek
- Laboratório de Investigação Médica, Hospital de Clínicase Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Fabiana Martins de Paula
- Laboratório de Investigação Médica, Hospital de Clínicase Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, Brazil
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15
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Khan U, Tchomobe G, Vakharia S, Suryadevara M, Nagarakanti S. A case of Strongyloides Stercoralis induced duodenitis and pancreatitis. IDCases 2022; 27:e01442. [PMID: 35198385 PMCID: PMC8844764 DOI: 10.1016/j.idcr.2022.e01442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- U. Khan
- Department of Internal Medicine, Rutgers – RWJBH Newark Beth Israel Medical Center, Newark NJ, United States
- Corresponding author.
| | - G. Tchomobe
- Department of Internal Medicine, Rutgers – RWJBH Newark Beth Israel Medical Center, Newark NJ, United States
| | - S. Vakharia
- Department of Internal Medicine, Rutgers – RWJBH Newark Beth Israel Medical Center, Newark NJ, United States
| | - M. Suryadevara
- Department of Infectious Disease, Rutgers – RWJBH Newark Beth Israel Medical Center, Newark, NJ, United States
| | - S. Nagarakanti
- Department of Infectious Disease, Rutgers – RWJBH Newark Beth Israel Medical Center, Newark, NJ, United States
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16
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Lee DAB, de Oliveira ELC, Lee GAS, da Silva PL, Santos POM, Lima VFS. Potentially zoonotic parasites in the soil of public squares in the city of Aracaju (Sergipe, Northeastern Brazil). Vet Parasitol Reg Stud Reports 2021; 26:100619. [PMID: 34879931 DOI: 10.1016/j.vprsr.2021.100619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 11/24/2022]
Abstract
This study evaluated the soil contamination of public squares in the city of Aracaju, Sergipe, by potentially zoonotic parasites and correlated their occurrence with climatic variables (temperature, humidity and precipitation). Samples were collected over a 18-month period, from 20 different public squares, and submitted to three different parasitological techniques: Faust's, Hoffman's and Rugai's methods, adapted to soil samples. Results indicated the presence of several potentially zoonotic parasitic species in eighteen of the 20 squares analyzed (90%). The parasites identified included Ancylostoma spp., Strongyloides stercoralis, Toxocara spp., Dipylidium caninum, Trichuris sp., Capillaria sp. and Giardia sp. They were identified during all months of the year and no influence of temperature, humidity or precipitation on the occurrence of those parasites was observed. Such results demonstrate that public squares in the city of Aracaju pose a parasitic contamination risk for people and pets that visit those places as a leisure activity.
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Affiliation(s)
- Daniel Antônio Braga Lee
- Departamento de Medicina Veterinária, Universidade Federal de Sergipe, CEP 49100-000 Sergipe, Brazil.
| | | | | | - Pablo Lopes da Silva
- Departamento de Medicina Veterinária, Universidade Federal de Sergipe, CEP 49100-000 Sergipe, Brazil
| | | | - Victor Fernando Santana Lima
- Núcleo de Graduação em Medicina Veterinária do Sertão, Universidade Federal de Sergipe, CEP 49680-000 Sergipe, Brazil
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17
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Costa IN, Bosqui LR, Corral MA, Costa-Cruz JM, Gryschek RCB, de Paula FM. Diagnosis of human strongyloidiasis: Application in clinical practice. Acta Trop 2021; 223:106081. [PMID: 34364894 DOI: 10.1016/j.actatropica.2021.106081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 12/28/2022]
Abstract
This review considers the advantages and disadvantages of parasitological techniques, methods of detecting antibodies and antigens, as well as molecular biology techniques in the diagnosis of human strongyloidiasis. In addition, it elucidates the potential of different techniques for rapid and effective detection of clinical cases, thus enabling early treatment and preventing fatal consequences of this helminthiasis.
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18
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Nascimento RC, Melo GB, Fonseca PDM, Gryschek RCB, Paula FM. Evaluation of targets for Strongyloides genus specific molecular diagnosis in experimental strongyloidiasis. Exp Parasitol 2021; 230:108157. [PMID: 34543651 DOI: 10.1016/j.exppara.2021.108157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022]
Abstract
Strongyloides venezuelensis has been used in different experimental studies, such as those aimed at the evaluation of diagnostic techniques for human strongyloidiasis, mainly the molecular diagnosis. In this study, three regions (genus, 18S and 28S targets) of Strongyloides ribosomal DNA were evaluated for the molecular diagnosis of experimental strongyloidiasis. Rats were infected subcutaneously with 400 or 4000 S. venezuelensis infective larvae (400iL3 and 4000iL3), and kept for 35 days. Fecal samples were collected daily to count eggs per gram of feces (EPG) and to perform the polymerase chain reaction (PCR). Egg count started on the 5th day post-infection (pi) and ended on days 33 and 34 pi, in 400iL3 and 4000iL3 groups, respectively. Based in EPG, fecal samples were selected from days 2, 5, 8, 11, 15, 23 and 35 pi for DNA extraction; PCR (genus, 18S and 28S); and sequencing. The PCR-28S products showed higher values of identity (95-100%) in the database with the Strongyloides sequences. Therefore, it is possible to reinforce the application of PCR-28S in the diagnosis of experimental and human strongyloidiasis.
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Affiliation(s)
- Rafael C Nascimento
- Laboratório de Investigação Médica (LIM-06) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Gessica B Melo
- Laboratório de Investigação Médica (LIM-06) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Priscilla D M Fonseca
- Laboratório de Investigação Médica (LIM-06) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Ronaldo C B Gryschek
- Laboratório de Investigação Médica (LIM-06) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - F M Paula
- Laboratório de Investigação Médica (LIM-06) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, Brazil.
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19
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Kathamuthu GR, Moideen K, Thiruvengadam K, Sridhar R, Baskaran D, Babu S. Helminth Coinfection Is Associated With Enhanced Plasma Levels of Matrix Metalloproteinases and Tissue Inhibitor of Metalloproteinases in Tuberculous Lymphadenitis. Front Cell Infect Microbiol 2021; 11:680665. [PMID: 34350132 PMCID: PMC8326810 DOI: 10.3389/fcimb.2021.680665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/03/2021] [Indexed: 01/06/2023] Open
Abstract
Matrix metalloproteinases (MMPs) are crucial for tissue remodeling and repair and are expressed in diverse infections, whereas tissue inhibitors of metalloproteinases (TIMPs) are endogenous inhibitors of MMPs. However, the interaction of MMPs and TIMPs in tuberculous lymphadenitis (TBL), an extra-pulmonary form of tuberculosis (EPTB) and helminth (Hel+) coinfection is not known. Therefore, this present study investigates the levels of circulating MMPs (1, 2, 3, 7, 8, 9, 12, 13) and TIMPs (1, 2, 3, 4) in TBL individuals with helminth (Strongyloides stercoralis [Ss], hereafter Hel+) coinfection and without helminth coinfection (hereafter, Hel-). In addition, we have also carried out the regression analysis and calculated the MMP/TIMP ratios between the two study groups. We describe that the circulating levels of MMPs (except MMP-8 and MMP-12) were elevated in TBL-Hel+ coinfected individuals compared to TBL-Hel- individuals. Similarly, the systemic levels of TIMPs (1, 2, 3, 4) were increased in TBL-Hel+ compared to TBL-Hel- groups indicating that it is a feature of helminth coinfection per se. Finally, our multivariate analysis data also revealed that the changes in MMPs and TIMPs were independent of age, sex, and culture status between TBL-Hel+ and TBL-Hel- individuals. We show that the MMP-2 ratio with all TIMPs were significantly associated with TBL-helminth coinfection. Thus, our results describe how helminth infection has a profound effect on the pathogenesis of TBL and that both MMPs and TIMPs could dampen the immunity against the TBL-Hel+ coinfected individuals.
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Affiliation(s)
- Gokul Raj Kathamuthu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India.,National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Kadar Moideen
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | | | | | - Dhanaraj Baskaran
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Subash Babu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India.,Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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20
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Ruantip S, Eamudomkarn C, Kopolrat KY, Sithithaworn J, Laha T, Sithithaworn P. Analysis of Daily Variation for 3 and for 30 Days of Parasite-Specific IgG in Urine for Diagnosis of Strongyloidiasis by Enzyme-Linked Immunosorbent Assay. Acta Trop 2021; 218:105896. [PMID: 33753029 DOI: 10.1016/j.actatropica.2021.105896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/03/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
Recent work has found urine analysis to be as sensitive as serology for diagnosis of strongyloidiasis. Here, we examined the daily variation of Strongyloides-specific IgG in urine by qualitative and quantitative ELISA and its effects on diagnostic accuracy and reliability. In the first part of the study, matched urine and fecal samples were collected from project participants in northeast Thailand for three consecutive days. Urine samples were analyzed for Strongyloides-specific IgG by ELISA using Strongyloides ratti as the antigen source. Performance of urine ELISA was compared with parasitological diagnosis by agar plate culture technique (APCT) and formalin-ethyl acetate concentration technique (FECT). In the second part of the study, urine IgG levels were compared daily for thirty consecutive days. The prevalence of Strongyloides infection, as measured by urine ELISA for three consecutive days, was significantly higher than that found using parasitological methods (63.1% vs. 22%). There was slight daily variation in prevalence estimates according to urine ELISA while there were significant variations according to parasitological examination methods over three consecutive days. For the 3-day experiment, urine ELISA had 83-86% diagnostic sensitivity when compared with the fecal examination method or with a composite standard (combined results from fecal examination methods (APCT or FECT) and/or urine ELISA). The levels of parasite-specific IgG in urine were stable throughout both the 3-day and the 30-day studies. In conclusion, diagnosis of strongyloidiasis by urine ELISA is more sensitive than by fecal methods, with minimal daily variation for qualitative and quantitative diagnosis. Urine ELISA has potential for clinical diagnosis and population screening of strongyloidiasis.
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Affiliation(s)
- Sirowan Ruantip
- Biomedical Science Program, Graduate School, Khon Kaen University, Khon Kaen, Thailand.
| | - Chatanun Eamudomkarn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Kulthida Y Kopolrat
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand.
| | | | - Thewarach Laha
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Paiboon Sithithaworn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand.
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21
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Páramo-Zunzunegui J, Rubio-López L, Benito-Barbero S, Muñoz-Fernández Á. Eosinophilic appendicitis due to Strongyloides stercoralis: a challenging differential diagnosis for clinicians. BMJ Case Rep 2021; 14:14/6/e239685. [PMID: 34078621 DOI: 10.1136/bcr-2020-239685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 45-year-old man presents with 48-hour status of high temperature, cough and dyspnoea. In the context of pandemic, the patient is initially diagnosed with COVID-19 syndrome. Later, the laboratory and ultrasound study supported acute appendicitis diagnosis. Appendicectomy was performed. The histopathology study confirmed eosinophilic appendicitis and that a parasitic infection was suspected. The stool sample was positive for Strongyloides stercoralis The diagnosis of a S stercoralis is a rare finding in Spain. S. stercoralis simulates clinical findings of inflammatory bowel disease or eosinophilic gastroenteritis, which may lead to the wrong therapeutic choice. Since in inflammatory diseases corticosteroid treatments are considered the initial choice in many cases, in the case of S. stercoralis infection, the administration of this therapy can be fatal. In Spain, the number of diagnoses is much lower than in the past decade, although it is highly probable that the infection has been underdiagnosed due to low clinical awareness among Spanish population.
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Affiliation(s)
- Javier Páramo-Zunzunegui
- Department of General and Digestive Surgery, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain .,Department of Surgery, Rey Juan Carlos University, Madrid, Spain
| | - Laura Rubio-López
- Department of General and Digestive Surgery, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - Silvia Benito-Barbero
- Department of General and Digestive Surgery, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
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22
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Levenhagen MA, Fujimura PT, Santos FDAA, Vecchi L, Alves-Balvedi RP, Madurro AGB, Madurro JM, Costa-Cruz JM, Goulart LR. Innovative approaches to improve serodiagnosis of Strongyloides stercoralis infection. Braz J Infect Dis 2021; 25:101545. [PMID: 33636109 PMCID: PMC9392097 DOI: 10.1016/j.bjid.2021.101545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/04/2021] [Accepted: 01/19/2021] [Indexed: 12/15/2022] Open
Abstract
Strongyloidiasis is a helminthiasis of neglected condition that has no gold standard parasitological diagnosis due to the intermittent release of larvae in feces. This study aimed to use an scFv (single chain variable fragment) obtained by Phage Display, previously validated to detect immune complexes in serum samples from individuals infected with Strongyloides stercoralis by enzyme-linked immunosorbent assay (ELISA). Now the ability of scFv to detect the immune complexes was verified by immunofluorescence, flow cytometry using magnetic beads and surface plasmon resonance (SPR). As ELISA, the SPR, immunofluorescence and flow cytometry demonstrated the ability of scFv to detect immune complexes in sera from individuals with strongyloidiasis and discriminate them from sera of individuals with other parasitic diseases and healthy individuals. Besides de conventional ELISA, the novel approaches can also be promptly applied as auxiliary diagnostic tools to the existing parasitological method for accurate diagnosis of human strongyloidiasis.
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Affiliation(s)
- Marcelo Arantes Levenhagen
- Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Laboratório de Diagnóstico de Parasitoses, Uberlândia, MG, Brazil.
| | - Patrícia Tiemi Fujimura
- Universidade Federal de Uberlândia, Instituto de Genética e Bioquímica, Laboratório de Nanobiotecnologia, Uberlândia, MG, Brazil
| | - Fabiana de Almeida Araújo Santos
- Universidade Federal de Uberlândia, Instituto de Genética e Bioquímica, Laboratório de Nanobiotecnologia, Uberlândia, MG, Brazil
| | - Lara Vecchi
- Universidade Federal de Uberlândia, Instituto de Genética e Bioquímica, Laboratório de Nanobiotecnologia, Uberlândia, MG, Brazil
| | - Renata Pereira Alves-Balvedi
- Universidade Federal de Uberlândia, Laboratório de Filmes Poliméricos e Nanotecnologia, Instituto de Química, Uberlândia, MG, Brazil
| | - Ana Graci Brito Madurro
- Universidade Federal de Uberlândia, Laboratório de Filmes Poliméricos e Nanotecnologia, Instituto de Química, Uberlândia, MG, Brazil
| | - João Marcos Madurro
- Universidade Federal de Uberlândia, Laboratório de Filmes Poliméricos e Nanotecnologia, Instituto de Química, Uberlândia, MG, Brazil
| | - Julia Maria Costa-Cruz
- Universidade Federal de Uberlândia, Instituto de Ciências Biomédicas, Laboratório de Diagnóstico de Parasitoses, Uberlândia, MG, Brazil
| | - Luiz Ricardo Goulart
- Universidade Federal de Uberlândia, Instituto de Genética e Bioquímica, Laboratório de Nanobiotecnologia, Uberlândia, MG, Brazil; Department of Medical Microbiology and Immunology, University of California, Davis, CA, USA
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23
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Pereira CVM, Mastandrea GRA, Medeiros ACCDS, Gryschek RCB, de Paula FM, Corral MA. COVID-19 and strongyloidiasis: what to expect from this coinfection? Clinics (Sao Paulo) 2021; 76:e3528. [PMID: 34817048 PMCID: PMC8579849 DOI: 10.6061/clinics/2021/e3528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | | | - Ronaldo Cesar Borges Gryschek
- Laboratorio de Investigacao Medica (LIM06-Laboratorio de Imunopatologia da Equistossomose), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Secao de Helmintologia, Instituto de Medicina Tropical (IMT), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Fabiana Martins de Paula
- Laboratorio de Investigacao Medica (LIM06-Laboratorio de Imunopatologia da Equistossomose), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Secao de Helmintologia, Instituto de Medicina Tropical (IMT), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcelo Andreetta Corral
- Faculdade de Medicina, Universidade Santo Amaro, Sao Paulo, SP, BR
- Laboratorio de Investigacao Medica (LIM06-Laboratorio de Imunopatologia da Equistossomose), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Secao de Helmintologia, Instituto de Medicina Tropical (IMT), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
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Dastan K, Assmar M, Amirmozafari N, Ghanaei FM, Mirpour M. Design, Expression and Purification of Strongyloides stercoralis IgG4 Immunoreactive Protein (NIE) in Escherichia coli. IRANIAN JOURNAL OF PARASITOLOGY 2020; 15:341-348. [PMID: 33082798 PMCID: PMC7548455 DOI: 10.18502/ijpa.v15i3.4198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Strongyloidiasis is a public health concern in northern regions of Iran, caused by Strongyloides stercoralis. Auto-infection cycle can be resulted in high parasitic load, especially in immunocompromised hosts. Because of low sensitivity of stool culture and stool-based microscopy techniques, detection of antibodies in patient's sera can be an alternative diagnostic technique for detection of the nematode. In the present study, as the first step of the development of an ELISA kit for the detection of antibodies against the nematode, IgG4 immunoreactive protein (NIE) was expressed in Escherichia coli expression system, purified and verified. Methods The NIE gene sequence was retrieved from the GenBank. This sequence was codon-optimized for the expression in E. coli BL21 (DE3). The sequence was inserted into the expression vector pET-30b (+). The recombinant vector was then transferred into competent E. coli BL21 (DE3). Transformed colonies were selected and verified by colony PCR. NIE gene expression was induced with IPTG induction. The protein production was evaluated by SDS-PAGE and verified using Western blotting. Results The codon-optimized NIE gene had required parameters for expression in E. coli. NIE protein was proved and verified by SDS-PAGE and Western blotting. Conclusion NIE recombinant protein was successfully expressed in E. coli expression system in appropriate amounts. The recombinant protein can be used for developing ELISA kit in diagnosis of S. stercoralis.
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Affiliation(s)
- Katayoun Dastan
- Department of Microbiology, Faculty of Basic Sciences, Lahijan Branch, Islamic Azad University, Lahijan, Iran
| | - Mehdi Assmar
- Department of Microbiology, Faculty of Basic Sciences, Lahijan Branch, Islamic Azad University, Lahijan, Iran.,Department of Parasitology, Pasteur Institute of Iran, Tehran, Iran
| | - Nour Amirmozafari
- Department of Microbiology, Faculty of Basic Sciences, Lahijan Branch, Islamic Azad University, Lahijan, Iran.,Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Fariborz Mansour Ghanaei
- Division of Gastroenterology, Faculty of Medicine, Gilan University of Medical Sciences, Gilan, Iran.,Gastrointestinal and Liver Disease Research Center, Razi Hospital, Rasht, Iran
| | - Mirsasan Mirpour
- Department of Microbiology, Faculty of Basic Sciences, Lahijan Branch, Islamic Azad University, Lahijan, Iran
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25
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Hoces D, Barros N, Woll F, Bauer A, White AC, Montes M. Regulatory T cell expansion resolves after effective strongyloidiasis treatment in subjects with HTLV-1 co-infection. Parasitol Int 2020; 76:102092. [PMID: 32120049 DOI: 10.1016/j.parint.2020.102092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/10/2020] [Accepted: 02/23/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Regulatory T-cells (Tregs) are increased in patients with HTLV-1/Strongyloides stercoralis co-infection, and they may modify otherwise protective antigen-specific cytokine production. We hypothesized that effective anti-helminthic treatment would decrease Tregs and restore antigen-specific cytokine responses. METHODS/RESULTS We enrolled 19 patients with Strongyloides larvae in their stool by Baerman's test. Six were positive and 13 negative for antibody to HTLV-1 by ELISA, with positive tests confirmed by immunoblot. Before treatment, co-infected subjects had higher Tregs percentages and lower antigen-stimulated IL-5 levels compared to subjects with Strongyloides without HTLV-1. All patients were treated with ivermectin. After effective treatment, Tregs percentages decreased in patients with HTLV-1; however, antigen-specific IL-5 production remained blunted in co-infected subjects. CONCLUSION These results suggest that treating strongyloidiasis infection decreases circulating Tregs, but antigen-specific cytokine remains altered. This may reflect blunting of sensitization by Tregs.
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Affiliation(s)
- Daniel Hoces
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nicolas Barros
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Fernando Woll
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Allison Bauer
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - A Clinton White
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0435, USA.
| | - Martin Montes
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru; Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555-0435, USA.
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Strong-LAMP Assay Based on a Strongyloides spp.-Derived Partial Sequence in the 18S rRNA as Potential Biomarker for Strongyloidiasis Diagnosis in Human Urine Samples. DISEASE MARKERS 2020; 2020:5265198. [PMID: 32566039 PMCID: PMC7281818 DOI: 10.1155/2020/5265198] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/24/2020] [Indexed: 01/14/2023]
Abstract
Human strongyloidiasis a soil-transmitted infection caused by Strongyloides stercoralis is one of the most neglected amongst the so-called Neglected Tropical Diseases (NTDs). S. stercoralis is a nematode, which is distributed worldwide; it has been estimated that it could affect millions of people, mainly in tropical and subtropical endemic regions. The difficulties of diagnosis lead to infection rates being underreported. Asymptomatic patients have chronic infections that can lead to severe hyperinfection syndrome or disseminated strongyloidiasis in immunocompromised patients. Strongyloidiasis can easily be misdiagnosed because conventional faecal-based techniques lack of sensitivity for the morphological identification of infective larvae in faeces. None of the currently used molecular methods have used urine samples as an alternative to faecal samples for diagnosing strongyloidiasis. This study was thus aimed at comparing, for the first time, the use of a new loop-mediated isothermal amplification (LAMP) molecular assay (Strong-LAMP) to traditional methods on patients' urine samples. Twenty-four urine samples were taken from patients included in a study involving two Spanish hospitals for strongyloidiasis screening using parasitological and serological tests. Strongyloides larvae were found in 11 patients' faecal samples, thereby ascertaining that they had the disease. Other patients had high antibody titres but no larvae were found in their faeces. All urine samples were analysed by PCR and Strong-LAMP assay. No amplification occurred when using PCR. Strong-LAMP led to detecting S. stercoralis DNA in urine samples from patients having previously confirmed strongyloidiasis by parasitological tests and/or a suspicion of being infected by serological ones. The Strong-LAMP assay is a useful molecular tool for research regarding strongyloidiasis in human urine samples. After further validation, the Strong-LAMP assay could also be used for complementary and effective diagnosis of strongyloidiasis in a clinical setting.
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de Souza JN, Oliveira CDL, Araújo WAC, Souza ABS, Silva MLS, da Cruz IDR, Sampaio LM, dos Santos JSB, Teixeira MCA, Soares NM. Strongyloides stercoralis in Alcoholic Patients: Implications of Alcohol Intake in the Frequency of Infection and Parasite Load. Pathogens 2020; 9:pathogens9060422. [PMID: 32481753 PMCID: PMC7350291 DOI: 10.3390/pathogens9060422] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023] Open
Abstract
Strongyloides stercoralis infection in immunocompromised subjects, including chronic alcoholics, can lead to a severe disease. Moreover, its prevalence in alcoholic patients seems to be higher than that in the general population. The aims of this study were to evaluate the frequency of S. stercoralis infection in alcoholic patients and to investigate the influence of alcohol intake on the parasite load, as well as to evaluate the sensitivity of three different parasitological methods according to the larval output. Fecal samples of 1290 chronic alcoholic patients were examined by spontaneous sedimentation, Baermann-Moraes, and agar plate culture (APC) methods. S. stercoralis was the most frequent parasite found (14.5%; n = 187). Alcoholic individuals infected with Strongyloides stercoralis had a higher daily consumption of alcohol than those who were not infected, 528.6 and 403.0 g/day, respectively (p < 0.05). In addition, individuals with higher alcohol intake presented an increase in parasite load. The S. stercoralis diagnostic method with the highest sensitivity was APC, 97.9% (183/187). In conclusion, S. stercoralis seems to be the most frequent parasite found in alcoholic individuals from endemic areas and alcohol intake is positively associated with S. stercoralis larvae output. In addition, this study confirms that APC is the most sensitive parasitological method used for Strongyloides diagnosis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Neci M. Soares
- Correspondence: or ; Tel.: +55-71-32836950; Fax: +55-71-32836919
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Karanam L SK, Basavraj GK, Papireddy CKR. Strongyloides stercoralis Hyper infection Syndrome. Indian J Surg 2020; 83:582-586. [PMID: 32419745 PMCID: PMC7223413 DOI: 10.1007/s12262-020-02292-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/24/2020] [Indexed: 12/19/2022] Open
Abstract
Strongyloides stercoralis is a helminth, widely distributed in tropical and subtropical countries. Its infestation in humans usually does not produce symptoms. However, in some patients, severe and life-threatening forms of this infection can occur, especially in immunocompromised individuals. Severe parasitic infection is triggered by any imbalance in the host’s immunity favouring the auto-infective cycle. This results in an increase in the intraluminal parasitic burden. In addition, tissue infestation is also very common. Clinical presentation is variable, and it is very difficult to diagnose clinically. Diagnosis requires a high index of suspicion. In some cases, the diagnosis is established only on histopathological examination of the excised tissue by the pathologist. Here, the authors report a case of an elderly male diabetic patient, who presented to the emergency department with the features of acute abdomen. On exploratory laparotomy, he was found to have the features suggestive of gangrene of small bowel. Resection of the gangrenous bowel was done, and end-to-end anastomosis was done as the rest of the bowel appeared to be normal. However, the patient died of multi-organ failure and septicaemia on the second postoperative day. The resected intestine showed tissue infestation of Strongyloides stercoralis on histopathological examination. In this review article, the authors summarize a case of hyper infection syndrome of strongyloidiasis and discuss the various aspects of Strongyloides stercoralis infection with emphasis on life cycle of the parasite and different clinical features of the disease.
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Affiliation(s)
- Sampath Kumar Karanam L
- Department of General Surgery, Narayana Medical College, Chinthareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Gopi Krishna Basavraj
- Department of General Surgery, Narayana Medical College, Chinthareddy Palem, Nellore, Andhra Pradesh 524003 India
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Couto BPD, Corrêa LQ, de Sousa JEN, Goulart de Carvalho EF, Gonzaga HT, Costa-Cruz JM. Parasitological and immunological aspects of oral and subcutaneous prednisolone treatment in rats experimentally infected with Strongyloides venezuelensis. Acta Trop 2020; 204:105349. [PMID: 31958413 DOI: 10.1016/j.actatropica.2020.105349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
Strongyloides venezuelensis is a model to study human strongyloidiasis, which infects wild rodents and shares common antigenic epitopes with Strongyloides stercoralis. This study aimed to evaluate parasitological and immunological parameters of prednisolone immunosuppression protocols in rats (Rattus novergicus) infected with S. venezuelensis. Rats were divided into six groups (n = 36): untreated and uninfected (-) or infected (+); oral treatment and uninfected (o-) or infected (o+); subcutaneous treatment and uninfected (sc-) or infected (sc+). For oral immunosuppression, 5 mg/mL of water diluted prednisolone were given five days before infection, and in the days 8 and 21 (for 5 days). For subcutaneous immunosuppression, 10 mg/kg of prednisolone were given daily. The infection was established by the subcutaneous injection of approximately 3,000 S. venezuelensis filarioid larvae per animal. All animals from the (+) and (o+) groups survived, while four rats from the (sc+) died prior to necropsy date. Parasitological analysis showed higher egg elimination in (o+) in comparison to (+) and (sc+) on 7, 13 and 26 days post infection (d.p.i.).The recovery of parasitic females at day 30 was significantly higher in (o+), compared to (+). The (+) and (o+) groups showed a clear increase in anti-S. venezuelensis IgG, IgG1 and IgG2 from 13th d.p.i. Oral immunosuppression led to a higher number of adult females and increased egg output while maintaining IgG and subclasses antibody levels comparable to the positive control.
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Affiliation(s)
- Bruna Patricia do Couto
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil
| | - Luísa Queiroz Corrêa
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil
| | - José Eduardo Neto de Sousa
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil
| | - Edson Fernando Goulart de Carvalho
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil
| | - Henrique Tomaz Gonzaga
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil
| | - Julia Maria Costa-Cruz
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Amazonas s/n, bloco 4C, 38400-902 Uberlândia, Minas Gerais, Brasil.
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Navarro M, Camprubí D, Requena-Méndez A, Buonfrate D, Giorli G, Kamgno J, Gardon J, Boussinesq M, Muñoz J, Krolewiecki A. Safety of high-dose ivermectin: a systematic review and meta-analysis. J Antimicrob Chemother 2020; 75:827-834. [PMID: 31960060 DOI: 10.1093/jac/dkz524] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 10/17/2019] [Accepted: 11/26/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Ivermectin is a key anthelmintic for the control of neglected tropical diseases. The main indications for population-level control with ivermectin through mass drug administration are onchocerciasis and lymphatic filariasis; however, there is interest in using higher, fixed-dose regimens for the control of scabies, soil-transmitted helminths and malaria. Safety data for these higher-dose regimens are needed. METHODS A systematic literature review and meta-analysis on the safety and doses of ivermectin was conducted. Eligible studies reported patient-level data and, for the meta-analysis, clinical trials reporting data on doses ≥200 and ≥400 μg/kg were included. Incidence ratios were used to compare adverse events by severity and organ system affected. RESULTS The systematic search identified six studies for inclusion, revealing no differences in the number of individuals experiencing adverse events. A descriptive analysis of these clinical trials for a variety of indications showed no difference in the severity of the adverse events between standard (up to 400 μg/kg) and higher doses of ivermectin. Organ system involvement only showed an increase in ocular events in the higher-dose group in one trial for the treatment of onchocerciasis, all of them transient and mild to moderate in intensity. CONCLUSIONS Although within this review the safety of high-dose ivermectin appears to be comparable to standard doses, there are not enough data to support a recommendation for its use in higher-than-approved doses. Ocular adverse events, despite being transient, are of concern in onchocerciasis patients. These data can inform programme managers and guide operational research activities as new approaches for the use of ivermectin are evaluated.
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Affiliation(s)
- Miriam Navarro
- Department of Public Health, Science History and Gynecology, Universidad Miguel Hernández de Elche, Alicante, Spain
| | - Daniel Camprubí
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Dora Buonfrate
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Giovanni Giorli
- Department of Infectious - Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Joseph Kamgno
- Centre de Recherche sur les Filarioses et autres Maladies tropicales, Yaounde, Cameroon
| | - Jacques Gardon
- Institut de Recherche pour le Développement, Montpellier, France
| | | | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Alejandro Krolewiecki
- Barcelona Institute for Global Health (ISGlobal) Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
- Instituto de Investigaciones de Enfermedades Tropicales Universidad Nacional de Salta/CONICET, Orán, Argentina
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Shotgun proteomics of Strongyloides venezuelensis infective third stage larvae: Insights into host-parasite interaction and novel targets for diagnostics. Mol Biochem Parasitol 2019; 235:111249. [PMID: 31881239 DOI: 10.1016/j.molbiopara.2019.111249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 02/06/2023]
Abstract
Strongyloides venezuelensis is an important alternative source of antigen for the serologic diagnosis of human strongyloidiasis. Proteomics techniques applied to the analysis of the protein content of infective third stage larvae (iL3) of S. venezuelensis provide a powerful tool for the discovery of new candidates for immunodiagnosis. This study presents an overview of the protein iL3 S. venezuelensis focusing on the diagnosis of strongyloidiasis. A total of 877 proteins were identified by shotgun proteomics. Many of these proteins are involved in different cellular processes, metabolic as well as structural maintenance. Our results point to a catalog of possible diagnostic targets for human strongyloidiasis and highlight the need for evaluation of uncharacterized proteins, especially the proteins within the CAP domain, transthyretin, and BTPI inhibitor domains, as a repertoire as yet unexplored in the context of strongyloidiasis diagnostic markers. We believe that the protein profile presented in this shotgun analysis extends our understanding of the protein composition within the Strongyloides genus, opening up new perspectives for research on biomarkers that may help with the diagnosis of human strongyloidiasis. Data are available via ProteomeXchange with identifier PXD013703.
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Abstract
Most of the 30 to 100 million people infected with Strongyloides stercoralis have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. The use of corticosteroids and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses that are like other nematodes. Definitive diagnosis of S stercoralis infection is based on stool examinations for larvae. S stercoralis remains largely neglected.
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Affiliation(s)
- Alejandro Krolewiecki
- Institute for Tropical Diseases Research, Universidad Nacional de Salta/CONICET, Alvarado 751, Oran 4530, Salta, Argentina
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Building 4 - Room B1-03, 4 Center Drive, Bethesda, MD 20892-0425, USA.
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Meamar A, jalallou N, Masoori L, Alipour M. Disseminated and Hyperinfection Fatal Strongyloidiasis in Two Patients on Immunosuppressive Therapy: A Case Report. MEDICAL LABORATORY JOURNAL 2019. [DOI: 10.29252/mlj.13.6.51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Rodrigues JP, Vasconcelos Azevedo FVP, Zoia MAP, Maia LP, Correia LIV, Costa-Cruz JM, de Melo Rodrigues V, Goulart LR. The Anthelmintic Effect on Strongyloides venezuelensis Induced by BnSP- 6, a Lys49-phospholipase A2 Homologue from Bothrops pauloensis Venom. Curr Top Med Chem 2019; 19:2032-2040. [DOI: 10.2174/1568026619666190723152520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/20/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
Background:
Phospholipases A2 (PLA2) from snake venoms have a broad potential as
pharmacological tools on medicine. In this context, strongyloidiasis is a neglected parasitic disease
caused by helminths of the genus Strongyloides. Currently, ivermectin is the drug of choice for treatment,
however, besides its notable toxicity, therapeutic failures and cases of drug resistance have been
reported. BnSP-6, from Bothorps pauloensis snake venom, is a PLA2 with depth biochemical characterization,
reporting effects against tumor cells and bacteria.
Objective:
The aim of this study is to demonstrate for the first time the action of the PLA2 on Strongyloides
venezuelensis.
Methods:
After 72 hours of treatment with BnSP-6 mortality of the infective larvae was assessed by motility
assay. Cell and parasite viability was evaluated by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl
tetrazolium bromide (MTT) assay. Furthermore, autophagic vacuoles were labeled with Monodansylcadaverine
(MDC) and nuclei of apoptotic cells were labeled with Propidium Iodide (PI). Tissue degeneration
of the parasite was highlighted by Transmission Electron Microscopy (TEM).
Results:
The mortality index demonstrated that BnSP-6 abolishes the motility of the parasite. In addition,
the MTT assay attested the cytotoxicity of BnSP-6 at lower concentrations when compared with
ivermectin, while autophagic and apoptosis processes were confirmed. Moreover, the anthelmintic effect
was demonstrated by tissue degeneration observed by TEM. Furthermore, we report that BnSP-6
showed low cytotoxicity on human intestinal cells (Caco-2).
Conclusion:
Altogether, our results shed light on the potential of BNSP-6 as an anthelmintic agent,
which can lead to further investigations as a tool for pharmaceutical discoveries.
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Affiliation(s)
- Jéssica Peixoto Rodrigues
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Fernanda Van Petten Vasconcelos Azevedo
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-227, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Mariana Alves Pereira Zoia
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Larissa Prado Maia
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Lucas Ian Veloso Correia
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-227, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Julia Maria Costa-Cruz
- Laboratory of Parasitological Diagnostics, Institute of Biomedical Sciences, Federal University of Uberlandia, Campus Umuarama BL-4C, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Veridiana de Melo Rodrigues
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-227, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Luiz Ricardo Goulart
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
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Poloni JAT, Zanotelli ML, Pedroso ADS, Trein MR, Tasca T. Strongyloides stercoralis larvae or egg: Which came first? Transpl Infect Dis 2019; 21:e13177. [PMID: 31541527 DOI: 10.1111/tid.13177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/30/2019] [Accepted: 09/14/2019] [Indexed: 11/28/2022]
Abstract
Strongyloides stercoralis (SS) hyperinfection is a well-documented condition. However, SS eggs in stool samples are not commonly observed during routine analysis. Here, we report a case on SS hyperinfection where both larvae and eggs were observed in the stool sample of an immunossupressed liver allograft transplanted patient.
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Affiliation(s)
- José Antonio Tesser Poloni
- Escola de Saúde, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil.,Controllab, Rio de Janeiro, Brazil
| | - Maria Lucia Zanotelli
- Hepatology Transplant Group, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | | | - Márcia Rodrigues Trein
- Laboratório de Pesquisa em Parasitologia, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tiana Tasca
- Laboratório de Pesquisa em Parasitologia, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Malpica L, White AC, Leguia C, Freundt N, Barros N, Chian C, Antunez EA, Montes M. Regulatory T cells and IgE expression in duodenal mucosa of Strongyloides stercoralis and human T lymphotropic virus type 1 co-infected patients. PLoS Negl Trop Dis 2019; 13:e0007415. [PMID: 31170141 PMCID: PMC6581271 DOI: 10.1371/journal.pntd.0007415] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 06/18/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background Strongyloides stercoralis is an intestinal nematode unique in its ability to replicate in the human host, allowing ongoing cycles of autoinfection, persisting for decades within the same host. Although usually asymptomatic, overwhelming infections can occur in Strongyloides and HTLV-1 co-infected individuals (SS/HTLV-1). Regulatory T cells (Tregs) are able to blunt specific Th2 responses necessary to control the parasite. We previously reported that peripheral blood Tregs are increased in SS/HTLV-1 and correlate with low Th2 responses. We hypothesized that Tregs are also increased at the site of infection in duodenal mucosa. Methods Paraffin embedded duodenal biopsies were obtained from 10 SS/HTLV-1 patients, 3 controls with non-parasitic chronic duodenitis, and 2 healthy controls. Immunohistochemistry was performed using monoclonal antibodies against human CD3, CD8, IgE and FoxP3. The number of cells were counted using a conventional light microscope. The number of CD3+, CD8+, FoxP3+ and IgE positive cells per 0.35 mm2 was measured using ImagePro Plus software comparing areas adjacent or distant from parasite material. Results In patients with SS/HTLV-1, T lymphocyte counts and CD8+ cells were lower in areas adjacent to the parasite compared to non-adjacent areas (CD3+: adjacent: 6.5 [Interquartile range (IQR: 2.8–12.3)]; non-adjacent: 24.5 [IQR: 20.9–34.4]; Mann-Whitney p = 0.0003; CD8+: adjacent: 4.5 [IQR: 2.3–11.8]; non-adjacent: 21 [IQR: 15.3–42.9]; Mann-Whitney p = 0.0011). Tregs cells in the intestines (FoxP3+ expressing cells) were increased in patients with SS/HTLV-1 compared with patients with chronic duodenitis (SS/HTLV-1: 1.5 [IQR: 0.7–2.3]; duodenitis controls: 0 [range 0–0.7]; healthy controls: 0; Mann-Whitney p = 0.034). There was also a trend towards fewer eosinophils adjacent to the parasites. Among SS/HTLV-1 patients the number of IgE expressing cells was increased for in areas not adjacent to the parasite compared to non-adjacent areas (ANOVA, p = 0.001). Conclusions Our data shows increased Treg cell numbers localized adjacent to the parasites in the duodenum SS/HTLV-1 patients. In addition, other T lymphocytes and IgE expressing cells were decreased adjacent to the parasites, suggesting an important role for Tregs in down-regulating local parasite effector responses. Strongyloidiasis is a parasitic infection found worldwide in warm, moist climates. In most people, Strongyloides causes a mild and chronic infection with few symptoms. However, some patients, including those infected with the Human T Lymphotrophic Virus 1 (HTLV-1), can get uncontrolled disease called hyperinfection, which can be fatal. To help determine why this infection is so serious in co-infected patients, we studied biopsies obtained from the small intestine from patients with both infections and compared them to control biopsies. The biopsies from patients with both Strongyloides and HTLV-1 had increased numbers of white blood cells in their biopsies. In particular they displayed a type of lymphocyte that downregulates immune responses. Some of them had increased numbers of cells called eosinophils in the intestines. These cells can help eliminate Strongyloides. However, they were not found near the parasite, suggesting that something near the parasite was suppressing the host response that would control infection. These studies provide more evidence that HTLV-1 suppresses the host response that controls Strongyloides and that the suppression occurs at the site of infection in the small intestines.
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Affiliation(s)
- Luis Malpica
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - A. Clinton White
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch at Galveston, Texas, United States of America
| | - Cristina Leguia
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Natalia Freundt
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nicolas Barros
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Chian
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Patología, Hospital Nacional Arzobispo Loayza in Lima, Peru
| | - E. Antonio Antunez
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Patología, Hospital Nacional Arzobispo Loayza in Lima, Peru
| | - Martin Montes
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch at Galveston, Texas, United States of America
- * E-mail:
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Fernández-Rivas G, Rivaya B, Romaní N, Hao Wang J, Alcaide M, Matas L. Diagnosis of soil-transmitted helminth infections. An unsolved problemin the omics era. Enferm Infecc Microbiol Clin 2019; 37 Suppl 1:20-25. [PMID: 31138419 DOI: 10.1016/s0213-005x(19)30178-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Infections caused by Strongyloides stercoralis and other soil-transmitted worms such as hookworms (Necator americanus and Ancylostoma duodenale) represent a major problem worldwide, especially in developing areas. They are difficult to suspect clinically since they produce non-specific and often overlapping signs and symptoms. Likewise, their long prepatent periods hamper the detection of parasitic structures. Microscopic diagnosis is still the most commonly used tool in healthcare laboratories but it is still far from being the ideal technique to detect these infections due to its low sensitivity. In addition, these nematodes have strong morphologic similarities and consequently microbiological diagnosis remains a challenge. Serology has made progress in the diagnosis of S. stercoralis infection but this option is not yet available for hookworms. Molecular biology techniques have been shown to slightly increase this lack of sensitivity, but as with other parasitic infections, they are not currently available for use in clinical microbiology laboratories. Supplement information: This article is part of a supplement entitled «SEIMC External Quality Control Programme. Year 2016», which is sponsored by Roche, Vircell Microbiologists, Abbott Molecular and Francisco Soria Melguizo, S.A. © 2019 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosasy Microbiología Clínica. All rights reserved.
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Affiliation(s)
- Gema Fernández-Rivas
- Departamento de Genética y Microbiología, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Belén Rivaya
- Departamento de Genética y Microbiología, Universitat Autònoma de Barcelona, Barcelona, España
| | - Nona Romaní
- Departamento de Genética y Microbiología, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jun Hao Wang
- Departamento de Genética y Microbiología, Universitat Autònoma de Barcelona, Barcelona, España
| | - Mireya Alcaide
- Departamento de Genética y Microbiología, Universitat Autònoma de Barcelona, Barcelona, España
| | - Lurdes Matas
- Departamento de Genética y Microbiología, Universitat Autònoma de Barcelona, Barcelona, España
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Barroso M, Salvador F, Sánchez-Montalvá A, Bosch-Nicolau P, Molina I. Strongyloides stercoralis infection: A systematic review of endemic cases in Spain. PLoS Negl Trop Dis 2019; 13:e0007230. [PMID: 30860995 PMCID: PMC6413904 DOI: 10.1371/journal.pntd.0007230] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/10/2019] [Indexed: 12/15/2022] Open
Abstract
Background Strongyloides stercoralis infection, a neglected tropical disease, is widely distributed. Autochthonous cases have been described in Spain, probably infected long time ago. In recent years the number of diagnosed cases has increased due to the growing number of immigrants, travelers and refugees, but endemically acquired cases in Spain remains undetermined. Methodology We systematically searched the literature for references on endemic strongyloidiasis cases in Spain. The articles were required to describe Strongyloides stercoralis infection in at least one Spanish-born person without a history of travel to endemic areas and be published before 31st May 2018. Epidemiological data from patients was collected and described individually as well as risk factors to acquisition of the infection, diagnostic technique that lead to the diagnosis, presence of eosinophilia and clinical symptoms at diagnosis. Findings Thirty-six studies were included, describing a total of 1083 patients with an average age of 68.3 years diagnosed with endemic strongyloidiasis in Spain. The vast majority of the cases were described in the province of Valencia (n = 1049). Two hundred and eight of the 251 (82.9%) patients in whom gender was reported were male, and most of them had current or past dedication to agriculture. Seventy percent had some kind of comorbidity. A decreasing trend in the diagnosed cases per year is observed from the end of last decade. However, there are still nefigw diagnoses of autochthonous cases of strongyloidiasis in Spain every year. Conclusions With the data provided by this review it is likely that in Spain strongyloidiasis might have been underestimated. It is highly probable that the infection remains undiagnosed in many cases due to low clinical suspicion among Spanish population without recent travel history in which the contagion probably took place decades ago. S. stercoralis is a soil transmitted helminth that is common in many subtropical and tropical countries, but is also found in other regions of the world. In this study we reviewed all published material on endemic infection of S. stercoralis acquired in Spain issued before 31st May 2018. We collected data from these articles and reported clinical and epidemiological characteristics of patients. Our systematic review of the articles showed a clear geographical pattern; nearly 97% of the cases described had been acquired in the Valencia province. Most of them (82.9%) were male, and most had current or past dedication to agriculture. Our results showed that 70.3% had at least one condition or treatment that could have made them more vulnerable to suffer a severe form of this helminthic disease. Our data suggests that S. stercoralis infection probably remains underdiagnosed in Spanish population. Due to the scarce information available about endemic strongyloidiasis in Spain until now, we believe that the present work will be relevant and the conclusions derived from it might raise awareness about underdiagnosis. Transmission risk factors described in the people diagnosed may be key for prevention and control strategies implementation.
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Affiliation(s)
- Maria Barroso
- Primary Health Centre La Marina, Autonomous University of Barcelona, Barcelona, Spain
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
- * E-mail:
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
| | - Pau Bosch-Nicolau
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
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Vasquez-Rios G, Pineda-Reyes R, Pineda-Reyes J, Marin R, Ruiz EF, Terashima A. Strongyloides stercoralis hyperinfection syndrome: a deeper understanding of a neglected disease. J Parasit Dis 2019; 43:167-175. [PMID: 31263320 DOI: 10.1007/s12639-019-01090-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/23/2019] [Indexed: 12/22/2022] Open
Abstract
Strongyloides stercoralis hyperinfection syndrome (SHS) is a life-threatening condition that warrants early detection and management. We describe the pathogenesis, organ-specific clinical manifestations, and risk factors associated to this condition. A comprehensive review of the literature was conducted in PubMed, LILACS, EBSCO and SciELO by using the keywords: "hyperinfection syndrome"; "Strongyloides stercoralis"; "disseminated strongyloidiasis"; "systemic strongyloidiasis", "pathogenesis" and "pathophysiology". Relevant articles on this topic were evaluated and included by consensus. Also, a secondary search of the literature was performed. Articles in English and Spanish language were included. SHS has been described in tropical and sub-tropical regions. However, there is growing evidence of cases detected in developed countries favored by increasing migration and the advance in immunosuppressive therapies for oncologic and inflammatory diseases. SHS is characterized by massive multiplication of larvae, typically in immunocompromised hosts. Clinical manifestations vary according to the organ involved and include diarrhea, intestinal bleeding, alveolar hemorrhages, heart failure, jaundice, bacteremia among others. Despite advances in the understanding of this condition, fatality rates are near 90%. Clinicians should consider SHS in the differential diagnosis of acutely ill patients with multiple organ damage and epidemiological risk factors. Adverse outcomes are common, especially with delayed anti-parasitic treatment.
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Affiliation(s)
- George Vasquez-Rios
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Roberto Pineda-Reyes
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Pineda-Reyes
- 2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Marin
- 2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eloy F Ruiz
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angélica Terashima
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
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Andreetta Corral M, de Paula FM, Meisel DMC, Abdala E, Figueiredo Costa S, Camera Pierrotti L, Yamashiro J, do Nascimento Gonçalves EM, Castilho VLP, Chieffi PP, Gryschek RCB. IgG reactivity with 40-35 kDa soluble and membrane antigen of Strongyloides venezuelensis in immunocompromised patients. Acta Trop 2019; 190:357-360. [PMID: 30552879 DOI: 10.1016/j.actatropica.2018.12.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/23/2018] [Accepted: 12/11/2018] [Indexed: 02/06/2023]
Abstract
Immunocompromised patients constitute a risk group for the development of severe clinical forms of human strongyloidiasis. The diagnosis of this infection is primarily performed by parasitological techniques, but with low sensitivity. Serological techniques appear as an alternative, especially with heterologous antigens use. The aim of this study was to perform the Western blot technique by using S. venezuelensis infective third stage larva (iL3) soluble (TS) and membrane (TM) saline antigens to reveal immunoreactive bands in immunocompromised patients with strongyloidiasis. Serum samples from 117 parasitologically well-characterized patients were divided into four groups: S. stercoralis positive and immunocompetent (S + IC); S. stercoralis positive and immunocompromised (S + IP); negative and immunocompetent (S-IC); negative and immunocompromised (S-IP). A 40-35 kDa band was recognized by 100% of patients in the S + IC group in both antigenic fractions, and by 62.5% and 50% in the S + IP group using the TS and TM fractions, respectively. A 29 kDa band was recognized by 86.3% and 72.7% (for TS and TM, respectively) of patients in the S + IC group, and only by 12.5% of patients in the S + IP group on the TM antigen. Regardless of the patients' immunological condition, the 40-35 kDa band from S. venezuelensis was detected more frequently and can be used as an important marker to the immunodiagnosis of human strongyloidiasis.
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Jing J, Edwards J, Harkin T, Hamula C, Szporn AH. Rhabditiform larvae of Strongyloides stercoralis hatching in a bronchoalveolar lavage specimen. Diagn Cytopathol 2018; 47:520-522. [PMID: 30593725 DOI: 10.1002/dc.24115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/02/2018] [Accepted: 10/19/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Jian Jing
- The Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Timothy Harkin
- The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Camille Hamula
- The Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arnold H Szporn
- The Icahn School of Medicine at Mount Sinai, New York, New York
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Laoraksawong P, Sanpool O, Rodpai R, Thanchomnang T, Kanarkard W, Maleewong W, Kraiklang R, Intapan PM. Impact of the health education and preventive equipment package (HEPEP) on prevention of Strongyloides stercoralis infection among rural communities in Northeast Thailand: a cluster randomized controlled trial. BMC Public Health 2018; 18:1184. [PMID: 30340481 PMCID: PMC6194667 DOI: 10.1186/s12889-018-6081-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 10/01/2018] [Indexed: 11/28/2022] Open
Abstract
Background Strongyloidiasis is prevalent in northeast Thailand. This study aimed to evaluate the impact of the Health Education and Preventive Equipment Package (HEPEP), a package we developed to improve awareness and aid in the prevention of Strongyloides stercoralis infection among rural communities in northeast Thailand. Methods This was an intervention trial conducted in 12 villages (six interventions and six controls) in rural areas of northeast Thailand from March 2016 to September 2017. Single stool sample was collected from each participant and examined using agar plate culture (APC) technique. Each participant was interviewed using a pre-tested questionnaire, treated with single dose of ivermectin (200 μg/Kg), and allocated to either the intervention or control group. Members of the intervention group were given “Practices to Prevent Strongyloidiasis” poster and vinyl boards containing information aimed at raising awareness of S. stercoralis and strongyloidiasis. In addition, they were given a poster lecture regarding the lifecycle of S. stercoralis before being treated with ivermectin. Aside from that, they were also given a protective equipment package. Monthly refresher courses were provided by village health volunteers (VHVs) regarding the health information they had received and proper equipment usage. The control group, on the other hand, was only provided with a five-minute lecture regarding strongyloidiasis. Assessment of new infection was conducted 3 months later in 327 and 318 participants in the intervention group and control group, respectively. Results The HEPEP had 41% greater efficacy in preventing S. stercoralis infection in the intervention group than the measures taken in the control group (adjusted Odds Ratio (aOR) = 0.59; 95%CI: 0.41 to 0.85, P-value = 0.005). The intervention group also scored significantly higher on all aspects of a test of S. stercoralis knowledge compared with the control group (mean difference (mean dif.) = 2.89, P-value = < 0.05). Conclusions The HEPEP was the first model that has been found to be effective in controlling of S. stercoralis in rural communities in the northeast Thailand. The results should encourage policy makers and public health personnel to improve control programs, as well as health promotion, with regard to parasites. Trial registration Thai Clinical Trials Registry (TCTR), Medical Research Foundation of Thailand, Medical Research Network of the Consortium of Thai Medical Schools: MedResNet (Thailand) (identification number: TCTR20180404002) Registered 4 April 2018 (retrospectively registered). Electronic supplementary material The online version of this article (10.1186/s12889-018-6081-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pokkamol Laoraksawong
- Department of Public Health Administration, Health Promotion, Nutrition, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Oranuch Sanpool
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Rutchanee Rodpai
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Tongjit Thanchomnang
- Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen, Thailand.,Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
| | - Wanida Kanarkard
- Department of Computer Engineering, Faculty of Engineering, Khon Kaen University, Khon Kaen, Thailand
| | - Wanchai Maleewong
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Ratthaphol Kraiklang
- Department of Public Health Administration, Health Promotion, Nutrition, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand. .,Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Pewpan M Intapan
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. .,Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen, Thailand.
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Brandelero E, Dambrós BP, Gonçalves EMDN, Castilho VLP, Ribas AM, Gaio ME. OCCASIONAL DIGESTIVE HEMORRHAGE IN CHILDREN DUE TO STRONGYLOIDIASIS: IMPORTANCE OF PARASITOLOGIC TESTING. ACTA ACUST UNITED AC 2018; 37:121-125. [PMID: 30066826 PMCID: PMC6362384 DOI: 10.1590/1984-0462/;2019;37;1;00013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/23/2017] [Indexed: 11/30/2022]
Abstract
Objective: To describe an uncommon case of infection by Strongyloides stercoralis (S. stercoralis) in a 4-month-old child and to highlight the importance of early diagnosis. Case description: The patient was a male child from the city of Videira, State of Santa Catarina, Southern Brazil, who was born preterm by Cesarean-section, weighing 1,655 g, and stayed in the neonatal intensive care unit for 20 days. At four months of age, the child started presenting blood in stools and the possibility of cow’s milk protein allergy was considered, given the symptoms and the use of infant formula in his 1st semester of life, which was then replaced by infant formula with hydrolyzed protein. White blood cell count and a parasitological stool sample were requested. Both tested positive and the stool ova and parasite examination showed a rhabditoid larva of S. stercoralis. The clinician maintained the initial hypothesis and diet, but requested three new stool samples, which tested positive for rhabditoid larvae of S. stercoralis. Since the child presented abdominal pain and vomiting, and there was still blood in stools, treatment with thiabendazole was initiated twice a day for two days. Treatment was repeated after seven days along with a new parasitological examination, which was then negative. Comments: Although strongyloidiasis is usually a mild parasitic infection, it may be severe and disseminated in immunocompromised patients. This agent must be considered in patients who live in endemic areas, and the diagnosis should be established by searching S. stercoralis larvae in tracheal secretions and in stools.
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Abstract
This manuscript presents a review of infectious causes of gastritis aimed at the practicing anatomic pathologist. We shall highlight unique histologic findings and clinical attributes that will assist those analyzing endoscopically obtained mucosal biopsies of the stomach or resection specimens.
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Repetto SA, Ruybal P, Batalla E, López C, Fridman V, Sierra M, Radisic M, Bravo PM, Risso MG, González Cappa SM, Alba Soto CD. Strongyloidiasis Outside Endemic Areas: Long-term Parasitological and Clinical Follow-up After Ivermectin Treatment. Clin Infect Dis 2018; 66:1558-1565. [PMID: 29360939 DOI: 10.1093/cid/cix1069] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/30/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Strongyloides stercoralis affects 30-100 million people worldwide. The first-line therapy is ivermectin. Cure is defined as the absence of larvae by parasitological methods 1 year after treatment. To date, no longitudinal parasitological studies for longer periods of time have been conducted to confirm its cure. Here, we evaluated treatment response in long-term follow-up patients with chronic infection using parasitological and molecular methods for larvae or DNA detection. METHODS A prospective, descriptive, observational study was conducted between January 2009 and September 2015 in Buenos Aires, Argentina. Twenty-one patients with S. stercoralis diagnosis were evaluated 30, 60, and 90 days as well as 1, 2, 3, and/or 4 years after treatment by conventional methods (fresh stool, Ritchie method, agar plate culture), S. stercoralis-specific polymerase chain reaction (PCR) in stool DNA, and eosinophil values. RESULTS During follow-up, larvae were detected by conventional methods in 14 of 21 patients. This parasitological reactivation was observed starting 30 days posttreatment (dpt) and then at different times since 90 dpt. Eosinophil values decreased (P = .001) 30 days after treatment, but their levels were neither associated with nor predicted these reactivations. However, S. stercoralis DNA was detected by PCR in all patients, both in their first and subsequent stool samples, thus reflecting the poor efficacy of ivermectin at eradicating parasite from host tissues. Asymptomatic eosinophilia was the most frequent clinical form among chronically infected patients. CONCLUSIONS These results suggest that the parasitological cure is unlikely. Strongyloidiasis must be considered a chronic infection and ivermectin administration schedules should be reevaluated.
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Affiliation(s)
- Silvia A Repetto
- Facultad de Medicina, Instituto de Investigaciones en Microbiología y Parasitología Médica, Consejo Nacional de Investigaciones Científicas y Técnicas
- División Infectología, Hospital de Clínicas "José de San Martín," Universidad de Buenos Aires
| | - Paula Ruybal
- Facultad de Medicina, Instituto de Investigaciones en Microbiología y Parasitología Médica, Consejo Nacional de Investigaciones Científicas y Técnicas
| | - Estela Batalla
- Facultad de Medicina, Instituto de Investigaciones en Microbiología y Parasitología Médica, Consejo Nacional de Investigaciones Científicas y Técnicas
| | - Carlota López
- Sección Infectología, Hospital General de Agudos "Carlos G. Durand"
| | - Vanesa Fridman
- División Infectología, Hospital de Clínicas "José de San Martín," Universidad de Buenos Aires
| | - Mariela Sierra
- División Infectología, Hospital de Clínicas "José de San Martín," Universidad de Buenos Aires
| | - Marcelo Radisic
- División de Enfermedades Infecciosas, Instituto de Nefrología/Nephrology, Buenos Aires, Argentina
| | - Pablo M Bravo
- División Infectología, Hospital de Clínicas "José de San Martín," Universidad de Buenos Aires
- División de Enfermedades Infecciosas, Instituto de Nefrología/Nephrology, Buenos Aires, Argentina
| | - Marikena G Risso
- Facultad de Medicina, Instituto de Investigaciones en Microbiología y Parasitología Médica, Consejo Nacional de Investigaciones Científicas y Técnicas
| | - Stella M González Cappa
- Facultad de Medicina, Instituto de Investigaciones en Microbiología y Parasitología Médica, Consejo Nacional de Investigaciones Científicas y Técnicas
| | - Catalina D Alba Soto
- Facultad de Medicina, Instituto de Investigaciones en Microbiología y Parasitología Médica, Consejo Nacional de Investigaciones Científicas y Técnicas
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Jourdan PM, Lamberton PHL, Fenwick A, Addiss DG. Soil-transmitted helminth infections. Lancet 2018; 391:252-265. [PMID: 28882382 DOI: 10.1016/s0140-6736(17)31930-x] [Citation(s) in RCA: 361] [Impact Index Per Article: 60.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/13/2017] [Accepted: 06/23/2017] [Indexed: 12/13/2022]
Abstract
More than a quarter of the world's population is at risk of infection with the soil-transmitted helminths Ascaris lumbricoides, hookworm (Ancylostoma duodenale and Necator americanus), Trichuris trichiura, and Strongyloides stercoralis. Infected children and adults present with a range of medical and surgical conditions, and clinicians should consider the possibility of infection in individuals living in, or returning from, endemic regions. Although safe and effective drugs are donated free to endemic countries, only half of at-risk children received treatment in 2016. This Seminar describes the epidemiology, lifecycles, pathophysiology, clinical diagnosis, management, and public health control of soil-transmitted helminths. Previous work has questioned the effect of population-level deworming; however, it remains beyond doubt that treatment reduces the severe consequences of soil-transmitted helminthiasis. We highlight the need for refined diagnostic tools and effective control options to scale up public health interventions and improve clinical detection and management of these infections.
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Affiliation(s)
- Peter Mark Jourdan
- Schistosomiasis Control Initiative, Imperial College London, St Mary's Campus, London, UK; DEWORM3, Natural History Museum, London, UK; Norwegian Centre for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Poppy H L Lamberton
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Campus, London, UK; Institute of Biodiversity, Animal Health and Comparative Medicine, The University of Glasgow, Glasgow, UK; Wellcome Centre for Molecular Parasitology, The University of Glasgow, Glasgow, UK.
| | - Alan Fenwick
- Schistosomiasis Control Initiative, Imperial College London, St Mary's Campus, London, UK
| | - David G Addiss
- The Task Force for Global Health, Decatur, GA, USA; Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
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Methylprednisolone acetate induces, and Δ7-dafachronic acid suppresses, Strongyloides stercoralis hyperinfection in NSG mice. Proc Natl Acad Sci U S A 2017; 115:204-209. [PMID: 29203662 DOI: 10.1073/pnas.1712235114] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Strongyloides stercoralis hyperinfection causes high mortality rates in humans, and, while hyperinfection can be induced by immunosuppressive glucocorticoids, the pathogenesis remains unknown. Since immunocompetent mice are resistant to infection with S. stercoralis, we hypothesized that NSG mice, which have a reduced innate immune response and lack adaptive immunity, would be susceptible to the infection and develop hyperinfection. Interestingly, despite the presence of large numbers of adult and first-stage larvae in S. stercoralis-infected NSG mice, no hyperinfection was observed even when the mice were treated with a monoclonal antibody to eliminate residual granulocyte activity. NSG mice were then infected with third-stage larvae and treated for 6 wk with methylprednisolone acetate (MPA), a synthetic glucocorticoid. MPA treatment of infected mice resulted in 50% mortality and caused a significant >10-fold increase in the number of parasitic female worms compared with infected untreated mice. In addition, autoinfective third-stage larvae, which initiate hyperinfection, were found in high numbers in MPA-treated, but not untreated, mice. Remarkably, treatment with Δ7-dafachronic acid, an agonist of the parasite nuclear receptor Ss-DAF-12, significantly reduced the worm burden in MPA-treated mice undergoing hyperinfection with S. stercoralis Overall, this study provides a useful mouse model for S. stercoralis autoinfection and suggests a therapeutic strategy for treating lethal hyperinfection.
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Strongyloides stercoralis is associated with significant morbidity in rural Cambodia, including stunting in children. PLoS Negl Trop Dis 2017; 11:e0005685. [PMID: 29059195 PMCID: PMC5695629 DOI: 10.1371/journal.pntd.0005685] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 11/02/2017] [Accepted: 06/07/2017] [Indexed: 01/01/2023] Open
Abstract
Background Strongyloides stercoralis is a soil-transmitted nematode that can replicate within its host, leading to long-lasting and potentially fatal infections. It is ubiquitous and highly prevalent in Cambodia. The extent of morbidity associated with S. stercoralis infection is difficult to assess due to the broad spectrum of symptoms and, thus, remains uncertain. Methodology/Principal findings Clinical signs were compared among S. stercoralis infected vs. non-infected participants in a cross-sectional survey conducted in 2012 in eight villages of Northern Cambodia, and before and after treatment with a single oral dose of ivermectin (200μg/kg BW) among participants harboring S. stercoralis. Growth retardation among schoolchildren and adolescents was assessed using height-for-age and thinness using body mass index-for-age. S. stercoralis prevalence was 31.1% among 2,744 participants. Urticaria (55% vs. 47%, OR: 1.4, 95% CI: 1.1–1.6) and itching (52% vs. 48%, OR: 1.2, 95% CI: 1.0–1.4) were more frequently reported by infected participants. Gastrointestinal, dermatological, and respiratory symptoms were less prevalent in 103 mono-infected participants after treatment. Urticaria (66% vs. 11%, OR: 0.03, 95% CI: 0.01–0.1) and abdominal pain (81 vs. 27%, OR: 0.07, 95% CI: 0.02–0.2) mostly resolved by treatment. S. stercoralis infection was associated with stunting, with 2.5-fold higher odds in case of heavy infection. Conclusions/Significance The morbidity associated with S. stercoralis confirmed the importance of gastrointestinal and dermatological symptoms unrelated to parasite load, and long-term chronic effects when associated with malnutrition. The combination of high prevalence and morbidity calls for the integration of S. stercoralis into ongoing STH control measures in Cambodia. Strongyloides stercoralis is an intestinal parasite that infects humans by penetrating intact skin. It thrives particularly in tropical countries with poor sanitation. Because it can replicate within its host, it causes long-lasting infections and is potentially fatal in patients with a disseminated infection. S. stercoralis is largely neglected due to the difficulty in detecting it with standard field diagnostic techniques but has recently been found to be very common in Cambodia, with prevalence rates exceeding 40%. It is difficult to identify symptoms associated with infection in endemic areas because co-infections with other helminths or protozoan parasites, which cause similar health problems, are common. We compared clinical signs in infected vs. non-infected participants living in eight villages in Northern Cambodia, and before and after treatment with ivermectin, the drug of choice against S. stercoralis, among 103 patients infected with S. stercoralis only. We also assessed the association between infection and growth retardation among children and adolescents. Of the participants, 31.1% were infected with S. stercoralis. Infected participants were more likely to report itching and urticaria. After treatment, fewer participants reported urticaria, abdominal pain, vomiting and, to a lesser extent, nausea, diarrhea, cough, and tiredness. S. stercoralis infection was associated with growth retardation as expressed by stunting.
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Pouillevet H, Dibakou SE, Ngoubangoye B, Poirotte C, Charpentier MJ. A Comparative Study of Four Methods for the Detection of Nematode Eggs and Large Protozoan Cysts in Mandrill Faecal Material. Folia Primatol (Basel) 2017; 88:344-357. [DOI: 10.1159/000480233] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/10/2017] [Indexed: 12/20/2022]
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Martínez-Girón R, Pantanowitz L. Cerebrospinal fluid cytology in nonmalignant aseptic meningeal disorders. Diagn Cytopathol 2017; 45:1020-1029. [PMID: 28816034 DOI: 10.1002/dc.23797] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/21/2017] [Accepted: 08/03/2017] [Indexed: 12/16/2022]
Abstract
Cerebrospinal fluid cytology examination is a common and reliable primary and/or complementary procedure for the diagnosis of central nervous system (CNS) disorders. This review provides an update of aseptic meningeal disorders that may be encountered in cytopathology practice. The article covers the cytological findings and helpful ancillary studies needed of nonmalignant aseptic CNS disorders such as viral, bacterial, fungal and parasitic infections, and other noninfectious diseases, such as Mollaret's meningitis (recurrent benign lymphocytic meningitis), Guillain-Barré syndrome, multiple Sclerosis, subarachnoid haemorrhage, and drug-induced disorders.
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Affiliation(s)
- Rafael Martínez-Girón
- INCLÍNICA Foundation for Clinical, Pneumological and Carcinogenic Research, Calvo Sotelo, 16, Oviedo, 33007, Spain
| | - Liron Pantanowitz
- Department of Pathology, UPMC Shadyside, UPMC Cancer Pavilion Suite 201, 5150 Centre Ave, Pittsburgh, Pennsylvania, 15232
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