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Lee YH. A case of disseminated strongyloidiasis diagnosed by worms in the urinary sediment. PARASITES, HOSTS AND DISEASES 2024; 62:238-242. [PMID: 38835264 DOI: 10.3347/phd.23124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/13/2024] [Indexed: 06/06/2024]
Abstract
Strongyloidiasis is a chronic infection caused by the intestinal nematode parasite Strongyloides stercoralis and is characterized by a diverse spectrum of nonspecific clinical manifestations. This report describe a case of disseminated strongyloidiasis with urination difficulty, generalized weakness, and chronic alcoholism diagnosed through the presence of worms in the urinary sediment. A 53-year-old man was hospitalized for severe abdominal distension and urinary difficulties that started 7-10 days prior. The patient also presented with generalized weakness that had persisted for 3 years, passed loose stools without diarrhea, and complained of dyspnea. In the emergency room, approximately 7 L of urine was collected, in which several free-living female adult and rhabditiform larvae of S. stercoralis, identified through their morphological characteristics and size measurements, were detected via microscopic examination. Rhabditiform larvae of S. stercoralis were also found in the patient's stool. During hospitalization, the patient received treatment for strongyloidiasis, chronic alcoholism, peripheral neurosis, neurogenic bladder, and megaloblastic anemia, and was subsequently discharged with improved generalized conditions. Overall, this report presents a rare case of disseminated strongyloidiasis in which worms were detected in the urinary sediment of a patient with urination difficulties and generalized weakness combined with chronic alcoholism, neurogenic bladder, and megaloblastic anemia.
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Affiliation(s)
- Young-Ha Lee
- Department of Infection Biology and Department of Medical Science, Chungnam National University College of Medicine, Daejeon 35015, Korea
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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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Yu P, Wang X, Wen X, Ji Y. Strongyloides stercoralis Infection in a Patient with Chronic Renal Failure from North China. Acta Parasitol 2021; 66:1089-1092. [PMID: 33740235 DOI: 10.1007/s11686-021-00356-w] [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: 07/24/2020] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Human strongyloidiasis is a generally neglected parasitic disease of major global distribution, spreading commonly in tropical and subtropical areas. As for China, strongyloidiasis occur mainly in South of China and no relevant information about the parasite infection in North China was available. CASE PRESENTATION An 84-year-old man from Shanxi province, North China, was admitted to Department of Nephrology with complaints of a 7-month history of intermittent edema of both lower extremity with foam urine and 3-day history of fever, chill and diarrhea. Large numbers of rhabditiform larva of Strongyloides stercoralis (S. stercoralis) were observed in a stool sample. Diagnosis of S. stercoralis infection was established by morphological observations of larvae under the microscope in both wet mount and Wright-Giemsa staining smear and further confirmed by molecular biology identification. CONCLUSIONS We report a rare case of S. stercoralis infection in a patient with chronic renal failure from North China, which implies the possibility of developing human strongyloidiasis in cooler climates. In addition, our case suggests that clinicians should consider the complication of S. stercoralis infection in immunosuppressed patient populations with chronic renal failure. Morphological details of S. stercoralis in Wright-Giemsa staining was first described in the present case. Our results also support the use of molecular techniques targeting COX1 gene sequence for the diagnosis of S. stercoralis infection, which was prove to be necessary in laboratory practice, especially for those inexperienced morphologists in temperature zone.
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Ra H, Chung JW, Chung DH, Kim JH, Kim YJ, Kim KO, Kwon KA, Park DK. Strongyloidiasis Presenting as Yellowish Nodules in Colonoscopy of an Immunocompetent Patient. Clin Endosc 2019; 52:80-82. [PMID: 30157619 PMCID: PMC6370920 DOI: 10.5946/ce.2018.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/30/2018] [Indexed: 11/14/2022] Open
Abstract
Strongyloides stercoralis is endemic to tropical and subtropical regions, and infections are usually asymptomatic. However, immunocompromised patients, such as those receiving immunosuppressive therapy, high-dose steroids, or chemotherapy, can develop fatal hyperinfections. An 84-year-old man without any symptoms was diagnosed with strongyloidiasis during a regular screening colonoscopy. His medical history only involved a gastric endoscopic submucosal dissection for early gastric cancer 6 months previously. Few cases have been published about asymptomatic strongyloidiasis diagnosed in an immunocompetent host via endoscopic mucosal resection with characteristic colonoscopic findings. We report a case of colon-involved asymptomatic strongyloidiasis with specific colonic findings of yellowish-white nodules. This finding may be an important marker of S. stercoralis infection, which could prevent hyperinfections.
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Affiliation(s)
- Hannah Ra
- Department of Internal Medicine, Gachon University of Medical and Science, Incheon, Korea
| | - Jun-Won Chung
- Department of Internal Medicine, Gachon University of Medical and Science, Incheon, Korea
- Correspondence: Jun-Won Chung Department of Internal medicine, Gachon University, Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, Korea Tel: +82-32-460-3778, Fax: +82-32-460-3778, E-mail:
| | - Dong Hae Chung
- Department of Pathology, Gachon University of Medical and Science, Incheon, Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Gachon University of Medical and Science, Incheon, Korea
| | - Yoon Jae Kim
- Department of Internal Medicine, Gachon University of Medical and Science, Incheon, Korea
| | - Kyoung Oh Kim
- Department of Internal Medicine, Gachon University of Medical and Science, Incheon, Korea
| | - Kwang An Kwon
- Department of Internal Medicine, Gachon University of Medical and Science, Incheon, Korea
| | - Dong Kyun Park
- Department of Internal Medicine, Gachon University of Medical and Science, Incheon, Korea
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Influence of parasite load on the diagnosis and occurrence of eosinophilia in alcoholic patients infected with Strongyloides stercoralis. J Helminthol 2017; 93:21-25. [PMID: 29179791 DOI: 10.1017/s0022149x17001110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Alcoholic patients are more susceptible to Strongyloides stercoralis infection. The chronic use of alcohol raises the levels of endogenous corticosteroids, which regulates the development of larvae and stimulates the differentiation of rhabditiform into infective filariform larvae, thus inducing internal autoinfection. Therefore, early diagnosis is important to prevent severe strongyloidiasis. The aim of this study was to evaluate the efficacy of parasitological methods, according to the parasite load and the number of stool samples, for diagnosis of S. stercoralis infection, as well the peripheral blood eosinophil count in alcoholic patients. A total of 330 patients were included in this study. The diagnosis was established using three parasitological methods: agar plate culture, Baermann-Moraes method and spontaneous sedimentation. Peripheral eosinophilia was considered when the level was >600 eosinophils/mm3. The agar plate culture (APC) had the highest sensitivity (97.3%). However, the analysis of multiple samples increased the sensitivity of all parasitological methods. The sensitivities of the methods were influenced by the parasite load. When the larval number was above 10, the sensitivity of APC was 100%, while in spontaneous sedimentation the sensitivity reached 100% when the larval number was above 50. In the present study, 15.4% of alcoholic patients infected with S. stercoralis (12/78) had increased peripheral blood eosinophil count (above 600 eosinophils/mm3). For an efficient parasitological diagnosis of S. stercoralis infection in alcoholic patients, repeated examination by two parasitological methods must be recommended, including agar plate culture due to its higher sensitivity. Moreover, S. stercoralis infection was associated with eosinophilia, mostly in patients excreting up to 10 larvae/g faeces.
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de Jesus Inês E, Sampaio Silva ML, de Souza JN, Galvão AA, Aquino Teixeira MC, Soares NM. Alterations in serum paraoxonase-1 activity and lipid profile in chronic alcoholic patients infected with Strongyloides stercoralis. Acta Trop 2017; 166:1-6. [PMID: 27771420 DOI: 10.1016/j.actatropica.2016.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 10/08/2016] [Accepted: 10/18/2016] [Indexed: 01/13/2023]
Abstract
The objective of this study was to investigate paraoxonase-1 (PON1) activity, cortisol levels, and the lipid profile in the sera of alcoholic and non-alcoholic Strongyloides stercoralis-infected and uninfected individuals in a sample of 276 individuals attended at the National Health System in Salvador, Bahia, Brazil. The activity of PON1 was measured by the Beltowski method, serum lipids, and cortisol levels using commercial kits. PON1 activity was low in both alcoholic and non-alcoholic individuals infected with S. stercoralis. A positive correlation was observed between PON1 activity and cortisol concentration in alcoholic individuals who were not infected with S. stercoralis; whereas a negative correlation occurred in S. stercoralis-infected nonalcoholic individuals. The levels of triglycerides, LDL-C, and VLDL-C in S. stercoralis-infected alcoholic individuals were significantly lower than in uninfected alcoholic individuals. The high level of HDL-C and the low level of LDL-C, VLDL, triglycerides and PON1 activity in alcoholic patients infected with S. stercoralis evidenced an anti-atherogenic pattern.
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Silva MLS, Inês EDJ, Souza ABDS, Dias VMDS, Guimarães CM, Menezes ER, Barbosa LG, Alves MDCM, Teixeira MCA, Soares NM. Association between Strongyloides stercoralis infection and cortisol secretion in alcoholic patients. Acta Trop 2016; 154:133-8. [PMID: 26592319 DOI: 10.1016/j.actatropica.2015.11.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 10/13/2015] [Accepted: 11/14/2015] [Indexed: 12/28/2022]
Abstract
A higher prevalence of Strongyloides stercoralis infections has been reported in alcoholic patients compared to nonalcoholic patients living in the same area. Excessive alcohol consumption increases the levels of endogenous corticosteroids that subsequently enhance the fecundity of S. stercoralis parthenogenetic females. These corticosteroids also enhance the transformation of rhabditiform larvae into infective filariform larvae by mimicking the effect of the ecdysteroid hormones produced by the parasite, thus leading to autoinfection. In addition, alterations in the intestinal barrier and host immune response contribute to the development of hyperinfection and severe strongyloidiasis in alcoholic patients. The aim of this study was to evaluate the frequency of S. stercoralis infections in alcoholic patients and to determine the association between S. stercoralis infection and endogenous cortisol levels. The frequency of infection was evaluated in 332 alcoholic and 92 nonalcoholic patients. The parasitological diagnosis was carried out by agar plate culture, the modified Baermann-Moraes method and spontaneous sedimentation. The immunological diagnosis was performed using an ELISA with anti-S. stercoralis IgG. The cortisol levels were measured in serum samples by ELISA. The frequency of S. stercoralis infection in alcoholic patients was 23.5% (78/332), while in nonalcoholic patients, it was 5.4% (5/92) (p<0.05). The cortisol levels were higher in alcoholic than in nonalcoholic patients (p<0.05). However, among the alcoholic patients, the cortisol levels did not differ between S. stercoralis-infected and uninfected patients (p>0.05). As demonstrated in this work, 81.3% (26/32) of patients with a high parasite load, considered as more than 11 larvae per gram of feces, presented serum cortisol levels above the normal reference value (24 mg/dL). High endogenous cortisol levels in alcoholic patients were not associated to susceptibility to S. stercoralis infection, however once infected, this may lead to a high parasite load.
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Affiliation(s)
- Mônica L S Silva
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Elizabete de J Inês
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Alex Bruno da S Souza
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Victória Maria dos S Dias
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | | | | | | | - Márcia Cristina A Teixeira
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Neci M Soares
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
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Teixeira MCA, Pacheco FTF, Souza JN, Silva MLS, Inês EJ, Soares NM. Strongyloides stercoralis Infection in Alcoholic Patients. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4872473. [PMID: 28105424 PMCID: PMC5220430 DOI: 10.1155/2016/4872473] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/13/2016] [Indexed: 12/28/2022]
Abstract
The course of Strongyloides stercoralis infection is usually asymptomatic with a low discharge of rhabditoid larva in feces. However, the deleterious effects of alcohol consumption seem to enhance the susceptibility to infection, as shown by a fivefold higher strongyloidiasis frequency in alcoholics than in nonalcoholics. Moreover, the association between S. stercoralis infection and alcoholism presents a risk for hyperinfection and severe strongyloidiasis. There are several possible mechanisms for the disruption of the host-parasite equilibrium in ethanol-addicted patients with chronic strongyloidiasis. One explanation is that chronic ethanol intake stimulates the hypothalamic-pituitary-adrenal (HPA) axis to produce excessive levels of endogenous cortisol, which in turn can lead to a deficiency in type 2 T helper cells (Th2) protective response, and also to mimic the parasite hormone ecdysone, which promotes the transformation of rhabditiform larvae to filariform larvae, leading to autoinfection. Therefore, when untreated, alcoholic patients are continuously infected by this autoinfection mechanism. Thus, the early diagnosis of strongyloidiasis and treatment can prevent serious forms of hyperinfection in ethanol abusers.
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Affiliation(s)
- Marcia C. A. Teixeira
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
- *Marcia C. A. Teixeira:
| | - Flavia T. F. Pacheco
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
| | - Joelma N. Souza
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
| | - Mônica L. S. Silva
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
| | - Elizabete J. Inês
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
| | - Neci M. Soares
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
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Santos FLN, Souza AMGCD, Soares NM. HOOKWORM AND THREADWORM INFECTIONS AND THEIR ASSOCIATION WITH HEMOGLOBIN AND EOSINOPHIL CONCENTRATIONS IN RESIDENTS OF SALVADOR-BAHIA, BRAZIL. Rev Inst Med Trop Sao Paulo 2013. [DOI: 10.1590/s0036-46652013000400003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
SUMMARY Parasitic infections are responsible for substantial mortality and morbidity worldwide. In most healthy individuals, little overt pathology is observed during infection with S. stercoralis. However, the symptoms in advanced cases may include gastrointestinal bleeding. Anemia is most commonly associated with hookworm infection, especially when several hundred worms are present. Our study evaluates the relationship between the hookworm or S. stercoralis infection status and the hemoglobin concentration of individuals examined by a private network of laboratories in Salvador, Bahia, Brazil. We examined 374,120 samples from middle-class individuals living in Salvador City from January 2004 to April 2008. The stool samples were analyzed by the Lutz and Baermann-Moraes methods, and the blood samples were analyzed for hemoglobin concentration and eosinophil counting. The prevalence of hookworm and S. stercoralis were 0.27% (1,027) and 0.34% (1,286), respectively. The prevalence of hookworm and S. stercoralis infection was significantly higher in males than in females and increased with age. Eosinophilia was a common laboratorial finding in individuals infected with hookworm and S. stercoralis. The hemoglobin concentration was lower in the hookworm-infected individuals than in non-infected ones, but none of the examined patients were anemic. Lack of anemia could be a consequence of the socioeconomic status of these patients.
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Wu TC, Lei WY, Chen MC, Hu CT. Strongyloides stercoralis infection: a health issue regarding indigenous people in Taiwan. Trans R Soc Trop Med Hyg 2012; 106:468-72. [PMID: 22647849 DOI: 10.1016/j.trstmh.2012.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 04/16/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022] Open
Abstract
Strongyloidiasis, caused by Strongyloides stercoralis, is endemic in tropical and subtropical regions. Whether or not the infection rate is higher among indigenous populations in Taiwan remains unclear. The aim of our study was to assess the racial demographics, diagnoses and clinical details of strongyloidiasis. A total of 41 patients (27 males and 14 females) with strongyloidiasis at a tertiary referral centre in eastern Taiwan in a 21-year period were investigated retrospectively. The majority (36/41, 88%) of these patients lived in rural townships. Common clinical symptoms were anorexia, abdominal pain, nausea, vomiting, fever, coughing and diarrhea. The laboratory abnormalities were anemia, eosinophilia, and leukocytosis. The average age of the indigenous patients was younger than that of the Hans Chinese patients. Alcoholism among the indigenous Taiwanese (all males) was significantly more frequent than in the Hans Chinese, which might be one of the reasons that the indigenous males had a higher infection rate than Hans Chinese males. The group of patients with intestinal strongyloidiasis exhibited a significant lower mortality and a higher recovery rate than those with hyperinfection syndrome. Leptospirosis should be considered as an underlying factor associated with strongyloidiasis, especially in indigenous patients. The relationship and mechanism of leptospira-induced overwhelming infection including strongyloidiasis remains to be elucidated.
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Affiliation(s)
- Ta-Chung Wu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and University, Hualien, No.707, Sec. 3, Chung Yang Rd., Hualien City, Hualien 970, Taiwan
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Inês EDJ, Souza JN, Santos RC, Souza ES, Santos FL, Silva ML, Silva MP, Teixeira MC, Soares NM. Efficacy of parasitological methods for the diagnosis of Strongyloides stercoralis and hookworm in faecal specimens. Acta Trop 2011; 120:206-10. [PMID: 21896267 DOI: 10.1016/j.actatropica.2011.08.010] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 08/18/2011] [Accepted: 08/19/2011] [Indexed: 12/27/2022]
Abstract
To compare the efficacy of stool examination for the detection of Strongyloides stercoralis and hookworm, a total of 634 stool samples from the routine laboratory service of the Pharmacia Faculty, Federal University of Bahia, Brazil, were examined by agar plate culture (APC), Baermann-Moraes and spontaneous sedimentation. The sensitivity of agar plate culture, calculated by combining results of all 3 methods, was 95% for S. stercoralis and 77.6% for hookwoorm. Moreover, APC had superior accuracy than Baermann-Moraes and spontaneous sedimentation for S. stercoralis and hookworm diagnosis, respectively. The S. stercoralis and hookworm positive samples from the laboratory routine, obtained after the previous analysis, along with those initially selected, were used to evaluate the concordance between microscopic examination and both the type of furrows left by larvae and the time for culture positivity using the APC method. Of 115 stool samples positive for S. stercoralis and 92 positive for hookworm, 110 (95.7%) and 89 (96.7%), respectively, had concordant results for furrows and morphological characteristics. The cumulative percentage of positivity increased to 94% by the third day of observation; at this time, only 19.6% of hookworm-positive samples had positive culture plates. Analyses of 74 S. stercoralis-positive stool samples stored at 4°C for 24, 48 and 72h showed the presence of larvae in 48.6%, 28.4% and 23% of samples, respectively when re-examined by the APC. As a definitive diagnosis of strongyloidiasis depends on the microscopic demonstration of parasites, increasing the sensitivity of the detection requires the use of different parasitological methods, including APC.
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