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Rojas OC, Montoya AM, Villanueva-Lozano H, Carrion-Alvarez D. Severe strongyloidiasis: a systematic review and meta-analysis of 339 cases. Trans R Soc Trop Med Hyg 2023; 117:682-696. [PMID: 37300462 DOI: 10.1093/trstmh/trad032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/15/2022] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Strongyloidiasis is a parasitosis representing a significant public health problem in tropical countries. It is often asymptomatic in immunocompetent individuals but its mortality rate increases to approximately 87% in severe forms of the disease. We conducted a systematic review, including case reports and case series, of Strongyloides hyperinfection and dissemination from 1998 to 2020 searching PubMed, EBSCO and SciELO. Cases that met the inclusion criteria of the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist were analysed. Statistical analysis was performed using Fisher's exact test and Student's t-test and a Bonferroni correction for all the significant values. A total of 339 cases were included in this review. The mortality rate was 44.83%. The presence of infectious complications, septic shock and a lack of treatment were risk factors for a fatal outcome. Eosinophilia and ivermectin treatment were associated with an improved outcome.
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Affiliation(s)
- Olga C Rojas
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Facultad de Medicina, Dr Eleuterio Gonzalez Gonzalitos-Francisco I. Madero s/n 64460, Monterrey, Nuevo Leon, Mexico
| | - Alexandra M Montoya
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Facultad de Medicina, Dr Eleuterio Gonzalez Gonzalitos-Francisco I. Madero s/n 64460, Monterrey, Nuevo Leon, Mexico
| | - Hiram Villanueva-Lozano
- Departamento de Medicina Interna, Hospital Regional ISSSTE Monterrey, Av. Adolfo López Mateos, 122 Burócratas Federales 64380, Monterrey, Nuevo León, Mexico
| | - Diego Carrion-Alvarez
- Departamento de Medicina Interna, Hospital Regional ISSSTE Monterrey, Av. Adolfo López Mateos, 122 Burócratas Federales 64380, Monterrey, Nuevo León, Mexico
- Departamento de Ciencias Basicas, Universidad de Monterrey. N.L. Mexico. Av. Ignacio Morones Prieto 4500, San Pedro, Garza García, Nuevo Leon, Mexico
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Murali S, Marks A, Heeger A, Dako F, Febbo J. Pneumonia in the Immunocompromised Host. Semin Roentgenol 2022; 57:90-104. [DOI: 10.1053/j.ro.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 11/11/2022]
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Corral de la Calle M, Encinas de la Iglesia J. Ultrasonography in infectious and neoplastic diseases of the bowel and peritoneum. RADIOLOGIA 2021. [DOI: 10.1016/j.rxeng.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Corral de la Calle MÁ, Encinas de la Iglesia J. Ultrasonography in infectious and neoplastic diseases of the bowel and peritoneum. RADIOLOGIA 2021; 63:270-290. [PMID: 33608108 DOI: 10.1016/j.rx.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/14/2020] [Accepted: 12/28/2020] [Indexed: 11/28/2022]
Abstract
Ultrasonography is not the most cited imaging technique for the evaluation of infectious and neoplastic diseases of the gastrointestinal tract and the peritoneum, but it is often the initial technique used in the initial workup for nonspecific clinical syndromes. Despite its limitations, ultrasonography's strengths enable it to provide meaningful diagnostic information. To discuss the most important ultrasonographic, clinical, and epidemiological findings for infectious disease, we follow a topographical approach: stomach (Anisakis), proximal small bowel (Giardia lamblia, Strongyloides stercoralis, Mycobacterium avium-intracellulare complex, and Cryptosporidium), distal small bowel (Yersinia, Salmonella, and Campylobacter), terminal ileum and cecum (tuberculosis), right colon (Entamoeba histolytica), left colon (Shigella), sigmoid colon and rectum, pancolitis (Clostridium difficile, Cytomegalovirus, and Escherichia coli), and peritoneum. To discuss the ultrasonographic and clinical findings of the most common neoplastic diseases, we follow a nosological approach: polyploid lesions as precursors of tumors, carcinomas, neuroendocrine tumors, hematological tumors, mesenchymal tumors, and metastases. We briefly discuss tumors of the peritoneum and the use of ultrasonography to guide percutaneous biopsy procedures.
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Chandra P, Chakravarthy S, Jain D, Nath S. Hypermetabolic Diffuse Proximal Small Bowel Wall Thickening on Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography? Consider Strongyloidiasis among the Differentials. Indian J Nucl Med 2018; 33:368-369. [PMID: 30386068 PMCID: PMC6194780 DOI: 10.4103/ijnm.ijnm_96_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Strongyloidiasis is an emerging tropical/subtropical parasitic infection commonly encountered in immunocompromised patients and often accompanied by life-threatening gram-negative bacteremia. We presented an interesting image of a critically ill 66-year-old lady, an asthmatic on high dose steroids, presenting with unexplained fever and vomiting where fluorodeoxyglucose positron emission tomography/computed tomography and endoscopic biopsy revealed this often neglected pathogenic nematode.
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Affiliation(s)
- Piyush Chandra
- Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
| | | | - Deepti Jain
- Department of Pathology, MIOT International, Chennai, Tamil Nadu, India
| | - Satish Nath
- Department of Nuclear Medicine, MIOT International, Chennai, Tamil Nadu, India
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Bae K, Jeon KN, Ha JY, Lee JS, Na BK. Pulmonary strongyloidiasis presenting micronodules on chest computed tomography. J Thorac Dis 2018; 10:E612-E615. [PMID: 30233896 DOI: 10.21037/jtd.2018.07.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kyungsoo Bae
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.,Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Kyung Nyeo Jeon
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.,Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Ji Young Ha
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jong Sil Lee
- Department of Pathology, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Byoung-Kuk Na
- Department of Parasitology and Tropical Medicine, and Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
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Santana Lima VF, Rocha PA, Dias Silva MA, Beltrão-Mendes R, Ramos RAN, Giannelli A, Rinaldi L, Cringoli G, Estrela PC, Alves LC. Survey on helminths and protozoa of free-living Neotropical bats from Northeastern Brazil. Acta Trop 2018; 185:267-272. [PMID: 29883575 DOI: 10.1016/j.actatropica.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 06/04/2018] [Indexed: 12/17/2022]
Abstract
Bats are considered important reservoirs of pathogens of veterinary and medical relevance worldwide. However, despite the increasing attention paid towards the central role of bats in the spreading of some zoonotic infections, studies on their own parasites remain patchy especially in Neotropical regions. Understanding the relationships occurring between bats and their pathogens is a crucial step to determine the implications undermining the ecology and biology of these animals. The present study aims to assess the endoparasitic fauna of Neotropical bats from Northeastern Brazil, with a particular focus on helminths and protozoa. From October 2016 to March 2017, 54 fresh faecal samples were collected in stable shelters inhabited by three different bat species (i.e., Molossus molossus, Myotis lavali and Noctilio albiventris). Samples were analysed using four different techniques (i.e., Centrifugal Sedimentation, Flotation Technique, Spontaneous Sedimentation Technique and FLOTAC®). A total of 96.29% (52/54) samples were positive for at least one gastrointestinal parasite and 11 different families were identified. In particular, 63.6% (7/11) of the families were of helminths and 36.4% (4/11) of protozoa. Helminths were classified into two different classes (Nematoda and Cestoda) and seven families, whereas the four protozoa classes detected (i.e., Coccidia, Gregarinomorphe, Lobosea and Zoomastigophora) into four families. Eggs of Ancylostomatidae and Hymenolepididae were the most abundan. The findings of this present study demonstrate that Neotropical bats from Northeastern Brazil are parasitized by a wide number of parasites, and some of them may have important implications for Public Health.
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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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Yung EE, Lee CMKL, Boys J, Grabo DJ, Buxbaum JL, Chandrasoma PT. Strongyloidiasis hyperinfection in a patient with a history of systemic lupus erythematosus. Am J Trop Med Hyg 2014; 91:806-9. [PMID: 25092815 DOI: 10.4269/ajtmh.14-0228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis, a nematode predominately endemic to tropical and subtropical regions, such as Southeast Asia. Autoinfection enables the organism to infect the host for extended periods. Symptoms, when present, are non-specific and may initially lead to misdiagnosis, particularly if the patient has additional co-morbid conditions. Immunosuppressive states place patients at risk for the Strongyloides hyperinfection syndrome (SHS), whereby the organism rapidly proliferates and disseminates within the host. Left untreated, SHS is commonly fatal. Unfortunately, the non-specific presentation of strongyloidiasis and the hyperinfection syndrome may lead to delays in diagnosis and treatment. We describe an unusual case of SHS in a 30-year-old man with a long-standing history of systemic lupus erythematosus who underwent a partial colectomy. The diagnosis was rendered on identification of numerous organisms during histologic examination of the colectomy specimen.
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Affiliation(s)
- Evan E Yung
- Department of Pathology, Department of Surgery, and Department of Gastroenterology, Los Angeles County-University of Southern California Medical Center, Los Angeles, California
| | - Cassie M K L Lee
- Department of Pathology, Department of Surgery, and Department of Gastroenterology, Los Angeles County-University of Southern California Medical Center, Los Angeles, California
| | - Joshua Boys
- Department of Pathology, Department of Surgery, and Department of Gastroenterology, Los Angeles County-University of Southern California Medical Center, Los Angeles, California
| | - Daniel J Grabo
- Department of Pathology, Department of Surgery, and Department of Gastroenterology, Los Angeles County-University of Southern California Medical Center, Los Angeles, California
| | - James L Buxbaum
- Department of Pathology, Department of Surgery, and Department of Gastroenterology, Los Angeles County-University of Southern California Medical Center, Los Angeles, California
| | - Parakrama T Chandrasoma
- Department of Pathology, Department of Surgery, and Department of Gastroenterology, Los Angeles County-University of Southern California Medical Center, Los Angeles, California
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Inês EDJ, Silva MLS, Souza JN, Teixeira MCA, Soares NM. The role of glycosylated epitopes in the serodiagnosis of Strongyloides stercoralis infection. Diagn Microbiol Infect Dis 2013; 76:31-5. [DOI: 10.1016/j.diagmicrobio.2013.01.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Revised: 01/03/2013] [Accepted: 01/15/2013] [Indexed: 11/24/2022]
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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: 229] [Impact Index Per Article: 20.8] [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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Basile A, Simzar S, Bentow J, Antelo F, Shitabata P, Peng SK, Craft N. Disseminated Strongyloides stercoralis: Hyperinfection during medical immunosuppression. J Am Acad Dermatol 2010; 63:896-902. [DOI: 10.1016/j.jaad.2009.09.037] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 09/04/2009] [Accepted: 09/23/2009] [Indexed: 11/25/2022]
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Abstract
A 10-week-old, male pit bull dog presented to the referring veterinarian with hind limb paresis and epaxial muscle atrophy. No spinal lesions were identified at gross necropsy; however, histologically there was marked granulomatous myelitis in the spinal cord between T13 and L2 with occasional, intralesional nematode larvae. Based on morphologic characteristics, the nematode larvae were identified as Strongyloides spp., possibly Strongyloides stercoralis.
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Affiliation(s)
- Eric R. Snook
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
| | - David G. Baker
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
| | - Rudy W. Bauer
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
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N'dri K, Kouame KE, Sahari R, Hommel D, Hulin A. [Strongyloides stercoralis hyperinfection syndrome with acute meningoencephalitis associated to HTLV-1 and HTLV-2 virus co-infection]. Med Mal Infect 2008; 38:162-4. [PMID: 18191522 DOI: 10.1016/j.medmal.2007.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 11/11/2007] [Indexed: 11/29/2022]
Affiliation(s)
- K N'dri
- Service de Réanimation Polyvalente, Centre Hospitalier de Cayenne, Cayenne, French Guiana.
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Sudré AP, Siqueira RC, Barreto MGM, Peralta RHS, Macedo HW, Peralta JM. Identification of a 26-kDa protein fraction as an important antigen for application in the immunodiagnosis of strongyloidiasis. Parasitol Res 2007; 101:1117-23. [PMID: 17569087 DOI: 10.1007/s00436-007-0596-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Accepted: 05/16/2007] [Indexed: 10/23/2022]
Abstract
Strongyloidiasis caused by the intestinal nematode Strongyloides stercoralis typically occurs in the asymptomatic form. The definitive diagnosis is usually done by detection of larvae on fecal samples. However, as the parasite load is often low in most cases, microscopy is not usually sensitive and specific, and diagnosis becomes extremely difficult. Thus, development of reliable serological methods is imperative. In the present study, a diversity of epitopes from S. stercoralis larva were characterized by analysis of reactivity with serum samples obtained from individuals with and without the infection by using Western blot technique. A total of 91 serum samples belonging to 5 groups were analyzed. Different reactivity profiles were observed, representing recognition of proteins with molecular mass varied from 6 to 129 kDa. A protein band of approximately 26 kDa presented a high frequency of reactivity with serum samples from the strongyloidiasis patients group (18/23). Reactivity with this protein band was also observed in only 7 of 64 non-infected individuals or individuals infected with other helminthes. Reactivity with 2 other bands, 1 of approximately 33 kDa and a duplet of approximately 21 kDa, were also found in high frequency (17/23 and 9/23, respectively). However, reactivity with these bands was also observed in all the other serum groups studied. The results indicate that the 26-kDa band maybe be an important tool for the development of diagnostic techniques for strongyloidiasis.
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Affiliation(s)
- Adriana P Sudré
- Departamento de Parasitologia e Microbiologia e, Universidade Federal Fluminense, Niterói, Rio de Janeiro 24030210, Brazil
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Mora CS, Segami MI, Hidalgo JA. Strongyloides Stercoralis Hyperinfection in Systemic Lupus Erythematosus and the Antiphospholipid Syndrome. Semin Arthritis Rheum 2006; 36:135-43. [PMID: 16949135 DOI: 10.1016/j.semarthrit.2006.06.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2005] [Revised: 06/07/2006] [Accepted: 06/14/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Strongyloides stercoralis hyperinfection syndrome (SHS) may develop in individuals with asymptomatic infection receiving immunosuppressive treatment. This report summarizes current knowledge regarding SHS in patients with systemic lupus erythematosus (SLE) and associated antiphospholipid syndrome (APS). METHODS Two patients with active SLE and associated APS presenting with SHS are reported. Additional cases of strongyloidiasis in SLE were identified and reviewed. RESULTS Patient 1: A 34-year-old woman with SLE and APS characterized by active glomerulonephritis, stroke, and several hospital-acquired infections presented with vomiting and diffuse abdominal pain. Intestinal vasculitis was suspected, and treatment with methylprednisolone and cyclophosphamide was given. Response was partial. A gastric biopsy revealed S. stercoralis larvae. She received ivermectin and eventually recovered. Patient 2: A 37-year-old man with active glomerulonephritis and APS with recurrent thrombosis presented with digital necrosis. Necrotizing vasculitis was suspected and treated with immunosupressants. He suddenly developed respiratory failure secondary to alveolar hemorrhage and bronchoalveolar lavage was performed. The patient developed Gram-negative septic shock and died. The postmortem result of bronchoalveolar lavage yielded Strongyloides larvae. Nine cases of strongyloidiasis and the SHS in SLE patients reported in the literature were identified and reviewed. Five of these patients died; none had associated APS. CONCLUSIONS These cases suggest that the SHS can exacerbate SLE and APS, predisposing to Gram-negative sepsis and death. Immunocompromised patients need an early diagnosis and specific treatment of parasitic diseases and their complications. The SHS should be considered in the differential diagnosis of lupus complications in patients from endemic areas.
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Affiliation(s)
- Claudia S Mora
- Department of Systemic Diseases, Service of Rheumatology, Edgardo Rebagliati Martins Hospital, Lima, Peru.
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Fardet L, Généreau T, Poirot JL, Guidet B, Kettaneh A, Cabane J. Severe strongyloidiasis in corticosteroid-treated patients: case series and literature review. J Infect 2006; 54:18-27. [PMID: 16533536 DOI: 10.1016/j.jinf.2006.01.016] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Revised: 01/18/2006] [Accepted: 01/22/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe the main features of severe strongyloidiasis in corticosteroid-treated patients METHODS We report on 3 cases of corticosteroid-treated patients with severe strongyloidiasis and review cases of severe strongyloidiasis in corticosteroid-treated patients reported in the literature. RESULTS One hundred and fifty-one cases of severe strongyloidiasis complicated a therapy with corticosteroids were evaluated. The mean age of the patients was 48+/-17 years and 71% were men. Corticosteroids were given for hematological malignancies in 34 (23%), systemic lupus erythematosus or vasculitis in 27 (18%), and nephropathy or renal transplantation in 32 (21%). At time of infection, the mean daily dosage of prednisone-equivalent was 52+/-42 mg (median: 40 mg) and 84% of patients had received a cumulative dosage of prednisone-equivalent higher than 1000 mg. The total duration of treatment ranged from 4 days to 20 years (6 months or less: 69%). Non-specific gastro-intestinal symptoms were reported in 91% of these patients associated or not with pulmonary complaints. Low-grade fever was present in 54% of patients. Fifty-nine patients (39%) experienced severe bacterial or yeast infection during the course of severe strongyloidiasis. Peripheral eosinophilia was detected at presentation in 32% of patients. Strongyloidiasis was usually confirmed by repeated stool examinations. Thiabendazole was the treatment the more widely used. Eighty-nine patients (59%) deceased during the course of the disease. CONCLUSIONS Severe strongyloidiasis is a risk in every corticosteroid-treated patient who has traveled to a soil-infested country, even if the contact was 30 years prior. This diagnosis should be suspected in patients who either experience unusual gastro-intestinal or pulmonary symptoms or suffer from unexplained Gram-negative bacilli sepsis.
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Affiliation(s)
- Laurence Fardet
- Hopital Saint-Antoine, Internal Medicine, Parasitology and Intensive Care Department, 184 rue du Fbg Saint-Antoine, 75012 Paris, France.
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Abstract
Globalization has produced an increase in the number of people at risk for contracting parasitic infection. Central nervous system infection by nematodal parasites can be devastating. Early recognition and treatment of infection can significantly decrease morbidity of the parasitic infection, as well as the risk of secondary superinfection. The clinical presentation, diagnosis, and treatment for five of the more common nematodal infections of the nervous system--Angiostrongylus spp., Baylisacaris procyonis, Gnathostoma spinigerum, Strongyloides stercoralis, and Toxocara spp.--is reviewed.
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Affiliation(s)
- M D Walker
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington 98104, USA
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Concha R, Harrington W, Rogers AI. Intestinal strongyloidiasis: recognition, management, and determinants of outcome. J Clin Gastroenterol 2005; 39:203-11. [PMID: 15718861 DOI: 10.1097/01.mcg.0000152779.68900.33] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Significant advances have occurred in our understanding of the biology, immunology, and immunopathology of the usually asymptomatic human infection by the intestinal parasite, Strongyloides stercoralis. Factors that increase the risk for the occurrence of symptomatic intestinal hyperinfection and/or often-fatal disseminated strongyloidiasis have been better defined. The pathophysiology underlying these risk factors, whether disease-related or iatrogenically induced, is a compromised immune system leading to dysfunction of TH-2 helper cells. These specialized lymphocytes are central to maintaining the delicate balance that exists between the infected human host and the stabilized parasite. Recognition of risk factors that impair the function of TH-2 lymphocytes is essential to heightening the index of clinical suspicion enhancing earlier, accurate diagnosis, and the introduction of appropriate therapy. This review summarizes what is understood about infection by S. stercoralis; its focus will be on the epidemiology, diagnosis, clinical presentation patterns in the immunocompetent and immunocompromised human hosts, and recommended treatment regimens.
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Affiliation(s)
- Ronald Concha
- Division of Internal Medicine, University of Miami, 8501 SW 87th Court, Miami, FL 33173-4552, USA.
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Gulbas Z, Kebapci M, Pasaoglu O, Vardareli E. Successful ivermectin treatment of hepatic strongyloidiasis presenting with severe eosinophilia. South Med J 2004; 97:907-10. [PMID: 15455986 DOI: 10.1097/01.smj.0000139936.20116.a7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 49-year-old, previously healthy nurse presented with hepatic lesions and severe peripheral eosinophilia due to strongyloidiasis. Imaging studies of the abdomen showed predominantly peripheral, confluent hepatic lesions. The hepatic lesions and eosinophilia did not show any improvement with albendazole, but completely resolved with ivermectin treatment. Our findings suggest that Strongyloides stercoralis can present with isolated focal hepatic lesions and severe eosinophilia, and resolves with ivermectin treatment.
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Affiliation(s)
- Zafer Gulbas
- Department of Hematology, Osmangazi University Medical Faculty, Meselik, 26480, Eskisehir, Turkey
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Ly MN, Bethel SL, Usmani AS, Lambert DR. Cutaneous Strongyloides stercoralis infection: an unusual presentation. J Am Acad Dermatol 2003; 49:S157-60. [PMID: 12894109 DOI: 10.1067/mjd.2003.338] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Strongyloides stercoralis is a widespread, soil-transmitted, intestinal nematode common in tropical and subtropical countries. The parasite is unique in its capability to carry out its entire life cycle inside the human body. Human beings contract strongyloidiasis by penetration of filariform larvae into the skin or mucous membrane after contact with contaminated soil. The larvae travel by the venous systems to the lungs, then ascend the bronchi to the trachea, where the larvae are coughed up by the human host, subsequently swallowed, and attain their habitat in the small intestine. Chronic strongyloidiasis acquired in endemic areas may last decades and gives rise to various dermatologic lesions, the most characteristic of which is larva currens, a serpiginous, creeping urticarial eruption. In disseminated strongyloidiasis, the characteristic skin lesions are widespread petechiae and purpura. We present a case of disseminated strongyloidiasis with an unusual manifestation mimicking a drug rash and review the dermatologic manifestations of strongyloidiasis infestation.
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Reiman S, Fisher R, Dodds C, Trinh C, Laucirica R, Whigham CJ. Mesenteric arteriographic findings in a patient with strongyloides stercoralis hyperinfection. J Vasc Interv Radiol 2002; 13:635-8. [PMID: 12050306 DOI: 10.1016/s1051-0443(07)61660-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The authors present a case of a Latin American patient with systemic lupus erythematosus who was referred for a mesenteric arteriogram because of acute lower gastrointestinal bleeding. Multiple segments of dilation alternating with stenosis or spasm were noted in the superior mesenteric artery/inferior mesenteric artery distributions. At the time, these irregularities were thought to be representative of lupus vasculitis. Despite appropriate treatment for vasculitis, the patient continued to have bleeding episodes and ultimately died of multiple organ failure. Autopsy demonstrated no evidence of vasculitis, but did demonstrate the unexpected finding of Strongyloides stercoralis hyperinfection with vessel invasion.
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Affiliation(s)
- Steven Reiman
- Department of Radiology, Ben Taub General Hospital, 1504 Taub Loop, Houston, Texas 77030-1608, USA.
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