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Yang R, Xu M, Zhang L, Liao Y, Liu Y, Deng X, Wang L. Human Strongyloides stercoralis infection. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024:S1684-1182(24)00120-8. [PMID: 39142910 DOI: 10.1016/j.jmii.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 06/14/2024] [Accepted: 07/15/2024] [Indexed: 08/16/2024]
Abstract
Strongyloides stercoralis is an important soil-transmitted helminth occurring world-wide and affecting 30-100 million people. Because many cases are asymptomatic and sensitive diagnostic methods are lacking, S. stercoralis infection is frequently underdiagnosed. The increasing incidence of autoimmune and wasting diseases and increased use of immunosuppressive agents, as well as the increased use of immunosuppressants and cytotoxic drugs, have increased S. stercoralis infection and their mortality. This review provides information about S. stercoralis epidemiology, life cycle, aetiology, pathology, comorbidities, immunology, vaccines, diagnosis, treatment, prevention, control and makes some recommendations for future prevention and control of this important parasite.
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Affiliation(s)
- Ruibing Yang
- Guangzhou Kingmed Center for Clinical Laboratory, Guangzhou, Guangdong 510320, China
| | - Meiyining Xu
- Department of Parasitology of Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Lichao Zhang
- Guangdong Clinical Laboratory Center Guangdong Provincial People's Hospital, Guangzhou 510080, China
| | - Yao Liao
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - Yuheng Liu
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, Guangdong 510180, China
| | - Xiaoyan Deng
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, Guangdong 510180, China.
| | - Lifu Wang
- Guangzhou Key Laboratory for Clinical Rapid Diagnosis and Early Warning of Infectious Diseases, KingMed School of Laboratory Medicine, Guangzhou Medical University, Guangzhou, Guangdong 510180, China.
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Gordon CA, Utzinger J, Muhi S, Becker SL, Keiser J, Khieu V, Gray DJ. Strongyloidiasis. Nat Rev Dis Primers 2024; 10:6. [PMID: 38272922 DOI: 10.1038/s41572-023-00490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Strongyloidiasis is a neglected tropical disease caused primarily by the roundworm Strongyloides stercoralis. Strongyloidiasis is most prevalent in Southeast Asia and the Western Pacific. Although cases have been documented worldwide, global prevalence is largely unknown due to limited surveillance. Infection of the definitive human host occurs via direct skin penetration of the infective filariform larvae. Parasitic females reside in the small intestine and reproduce via parthenogenesis, where eggs hatch inside the host before rhabditiform larvae are excreted in faeces to begin the single generation free-living life cycle. Rhabditiform larvae can also develop directly into infectious filariform larvae in the gut and cause autoinfection. Although many are asymptomatic, infected individuals may report a range of non-specific gastrointestinal, respiratory or skin symptoms. Autoinfection may cause hyperinfection and disseminated strongyloidiasis in immunocompromised individuals, which is often fatal. Diagnosis requires direct examination of larvae in clinical specimens, positive serology or nucleic acid detection. However, there is a lack of standardization of techniques for all diagnostic types. Ivermectin is the treatment of choice. Control and elimination of strongyloidiasis will require a multifaceted, integrated approach, including highly sensitive and standardized diagnostics, active surveillance, health information, education and communication strategies, improved water, sanitation and hygiene, access to efficacious treatment, vaccine development and better integration and acknowledgement in current helminth control programmes.
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Affiliation(s)
- Catherine A Gordon
- Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia.
- Faculty of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia.
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Department of Microbiology and Immunology, Parkville, Victoria, Australia
| | - Sören L Becker
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Darren J Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
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Corredoira Sánchez J, Ayuso García B, Romay Lema EM, García-Pais MJ, Rodríguez-Macias AI, Capón González P, Otero López R, Rabuñal Rey R, Alonso García P. Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:4-12. [PMID: 37076331 DOI: 10.1016/j.eimce.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/22/2022] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections. METHODS Four cases of S. bovis CNS infections from our institution are presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted. RESULTS 52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001). CONCLUSIONS CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.
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Affiliation(s)
| | | | | | | | | | | | - Rocio Otero López
- Neurosurgery Department, Universitary Hospital Lucus Augusti, Lugo, Spain
| | - Ramón Rabuñal Rey
- Infectious Disease Unit, Universitary Hospital Lucus Augusti, Lugo, Spain
| | - Pilar Alonso García
- Clinical Microbiology Department, Universitary Hospital Lucus Augusti, Lugo, Spain
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Gardini G, Froeschl G, Gurrieri F, De Francesco MA, Cattaneo C, Marchese V, Piccinelli G, Corbellini S, Pagani C, Santagiuliana M, Fumarola B, Gulletta M, Perandin F, Castelli F, Matteelli A. Strongyloides stercoralis infection: an underlying cause of invasive bacterial infections of enteric origin. Results from a prospective cross-sectional study of a northern Italian tertiary hospital. Infection 2023; 51:1541-1548. [PMID: 37462896 PMCID: PMC10545639 DOI: 10.1007/s15010-023-02072-1] [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: 02/03/2022] [Accepted: 06/28/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE OF THE STUDY We assessed the prevalence of S. stercoralis in a cohort of inpatients with invasive bacterial infections of enteric origin to investigate whether the parasite may facilitate these bacterial infections even in the absence of larval hyperproliferation. METHODS We performed a prospective cross-sectional study in a hospital in northern Italy. Subjects admitted due to invasive bacterial infection of enteric origin and potential previous exposure to S. stercoralis were systematically enrolled over a period of 10 months. S. stercoralis infection was investigated with an in-house PCR on a single stool sample and with at least one serological method (in-house IFAT and/or ELISA Bordier). Univariate, bi-variate and logistic regression analyses were performed. RESULTS Strongyloidiasis was diagnosed in 14/57 patients (24.6%; 95% confidence interval 14.1-37.8%) of which 10 were Italians (10/49, 20.4%) and 4 were migrants (4/8, 50.0%). Stool PCR was performed in 43/57 patients (75.4%) and no positive results were obtained. Strongyloidiasis was found to be significantly associated (p ≤ 0.05) with male gender, long international travels to areas at higher endemicity, deep extra-intestinal infectious localization and solid tumors. In the logistic regression model, increased risk remained for the variables deep extra-intestinal infectious localization and oncologic malignancy. CONCLUSIONS Our findings suggest a new role of chronic strongyloidiasis in favoring invasive bacterial infections of enteric origin even in the absence of evident larval dissemination outside the intestinal lumen. Further well-designed studies should be conducted to confirm our results, and possibly establish the underlying mechanisms.
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Affiliation(s)
- Giulia Gardini
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Francesca Gurrieri
- Department of Microbiology and Virology, University Hospital of Brescia, Brescia, Italy
| | | | - Chiara Cattaneo
- Division of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Marchese
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giorgio Piccinelli
- Department of Microbiology and Virology, University Hospital of Brescia, Brescia, Italy
| | - Silvia Corbellini
- Department of Microbiology and Virology, University Hospital of Brescia, Brescia, Italy
| | - Chiara Pagani
- Division of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Benedetta Fumarola
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Maurizio Gulletta
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesca Perandin
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Francesco Castelli
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Matteelli
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
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Lupia T, Crisà E, Gaviraghi A, Rizzello B, Di Vincenzo A, Carnevale-Schianca F, Caravelli D, Fizzotti M, Tolomeo F, Vitolo U, De Benedetto I, Shbaklo N, Cerutti A, Fenu P, Gregorc V, Corcione S, Ghisetti V, De Rosa FG. Overlapping Infection by Strongyloides spp. and Cytomegalovirus in the Immunocompromised Host: A Comprehensive Review of the Literature. Trop Med Infect Dis 2023; 8:358. [PMID: 37505654 PMCID: PMC10385408 DOI: 10.3390/tropicalmed8070358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
Strongyloides and cytomegalovirus co-infections are rarely reported, even though they are distinguished by high morbidity and mortality, especially in immunocompromised hosts. We narratively reviewed the literature on reported cases of Strongyloides and CMV co-infections in immunosuppressed patients. Most cases occurred in males with a median age of 47 (IQR, 37-59). Strongyloides/CMV co-infections occurred among immunocompromised hosts, especially in solid organ transplants and hematological or rheumatological diseases. Most of the patients underwent a course of steroid treatment before the diagnosis of co-infections. Other common immunomodulatory agents were tacrolimus and mycophenolate. The first clinical manifestations of co-infections were mainly gastrointestinal, followed by respiratory symptoms. CMV was, in most patients, co-infected with an isolated reactivation, although Strongyloides manifested especially as hyperinfection syndrome. Ganciclovir and ivermectin are the mainstays of CMV and Strongyloides treatment. However, the treatment mortality reported in this narrative review is around 52.4%. Interestingly secondary bacterial infections are common in CMV/Strongyloides-infected patients.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
| | - Elena Crisà
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Alberto Gaviraghi
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Barbara Rizzello
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | - Fabrizio Carnevale-Schianca
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Daniela Caravelli
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Marco Fizzotti
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Francesco Tolomeo
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Umberto Vitolo
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | - Piero Fenu
- Healthcare Management, IRCCS Candiolo, 10100 Candiolo, Italy
| | - Vanesa Gregorc
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Valeria Ghisetti
- Microbiology Unit, Amedeo di Savoia Hospital, 10100 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
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Tian Y, Monsel G, Paris L, Danis M, Caumes E. Larva Currens: Report of Seven Cases and Literature Review. Am J Trop Med Hyg 2023; 108:340-345. [PMID: 36535252 PMCID: PMC9896332 DOI: 10.4269/ajtmh.21-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/19/2021] [Indexed: 12/23/2022] Open
Abstract
Strongyloidiasis is a frequent and often unrecognized parasitic disease because of the frequently asymptomatic nature and lack of sensitivity of diagnostic tests. Under conditions of immunosuppression (particularly systemic corticosteroid treatment), potentially fatal dissemination may occur. Thus, prevention and early diagnosis are important. Larva currens is a rare and pathognomonic cutaneous sign of strongyloidiasis, but is poorly described because of its unpredictable and fleeting occurrence. We report seven imported cases of larva currens seen in Paris between 1990 and 2020. We illustrate the clinical and biological features of this specific but uncommon sign of strongyloidiasis with clinical pictures. There were three males and four females, aged between 29 and 58 years. There were five migrants from endemic countries, one tourist and one expatriate. Digestive disorders were the main extracutaneous signs. All patients had eosinophilia above 0.5 G/L. All cases were confirmed by stool tests. All were cured with ivermectin. The rapidity and the short duration of the creeping eruption distinguish it from other parasitoses. Ivermectin is a treatment of choice. The key point is to think about preventing disseminated strongyloidiasis before giving corticosteroids not only among migrants but also among expatriates and tourists in endemic countries.
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Affiliation(s)
- Yuan Tian
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Gentiane Monsel
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Luc Paris
- Laboratoire de Parasitologie-Mycologie, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Martin Danis
- Laboratoire de Parasitologie-Mycologie, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Eric Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
- Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, INSERM, Paris, France
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Corredoira Sánchez J, Ayuso García B, Romay Lema EM, García-Pais MJ, Rodríguez-Macias AI, Capón González P, Otero López R, Rabuñal Rey R, Alonso García P. Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Boyle E, Coppock D. Polymicrobial bacteremia and Strongyloides hyperinfection syndrome: Vigilance in patients on corticosteroids. IDCases 2022; 28:e01520. [PMID: 35615701 PMCID: PMC9125627 DOI: 10.1016/j.idcr.2022.e01520] [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: 02/10/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Strongyloidiasis is a worldwide parasitic infection. Many who develop infection remain asymptomatic. Due to Stronygloides autoinfection cycle it can result in chronic infection over decades. Immunosuppression particularly with corticosteroids has been associated with a rapid acceleration of the autoinfection cycle known as Strongyloides hyperinfection syndrome. The hyperinfection syndrome has severe complications and is associated with significant patient mortality. Here we report a case of hyperinfection complicated by polymicrobial bacteremia and intestinal ileus and review the literature regarding the hyperinfection syndrome.
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De la Cruz Mayhua JC, Rizvi B. Strongyloides Hyperinfection Causing Gastrointestinal Bleeding and Bacteremia in an Immunocompromised Patient. Cureus 2021; 13:e15902. [PMID: 34322346 PMCID: PMC8310433 DOI: 10.7759/cureus.15902] [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] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
Strongyloidiasis is a parasitic infestation caused by Strongyloides stercoralis (S. stercoralis). Most cases are asymptomatic or mildly symptomatic with respiratory, gastrointestinal, or non-specific cutaneous symptoms. However, in immunocompromised patients, such as patients on chronic corticosteroids, malignancy, or human immunodeficiency virus (HIV) infection, hyperinfection syndrome can occur. The following is a case of Strongyloides hyperinfection in an individual taking prednisone for uveitis who developed upper gastrointestinal (GI) bleed and gram-negative bacteremia.
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Affiliation(s)
| | - Bisharah Rizvi
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
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10
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Ashour DS, Othman AA. Parasite-bacteria interrelationship. Parasitol Res 2020; 119:3145-3164. [PMID: 32748037 DOI: 10.1007/s00436-020-06804-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/06/2020] [Indexed: 12/18/2022]
Abstract
Parasites and bacteria have co-evolved with humankind, and they interact all the time in a myriad of ways. For example, some bacterial infections result from parasite-dwelling bacteria as in the case of Salmonella infection during schistosomiasis. Other bacteria synergize with parasites in the evolution of human disease as in the case of the interplay between Wolbachia endosymbiont bacteria and filarial nematodes as well as the interaction between Gram-negative bacteria and Schistosoma haematobium in the pathogenesis of urinary bladder cancer. Moreover, secondary bacterial infections may complicate several parasitic diseases such as visceral leishmaniasis and malaria, due to immunosuppression of the host during parasitic infections. Also, bacteria may colonize the parasitic lesions; for example, hydatid cysts and skin lesions of ectoparasites. Remarkably, some parasitic helminths and arthropods exhibit antibacterial activity usually by the release of specific antimicrobial products. Lastly, some parasite-bacteria interactions are induced as when using probiotic bacteria to modulate the outcome of a variety of parasitic infections. In sum, parasite-bacteria interactions involve intricate processes that never cease to intrigue the researchers. However, understanding and exploiting these interactions could have prophylactic and curative potential for infections by both types of pathogens.
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Affiliation(s)
- Dalia S Ashour
- Medical Parasitology Department, Faculty of Medicine, Tanta University, Tanta, 31527, Egypt.
| | - Ahmad A Othman
- Medical Parasitology Department, Faculty of Medicine, Tanta University, Tanta, 31527, Egypt
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Page WA, Judd JA, MacLaren DJ, Buettner P. Integrating testing for chronic strongyloidiasis within the Indigenous adult preventive health assessment system in endemic communities in the Northern Territory, Australia: An intervention study. PLoS Negl Trop Dis 2020; 14:e0008232. [PMID: 32401755 PMCID: PMC7219702 DOI: 10.1371/journal.pntd.0008232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 03/18/2020] [Indexed: 01/29/2023] Open
Abstract
Background The life-threatening clinical manifestations of strongyloidiasis are preventable with early detection and effective treatment. The aim of this study was to assess if there was an increase to the number and proportion of persons tested for chronic strongyloidiasis, as a result of integrating Strongyloides stercoralis serology into the existing preventive health assessment system in four Aboriginal health services in endemic communities. Methodology A prospective, longitudinal, before-and-after intervention study was conducted in four Aboriginal health services in remote endemically infected communities in the Northern Territory, Australia, from July 2012 to December 2016. The electronic patient information and recall systems enabled the integration of Strongyloides stercoralis serology into the adult preventive health assessment. Strongyloides reports for each health service were extracted half-yearly to examine the number and proportion of persons tested for chronic strongyloidiasis during the study and to measure the effect of the intervention. Principal findings The number and proportion of persons tested increased significantly during the study. From a total resident population of 3650 Indigenous adults over 15 years of age, 1686 persons (47.4%) were tested. The percentage of adults who had at least one serology test increased in all four health services to between 41% (446/1086) and 81.9% (172/210). Of the 1686 persons tested, 680 positive cases of chronic strongyloidiasis (40.3%) were identified. Conclusions/Significance This population health systems intervention increased the number and proportion of persons tested for chronic strongyloidiasis in four health services in endemically infected communities. This intervention is relevant to other health services with high-risk populations. Strongyloidiasis is a neglected tropical disease that is endemic in some Aboriginal communities in the Northern Territory. This study asks if the number and proportion of persons tested for chronic strongyloidiasis can be increased by incorporating a Strongyloides serology test into the existing routine Indigenous adult preventive health assessment system in remote endemic communities. This study demonstrated that integrating Strongyloides serology test within the Indigenous adult preventive health assessment system does increase the number and proportion of people tested in endemic communities. This intervention means that life-threatening clinical complications of strongyloidiasis can be prevented by early detection and treatment. Primary health care services have an important role in increased testing in this high-risk population. Primary health care clinicians incorporated chronic strongyloidiasis with other preventable chronic and infectious diseases. The sustainable population health systems-based approach successfully increased coverage by integrating testing for chronic strongyloidiasis into the adult preventive health assessment in health services in remote Indigenous Australian endemic communities, utilising the electronic health record system. The Strongyloides report developed to measure the change in clinical practice would be replicable in other health services with high risk populations.
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Affiliation(s)
- Wendy A. Page
- Miwatj Health Aboriginal Corporation, Nhulunbuy, Northern Territory, Australia
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
- * E-mail:
| | - Jenni A. Judd
- School of Health, Medical and Applied Sciences, Division of Higher Education, Central Queensland University, Bundaberg, Queensland, Australia
- Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg, Queensland, Australia
- Centre for Health Systems Strengthening, James Cook University, Townsville, Queensland, Australia
| | - David J. MacLaren
- College of Medicine and Dentistry, Division of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Petra Buettner
- Centre for Chronic Disease Prevention, James Cook University, Cairns, Queensland, Australia
- Tropical Health Solutions, Queensland, Australia
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Yashwanth Raj T, Vairakkani R, Harshavardhan TS, Srinivasaprasad ND, Dilli Rani V, Edwin Fernando M. Post-Renal Transplant Miliary Mottling: Not Always Tuberculosis. Indian J Nephrol 2020; 30:121-124. [PMID: 32269438 PMCID: PMC7132843 DOI: 10.4103/ijn.ijn_141_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/31/2019] [Accepted: 06/11/2019] [Indexed: 11/21/2022] Open
Abstract
A 28-year-old male, 3 years post renal transplant with stable graft function, presented with vomiting for 2 days. He had graft dysfunction and graft biopsy done revealed acute cell - mediated rejection BANFF-IA. After receiving glucocorticoids for rejection, he developed severe enterocolitis and impending respiratory failure. Chest X-ray and computed tomography of the chest revealed miliary mottling. Evaluation showed presence of filariform larvae of Strongyloides stercoralis in the stool and sputum. A diagnosis of Strongyloides Hyperinfection Syndrome (SHS) was made. After a prolonged course of treatment with noninvasive ventilation, broad-spectrum antimicrobials, parenteral ivermectin and oral albendazole therapy, he eventually recovered. This case report is to highlight that Strongyloides Hyperinfection Syndrome should also be considered in the differential in any immunocompromised patient presenting with miliary mottling in imaging.
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Affiliation(s)
- T Yashwanth Raj
- Department of Nephrology and Microbiology, Government Stanley Medical College, The TN Dr. MGR Medical University, Chennai, Tamil Nadu, India
| | - R Vairakkani
- Department of Nephrology and Microbiology, Government Stanley Medical College, The TN Dr. MGR Medical University, Chennai, Tamil Nadu, India
| | - T S Harshavardhan
- Department of Nephrology and Microbiology, Government Stanley Medical College, The TN Dr. MGR Medical University, Chennai, Tamil Nadu, India
| | - N D Srinivasaprasad
- Department of Nephrology and Microbiology, Government Stanley Medical College, The TN Dr. MGR Medical University, Chennai, Tamil Nadu, India
| | - V Dilli Rani
- Department of Nephrology and Microbiology, Government Stanley Medical College, The TN Dr. MGR Medical University, Chennai, Tamil Nadu, India
| | - M Edwin Fernando
- Department of Nephrology and Microbiology, Government Stanley Medical College, The TN Dr. MGR Medical University, Chennai, Tamil Nadu, India
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Miglioli-Galvão L, Pestana JOM, Lopes-Santoro G, Torres Gonçalves R, Requião Moura LR, Pacheco Silva Á, Camera Pierrotti L, David Neto E, Santana Girão E, Costa de Oliveira CM, Saad Abboud C, Dias França JÍ, Devite Bittante C, Corrêa L, Aranha Camargo LF. Severe Strongyloides stercoralis infection in kidney transplant recipients: A multicenter case-control study. PLoS Negl Trop Dis 2020; 14:e0007998. [PMID: 32004346 PMCID: PMC7015428 DOI: 10.1371/journal.pntd.0007998] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/12/2020] [Accepted: 12/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Severe Strongyloides stercoralis infection in kidney transplant recipients is associated with considerable morbidity and mortality, although little is known about the risk factors for such infection. METHODOLOGY/PRINCIPAL FINDINGS This was a retrospective, multicenter, case-control study in which we assessed the risk factors for and clinical outcomes of severe S. stercoralis infections in kidney transplant recipients in Brazil. We included 138 kidney transplant recipients: 46 cases and 92 controls. Among the cases, the median number of days from transplantation to diagnosis was 117 (interquartile range [IQR], 73.5-965) and the most common clinical findings were gastrointestinal symptoms (in 78.3%) and respiratory symptoms (in 39.1%), whereas fever and eosinophilia were seen in only 32.6% and 43.5%, respectively. The 30-day all-cause mortality among the cases was 28.3% overall and was significantly higher among the cases of infection occurring within the first three months after transplantation (47% vs. 17.2%, P = 0.04). The independent risk factors were receiving a transplant from a deceased donor (odds ratio [OR] = 6.16, 95% confidence interval [CI] = 2.05-18.5), a history of bacterial infection (OR = 3.04, 95% CI = 1.2-7.5), and a cumulative corticosteroid dose (OR = 1.005, 95% CI = 1.001-1.009). The independent predictors of mortality were respiratory failure (OR = 98.33, 95% CI = 4.46-2169.77) and concomitant bacteremia (OR = 413.00, 95% CI = 4.83-35316.61). CONCLUSIONS/SIGNIFICANCE Severe S. stercoralis infections are associated with considerable morbidity and mortality after kidney transplantation. In endemic areas, such infection may occur late after transplantation, although it seems to be more severe when it occurs earlier after transplantation. Specific risk factors and clinical manifestations can identify patients at risk, who should receive prophylaxis or early treatment.
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Affiliation(s)
- Lísia Miglioli-Galvão
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
- * E-mail:
| | | | - Guilherme Lopes-Santoro
- Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Álvaro Pacheco Silva
- Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Kidney Unit, Universidade Federal de São Paulo,São Paulo, Brazil
| | | | - Elias David Neto
- Kidney Transplant Unit, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Cely Saad Abboud
- Infectious Diseases Unit, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - João Ítalo Dias França
- Department of Epidemiology and Statistics, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Luci Corrêa
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luís Fernando Aranha Camargo
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
- Infectious Diseases Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
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14
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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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15
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Patra AA, Nath P, Pati GK, Panigrahi SC, Mallick B, Acharya JC, Adhya A. Strongyloides Infection Presenting as Proximal Small Intestinal Obstruction. ACG Case Rep J 2019; 6:e00124. [PMID: 31616778 PMCID: PMC6722340 DOI: 10.14309/crj.0000000000000124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/13/2019] [Indexed: 11/17/2022] Open
Abstract
Duodenal obstruction is an infrequent but potentially fatal complication of strongyloidiasis infection. Strongyloides stercoralis can clinically manifest in a broad variety of ways and lacks a classic clinical syndrome, which makes the diagnosis of strongyloidiasis difficult. The diagnosis is usually delayed and made by duodenal aspirate, duodenal biopsy, and/or postoperative biopsy specimen of the resection stricture segment. We present a case of partial duodenal obstruction caused by S. stercoralis. A 46-year-old man had presented with repeated bilious vomiting for 12 days. Upper gastrointestinal endoscopy showed ulceronodular mucosa with luminal compromise at the second part of the duodenum. Abdominal computed tomography scan also showed a wall thickening with luminal narrowing of the second and third part of the duodenum. Duodenal mucosal biopsy revealed larval forms of S. stercoralis.
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Affiliation(s)
- Ananya Apurba Patra
- Department of Radiodiagnosis and Imaging, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Preetam Nath
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Girish Kumar Pati
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Sarat Chandra Panigrahi
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Bipadabhanjan Mallick
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Jyotiprakash C.K. Acharya
- Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, India
| | - Amit Adhya
- Department of Pathology, All India Institute of Medical Sciences, Bhubaneswar, India
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16
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Al-Obaidi M, Hasbun R, Vigil KJ, Edwards AR, Chavez V, Hall DR, Dar WA, De Golovine A, Ostrosky-Zeichner L, Bynon JS, Nigo M. Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012-2017). Open Forum Infect Dis 2019; 6:5452022. [PMID: 31363770 PMCID: PMC6656655 DOI: 10.1093/ofid/ofz172] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023] Open
Abstract
Background Disseminated strongyloidiasis in solid organ transplant recipients is a rare but devastating infection. In our center, we implemented a universal screening of all candidates for kidney transplantation. We assessed the seroprevalence and utility of universal screening for strongyloidiasis in our center. Methods Patients were identified from our transplant referral list (from July 2012 to June 2017). Demographics, pretransplant laboratory, and serological screenings were retrospectively collected. For Strongyloides-seropositive (SSp) patients, data on travel history, symptoms, treatment, and stool ova and parasite examinations were extracted. Logistic regression and multiple imputation for missing data were performed. Results A total of 1689 patients underwent serological screening, of whom 168 (9.9%) were SSp. Univariate analysis revealed that SSp patients had higher rates of eosinophilia, diabetes mellitus, latent tuberculosis and were likely to be either Hispanic or Asian (P < .05). In multivariate analysis, eosinophilia (P = .01), diabetes mellitus (P = .02), and Asian race (P = .03) were associated with being SSp, but 45 (27%) of the SSp patients did not have any of these 3 factors, and 18 SSp patients (11%) had no epidemiological risk factors. All patients received ivermectin, and none developed disseminated strongyloidiasis. Of patients who underwent serological screening on multiple occasions, 6.8% seroconverted while waiting for kidney transplantation. Conclusions We found a high rate of Strongyloides seropositivity among our kidney transplantation candidates. No epidemiological risk factors effectively predicted SSp status in our population, and universal screening identified a large number of patients without such factors. Serial screening should be considered when a long wait time is expected before transplantation.
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Affiliation(s)
- Mohanad Al-Obaidi
- Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Rodrigo Hasbun
- Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Karen J Vigil
- Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Angelina R Edwards
- Division of Renal Disease and Hypertension, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Violeta Chavez
- Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| | - David R Hall
- Division of Immunology and Organ Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Wasim A Dar
- Division of Immunology and Organ Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Aleksandra De Golovine
- Division of Renal Disease and Hypertension, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston
| | - John S Bynon
- Division of Immunology and Organ Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Masayuki Nigo
- Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston
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Chapman PA, Cribb TH, Flint M, Traub RJ, Blair D, Kyaw-Tanner MT, Mills PC. Spirorchiidiasis in marine turtles: the current state of knowledge. DISEASES OF AQUATIC ORGANISMS 2019; 133:217-245. [PMID: 31187736 DOI: 10.3354/dao03348] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Blood flukes of the family Spirorchiidae are important disease agents in marine turtles. The family is near cosmopolitan in distribution. Twenty-nine marine species across 10 genera are currently recognized, but taxonomic problems remain and it is likely that more species will be discovered. Spirorchiids infect the circulatory system, where they and their eggs cause a range of inflammatory lesions. Infection is sometimes implicated in the death of the turtle. In some regions, prevalence in stranded turtles is close to 100%. Knowledge of life cycles, important for control and epidemiological studies, has proven elusive until recently, when the first intermediate host identifications were made. Recent molecular studies of eggs and adult worms indicate that a considerable level of intrageneric and intraspecific diversity exists. The characterization of this diversity is likely to be of importance in exploring parasite taxonomy and ecology, unravelling life cycles, identifying the differential pathogenicity of genotypes and species, and developing antemortem diagnostic tools, all of which are major priorities for future spirorchiid research. Diagnosis to date has been reliant on copromicroscopy or necropsy, which both have significant limitations. The current lack of reliable antemortem diagnostic options is a roadblock to determining the true prevalence and epidemiology of spirorchiidiasis and the development of effective treatment regimes.
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Affiliation(s)
- Phoebe A Chapman
- Veterinary-Marine Animal Research, Teaching and Investigation, School of Veterinary Science, The University of Queensland, Gatton, Queensland 4343, Australia
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Tariq H, Kamal MU, Reddy P, Bajantri B, Niazi M, Matela A, Zeana C, Ihimoyan A, Dev A, Chilimuri S. Anemia, intractable vomiting, chronic diarrhea, and syndrome of inappropriate antidiuretic secretion: a diagnostic dilemma: Disseminated strongyloidosis in a patient with newly diagnosed HTLV infection-case report and review of literature. Medicine (Baltimore) 2017; 96:e9229. [PMID: 29384908 PMCID: PMC6392699 DOI: 10.1097/md.0000000000009229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Strongyloidiasis hyperinfection and disseminated disease have high mortality rates due to several complications and early detection of Strongyloides infection is therefore prudent. PATIENT CONCERNS A 37-year-old male patient came with chronic diarrhea, intractable vomiting and was found to have hyponatremia, and anemia on the initial laboratory tests. DIAGNOSES Further work up revealed syndrome of inappropriate antidiuretic secretion to be the cause of the hyponatremia in addition to gastrointestinal loses. His hospital course was complicated by persistent hyponatremia and later development of partial small bowel obstruction. INTERVENTIONS Considering his symptoms we had a suspicion of small bowel pathology for which he underwent an esophagogastroduodenoscopywith biopsies that revealed strongyloidosis as the cause of his symptoms. He was also found to have human T-cell lymphotropic virus infection, likely contributing to the disseminated disease. OUTCOMES He was started on ivermectin with complete resolution of symptoms and improvement of hyponatremia. LESSONS It is very important to suspect Strongyloides infection in a patient presenting with syndrome ofinappropriate antidiuretic secretion as hyperinfection and disseminated disease can be life threatening without antihelmintic therapy.
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Affiliation(s)
| | | | | | | | - Masooma Niazi
- Department of Pathology, Bronx Lebanon Hospital Center, Bronx, NY
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19
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Glenn K, Lindholm DA, Meis G, Watts L, Conger N. Case Report: A Case of Recurrent Strongyloides stercoralis Colitis in a Patient with Multiple Myeloma. Am J Trop Med Hyg 2017; 97:1619-1622. [PMID: 29140233 DOI: 10.4269/ajtmh.17-0112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Strongyloides stercoralis chronic infection is frequently subclinical and thus under-recognized, although its increasing prevalence in nonendemic regions has implications for immunocompromised hosts. We present a 75-year-old male with stage II multiple myeloma who presented with relapse of Strongyloides infection after initial treatment, negative surveillance testing, and subsequent resumption of chemotherapy for his multiple myeloma. The optimal regimen for secondary prophylaxis against recurrent infections is unknown. Secondary prophylaxis should be considered for patients who recur and/or remain at high risk of recurrence because of ongoing immunosuppression. We implemented a prophylactic regimen of ivermectin 200 mcg/kg once monthly. In addition, improved laboratory assays for strongyloidiasis are needed to aid with diagnosis, monitoring of treatment response, and early detection of relapse.
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Affiliation(s)
- Keith Glenn
- Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Ohio
| | - David A Lindholm
- Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Ohio
| | - Gregory Meis
- Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Ohio
| | - Luisa Watts
- Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Ohio
| | - Nicholas Conger
- Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Ohio
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20
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Vancomycin-Resistant Enterococcal Meningitis, Disseminated Strongyloidiasis, and Hypogammaglobulinemia. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2017. [DOI: 10.1097/ipc.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Abstract
Bacteremia and sepsis are conditions associated with high mortality and are of great impact to health care operations. Among the top causes of mortality in the United States, these conditions cause over 600 fatalities each day. Empiric, broad-spectrum treatment is a common but often a costly approach that may fail to effectively target the correct microbe, may inadvertently harm patients via antimicrobial toxicity or downstream antimicrobial resistance. To meet the diagnostic challenges of bacteremia and sepsis, laboratories must understand the complexity of diagnosing and treating septic patients, in order to focus on creating algorithms that can help direct a more targeted approach to antimicrobial therapy and synergize with existing clinical practices defined in new Surviving Sepsis Guidelines. Significant advances have been made in improving blood culture media; as yet no molecular or antigen-based method has proven superior for the detection of bacteremia in terms of limit of detection. Several methods for rapid molecular identification of pathogens from blood cultures bottles are available and many more are on the diagnostic horizon. Ultimately, early intervention by molecular detection of bacteria and fungi directly from whole blood could provide the most patient benefit and contribute to tailored antibiotic coverage of the patient early on in the course of the disease. Although blood cultures remain as the best means of diagnosing bacteremia and candidemia, complementary testing with antigen tests, microbiologic investigations from other body sites, and histopathology can often aid in the diagnosis of disseminated disease, and application of emerging nucleic acid test methods and other new technology may greatly impact our ability to bacteremic and septic patients, particularly those who are immunocompromised.
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22
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Jariwala S, Redding L, Hewitt D. The severely under-recognized public health risk of strongyloidiasis in North American cities-A One Health approach. Zoonoses Public Health 2017; 64:579-588. [DOI: 10.1111/zph.12371] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Indexed: 11/26/2022]
Affiliation(s)
- S. Jariwala
- Division of Allergy/Immunology; Department of Medicine; Montefiore Medical Center; Albert Einstein College of Medicine; Bronx NY USA
| | - L. Redding
- University of Pennsylvania School of Veterinary Medicine; Philadelphia PA USA
| | - D. Hewitt
- Department of Botany; Academy of Natural Sciences; Philadelphia PA USA
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23
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Nabeya D, Haranaga S, Parrott GL, Kinjo T, Nahar S, Tanaka T, Hirata T, Hokama A, Tateyama M, Fujita J. Pulmonary strongyloidiasis: assessment between manifestation and radiological findings in 16 severe strongyloidiasis cases. BMC Infect Dis 2017; 17:320. [PMID: 28464844 PMCID: PMC5414214 DOI: 10.1186/s12879-017-2430-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 04/28/2017] [Indexed: 11/17/2022] Open
Abstract
Background Strongyloidiasis is a chronic parasitic infection caused by Strongyloides stercoralis. Severe cases such as, hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), can involve pulmonary manifestations. These manifestations frequently aid the diagnosis of strongyloidiasis. Here, we present the pulmonary manifestations and radiological findings of severe strongyloidiasis. Methods From January 2004 to December 2014, all patients diagnosed with severe strongyloidiasis at the University of the Ryukyus Hospital or affiliated hospitals in Okinawa, Japan, were included in this retrospective study. All diagnoses were confirmed by the microscopic or histopathological identification of larvae. Severe strongyloidiasis was defined by the presence of any of the following: 1) the identification of S. stercoralis from extra gastrointestinal specimens, 2) sepsis, 3) meningitis, 4) acute respiratory failure, or 5) respiratory tract hemorrhage. Patients were assigned to either HS or DS. Medical records were further reviewed to extract related clinical features and radiological findings. Results Sixteen severe strongyloidiasis cases were included. Of those, fifteen cases had pulmonary manifestations, eight had acute respiratory distress syndrome (ARDS) (53%), seven had enteric bacterial pneumonia (46%) and five had pulmonary hemorrhage (33%). Acute respiratory failure was a common indicator for pulmonary manifestation (87%). Chest X-ray findings frequently showed diffuse shadows (71%). Additionally, ileum gas was detected for ten of the sixteen cases in the upper abdomen during assessment with chest X-ray. While, chest CT findings frequently showed ground-glass opacity (GGO) in 89% of patients. Interlobular septal thickening was also frequently shown (67%), always accompanying GGO in upper lobes. Conclusions In summary, our study described HS/DS cases with pulmonary manifestations including, ARDS, bacterial pneumonia and pulmonary hemorrhage. Chest X-ray findings in HS/DS cases frequently showed diffuse shadows, and the combination of GGO and interlobular septal thickening in chest CT was common in HS/DS, regardless of accompanying pulmonary manifestations. This CT finding suggests alveolar hemorrhage could be used as a potential marker indicating the transition from latent to symptomatic state. Respiratory specimens are especially useful for detecting larvae in cases of HS/DS.
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Affiliation(s)
- Daijiro Nabeya
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
| | - Shusaku Haranaga
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Gretchen Lynn Parrott
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Takeshi Kinjo
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Saifun Nahar
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Teruhisa Tanaka
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Tetsuo Hirata
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Akira Hokama
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Masao Tateyama
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
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Effect of ivermectin on allergy-type manifestations in occult strongyloidiasis. Ann Allergy Asthma Immunol 2016; 117:423-428. [PMID: 27566864 DOI: 10.1016/j.anai.2016.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/08/2016] [Accepted: 07/15/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND The immunomodulatory effects of helminths have been well described. However, there is a relative lack of literature regarding the link between parasites and allergic diseases. A number of patients with allergic symptoms have positive serologic test results for Strongyloides stercoralis. OBJECTIVE To identify patients with allergy-type symptoms and coexisting Strongyloides infection and to analyze the effect of Strongyloides eradication therapy with ivermectin on these symptoms. METHODS The medical records of our allergy clinic sites were reviewed for Strongyloides test results between January 2011 and October 2014. Each allergy-type symptom was assessed separately with regard to improvement after ivermectin therapy. RESULTS Among the 1,446 patients who had Strongyloides serologic tests ordered, 127 (8.8%) had positive test results. Eighty-four patients had follow-up data regarding allergy-type symptoms after ivermectin treatment. Among these, 52 patients (61.9%) reported skin-related problems (pruritus, urticaria, angioedema, and/or rash). Forty-nine patients (58.3%) had asthma, and 73.8% had allergic rhinoconjunctivitis. Although respiratory symptoms typically did not respond to ivermectin treatment, 24 of 48 patients (50%) with skin symptoms reported a significant subjective improvement of symptoms after ivermectin treatment. Peripheral eosinophil counts significantly decreased after ivermectin treatment from 450 to 200/μL (P < .001). CONCLUSION Serologic testing for strongyloides may be indicated for patients with allergy-type symptoms and a suggestive exposure history. Patients with strongyloidiasis and primarily cutaneous symptoms experienced significant symptomatic improvement after ivermectin therapy.
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Choksi TT, Madison G, Dar T, Asif M, Fleming K, Clarke L, Danilewitz M, Hennawy R. Multiorgan Dysfunction Syndrome from Strongyloides stercoralis Hyperinfection in a Patient with Human T-Cell Lymphotropic Virus-1 Coinfection After Initiation of Ivermectin Treatment. Am J Trop Med Hyg 2016; 95:864-867. [PMID: 27527631 DOI: 10.4269/ajtmh.16-0259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/25/2016] [Indexed: 11/07/2022] Open
Abstract
Strongyloides stercoralis is well known to cause hyperinfection syndrome during the period of immunosuppression; but dissemination, worsening hyperinfection, and development of multiorgan dysfunction syndrome after initiation of ivermectin has not been reported in the past. Herein, we describe the case of a 62-year-old man with chronic strongyloidiasis and human T-cell lymphotropic virus-1 coinfection, who developed significant clinical worsening after 24-48 hours of initiation of treatment with ivermectin (200 μg/kg daily). Oral albendazole (600 mg every 12 hours) was added to the regimen due to clinical deterioration. Notably, after a protracted clinical course with multiple complications, which included respiratory failure from gram-negative pneumonia and pulmonary alveolar hemorrhage, Klebsiella meningitis, Clostridium difficile colitis, and herpes labialis, the patient eventually recovered. Health-care providers should be aware that during the early days of antihelminthic treatment initiation, significant dissemination of S. stercoralis and worsening of the clinical scenario can occur.
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Affiliation(s)
- Tatvam T Choksi
- Department of Internal Medicine, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania.
| | - Gul Madison
- Department of Infectious Diseases, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania
| | - Tawseef Dar
- Department of Internal Medicine, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania
| | - Mohammed Asif
- Department of Surgery, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania
| | - Kevin Fleming
- Department of Internal Medicine, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania
| | - Leon Clarke
- Department of Surgery, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania
| | - Mervyn Danilewitz
- Department of Gastroenterology, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania
| | - Randa Hennawy
- Department of Pathology, Mercy Philadelphia Hospital, Philadelphia, Pennsylvania
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Abstract
The majority of the 30-100 million people infected with Strongyloides stercoralis, a soil transmitted intestinal nematode, have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding because of the autoinfective process associated with its unique life cycle. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. Corticosteroid use and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses both local and systemic that remain poorly characterized. Definitive diagnosis of S. stercoralis infection is based on stool examinations for larvae, but newer diagnostics - including new immunoassays and molecular tests - will assume primacy in the next few years. Although good treatment options exist for infection and control of this infection might be possible, S. stercoralis remains largely neglected.
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Rathor N, Khillan V, Sarin SK. Strongyloides stercoralis hyperinfection in patient with autoimmune hepatitis and purpura fulminans. Indian J Crit Care Med 2016; 20:52-4. [PMID: 26955218 PMCID: PMC4759996 DOI: 10.4103/0972-5229.173694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Strongyloidiosis is usually an asymptomatic chronic nematodal disease. The term hyperinfection is used to denote autoinfection, a phenomenon in which the number of worms increases enormously. Development or exacerbation of gastrointestinal and pulmonary symptoms is seen, (A) and the detection of increased numbers of larvae in stool and or sputum is the hallmark. It is known to occur with a change in immune status of the host; this can occur due to immunosuppressants. Cytomegalovirus (CMV) is also known to suppress host immunity. Due to the nonspecific presentation, the diagnosis is frequently missed, and the outcome remains poor with 15–87% mortality despite therapy. We report here a case of Strongyloides stercoralis hyperinfection following immunosuppressive therapy for autoimmune hepatitis and concomitant CMV infection with purpura fulminance and frank sepsis, with fatal outcome.
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Affiliation(s)
- Neha Rathor
- Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Vikas Khillan
- Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S K Sarin
- Department of Gastroenterology, Institute of Liver and Biliary Sciences, New Delhi, India
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Chand T, Bansal A, Jasuja S, Sagar G. Pulmonary strongyloidiasis and hyperinfection in a renal transplant patient. Lung India 2016; 33:692-694. [PMID: 27891008 PMCID: PMC5112836 DOI: 10.4103/0970-2113.192860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Trilok Chand
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India. E-mail:
| | - Avdhesh Bansal
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India. E-mail:
| | - Sanjeev Jasuja
- Department of Nephrology, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Gaurav Sagar
- Department of Nephrology, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
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Streptococcus gallolyticus meningitis in adults: report of five cases and review of the literature. Clin Microbiol Infect 2015; 21:1077-83. [DOI: 10.1016/j.cmi.2015.08.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 12/22/2022]
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Pochineni V, Lal D, Hasnayen S, Restrepo E. Fatal Strongyloides Hyperinfection Syndrome in an Immunocompromised Patient. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:603-5. [PMID: 26348071 PMCID: PMC4573068 DOI: 10.12659/ajcr.894110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Currently, it is normal to screen for Strongyloides as part of the workup in pre-transplant patients who have eosinophilia. Given the high mortality rates in Strongyloides hyperinfection, this article illustrates the need to screen all patients with eosinophilia who will be started on immunosuppression. CASE REPORT We present here an interesting case of a 76-year-old man with membranous glomerulopathy who developed a severe Strongyloides hyperinfection that required an ICU stay and ultimately led to his death a few weeks after initiation of cyclophosphamide and steroids. CONCLUSIONS We recommend that a detailed workup to detect or rule out this parasitic infection be conducted prior to the initiation of immunosuppression in any patient with eosinophilia.
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Affiliation(s)
- Vaishnavi Pochineni
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, USA
| | - Darshan Lal
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, USA
| | - Shahed Hasnayen
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, USA
| | - Erfidia Restrepo
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, USA
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Toledo R, Muñoz-Antoli C, Esteban JG. Strongyloidiasis with emphasis on human infections and its different clinical forms. ADVANCES IN PARASITOLOGY 2015; 88:165-241. [PMID: 25911368 DOI: 10.1016/bs.apar.2015.02.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Strongyloidiasis (caused by Strongyloides stercoralis, and to a lesser extent by Strongyloides fuelleborni) is one of the most neglected tropical diseases with endemic areas and affecting more than 100 million people worldwide. Chronic infections in endemic areas can be maintained for decades through the autoinfective cycle with the L3 filariform larvae. In these endemic areas, misdiagnosis, inadequate treatment and the facilitation of the hyperinfection syndrome by immunosuppression are frequent and contribute to a high mortality rate. Despite the serious health impact of strongyloidiasis, it is a neglected disease and very little is known about this parasite and the disease when compared to other helminth infections. Control of the disease is difficult because of the many gaps in our knowledge of strongyloidiasis. We examine the recent literature on different aspects of strongyloidiasis with emphasis in those aspects that need further research.
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Affiliation(s)
- Rafael Toledo
- Departamento de Parasitología, Universidad de Valencia, Valencia, Spain
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Shimasaki T, Chung H, Shiiki S. Five cases of recurrent meningitis associated with chronic strongyloidiasis. Am J Trop Med Hyg 2014; 92:601-4. [PMID: 25548379 DOI: 10.4269/ajtmh.14-0564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Although meningitis secondary to chronic strongyloidiasis is a rare complication, it is associated with a high mortality rate. Recurrent meningitis can occur if the underlying parasitic infection is left untreated. We report five cases of recurrent meningitis related to chronic strongyloidiasis that were associated with human T-lymphotropic virus type 1 (HTLV-1) infection. Common causative organisms are Escherichia coli, Streptococcus bovis, and Klebsiella pneumonia. One patient died during the second episode of meningitis. Three patients showed significant gastrointestinal and respiratory symptoms before developing headache and fever. In four cases, patients developed multiple recurrences even with the treatment of thiabendazol. Ivermectin seems to be a better agent compared with thiabendazol to achieve eradication of strongyloidiasis.
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Affiliation(s)
- Teppei Shimasaki
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Heath Chung
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan
| | - Soichi Shiiki
- Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii; Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan
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Pukkila-Worley R, Nardi V, Branda JA. Case records of the Massachusetts General Hospital. Case 28-2014. A 39-year-old man with a rash, headache, fever, nausea, and photophobia. N Engl J Med 2014; 371:1051-60. [PMID: 25207769 DOI: 10.1056/nejmcpc1405886] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Dogan C, Gayaf M, Ozsoz A, Sahin B, Aksel N, Karasu I, Aydogdu Z, Turgay N. Pulmonary Strongyloides stercoralis infection. Respir Med Case Rep 2014; 11:12-5. [PMID: 26029521 PMCID: PMC3969601 DOI: 10.1016/j.rmcr.2013.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 10/04/2013] [Indexed: 11/30/2022] Open
Abstract
The 17-year-old male patient presented with fever, weakness, dyspnea and weight loss. His chest radiography demonstrated diffuse reticulonodular density, and high-resolution lung tomography indicated diffuse micronodules and prevalent ground-glass pattern. The findings were consistent with miliary involvement. The patient underwent examinations for rheumatology, immunology, cytology and infectious conditions. His immune system was normal and had no comorbidities or any history of immunosuppressive treatment. Strongyloides stercoralis larvae were noted upon direct inspection of the feces. Clinical and radiological improvement was achieved with albendazole 400 mg/day. This case is being presented since miliary involvement in the lungs caused by S. stercoralis infection in an individual with intact immune system is rare and difficult to diagnosis.
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Affiliation(s)
- Canan Dogan
- Erzurum Bölge Training and Research Hospital, Turkey
| | - Mine Gayaf
- Erzurum Bölge Training and Research Hospital, Turkey
| | - Ayse Ozsoz
- Erzurum Bölge Training and Research Hospital, Turkey
| | - Birsen Sahin
- Erzurum Bölge Training and Research Hospital, Turkey
| | - Nimet Aksel
- Erzurum Bölge Training and Research Hospital, Turkey
| | - Isil Karasu
- Erzurum Bölge Training and Research Hospital, Turkey
| | | | - Nevin Turgay
- Erzurum Bölge Training and Research Hospital, Turkey
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Sasaki Y, Taniguchi T, Kinjo M, McGill RL, McGill AT, Tsuha S, Shiiki S. Meningitis associated with strongyloidiasis in an area endemic for strongyloidiasis and human T-lymphotropic virus-1: a single-center experience in Japan between 1990 and 2010. Infection 2013; 41:1189-93. [PMID: 23761268 PMCID: PMC3832757 DOI: 10.1007/s15010-013-0483-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 05/22/2013] [Indexed: 11/30/2022]
Abstract
Meningitis caused by enteric flora is a known complication of strongyloidiasis, and human T-lymphotropic virus-1 (HTLV-1) predisposes individuals to severe strongyloidiasis. We reviewed the clinical features of bacterial meningitis associated with strongyloidiasis seen at a single center in subtropical Japan, in an area endemic for both strongyloidiasis and HTLV-1. We found 33 episodes in 21 patients between 1990 and 2010. The results were remarkable for the high incidence of meningitis due to Gram-positive cocci (27.3 %), especially Streptococcus bovis, and culture-negative cases (42.4 %). Given the high incidence of Gram-positive meningitis, a modified approach to corticosteroid use would be advisable in areas where strongyloidiasis is endemic, due to the potentially adverse consequences of glucocorticoid therapy.
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Affiliation(s)
- Y Sasaki
- Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan,
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Rampur L, Jariwala S, Amin B, Patel P, Rosenstreich DL. DRESS syndrome with suspected Strongyloides infection in a patient treated for hepatitis C. Ann Allergy Asthma Immunol 2013; 111:138-9. [PMID: 23886233 DOI: 10.1016/j.anai.2013.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 05/13/2013] [Accepted: 05/20/2013] [Indexed: 11/30/2022]
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Buonfrate D, Requena-Mendez A, Angheben A, Muñoz J, Gobbi F, Van Den Ende J, Bisoffi Z. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis 2013; 13:78. [PMID: 23394259 PMCID: PMC3598958 DOI: 10.1186/1471-2334-13-78] [Citation(s) in RCA: 231] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 01/19/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Strongyloidiasis is commonly a clinically unapparent, chronic infection, but immuno suppressed subjects can develop fatal disease. We carried out a review of literature on hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), in order to describe the most challenging aspects of severe strongyloidiasis. METHODS We conducted a structured search using PubMed to collect case reports and short case series on HS/DS published from 1991 to 2011. We restricted search to papers in English, Spanish, Italian and French. Case reports were classified as HS/DS according to given definitions. RESULTS Records screened were 821, and 311 were excluded through titles and abstract evaluation. Of 510 full-text articles assessed for eligibility, 213 were included in qualitative analysis. As some of them were short case series, eventually the number of cases analyzed was 244.Steroids represented the main trigger predisposing to HS and DS (67% cases): they were mostly administered to treat underlying conditions (e.g. lymphomas, rheumatic diseases). However, sometimes steroids were empirically prescribed to treat signs and symptoms caused by unsuspected/unrecognized strongyloidiasis. Diagnosis was obtained by microscopy examination in 100% cases, while serology was done in a few cases (6.5%). Only in 3/29 cases of solid organ/bone marrow transplantation there is mention of pre-transplant serological screening. Therapeutic regimens were different in terms of drugs selection and combination, administration route and duration. Similar fatality rate was observed between patients with DS (68.5%) and HS (60%). CONCLUSIONS Proper screening (which must include serology) is mandatory in high - risk patients, for instance candidates to immunosuppressive medications, currently or previously living in endemic countries. In some cases, presumptive treatment might be justified. Ivermectin is the gold standard for treatment, although the optimal dosage is not clearly defined in case of HS/DS.
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Affiliation(s)
- Dora Buonfrate
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Ana Requena-Mendez
- Barcelona Centre for International Health Research (CRESIB) Hospital Clinic, Barcelona, Spain
| | - Andrea Angheben
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Jose Muñoz
- Barcelona Centre for International Health Research (CRESIB) Hospital Clinic, Barcelona, Spain
| | - Federico Gobbi
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Jef Van Den Ende
- Department of Clinical sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Zeno Bisoffi
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Negrar, Verona, Italy
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Strongyloides stercoralis infection complicating the central nervous system. NEUROPARASITOLOGY AND TROPICAL NEUROLOGY 2013; 114:229-34. [DOI: 10.1016/b978-0-444-53490-3.00017-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Gomez JB, Maque Y, Moquillaza MA, Anicama WE. E. coli Meningitis Presenting in a Patient with Disseminated Strongyloides stercoralis. Case Rep Infect Dis 2013; 2013:424362. [PMID: 24324900 PMCID: PMC3845250 DOI: 10.1155/2013/424362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/07/2013] [Indexed: 11/23/2022] Open
Abstract
Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides stercoralis (SS) infections. Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell's palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrum β -lactamase producing E. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multiple Strongyloides larvae throughout the body. Conclusion. Strongyloides stercoralis infection should be excluded in adults with spontaneous E. coli meningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis.
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Affiliation(s)
- Juliana B. Gomez
- 1Department of Internal Medicine, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
- *Juliana B. Gomez:
| | - Yvan Maque
- 2Grupo de Investigacion en Inmunologia, Universidad Nacional de San Agustin, Arequipa, Peru
| | - Manuel A. Moquillaza
- 3Department of Neurology, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
| | - William E. Anicama
- 4Department of Pathology, Guillermo Almenara Irigoyen National Hospital, Lima, Peru
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Cho JY, Kwon JG, Ha KH, Oh JY, Jin MI, Heo SW, Lee GH, Cho CH. [A case of steroid-induced hyperinfective strongyloidiasis with bacterial meningitis]. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2012; 60:330-4. [PMID: 23172283 DOI: 10.4166/kjg.2012.60.5.330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Strongyloides stercoralis is a soil transmitted intestinal nematode that is endemic in the tropical and subtropical regions. In most individuals who are infected, chronic, usually asymptomatic, gastrointestinal infection persists. But, in immunocompromized hosts or in patients receiving immunosuppressive therapy, autoinfection of S. stercoralis may result in the dissemination of larvae, leading to fatal hyperinfection and increased rate of complications. We report a case of hyperinfective strongyloidiasis with bacterial meningitis in a patient receiving steroid therapy. Strongyloidiasis was diagnosed by the presence of filariform larvae of S. stercoralis in the bronchoalveolar lavage cytology and upper gastrointestinal endoscopic biopsy specimen. Her clinical symptoms had progressively aggravated and developed bacterial meningitis during treatment. She died despite aggressive antibiotic and antihelminthic therapy.
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Affiliation(s)
- Joo Yun Cho
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
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Jariwala S, Langman Y, Benson AA, Wolf E, Moss J, Zhu CC, Brandt L. Strongyloidiasis presenting as eosinophilic ascites. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2011; 105:335-8. [PMID: 21871171 DOI: 10.1179/136485911x12987676649863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S Jariwala
- Albert Einstein College of Medicine, Bronx, NY 10467, USA.
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Varón de 69 años con meningitis recidivante. Med Clin (Barc) 2011; 136:167-74. [DOI: 10.1016/j.medcli.2010.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 09/28/2010] [Indexed: 11/22/2022]
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Tourret J, Aloulou M, Garry L, Tenaillon O, Dion S, Ryffel B, Monteiro RC, Denamur E. The interaction between a non-pathogenic and a pathogenic strain synergistically enhances extra-intestinal virulence in Escherichia coli. MICROBIOLOGY-SGM 2010; 157:774-785. [PMID: 21071495 DOI: 10.1099/mic.0.037416-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Finding two or more genotypes of a single species within an infected sample is a not infrequent event. In this work, three Escherichia coli strains of decreasing extra-intestinal virulence (pathogenic B2S and B1S strains, and the avirulent K-12 MG1655 strain) were tested in septicaemia and urinary tract infection (UTI) mouse models, either separately or in pairs. Survival was monitored and bacteria were counted in various organs. Serum interleukin (IL)-6, tumour necrosis factor alpha (TNFα) and IL-10 were measured. We show that a mix of high amounts of B1S or of MG1655 with low amounts of B2S killed more rapidly (B1S), or killed more mice (MG1655), than either high amounts of B1S, high amounts of MG1655 or low amounts of B2S separately in the mouse septicaemia model. This bacterial synergy persisted when high amounts of dead or abnormal-LPS K-12 cells were injected together with a low amount of B2S. In both septicaemia and UTI models, significantly more bacteria were recovered from the organs of mice injected with the MG1655/B2S mix than from those of mice injected with the inocula separately. Consistently, in the septicaemia model, more IL-6 was secreted before death by the mice that were injected with the mix of bacteria than by the mice that were injected with the inocula separately. The synergistically enhanced mortality in the case of co-infection in the septicaemia model persisted in RFcγ(-/-), Myd88(-/-) and IL-6(-/-) knockout mice. This synergistically increased virulence resulting from the interaction between an avirulent and a pathogenic strain of the same bacterial species raises questions about the role of avirulent bacteria in the development of some extra-intestinal infections.
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Affiliation(s)
- Jérôme Tourret
- INSERM U722, and Université Paris 7 Denis Diderot, Site Xavier Bichat, 75018 Paris, France
| | - Meryem Aloulou
- INSERM U699, and Université Paris 7 Denis Diderot, Site Xavier Bichat, 75018 Paris, France
| | - Louis Garry
- INSERM U722, and Université Paris 7 Denis Diderot, Site Xavier Bichat, 75018 Paris, France
| | - Olivier Tenaillon
- INSERM U722, and Université Paris 7 Denis Diderot, Site Xavier Bichat, 75018 Paris, France
| | - Sara Dion
- INSERM U722, and Université Paris 7 Denis Diderot, Site Xavier Bichat, 75018 Paris, France
| | - Bernard Ryffel
- CNRS UMR6218, and Université d'Orléans and Molecular Immunology and Embryology, IEM2815, 45071 Orléans, France
| | - Renato C Monteiro
- INSERM U699, and Université Paris 7 Denis Diderot, Site Xavier Bichat, 75018 Paris, France
| | - Erick Denamur
- INSERM U722, and Université Paris 7 Denis Diderot, Site Xavier Bichat, 75018 Paris, France
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Strongyloides stercoralis Hyperinfection: A Therapeutic Challenge. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2010. [DOI: 10.1097/ipc.0b013e3181d654a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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García A, Nambiar PR, Marini RP, Fox JG. Staphylococcal meningoencephalitis, nematodiasis, and typhlocolitis in a squirrel monkey (Saimiri sciureus). J Med Primatol 2009; 38:377-81. [PMID: 19737242 DOI: 10.1111/j.1600-0684.2009.00363.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Seizures were observed in a 16-year old male Guyanese squirrel monkey with a history of inappetence and weakness. METHODS AND RESULTS Complete blood count, biochemical profile, and urinalysis indicated systemic disease. Nematode larvae were detected in the feces. Cerebrospinal fluid (CSF) analysis revealed leukocytes and gram-positive cocci. Staphylococcus aureus was isolated from the CSF. Histopathological evaluation revealed systemic lesions with inflammation and nematodes in the small and large intestine. CONCLUSION This is the first report describing spontaneous staphylococcal CNS infection in a squirrel monkey.
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Affiliation(s)
- A García
- Division of Comparative Medicine, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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Al Maslamani MA, Al Soub HA, Al Khal ALM, Al Bozom IA, Abu Khattab MJ, Chacko KC. Strongyloides stercoralis hyperinfection after corticosteroid therapy: a report of two cases. Ann Saudi Med 2009; 29:397-401. [PMID: 19700900 PMCID: PMC2860402 DOI: 10.4103/0256-4947.55172] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Two cases of Strongyloides stercoralis hyperinfection are described. Both patients were expatriates from the Indian subcontinent, and reported the use of corticosteroids. The first patient presented with severe pulmonary disease that necessitated respiratory support, followed by acute abdomen and intestinal obstruction and he succumbed to these diseases. The second patient also presented with acute pulmonary disease, which responded to antihelmintic treatment and supportive care; however, he died later due to his primary disease. The clinical features of S stercoralis hyperinfection are nonspecific; therefore, a high index of suspicion is required for early diagnosis and to start appropriate therapy. Because of the seriousness of the disease and the associated high mortality we suggest screening for S stercoralis in patients from endemic areas who will be taking immunosuppressive therapy.
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48
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Aregawi D, Lopez D, Wick M, Scheld WM, Schiff D. Disseminated strongyloidiasis complicating glioblastoma therapy: a case report. J Neurooncol 2009; 94:439-43. [PMID: 19333553 DOI: 10.1007/s11060-009-9878-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 03/19/2009] [Indexed: 10/20/2022]
Abstract
Strongyloides stercoralis is an intestinal parasite that can cause fatal opportunistic infections in immunocompromised patients. Here we report an immunocompromised patient with glioblastoma who developed disseminated strongyloidiasis 6 weeks after completion of standard radiotherapy and concurrent temozolomide chemotherapy. She was effectively treated with albendazole and ivermectin. Strongyloidiasis should be considered in patients being treated for glioma who have lived or traveled to high risk areas and developed gram negative sepsis, along with gastrointestinal or respiratory symptoms, skin rash or SIADH.
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Affiliation(s)
- Dawit Aregawi
- Neuro-Oncology Center and Departments of Neurology, Neurological Surgery, and Medicine (Hematology-Oncology), University of Virginia, Charlottesville, VA 22908-0432, USA
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Liu HC, Hsu JY, Chang KM. Strongyloides stercoralis hyperinfection presenting with symptoms mimicking acute exacerbation of chronic obstructive pulmonary disease. J Chin Med Assoc 2009; 72:442-5. [PMID: 19687002 DOI: 10.1016/s1726-4901(09)70403-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hyperinfection syndrome with Strongyloides stercoralis is not uncommon in immunocompromised patients. We present 2 fatal cases of Strongyloides hyperinfection with initial presentation mimicking acute exacerbation of chronic obstructive pulmonary disease (COPD). Both cases had a history of COPD and had received systemic steroid treatment before or during admission. The initial chest radiograph in both of these cases showed diffuse axial interstitial pattern. The sputum examinations of Gram stain both yielded larvae of Strongyloides stercoralis precipitously. Case 1 developed acute respiratory distress syndrome and bacteremia of Escherichia coli and Klebsiella pneumoniae soon after admission, and died even after receiving albendazole and antibiotic treatment. Case 2 received albendazole and antibiotic treatment for over 2 weeks, but developed refractory aseptic meningitis and died of septic shock. Neither case had high eosinophil count in peripheral blood during admission. Clinical manifestations of unexplained wheezing and respiratory failure, increased infiltration on chest radiograph, Gram-negative bacteremia, and aseptic meningitis may all be clues of Strongyloides hyperinfection. Due to the high mortality rate and severe complications in these patients, clinicians should always keep this diagnosis in mind, especially when dealing with immunocompromised patients. We suggest that a screening test be done for patients who live in endemic areas and those who are going to receive steroids for chronic disease.
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Affiliation(s)
- Hsu-Chung Liu
- Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
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50
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Vilela EG, Clemente WT, Mira RRL, Torres HOG, Veloso LF, Fonseca LP, de Carvalho E Fonseca LR, Franca MDC, Lima AS. Strongyloides stercoralis hyperinfection syndrome after liver transplantation: case report and literature review. Transpl Infect Dis 2009; 11:132-6. [PMID: 18983416 DOI: 10.1111/j.1399-3062.2008.00350.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Strongyloides stercoralis is an intestinal nematode that causes human infections and whose life cycle has special features, including autoinfection. Strongyloides infection may be asymptomatic for years, owing to a low parasite load. During immunosuppressive therapy, however, if cellular immunity is depressed, autoinfection can occur at a higher rate, resulting in hyperinfection syndrome. In this specific circumstance, it can become a fatal illness. We describe a case of hyperinfection syndrome in a liver transplant recipient and also review the literature.
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Affiliation(s)
- E G Vilela
- Transplant Unit, Alfa Institute of Gastroenterology, Clinic Hospital, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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