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Buonfrate D, Bradbury RS, Watts MR, Bisoffi Z. Human strongyloidiasis: complexities and pathways forward. Clin Microbiol Rev 2023; 36:e0003323. [PMID: 37937980 PMCID: PMC10732074 DOI: 10.1128/cmr.00033-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/11/2023] [Indexed: 11/09/2023] Open
Abstract
Strongyloidiasis is a World Health Organization neglected tropical disease usually caused by Strongyloides stercoralis, a parasitic worm with a complex life cycle. Globally, 300-600 million people are infected through contact with fecally contaminated soil. An autoinfective component of the life cycle can lead to chronic infection that may be asymptomatic or cause long-term symptoms, including malnourishment in children. Low larval output can limit the sensitivity of detection in stool, with serology being effective but less sensitive in immunocompromise. Host immunosuppression can trigger catastrophic, fatal hyperinfection/dissemination, where large numbers of larvae pierce the bowel wall and disseminate throughout the organs. Stable disease is effectively treated by single-dose ivermectin, with disease in immunocompromised patients treated with multiple doses. Strategies for management include raising awareness, clarifying zoonotic potential, the development and use of effective diagnostic tests for epidemiological studies and individual diagnosis, and the implementation of treatment programs with research into therapeutic alternatives and medication safety.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Richard S. Bradbury
- School of Health and Life Sciences, Federation University Australia, Berwick, Victoria, Australia
| | - Matthew R. Watts
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research – New South Wales Health Pathology and Sydney Institute for Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Zeno Bisoffi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
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2
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Hamze H, Tai T, Harris D. Strongyloides hyperinfection syndrome precipitated by immunosuppressive therapy for rheumatoid arthritis and COVID-19 pneumonia. Trop Dis Travel Med Vaccines 2023; 9:15. [PMID: 37794447 PMCID: PMC10552379 DOI: 10.1186/s40794-023-00201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/17/2023] [Indexed: 10/06/2023] Open
Abstract
The COVID-19 pandemic has posed clinical and public health challenges worldwide. The use of corticosteroids has become an evidence-based practice to reduce the hyperinflammatory process involved in severe COVID-19 disease. However, this can result in the reactivation of parasitic infestations, even with a short course. We report the case of a 64-year-old Cuban born patient who passed away from S. stercoralis hyperinfection syndrome following treatment with dexamethasone for severe COVID-19 disease on a background of prolonged immunosuppression for rheumatoid arthritis. Clinicians should be aware of the risk of strongyloidiasis as a complication of the treatment for severe COVID-19 and other immunosuppressive therapies. We recommend empiric Strongyloides treatment for those who are from, or who have accumulated risk by travelling to endemic areas, and are being treated with corticosteroids for severe COVID-19 disease.
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Affiliation(s)
- Hasan Hamze
- Department of Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 1Z7, Canada
| | - Teresa Tai
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - David Harris
- Department of Medicine, Division of Infectious Diseases, BC Centre for Excellence in HIV/AIDS (BC-CfE), St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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3
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Chan AHE, Kusolsuk T, Watthanakulpanich D, Pakdee W, Doanh PN, Yasin AM, Dekumyoy P, Thaenkham U. Prevalence of Strongyloides in Southeast Asia: a systematic review and meta-analysis with implications for public health and sustainable control strategies. Infect Dis Poverty 2023; 12:83. [PMID: 37705080 PMCID: PMC10498648 DOI: 10.1186/s40249-023-01138-4] [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: 05/15/2023] [Accepted: 09/03/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Strongyloidiasis, caused by the nematodes Strongyloides stercoralis and Strongyloides fuelleborni, is estimated to affect over 600 million individuals worldwide. The disease is endemic in Southeast Asia, where a warm-humid climate and socio-economic conditions maintain the parasite's life cycle and transmission. However, the current diagnostic methods may not be sufficiently sensitive, suggesting that the true prevalence of strongyloidiasis could be seriously underestimated in this. This study aims to determine the prevalence of strongyloidiasis in Southeast Asia through a systematic review and meta-analysis and to discuss the implications of the estimated prevalence on diagnostic approaches and control strategies. METHODS Following PRISMA guidelines, we conducted a systematic literature search in PubMed and Google Scholar databases to identify studies reporting Strongyloides prevalence data in the 11 Southeast Asian countries up to December 2022. A random effects model was employed to estimate the pooled prevalence of S. stercoralis at both regional and country levels. RESULTS Out of 3722 articles identified, 224 met our inclusion criteria. For S. stercoralis specifically, we found 187 articles, of which 52.4% were from Thailand. All Southeast Asian countries, except Brunei, had at least one study on Strongyloides prevalence. The estimated pooled prevalence of S. stercoralis regionally was 12.7% (95% CI 10.70-14.80%), ranging from 0.4 to 24.9% at the country level. Cambodia had the highest pooled prevalence (24.9%, 95% CI 15.65-35.38%), followed by Lao PDR (16.5%, 95% CI 9.50-24.95%). Moreover, we obtained a pooled prevalence of 10% (95% CI 7.06-13.52%) in a group comprising immigrants, workers, and veterans from Southeast Asian countries. S. stercoralis infects various host types, including nonhuman primates, domestic dogs and cats, rodents, and transport carriers such as cockroaches and vegetables. CONCLUSIONS A high prevalence of strongyloidiasis in Southeast Asia was revealed, highlighting the importance of the region's ongoing research, surveillance, and control efforts. Factors contributing to the strongyloidiasis transmission include the role of animal hosts, the impact of global connectivity, and the significance of the co-endemicity of other Strongyloides species. Based on these findings, a multi-pronged One-Health approach is essential for sustainable intervention and control.
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Affiliation(s)
- Abigail Hui En Chan
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Teera Kusolsuk
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Dorn Watthanakulpanich
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Wallop Pakdee
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pham Ngoc Doanh
- Institute of Ecology and Biological Resources, Graduate University of Science and Technology, Vietnam Academy of Science and Technology, Hanoi, Vietnam
| | - Azlin Mohd Yasin
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Selangor, Malaysia
| | - Paron Dekumyoy
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Urusa Thaenkham
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
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4
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Gonçalves AAS, Lopes CA, Levenhagen MA, Gonzaga HT, Oliveira LCM, Costa-Cruz JM. Multiple Stool Sampling and Specific Parasitological Technique are Crucial to Diagnose Strongyloidiasis in Alcoholic Patients. Acta Parasitol 2023; 68:718-722. [PMID: 37531007 DOI: 10.1007/s11686-023-00700-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/18/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Chronic alcoholism is a well-known risk factor for strongyloidiasis, in these patients the disease is potentially more severe, probably due to the breakdown of local protective barriers and immunosuppression caused by alcohol, which can lead to autoinfection and dissemination. The aim of this study was to evaluate multiple stool sampling and a specific parasitological assay agar plate culture (APC) for the diagnosis of Strongyloides stercoralis in alcoholics. METHODS APC was compared to sedimentation technique (HPJ; Hoffman, Pons and Janer), as parasitological methods to detect S. stercoralis infection in alcoholic individuals. Three stool samples from 60 alcoholic and 60 non-alcoholic individuals were analyzed. RESULTS S. stercoralis larvae were observed in 11 (18.3%) alcoholic individuals and 1 (1.7%) nonalcoholic individual (P = 0.0042). In view of the combined results, sensitivity for the APC method was 63.6% (CI 31.6-87.6%) with the first sample reaching 100% (CI 67.8-100%) after analyzing three fecal samples. The HPJ sensitivity was 36.4% (CI 12.4-68.4) in the first sample, reaching 72.7% (CI 39.3-92.7) after three samples analyzed. CONCLUSION The present results suggest that in alcoholic patients, it is important to repeat stool sampling with specific techniques, especially using the APC method, to avoid misdiagnosis in cases that could evolve to disseminated strongyloidiasis.
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Affiliation(s)
- Alana A S Gonçalves
- PostGraduate Program in Health Sciences, Medicine School, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Camila A Lopes
- Laboratory of Parasitosis Diagnosis, Biomedical Sciences Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Marcelo A Levenhagen
- Laboratory of Parasitosis Diagnosis, Biomedical Sciences Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Henrique T Gonzaga
- Laboratory of Parasitosis Diagnosis, Biomedical Sciences Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
| | - Luiz Carlos M Oliveira
- PostGraduate Program in Health Sciences, Medicine School, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Julia Maria Costa-Cruz
- Laboratory of Parasitosis Diagnosis, Biomedical Sciences Institute, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
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Bansal SB, Ramasubramanian V, Prasad N, Saraf N, Soman R, Makharia G, Varughese S, Sahay M, Deswal V, Jeloka T, Gang S, Sharma A, Rupali P, Shah DS, Jha V, Kotton CN. South Asian Transplant Infectious Disease Guidelines for Solid Organ Transplant Candidates, Recipients, and Donors. Transplantation 2023; 107:1910-1934. [PMID: 36749281 DOI: 10.1097/tp.0000000000004521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
These guidelines discuss the epidemiology, screening, diagnosis, posttransplant prophylaxis, monitoring, and management of endemic infections in solid organ transplant (SOT) candidates, recipients, and donors in South Asia. The guidelines also provide recommendations for SOT recipients traveling to this region. These guidelines are based on literature review and expert opinion by transplant physicians, surgeons, and infectious diseases specialists, mostly from South Asian countries (India, Pakistan, Bangladesh, Nepal, and Sri Lanka) as well as transplant experts from other countries. These guidelines cover relevant endemic bacterial infections (tuberculosis, leptospirosis, melioidosis, typhoid, scrub typhus), viral infections (hepatitis A, B, C, D, and E; rabies; and the arboviruses including dengue, chikungunya, Zika, Japanese encephalitis), endemic fungal infections (mucormycosis, histoplasmosis, talaromycosis, sporotrichosis), and endemic parasitic infections (malaria, leishmaniasis, toxoplasmosis, cryptosporidiosis, strongyloidiasis, and filariasis) as well as travelers' diarrhea and vaccination for SOT candidates and recipients including travelers visiting this region. These guidelines are intended to be an overview of each topic; more detailed reviews are being published as a special supplement in the Indian Journal of Transplantation .
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Affiliation(s)
- Shyam Bihari Bansal
- Department of Nephrology and Kidney Transplantation, Medanta Institute of Kidney and Urology Medanta-Medicity, Gurgaon, India
| | | | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Neeraj Saraf
- Department of Hepatology, Medanta, Medicity, Gurgaon, India
| | - Rajeev Soman
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | - Govind Makharia
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manisha Sahay
- Department of Nephrology, Osmania Medical College, and Hospital, Hyderabad, India
| | - Vikas Deswal
- Department of Infectious Diseases, Medanta, Medicity, Gurgaon, India
| | - Tarun Jeloka
- Department of Infectious Diseases, Jupiter Hospital, Pune, India
| | - Sishir Gang
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujrat, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, PGIMER, Chandigarh, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dibya Singh Shah
- Department of Nephrology and Transplant Medicine, Institute of Medicine, Tribhuvan University of Teaching hospital, Kathmandu, Nepal
| | | | - Camille Nelson Kotton
- Transplant and Immunocompromised Host Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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6
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Chan AHE, Thaenkham U. From past to present: opportunities and trends in the molecular detection and diagnosis of Strongyloides stercoralis. Parasit Vectors 2023; 16:123. [PMID: 37041645 PMCID: PMC10088203 DOI: 10.1186/s13071-023-05763-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/30/2023] [Indexed: 04/13/2023] Open
Abstract
Strongyloides stercoralis is a soil-transmitted helminth that is mainly found in the tropical and subtropical regions and affects approximately 600 million people globally. The medical importance of strongyloidiasis lies in its capacity to remain asymptomatic and chronically unnoticed until the host is immunocompromised. Additionally, in severe strongyloidiasis, hyperinfection syndrome and larva dissemination to various organs can occur. Parasitological techniques such as Baermann-Moraes and agar plate culture to detect larvae in stool samples are the current gold standard. However, the sensitivity might be inadequate, especially with reduced worm burden. Complementing parasitological techniques, immunological techniques including immunoblot and immunosorbent assays are employed, with higher sensitivity. However, cross-reactivity to other parasites may occur, hampering the assay's specificity. Recently, advances in molecular techniques such as polymerase chain reaction and next-generation sequencing technology have provided the opportunity to detect parasite DNA in stool, blood, and environmental samples. Molecular techniques, known for their high sensitivity and specificity, have the potential to circumvent some of the challenges associated with chronicity and intermittent larval output for increased detection. Here, as S. stercoralis was recently included by the World Health Organization as another soil-transmitted helminth targeted for control from 2021 to 2030, we aimed to present a review of the current molecular techniques for detecting and diagnosing S. stercoralis in a bid to consolidate the molecular studies that have been performed. Upcoming molecular trends, especially next-generation sequencing technologies, are also discussed to increase the awareness of its potential for diagnosis and detection. Improved and novel detection methods can aid in making accurate and informed choices, especially in this era where infectious and non-infectious diseases are increasingly commonplace.
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Affiliation(s)
| | - Urusa Thaenkham
- Department of Helminthology, Mahidol University, Bangkok, Thailand
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7
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Carranza-Rodríguez C, López-Delgado L, Granados-Magan Á, Pérez-Arellano JL. Seroprevalence of Strongyloides stercolaris in Patients about to Receive Immunosuppressive Treatment in Gran Canaria (Spain). Trop Med Infect Dis 2023; 8:tropicalmed8030181. [PMID: 36977182 PMCID: PMC10057594 DOI: 10.3390/tropicalmed8030181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/22/2023] Open
Abstract
Strongyloides stercoralis infection is generally asymptomatic or mildly symptomatic, but in the immunosuppressed host, it is associated with more severe and complicated forms with a worse prognosis. S. stercoralis seroprevalence was studied in 256 patients before receiving immunosuppressive treatment (before kidney transplantation or starting biological treatments). As a control group, serum bank data of 642 individuals representative of the population of the Canary Islands were retrospectively analyzed. To avoid false positives due to cross-reactivity with other similar helminth antigens present in the study area, IgG antibodies to Toxocara spp. and Echinococcus spp. were evaluated in cases positive for Strongyloides. The data show this is a prevalent infection: 1.1% of the Canarian population, 2.38% of Canarian individuals awaiting organ transplants and 4.8% of individuals about to start biological agents. On the other hand, strongyloidiasis can remain asymptomatic (as observed in our study population). There are no indirect data, such as country of origin or eosinophilia, to help raise suspicion of the disease. In summary, our study suggests that screening for S. stercoralis infection should be performed in patients who receive immunosuppressive treatment for solid organ transplantation or biological agents, in line with previous publications.
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Affiliation(s)
- Cristina Carranza-Rodríguez
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Correspondence: ; Tel.: +34-928451213; Fax: +34-928441413
| | - Laura López-Delgado
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Álvaro Granados-Magan
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - José-Luis Pérez-Arellano
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
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8
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Strongyloides and COVID-19: Challenges and Opportunities for Future Research. Trop Med Infect Dis 2023; 8:tropicalmed8020127. [PMID: 36828543 PMCID: PMC9967524 DOI: 10.3390/tropicalmed8020127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Strongyloides stercoralis is a soil transmitted helminth endemic to tropical and subtropical areas that can persist for decades in immunocompetent human hosts as a chronic asymptomatic infection. The use of corticosteroids, a mainstay of treatment for patients hospitalized with severe coronavirus disease (COVID-19), can trigger a life-threatening Strongyloides hyperinfection syndrome and disseminated disease. We identified 22 previously published cases of strongyloidiasis occurring in individuals with COVID-19, with one death reported among the seven patients who had Strongyloides hyperinfection syndrome. A total of seventeen patients had previously received corticosteroids, and of the five with no prior corticosteroid use, one presented with hyperinfection syndrome. We identify the key challenges in the diagnosis and treatment of Strongyloides within the context of COVID-19, including our imprecise knowledge of the global distribution of Strongyloides, the overlapping symptoms and signs of COVID-19 and Strongyloides hyperinfection syndrome, the limited utility of eosinophilia as a clinical marker for strongyloidiasis in this setting, the lack of validated algorithms to screen for Strongyloides prior to corticosteroid use, and the paucity of treatment options for critically ill patients with COVID-19 who cannot take oral ivermectin. Future research should focus on improved diagnostic methods and population prevalence estimates, optimizing the approaches for Strongyloides screening in persons with COVID-19 (including clinical trial participants and strategies for resource-limited settings) and better defining the role of pre-emptive treatment.
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Gomes BB, Gonzales WHR, Meisel DMC, Gryschek RCB, de Paula FM. Evaluation of larval surface antigens from infective larvae of Strongyloides venezuelensis for the serodiagnosis of human strongyloidiasis. Rev Inst Med Trop Sao Paulo 2023; 65:e1. [PMID: 36651462 PMCID: PMC9870252 DOI: 10.1590/s1678-9946202365001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/07/2022] [Indexed: 01/18/2023] Open
Abstract
Serodiagnosis of strongyloidiasis is usually performed by ELISA for the detection of IgG antibodies due to its high sensitivity and practicality, but its main limitation is a constant source of S. stercoralis antigens. The use of S. venezuelensis as a heterologous source of antigens has facilitated several published studies on the serodiagnosis and epidemiology of human strongyloidiasis. The main objective of this study was to evaluate the diagnostic accuracy of surface cuticle antigens of infective larvae of S. venezuelensis extracted with CTAB detergent (L3-CTAB) in comparison with soluble somatic extracts (L3-SSE) using a panel of sera from immunocompetent and immunocompromised individuals, at three different cut-offs. ROC curve analysis showed that L3-CTAB had an AUC of 0.9926. At the first cut-off value (OD 450 nm = 0.214), sensitivity and specificity were 100% and 90.11%, respectively, with a diagnostic accuracy of 0.93. At a second cut-off value (OD 450 nm = 0.286), sensitivity and specificity were 70% and 100%, respectively, with a diagnostic accuracy of 0.91. However, at an alternative third cut-off value (OD 450 nm = 0.589), sensitivity and specificity were 95% and 97.8%, respectively, with a diagnostic accuracy of 0.97. Using L3-CTAB as an antigenic source, the seropositivity rate in immunocompromised patients was 28.13% (9/32) whereas a seropositivity rate of 34.38% (11/32) was found when L3-SSE was used in ELISA. Therefore, the L3-CTAB is simple and practical to obtain and was found to be highly sensitive and specific.
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Affiliation(s)
- Bruna Barroso Gomes
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Laboratório de Investigação Médica (LIM-06), São Paulo, São Paulo,
Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - William Henry Roldan Gonzales
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Laboratório de Investigação Médica (LIM-06), São Paulo, São Paulo,
Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Dirce Mary Correa Meisel
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Laboratório de Investigação Médica (LIM-06), São Paulo, São Paulo,
Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Ronaldo Cesar Borges Gryschek
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Laboratório de Investigação Médica (LIM-06), São Paulo, São Paulo,
Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Fabiana Martins de Paula
- Universidade de São Paulo, Faculdade de Medicina, Hospital das
Clínicas, Laboratório de Investigação Médica (LIM-06), São Paulo, São Paulo,
Brazil
- Universidade de São Paulo, Faculdade de Medicina, Instituto de
Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
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10
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Ramprasad A, Kodan P, Jonnalagadda K, Bir R, Verma N, Sahni K, Vikram NK, Soneja M, Mirdha BR, Wig N. Seroprevalence of Strongyloides infection among steroid recipients in a tertiary care centre in North India. LE INFEZIONI IN MEDICINA 2022; 30:593-601. [PMID: 36482946 PMCID: PMC9715000 DOI: 10.53854/liim-3004-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/10/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Strongyloides stercoralis (S. stercoralis), a unique parasite, can cause mortal disease even years after the exposure. Iatrogenic use of steroids can complicate asymptomatic infections to a life-threatening hyperinfection and/or disseminated infection. Data regarding seroprevalence of strongyloidiasis remains scarce and this knowledge gap needs due attention in many endemic countries including India. AIM The present study is aimed at assessing the seroprevalence of Strongyloides infection and the need for routine screening among individuals receiving steroid therapy. METHODOLOGY Eighty patients receiving steroid therapy and thirty healthy volunteers who had not received any immunosuppressive drugs and/or anthelminthic therapy in last six months were enrolled as cases and controls respectively and they were screened by Strongyloides IgG ELISA. RESULTS Among the 80 patients on steroids, the mean cumulative prednisolone equivalent dose received was 8.2 g (±11.2 g) for a mean duration of 184 days, 16 patients (20%, 95% CI 11.9-30) had a positive Strongyloides IgG serology. Only 4 controls (4/30, 13.3%, CI 3.8-30.7) tested positive (p=0.4). CONCLUSIONS Our study demonstrated a Strongyloides seroprevalence of 20% in the study population emphasizing the need for screening for Strongyloides infection prior to immunosuppressive therapy in order to prevent hyperinfection or possible dissemination.
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Affiliation(s)
- Aishwarya Ramprasad
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Parul Kodan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Kirtana Jonnalagadda
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Raunak Bir
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi,
India
| | - Nishant Verma
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi,
India
| | - Kanika Sahni
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi,
India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Bijay Ranjan Mirdha
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi,
India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
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11
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Buonfrate D, Rodari P, Barda B, Page W, Einsiedel L, Watts M. Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment. Expert Opin Pharmacother 2022; 23:1617-1628. [PMID: 35983698 DOI: 10.1080/14656566.2022.2114829] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Strongyloidiasis, an infection caused by the soil-transmitted helminth Strongyloides stercoralis, can lead immunocompromised people to a life-threatening syndrome. We highlight here current and emerging pharmacotherapeutic strategies for strongyloidiasis and discuss treatment protocols according to patient cohort. We searched PubMed and Embase for papers published on this topic between 1990 and May 2022. AREAS COVERED Ivermectin is the first-line drug, with an estimated efficacy of about 86% and excellent tolerability. Albendazole has a lower efficacy, with usage advised when ivermectin is not available or not recommended. Moxidectin might be a valid alternative to ivermectin, with the advantage of being a dose-independent formulation. EXPERT OPINION The standard dose of ivermectin is 200 µg/kg single dose orally, but multiple doses might be needed in immunosuppressed patients. In the case of hyperinfection, repeated doses are recommended up to 2 weeks after clearance of larvae from biological fluids, with close monitoring and further dosing based on review. Subcutaneous ivermectin is used where there is impaired intestinal absorption/paralytic ileus. In pregnant or lactating women, studies have not identified increased risk with ivermectin use. However, with limited available data, a risk-benefit assessment should be considered for each case.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria hospital, via Sempreboni 5, 37024 Negrar, Verona, Italy
| | - Paola Rodari
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria hospital, via Sempreboni 5, 37024 Negrar, Verona, Italy
| | - Beatrice Barda
- Ospedale La Carità, Ospedale regionale di Locarno, Locarno 6600, Switzerland
| | - Wendy Page
- Miwatj Health Aboriginal Corporation, 1424 Arnhem Rd, Nhulunbuy NT 0880, Australia
| | - Lloyd Einsiedel
- Peter Doherty Institute, University of Melbourne, 792 Elizabeth St, Melbourne VIC 3000, Australia
| | - Matthew Watts
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research - New South Wales Health Pathology and Sydney Institute for Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
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12
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Wikman-Jorgensen P, Requena-Méndez A, Navarro M, Llenas-García J. Comments to the document GEPI-SEIMC screening recommendations for patients with suspected strongyloidosis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:411-412. [PMID: 35624067 PMCID: PMC9574943 DOI: 10.1016/j.eimce.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
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13
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Meira Dias O, Belousova N, Sharif N, Brasg I, Singer LG, Tikkanen J, Chaparro C, Rotstein C. Strongyloides hyper-infection in a lung transplant recipient: Case report and review of the literature. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:150-156. [PMID: 36337355 PMCID: PMC9608110 DOI: 10.3138/jammi-2021-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 06/16/2023]
Abstract
CASE PRESENTATION A 63-year-old man with a left single lung transplant for end-stage combined restrictive and obstructive lung disease developed persistent pulmonary infiltrates and recurrent gram-negative bacteremia post-transplant. Bronchoalveolar lavage fluid revealed a nematode on Papanicolau staining compatible with Strongyloides stercoralis larvae on day 50 post-transplant. Although Strongyloides serology performed post-transplant was negative, a retrospective review of the medical record revealed marked peripheral blood eosinophilia on several occasions before transplantation. Despite reduction in immunosuppression and treatment with albendazole and ivermectin, the patient developed another episode of Escherichia coli bacteremia. He died 3 months post-transplant from pulmonary and neurological complications. DIAGNOSIS Strongyloides hyper-infection. DISCUSSION Strongyloides hyper-infection syndrome is known to occur in immunocompromised patients, but it has only been reported once in a lung transplant recipient. This case illustrates the importance of screening for parasitic infections before transplantation in patients with marked eosinophilia, especially among immigrants from countries in which Strongyloides is endemic. Hyper-infection syndrome may appear years after infection in the context of immunosuppression or immunodeficiency. This case also highlights the association between Strongyloides hyper-infection and bacteremia with enteric organisms.
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Affiliation(s)
- Olívia Meira Dias
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Natalia Belousova
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nadia Sharif
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ian Brasg
- Multi-Organ Transplant Program, Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lianne G Singer
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jussi Tikkanen
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Cecilia Chaparro
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Coleman Rotstein
- Multi-Organ Transplant Program, Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada
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14
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Wikman-Jorgensen P, Requena-Méndez A, Navarro M, Llenas-García J. [Comments to the document GEPI-SEIMC screening recommendations for patients with suspected strongyloidosis]. Enferm Infecc Microbiol Clin 2022; 40:411-412. [PMID: 35469335 PMCID: PMC9020610 DOI: 10.1016/j.eimc.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Philip Wikman-Jorgensen
- Servicio de Medicina Interna, Hospital Universitario San Juan de Alicante-FISABIO, San Juan de Alicante, España
| | - Ana Requena-Méndez
- Instituto de Salud Global de Barcelona (ISGlobal, Hospital Clinic-University of Barcelona), Barcelona, España.,Department of Medicine Solna, Karolinska Institutet, Solna, Suecia
| | - Miriam Navarro
- Unidad de Epidemiología, Centro de Salud Pública de Elche, Alicante, España.,Departamento de Salud Pública, Historia de la Ciencia y Ginecología; Universidad Miguel Hernández de Elche, Alicante, España
| | - Jara Llenas-García
- Servicio de Medicina Interna/infecciosas, Hospital Vega Baja-FISABIO, Alicante, España.,Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, España
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15
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Mah J, Lieu A, Holmes E, Vaughan S. A case of disseminated strongyloidiasis after multiple courses of immunosuppression. CMAJ 2022; 194:E89-E92. [PMID: 35074835 PMCID: PMC8900751 DOI: 10.1503/cmaj.211056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jordan Mah
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta.
| | - Anthony Lieu
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta
| | - Emma Holmes
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta
| | - Stephen Vaughan
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta
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16
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Hansen M, Currie BJ. Author reply. Intern Med J 2021; 51:2162. [PMID: 34939282 DOI: 10.1111/imj.15613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Martin Hansen
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Bart J Currie
- Infectious Diseases Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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17
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A Practical Approach to Screening for Strongyloides stercoralis. Trop Med Infect Dis 2021; 6:tropicalmed6040203. [PMID: 34941659 PMCID: PMC8704417 DOI: 10.3390/tropicalmed6040203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022] Open
Abstract
Strongyloides stercoralis, causative agent of a neglected tropical disease, is a soil-transmitted helminth which may cause lifelong persisting infection due to continuous autoinfection. In the case of immunosuppression, life-threatening hyperinfection and disseminated strongyloidiasis can develop. We propose a pragmatic screening algorithm for latent strongyloidiasis based on epidemiologic exposure and immunosuppression status that can be applied for any kind of immunosuppressive therapy. The algorithm allows the diagnosis of latent strongyloidiasis with optimal accuracy in a well-equipped setting, while for endemic settings where the complete testing array is unavailable, an empiric treatment is generally recommended. Accurate diagnosis and extensive empiric treatment will both contribute to decreasing the current neglect of strongyloidiasis.
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18
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Fallahzadeh MA, Rico NT, Vahhab E, He H, Elhamahmi DA, Sandkovsky U. Strongyloides stercoralis and cytomegalovirus coinfection in a patient with a transplanted kidney. Proc AMIA Symp 2021; 35:190-192. [DOI: 10.1080/08998280.2021.1997262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Nina T. Rico
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Transplant Nephrology, Baylor University Medical Center, Dallas, Texas
| | - Elham Vahhab
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Huang He
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Dina Abdelwahab Elhamahmi
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Transplant Nephrology, Baylor University Medical Center, Dallas, Texas
| | - Uriel Sandkovsky
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Division of Infectious Diseases, Baylor University Medical Center, Dallas, Texas
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19
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Costa IN, Bosqui LR, Corral MA, Costa-Cruz JM, Gryschek RCB, de Paula FM. Diagnosis of human strongyloidiasis: Application in clinical practice. Acta Trop 2021; 223:106081. [PMID: 34364894 DOI: 10.1016/j.actatropica.2021.106081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 12/28/2022]
Abstract
This review considers the advantages and disadvantages of parasitological techniques, methods of detecting antibodies and antigens, as well as molecular biology techniques in the diagnosis of human strongyloidiasis. In addition, it elucidates the potential of different techniques for rapid and effective detection of clinical cases, thus enabling early treatment and preventing fatal consequences of this helminthiasis.
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20
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Wikman-Jorgensen P, Requena-Méndez A, Llenas-García J. A Review on Strongyloidiasis in Pregnant Women. Res Rep Trop Med 2021; 12:219-225. [PMID: 34584485 PMCID: PMC8464358 DOI: 10.2147/rrtm.s282268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/07/2021] [Indexed: 12/21/2022] Open
Abstract
Strongyloidiasis is a parasitic infection distributed worldwide, with an estimated 614 million people infected. Strongyloidiasis usually presents asymptomatically or with aspecific and mild clinical symptoms, mainly cutaneous, respiratory, or gastrointestinal. Disseminated disease and hyperinfection syndrome are the most serious complications, have a high mortality rate, usually occur in immunosuppressed patients, and are particularly associated with the use of corticosteroids. Strongyloidiasis is the most neglected of the neglected diseases, and its occurrence in pregnancy has been neglected and understudied. In this review, we focus on the effects of strongyloidiasis during pregnancy and highlight the knowledge shortage and the need for more research on the subject. There are few studies addressing strongyloidiasis prevalence during pregnancy and hyperinfection incidence during pregnancy is practically unknown, with only isolated case reports published. Although data are scarce, the infection has been associated with developmental disabilities and anemia during pregnancy, while hyperinfection may cause both maternal and neonatal death. Data on the best screening and diagnostic strategies during pregnancy are lacking. There is insufficient evidence on ivermectin safety in pregnancy, complicating treatment recommendations.
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Affiliation(s)
- Philip Wikman-Jorgensen
- Internal Medicine Department, Hospital Universitario San Juan de Alicante-FISABIO, San Juan de Alicante, Alicante, Spain
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jara Llenas-García
- Internal Medicine and Infectious Diseases Department, Hospital Vega Baja-FISABIO, Alicante, Spain.,Clinical Medicine Department, Universidad Miguel Hernández de Elche, Elche, Spain
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21
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Carnino L, Schwob JM, Neofytos D, Lazo-Porras M, Chappuis F, Eperon G. Screening for Parasitic Infection and Tuberculosis in Immunosuppressed and Pre-Immunosuppressed Patients: An Observational Study. Trop Med Infect Dis 2021; 6:tropicalmed6030170. [PMID: 34564554 PMCID: PMC8482080 DOI: 10.3390/tropicalmed6030170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
Reactivation of latent tuberculosis infection (LTBI) or latent parasitic infection (LPI) during drug-induced immunosuppression can have serious consequences. The Division of tropical and humanitarian medicine of the Geneva University Hospitals runs a specific consultation for parasitic screening of immunosuppressed or pre-immunosuppressed patients. We sought to determine the seroprevalence of LTBI and LPI in such patients and explore its relationship with country of origin or previous travel in a retrospective, single-centre observational study from 2016 to 2019. Demographic data, travel history, ongoing treatments and results of the parasitological (Strongyloides stercoralis, Trypanosoma cruzi, Echinococcus multilocularis, Entamoeba histolytica and Leishmania spp.) and TB screening were collected to calculate LPI or LTBI prevalence. Risk factors for LTBI and strongyloidiasis were analysed using Poisson regression with robust variance. Among 406 eligible patients, 24/353 (6.8%) had LTBI, 8/368 (2.2%) were positive for Strongyloides stercoralis infection, 1/32 (3.1%) was positive for Entamoeba histolytica and 1/299 (0.3%) was positive for Leishmaniasis. No cases of Trypanosoma cruzi (0/274) or Echinococcus multilocularis (0/56) infection were detected. Previous travel to or originating from high-prevalence countries was a risk factor for LTBI (PR = 3.4, CI 95%: 1.4–8.2 and 4.0, CI 95%: 1.8–8.9, respectively). The prevalence of serological Strongyloidiasis in immunosuppressed patients is lower in comparison to those without immunosuppression (PR = 0.1, CI 95%: 0.01–0.8). In conclusion, screening before immunosuppression needs to be individualized, and LTBI and LPI need to be ruled out in patients who originate from or have travelled to high-prevalence countries. The sensitivity of strongyloidiasis serology is reduced following immunosuppression, so an algorithm combining different tests or presumptive treatment should be considered.
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Affiliation(s)
- Luisa Carnino
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-(0)223729611; Fax: +41-(0)223729626
| | - Jean-Marc Schwob
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
| | - Dionysios Neofytos
- Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland;
| | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1205 Geneva, Switzerland
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1205 Geneva, Switzerland
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22
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Kalantari N, Chehrazi M, Ghaffari S, Gorgani-Firouzjaee T. Serological assays for the diagnosis of Strongyloides stercoralis infection: a systematic review and meta-analysis of diagnostic test accuracy. Trans R Soc Trop Med Hyg 2021; 114:459-469. [PMID: 32052848 DOI: 10.1093/trstmh/trz135] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/04/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022] Open
Abstract
The standard method for the diagnosis of Strongyloides stercoralis, stool examinations, is inconvenient and, therefore, serological methods have been proposed. This study aimed to evaluate the accuracy of serological assays for the diagnosis of strongyloidiasis using a systematic review and meta-analysis model. Four electronic databases were reviewed. We used a random effects model and 95% CIs to determine the overall sensitivity, specificity and diagnostic odds ratio (DOR). Heterogeneity was intended with Cochran Q χ2 test and I2 statistic. The accuracy of serological assays resulted in a sensitivity of 71.7% (95% CI: 56.07 to 83.4%), a specificity of 89.9% (95% CI: 80.8 to 94.9%) and a DOR of 22.5 (95% CI: 10.8 to 46.9). The forest plot showed high heterogeneity regarding sensitivity (I2=90.4%, 95% CI: 87.4 to 93.3%; Q=228.1, p=0.000) and specificity (I2=98.9%, 95% CI: 98.8 to 99.1%; Q=2066.4, p=0.000). Fagan's nomogram showed that the probability of someone having the infection and with a positive test result was 49%. Deeks' funnel plots showed no evidence of potential publication bias for the studies (p=0.26). The current review suggests that serological techniques have acceptable sensitivity and specificity and therefore can be recommended for the screening of S. stercoralis infection.
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Affiliation(s)
- Narges Kalantari
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I. R. Iran
- Department of Laboratory Sciences, Faculty of Paramedical Sciences, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Medicine, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I. R. Iran
| | - Salman Ghaffari
- Department of Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
| | - Tahmineh Gorgani-Firouzjaee
- Department of Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
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23
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Wikman-Jorgensen PE, Llenas-Garcia J, Shedrawy J, Gascon J, Muñoz J, Bisoffi Z, Requena-Mendez A. Cost-effectiveness of different strategies for screening and treatment of Strongyloides stercoralis in migrants from endemic countries to the European Union. BMJ Glob Health 2021; 5:bmjgh-2020-002321. [PMID: 32461226 PMCID: PMC7254101 DOI: 10.1136/bmjgh-2020-002321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The best strategy for controlling morbidity due to imported strongyloidiasis in migrants is unclear. We evaluate the cost-effectiveness of six possible interventions. METHODS We developed a stochastic Markov chain model. The target population was adult migrants from endemic countries to the European Union; the time horizon, a lifetime and the perspective, that of the health system. Average and incremental cost-effectiveness ratios (ACER and ICER) were calculated as 2016 EUR/life-year gained (LYG). Health interventions compared were: base case (no programme), primary care-based presumptive treatment (PCPresTr), primary care-based serological screening and treatment (PCSerTr), hospital-based presumptive treatment (HospPresTr), hospital-based serological screening and treatment (HospSerTr), hospital-based presumptive treatment of immunosuppressed (HospPresTrim) and hospital-based serological screening and treatment of the immunosuppressed (HospSerTrim). The willingness to pay threshold (WTP) was €32 126.95/LYG. RESULTS The base case model yielded a loss of 2 486 708.24 life-years and cost EUR 3 238 393. Other interventions showed the following: PCPresTr: 2 488 095.47 life-years (Δ1 387.23LYG), cost: EUR 8 194 563; ACER: EUR 3573/LYG; PCSerTr: 2 488 085.8 life-years (Δ1377.57LYG), cost: EUR 207 679 077, ACER: EUR 148 407/LYG; HospPresTr: 2 488 046.17 life-years (Δ1337.92LYG), cost: EUR 14 559 575; ACER: EUR 8462/LYG; HospSerTr: 2 488 024.33 life-years (Δ1316.08LYG); cost: EUR 207 734 073; ACER: EUR 155 382/LYG; HospPresTrim: 2 488 093.93 life-years, cost: EUR 1 105 483; ACER: EUR -1539/LYG (cost savings); HospSerTrim: 2 488 073.8 life-years (Δ1365.55LYG), cost: EUR 4 274 239; ACER: EUR 759/LYG. One-way and probabilistic sensitivity analyses were undertaken; HospPresTrim remained below WTP for all parameters' ranges and iterations. CONCLUSION Presumptively treating all immunosuppressed migrants from areas with endemic Strongyloides would generate cost savings to the health system.
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Affiliation(s)
- Philip Erick Wikman-Jorgensen
- Medicina Interna, Hospital Universitari San Juan de Alicante, San Juan de Alicante, Alicante, Spain .,Foundation for the Promotion of the Research in Healthcare and Biomedicine, Valencia, Spain
| | - Jara Llenas-Garcia
- Medicina Interna/Enfermedades Infecciosas, Hospital Vega Baja-FISABIO, San Bartolome-Orihuela, Alicante, Spain.,Clinical Medicine, Universidad Miguel Hernandez de Elche Facultad de Medicina, Sant Joan D'Alacant, Spain
| | - Jad Shedrawy
- Public Health, Karolinska Institutet, Stockholm, Stockholm County, Sweden
| | | | | | - Zeno Bisoffi
- Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Veneto, Italy.,Diagnostics and Public Health, University of Verona, Verona, Veneto, Italy
| | - Ana Requena-Mendez
- Instituto de Salud Global Barcelona, Barcelona, Spain.,Division of Infectious Diseases, Department of Medicine-Solna, Karolinska Institutet, Stockholm, Sweden
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24
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Clark E, Pritchard H, Hemmige V, Restrepo A, Bautista K, Damania A, Ricciardi A, Nutman TB, Mejia R. Strongyloides stercoralis Infection in Solid Organ Transplant Patients Is Associated With Eosinophil Activation and Intestinal Inflammation: A Cross-sectional Study. Clin Infect Dis 2021; 71:e580-e586. [PMID: 32155244 DOI: 10.1093/cid/ciaa233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/04/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Strongyloidiasis can cause devastating morbidity and death in immunosuppressed patients. Identification of reliable biomarkers for strongyloidiasis in immunosuppressed patients is critical for the prevention of severe disease. METHODS In this cross-sectional study of solid organ transplant (SOT) candidates and recipients, we quantified Strongyloides-specific IgG to the recombinant NIE-Strongyloides antigen and/or to a soluble extract of S. stercoralis somatic antigens ("crude antigen") using enzyme-linked immunosorbent assays (ELISAs). We also measured peripheral eosinophilia, 4 different eosinophil granule proteins, and intestinal fatty acid-binding protein (IFABP). RESULTS We evaluated serum biomarkers in 149 individuals; 77 (52%) pre-SOT and 72 (48%) post-SOT. Four percent (6/149) tested positive by NIE ELISA and 9.6% (11/114) by crude antigen ELISA (overall seropositivity of 9.4% [14/149]). Seropositive patients had higher absolute eosinophil counts (AECs) than seronegative patients (P = .004). AEC was positively correlated to the levels of eosinophil granule proteins eosinophil cationic protein (ECP) and eosinophil peroxidase (EPO) (P < .05), while IFABP was positively related to the 2 other eosinophil granule proteins (major basic protein [MBP] and eosinophil-derived neurotoxin [EDN]; Spearman's r = 0.3090 and 0.3778, respectively; P < .05; multivariate analyses slopes = 0.70 and 2.83, respectively). CONCLUSIONS This study suggests that, in SOT patients, strongyloidiasis triggers both eosinophilia and eosinophil activation, the latter being associated with intestinal inflammation. These data provide insight into the pathogenesis of S. stercoralis infection in the immunocompromised population at high risk of severe strongyloidiasis syndromes.
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Affiliation(s)
- Eva Clark
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA.,Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston Texas, USA.,Houston Health Services Research & Development, Innovations in Quality, Effectiveness and Safety (IQuESt), Baylor College of Medicine Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Haley Pritchard
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vagish Hemmige
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA.,Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Bronx, New York, USA.,Department of Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alejandro Restrepo
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA
| | - Karla Bautista
- Laboratory of Clinical Parasitology and Diagnostics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Ashish Damania
- Laboratory of Clinical Parasitology and Diagnostics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Alessandra Ricciardi
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Rojelio Mejia
- Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston Texas, USA.,Laboratory of Clinical Parasitology and Diagnostics, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA
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Mirzaei L, Ashrafi K, Atrkar Roushan Z, Mahmoudi MR, Shenavar Masooleh I, Rahmati B, Saadat F, Mirjalali H, Sharifdini M. Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran: a closer look at risk factors. Epidemiol Health 2021; 43:e2021009. [PMID: 33494130 PMCID: PMC8060525 DOI: 10.4178/epih.e2021009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/20/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the prevalence of Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran and to investigate related risk factors. METHODS This cross-sectional study was conducted among 494 patients receiving immunosuppressive drugs, including cancer patients undergoing chemotherapy (n=188) and those treated with prolonged corticosteroid administration (n=306). All fresh fecal samples were examined using the direct wet-mount, formalin ethyl acetate concentration, and agar plate culture techniques. RESULTS In total, 16.8% of patients were positive for at least 1 intestinal parasite; the helminthic and protozoan infection rates were 5.1% and 12.3%, respectively. The infection rate was significantly higher in corticosteroid-treated individuals (19.6%) than cancer patients (12.2%) (p<0.05). The prevalence rate of S. stercoralis among patients receiving chemotherapy and those treated with corticosteroids were 4.3% and 5.2%, respectively. The prevalence rate of S. stercoralis infection was significantly higher in older patients (p<0.05). CONCLUSIONS Strongyloidiasis is one of the most common parasites among patients receiving immunosuppressive drugs in northern Iran. Early diagnosis and proper treatment of these patients are necessary to minimize the complications of severe strongyloidiasis.
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Affiliation(s)
- Leila Mirzaei
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Keyhan Ashrafi
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Atrkar Roushan
- Department of Biostatistics, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Reza Mahmoudi
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Irandokht Shenavar Masooleh
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Behnaz Rahmati
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Farshid Saadat
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamed Mirjalali
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meysam Sharifdini
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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26
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Eslahi AV, Badri M, Nahavandi KH, Houshmand E, Dalvand S, Riahi SM, Johkool MG, Asadi N, Hoseini Ahangari SA, Taghipour A, Zibaei M, Khademvatan S. Prevalence of strongyloidiasis in the general population of the world: a systematic review and meta-analysis. Pathog Glob Health 2021; 115:7-20. [PMID: 33433291 DOI: 10.1080/20477724.2020.1851922] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Strongyloides stercoralis is a neglected soil-transmitted helminth affects approximately 100-370 million people globally. The life cycle is unusual as only larvae can be found in stool specimens. Thecurrent review and meta-analysis represented the distribution of strongyloidiasis in general population of the world based on published papers. Five English databases (Science Direct, Scopus, PubMed, Web of Science, and Google Scholar(were explored for literature published before October 2019.Altogether 235 studies (862243 participants) was eligible. Regarding diagnostic method, the overall prevalence for studies performed microscopic, culture, immunological and molecular method was 1.47% (95% CI = 1.56%), 10.08% (95% CI = 8.99% - 11.16%), 23.88% (95% CI = 20.82% - 26.94%) and 9.3% (95% CI = 7.2% - 11.3%), respectively. Based on microscopic methods, the highest prevalence was related to the Western Pacific region [9.47% (95% CI = 8.55% - 10.39%)]. According to the culture method, Western Pacific region [21.36% (95% CI = 16.32% - 26.39%)] had the highest estimated pooled prevalence. In immunological studies, Eastern Mediterranean Region [40.72% (95% CI = 36.74% - 44.70%)] had the highest seroprevalence.Also in molecular surveys, the highest prevalence was related to the African region [19.72% (95% CI = 16.71% - 22.73%)]. The current study indicated that strongyloidiasis is still considered a health problem in many parts of the world. Thus a comprehensive control program and improvement of public health sectors are required.
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Affiliation(s)
- Aida Vafae Eslahi
- Student Research Committee, Urmia University of Medical Sciences , Urmia, Iran
| | - Milad Badri
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences , Qazvin, Iran
| | | | - Elham Houshmand
- Department of Parasitology, Faculty of veterinary medicine, Rasht Branch, Islamic Azad university , Guilan, Iran
| | - Sahar Dalvand
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Seyed Mohammad Riahi
- Social Determinants of Health Research Centre, Department of Epidemiology and Biostatistics, School of Health, Birjand University of Medical Sciences , Birjand, Iran
| | - Morteza Ghanbari Johkool
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences , Qazvin, Iran
| | - Negar Asadi
- Student Research Committee, Urmia University of Medical Sciences , Urmia, Iran.,Cellular and Molecular Research Center & Department of Medical Parasitology and Mycology, Urmia University of Medical Sciences , Urmia, Iran
| | | | - Ali Taghipour
- Department of Parasitology, Faculty of medical sciences, Tarbiat Modares University , Tehran, Iran
| | - Mohammad Zibaei
- Department of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences , Karaj, Iran.,Evidence-based Phytotherapy and Complementary Medicine Research Center, Alborz University of Medical Sciences , Karaj, Iran
| | - Shahram Khademvatan
- Student Research Committee, Urmia University of Medical Sciences , Urmia, Iran.,Cellular and Molecular Research Center & Department of Medical Parasitology and Mycology, Urmia University of Medical Sciences , Urmia, Iran
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Ashiri A, Rafiei A, Beiromvand M, Khanzadeh A, Alghasi A. Screening of Strongyloides stercoralis infection in high-risk patients in Khuzestan Province, Southwestern Iran. Parasit Vectors 2021; 14:37. [PMID: 33422116 PMCID: PMC7796600 DOI: 10.1186/s13071-020-04549-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strongyloidiasis, one of the neglected tropical diseases (NTDs), can be fatal in immunocompromised patients. Available data on Strongyloides stercoralis infection in high-risk patients in Iran are limited. The aim of the present study was to determine the prevalence of S. stercoralis infection and associated risk factors among high-risk patients as well as to evaluate the sensitivity of the diagnostic tests used in the diagnose of S. stercoralis infection. METHODS This cross-sectional study was performed from 2019 to 2020 among 300 high-risk patients in Khuzestan Province, southwestern Iran. Patients with autoimmune diseases, uncontrolled diabetes, HIV/AIDS, cancer, organ transplant, hematological malignancy, asthma and chronic obstructive pulmonary disease (COPD) were examined using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test. Since agar plate culture was considered the reference diagnostic test, culture-positive samples were confirmed by PCR amplification and the sequencing of the nuclear 18S rDNA (SSU) hypervariable region (HVRIV) of the parasite. RESULTS The prevalence of S. stercoralis infection was 1%, 1.3%, 2%, 2.7%, and 8.7% using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test, respectively. All culture-positive samples were confirmed by SSU-PCR. According to the results, the most sensitive test was ELISA, with 100% sensitivity, followed by the Baermann funnel technique with the sensitivity of 75%. Direct smear examination, formalin-ether concentration technique, and Baermann funnel technique had the highest PPV (100%) while the ELISA test had the highest NPV (100%). Significant eosinophilia was observed in the patients whose culture test was positive (7/8; P < 0.05). In the present study, the majority of the positive cases by the agar plate culture had a history of prolonged exposure to soil and of asthma and COPD and were > 60 years old. CONCLUSIONS Given that the ELISA test had the highest NPV, the screening of all high-risk patients for S. stercoralis infection in endemic areas is recommended prior to starting corticosteroid therapy with the ELISA test. The results indicate the importance of paying attention to patients with unknown eosinophilia in endemic areas. Ivermectin should be available to strongyloidiasis patients in the endemic areas.
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Affiliation(s)
- Alireza Ashiri
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran.,Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
| | - Abdollah Rafiei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran.,Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
| | - Molouk Beiromvand
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran. .,Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran.
| | | | - Arash Alghasi
- Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
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Lucas Dato A, Pacheco-Tenza MI, Borrajo Brunete E, Martínez López B, García López M, González Cuello I, Gregori Colomé J, Navarro Cots M, Saugar JM, García-Vazquez E, Ruiz-Maciá JA, Llenas-García J. Strongyloidiasis in Southern Alicante (Spain): Comparative Retrospective Study of Autochthonous and Imported Cases. Pathogens 2020; 9:pathogens9080601. [PMID: 32717912 PMCID: PMC7460300 DOI: 10.3390/pathogens9080601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Strongyloidiasis is a parasitic disease with global prevalence. In Spain, autochthonous cases are concentrated in the Mediterranean basin. We aimed to analyze clinical and epidemiological characteristics of Strongyloides stercoralis infection in Vega Baja del Segura (Spain), comparing autochthonous versus imported cases. METHODS Observational retrospective study of all strongyloidiasis cases from January 2009 to January 2019. Cases were diagnosed by stool larvae visualization, positive culture, PCR, Strongyloides serology, and/or compatible histology. RESULTS We included 36 patients (21 men) with a mean age of 60.8 years ±17.6; 15 cases were autochthonous and 21 imported 80.9% from Latin America. Autochthonous cases were associated with older age (mean 71.3 vs. 53.3 years; p = 0.002), male sex (odds ratio (OR) 5.33; 95% confidence interval (CI) 1.15-24.68; p = 0.041), and agricultural activity (OR 13.5; 95% CI 2.4-73.7; p = 0.002). Fourteen were asymptomatic, three autochthonous cases presented with hyperinfection syndrome, and two patients died. There was no difference between autochthonous versus imported origin in eosinophilia at diagnosis (93.3% vs. 75%; p = 0.207), treatment received, or clinical response (85.7% vs. 88.9% cured; p = 1). CONCLUSION In our region, imported strongyloidiasis coexists with autochthonous cases, which are mainly in older male farmers who are diagnosed at more advanced stages. Systematic screening programs are needed.
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Affiliation(s)
- Ana Lucas Dato
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Correspondence: (A.L.D.); (J.L.-G.)
| | - María Isabel Pacheco-Tenza
- Internal Medicine Department, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Emilio Borrajo Brunete
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Microbiology Department, Hospital Vega Baja, 03314 Orihuela, Spain
| | - Belén Martínez López
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - María García López
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - Inmaculada González Cuello
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - Joan Gregori Colomé
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - María Navarro Cots
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Microbiology Department, Hospital Vega Baja, 03314 Orihuela, Spain
| | - José María Saugar
- Parasitology Department, Centro Nacional de Microbiología, Instituto Carlos III, 28903 Madrid, Spain;
| | - Elisa García-Vazquez
- Infectious Diseases Unit, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
- Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, 30120 Murcia, Spain
| | - José Antonio Ruiz-Maciá
- Pathological Department, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Jara Llenas-García
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Clinical Medicine Department, Universidad Miguel Hernández de Elche, 03202 Elche, Spain
- Correspondence: (A.L.D.); (J.L.-G.)
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Strong-LAMP Assay Based on a Strongyloides spp.-Derived Partial Sequence in the 18S rRNA as Potential Biomarker for Strongyloidiasis Diagnosis in Human Urine Samples. DISEASE MARKERS 2020; 2020:5265198. [PMID: 32566039 PMCID: PMC7281818 DOI: 10.1155/2020/5265198] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 04/24/2020] [Indexed: 01/14/2023]
Abstract
Human strongyloidiasis a soil-transmitted infection caused by Strongyloides stercoralis is one of the most neglected amongst the so-called Neglected Tropical Diseases (NTDs). S. stercoralis is a nematode, which is distributed worldwide; it has been estimated that it could affect millions of people, mainly in tropical and subtropical endemic regions. The difficulties of diagnosis lead to infection rates being underreported. Asymptomatic patients have chronic infections that can lead to severe hyperinfection syndrome or disseminated strongyloidiasis in immunocompromised patients. Strongyloidiasis can easily be misdiagnosed because conventional faecal-based techniques lack of sensitivity for the morphological identification of infective larvae in faeces. None of the currently used molecular methods have used urine samples as an alternative to faecal samples for diagnosing strongyloidiasis. This study was thus aimed at comparing, for the first time, the use of a new loop-mediated isothermal amplification (LAMP) molecular assay (Strong-LAMP) to traditional methods on patients' urine samples. Twenty-four urine samples were taken from patients included in a study involving two Spanish hospitals for strongyloidiasis screening using parasitological and serological tests. Strongyloides larvae were found in 11 patients' faecal samples, thereby ascertaining that they had the disease. Other patients had high antibody titres but no larvae were found in their faeces. All urine samples were analysed by PCR and Strong-LAMP assay. No amplification occurred when using PCR. Strong-LAMP led to detecting S. stercoralis DNA in urine samples from patients having previously confirmed strongyloidiasis by parasitological tests and/or a suspicion of being infected by serological ones. The Strong-LAMP assay is a useful molecular tool for research regarding strongyloidiasis in human urine samples. After further validation, the Strong-LAMP assay could also be used for complementary and effective diagnosis of strongyloidiasis in a clinical setting.
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Theunissen C, Bottieau E, Van Esbroeck M, Tsoumanis A, Florence E. Should We Screen HIV-Positive Migrants for Strongyloidiasis? Pathogens 2020; 9:pathogens9050388. [PMID: 32443596 PMCID: PMC7281463 DOI: 10.3390/pathogens9050388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Strongyloides stercoralis, a nematode endemic in all (sub)tropical regions, can cause life-threatening disease, especially in immunosuppressed patients. Many countries with high HIV-prevalence rates are also highly S. stercoralis endemic, and co-infection may occur. METHODS Retrospective study based on serological testing for S. stercoralis in all HIV-infected migrants followed at the Institute of Tropical Medicine, Antwerp, Belgium. If untested, serologic testing was performed on stored samples, dating from the first HIV viral load determination. The epidemiological, clinical and laboratory features of patients with and without strongyloidiasis were retrieved from the electronic medical files. RESULTS Of the 2846 HIV patients in active follow-up, 723 (25.4%) had a migration background. Thirty-six patients (5.1%) were diagnosed with Strongyloides co-infection, including 29 during their medical evaluation and seven retrospectively. Patients had a median age of 35.3 years (IQR 30.3-44.4), 28 patients (78%) originated from Sub-Saharan Africa and median time in Belgium was 3.5 years (IQR 0.8-5.7). Symptoms compatible with strongyloidiasis were present in 17 (47%) patients, of whom two were diagnosed retrospectively. Eosinophilia (eosinophil cell count > 450/µL) was observed in 19 (53%) participants. Median CD4 level was 386 /µL (IQR 299-518) at diagnosis of co-infection. Of note, 8 (22%) patients with strongyloidiasis had no reported symptoms nor eosinophilia. None of the patients developed hyperinfection syndrome. There were no differences in age, gender, geographic origin, clinical presentation, CD4 level or viral load between patients with and without strongyloidiasis. Only eosinophilia was strongly correlated with the presence of Strongyloides in multivariate analysis (OR 10.74 (95% CI 5.19-22.25), p < 0.001); the positive likelihood ratio (LR+) of eosinophilia for strongyloidiasis was 5.38 (95% CI 3.66-7.91). CONCLUSION Strongyloidiasis was diagnosed in 5.1% of HIV-infected migrants. Eosinophilia had good confirming power for the presence of the disease. However, a sizeable proportion (22%) of co-infected individuals were asymptomatic and had normal eosinophil count, supporting universal screening of all HIV-positive patients native to tropical countries.
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Juthong S, Geater AF, Dekumyoy P, Hortiwakul T, Siripaitoon B, Aiewruengsurat D, Thongbun N. Prevalence and risk factors of strongyloidiasis in patients with systemic lupus erythematosus in Southern Thailand. Lupus 2020; 29:539-546. [PMID: 32183590 DOI: 10.1177/0961203320911091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Strongyloidiasis can be fatal in systemic lupus erythematosus (SLE) patients, but few epidemiological
studies have investigated the burden of this tropical disease among the SLE population. This study aimed to assess the prevalence and associated factors of strongyloidiasis among SLE patients in Southern Thailand. Methods A cross-sectional study was conducted on 180 SLE patients attending the Rheumatology Clinic at
Songklanagarind Hospital. Stool specimens were collected and examined using the direct smear technique and agar plate culture technique. Serum anti-Strongyloides stercoralis IgG was measured by IgG-ELISA. Results The overall prevalence of strongyloidiasis by combined parasitologyl and/or serology was 15.6%. The prevalence of strongyloidiasis by parasitological methods was 2.2%. Positive parasitology and/or serology was associated with male sex and a SLE disease duration of less than two years. Conclusion Strongyloidiasis is highly prevalent among the SLE population. A combination of serological and parasitological methods increases the rate of diagnosis of strongyloidiasis in SLE patients.
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Affiliation(s)
- Siriporn Juthong
- Allergy and Rheumatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Alan F Geater
- Epidemiology Unit, Faculty of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Paron Dekumyoy
- Department of Helminthology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thanaporn Hortiwakul
- Infectious Disease Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Boonjing Siripaitoon
- Allergy and Rheumatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Duangkamol Aiewruengsurat
- Allergy and Rheumatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Nannapas Thongbun
- Division of Clinical Microbiology, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
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Sengthong C, Yingklang M, Intuyod K, Hongsrichan N, Pinlaor S. An optimized agar plate culture improves diagnostic efficiency for Strongyloides stercoralis infection in an endemic community. Parasitol Res 2020; 119:1409-1413. [PMID: 32086591 DOI: 10.1007/s00436-020-06626-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/14/2020] [Indexed: 02/05/2023]
Abstract
We aimed to compare the efficacy of modified agar plate fecal culture (mAPC) and standard agar plate culture (sAPC) for diagnosis of Strongyloides stercoralis infection in a community at Khon Kaen Province, Thailand. Fecal samples were collected from participants individually (n = 1076) and were tested using these two methods. Modified APC and sAPC detected 129 (11.99%) and 91 (8.46%) infected individuals, respectively. Thirty-eight participants were negative according to sAPC, but positive for mAPC. Moreover, in the participants who were positive for both methods, the number of worm developmental stages obtained was higher for mAPC than for sAPC. Our study suggests that mAPC is an effective and useful tool for S. stercoralis diagnosis and can be applied for mass-screening in community and/or control programs.
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Affiliation(s)
- Chatchawan Sengthong
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.,Medical Technology Unit of Bangkatum Hospital, Phitsanulok, 65110, Thailand.,Chronic Kidney Disease Prevention in the Northeastern Thailand, Khon Kaen, 40002, Thailand
| | - Manachai Yingklang
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.,Chronic Kidney Disease Prevention in the Northeastern Thailand, Khon Kaen, 40002, Thailand
| | - Kitti Intuyod
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.,Chronic Kidney Disease Prevention in the Northeastern Thailand, Khon Kaen, 40002, Thailand
| | - Nuttanan Hongsrichan
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.,Chronic Kidney Disease Prevention in the Northeastern Thailand, Khon Kaen, 40002, Thailand
| | - Somchai Pinlaor
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand. .,Chronic Kidney Disease Prevention in the Northeastern Thailand, Khon Kaen, 40002, Thailand.
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Requena-Méndez A, Salas-Coronas J, Salvador F, Gomez-Junyent J, Villar-Garcia J, Santin M, Muñoz C, González-Cordón A, Cabezas Fernández MT, Sulleiro E, Arenas MDM, Somoza D, Vazquez-Villegas J, Treviño B, Rodríguez E, Valls ME, Llaberia-Marcual J, Subirá C, Muñoz J. High Prevalence of Strongyloidiasis in Spain: A Hospital-Based Study. Pathogens 2020; 9:pathogens9020107. [PMID: 32053864 PMCID: PMC7167856 DOI: 10.3390/pathogens9020107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction: Strongyloidiasis is a prevailing helminth infection ubiquitous in tropical and subtropical areas, however, seroprevalence data are scarce in migrant populations, particularly for those coming for Asia. Methods: This study aims at evaluating the prevalence of S. stercoralis at the hospital level in migrant populations or long term travellers being attended in out-patient and in-patient units as part of a systematic screening implemented in six Spanish hospitals. A cross-sectional study was conducted and systematic screening for S. stercoralis infection using serological tests was offered to all eligible participants. Results: The overall seroprevalence of S. stercoralis was 9.04% (95%CI 7.76-10.31). The seroprevalence of people with a risk of infection acquired in Africa and Latin America was 9.35% (95%CI 7.01-11.69), 9.22% (7.5-10.93), respectively. The number of individuals coming from Asian countries was significantly smaller and the overall prevalence in these countries was 2.9% (95%CI -0.3-6.2). The seroprevalence in units attending potentially immunosuppressed patients was significantly lower (5.64%) compared with other units of the hospital (10.20%) or Tropical diseases units (13.33%) (p < 0.001). Conclusions: We report a hospital-based strongyloidiasis seroprevalence of almost 10% in a mobile population coming from endemic areas suggesting the need of implementing strongyloidiasis screening in hospitalized patients coming from endemic areas, particularly if they are at risk of immunosuppression.
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Affiliation(s)
- Ana Requena-Méndez
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.S.); (J.M.)
- Department of Global Public Health, Karolinska Institutet, 171 77 Solna, Sweden
- Correspondence: ; Tel.: +34-652-870-779
| | - Joaquin Salas-Coronas
- Tropical Medicine Unit. Hospital de Poniente, El Ejido, 04700 Almería, Spain; (J.S.-C.); (M.T.C.F.)
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain;
| | - Joan Gomez-Junyent
- Department of Infectious Diseases, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (J.G.-J.), (M.S.)
| | - Judith Villar-Garcia
- Infectious Diseases Department, Hospital del Mar-IMIM, 08003 Barcelona, Spain; (J.V.-G.); (M.d.M.A.)
| | - Miguel Santin
- Department of Infectious Diseases, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (J.G.-J.), (M.S.)
| | - Carme Muñoz
- Department of Microbiology, Hospital Sant Pau, 08041 Barcelona, Spain; (C.M.); (J.L.-M.)
| | | | | | - Elena Sulleiro
- Department of Microbiology, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain;
| | - Maria del Mar Arenas
- Infectious Diseases Department, Hospital del Mar-IMIM, 08003 Barcelona, Spain; (J.V.-G.); (M.d.M.A.)
| | - Dolors Somoza
- Department of Microbiology. Hospital Universitari Bellvitge, 08907 Barcelona, Spain;
| | | | - Begoña Treviño
- Tropical Medicine Unit Vall d’Hebron-Drassanes, PROSICS Barcelona, 08035 Barcelona, Spain;
| | - Esperanza Rodríguez
- Parasitology Department, Centro Nacional de Microbiologia—Instituto de Salud Carlos III, 28020 Madrid, Spain;
| | | | - Jaume Llaberia-Marcual
- Department of Microbiology, Hospital Sant Pau, 08041 Barcelona, Spain; (C.M.); (J.L.-M.)
| | - Carme Subirá
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.S.); (J.M.)
| | - Jose Muñoz
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.S.); (J.M.)
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Baker EC, Ming DK, Choudhury Y, Rahman S, Smith PJ, Muñoz J, Chiodini PL, Griffiths CJ, Whitty CJM, Brown M. High Prevalence of Strongyloides among South Asian Migrants in Primary Care-Associations with Eosinophilia and Gastrointestinal Symptoms. Pathogens 2020; 9:E103. [PMID: 32041352 PMCID: PMC7168230 DOI: 10.3390/pathogens9020103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/29/2020] [Accepted: 02/04/2020] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal (GI) symptoms are a frequent reason for primary care consultation, and common amongst patients with strongyloidiasis. We conducted a prospective cohort and nested case control study in East London to examine the predictive value of a raised eosinophil count or of GI symptoms, for Strongyloides infection in South Asian migrants. We included 503 patients in the final analyses and all underwent a standardised GI symptom questionnaire, eosinophil count and Strongyloides serology testing. Positive Strongyloides serology was found in 33.6% in the eosinophilia cohort against 12.5% in the phlebotomy controls, with adjusted odds ratio of 3.54 (95% CI 1.88-6.67). In the GI symptoms cohort, 16.4% were seropositive but this was not significantly different compared with controls, nor were there associations between particular symptoms and Strongyloidiasis. Almost a third (35/115) of patients with a positive Strongyloides serology did not have eosinophilia at time of testing. Median eosinophil count declined post-treatment from 0.5 cells × 109/L (IQR 0.3-0.7) to 0.3 (0.1-0.5), p < 0.001. We conclude Strongyloides infection is common in this setting, and the true symptom burden remains unclear. Availability of ivermectin in primary care would improve access to treatment. Further work should clarify cost-effectiveness of screening strategies for Strongyloides infection in UK migrant populations.
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Affiliation(s)
| | - Damien K. Ming
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
| | - Yasmin Choudhury
- William Harvey Heart Centre, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK;
| | | | | | - Jose Muñoz
- Barcelona Centre for International Health Research, 08014 Barcelona, Spain;
| | - Peter L. Chiodini
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
| | - Chris J. Griffiths
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK;
| | - Christopher J. M. Whitty
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Michael Brown
- Hospital for Tropical Diseases, University College London Hospitals, London WC1E 6JB, UK; (P.L.C.); (C.J.M.W.); (M.B.)
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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McLellan J, Gill MJ, Vaughan S, Meatherall B. Schistosoma and Strongyloides screening in migrants initiating HIV Care in Canada: a cross sectional study. BMC Infect Dis 2020; 20:76. [PMID: 31992216 PMCID: PMC6986152 DOI: 10.1186/s12879-020-4779-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Following migration from Schistosoma and Strongyloides endemic to non-endemic regions, people remain at high risk for adverse sequelae from these chronic infections. HIV co-infected persons are particularly vulnerable to the serious and potentially fatal consequences of untreated helminth infection. While general screening guidelines exist for parasitic infection screening in immigrant populations, they remain silent on HIV positive populations. This study assessed the seroprevalence, epidemiology and laboratory characteristics of these two parasitic infections in a non-endemic setting in an immigrant/refugee HIV positive community. METHODS Between February 2015 and 2018 individuals born outside of Canada receiving care at the centralized HIV clinic serving southern Alberta, Canada were screened by serology and direct stool analysis for schistosomiasis and strongyloidiasis. Canadian born persons with travel-based exposure risk factors were also screened. Epidemiologic and laboratory values were analyzed using bivariate logistic regression. We assessed the screening utility of serology, direct stool analysis, eosinophilia and hematuria. RESULTS 253 HIV positive participants were screened. The prevalence of positive serology for Schistosoma and Strongyloides was 19.9 and 4.4%, respectively. Age between 40 and 50 years (OR 2.50, 95% CI 1.13-5.50), refugee status (3.55, 1.72-7.33), country of origin within Africa (6.15, 2.44-18.60), eosinophilia (3.56, 1.25-10.16) and CD4 count < 200 cells/mm3 (2.46, 1.02-5.92) were associated with positive Schistosoma serology. Eosinophilia (11.31, 2.03-58.94) was associated with positive Strongyloides serology. No Schistosoma or Strongyloides parasites were identified by direct stool microscopy. Eosinophilia had poor sensitivity for identification of positive serology. Hematuria was not associated with positive Schistosoma serology. CONCLUSION Positive Schistosoma and Strongyloides serology was common in this migrant HIV positive population receiving HIV care in Southern Alberta. This supports the value of routine parasitic screening as part of standard HIV care in non-endemic areas. Given the high morbidity and mortality in this relatively immunosuppressed population, especially for Strongyloides infection, screening should include both serologic and direct parasitological tests. Eosinophilia and hematuria should not be used for Schistosoma and Strongyloides serologic screening in HIV positive migrants in non-endemic settings.
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Affiliation(s)
- Jessica McLellan
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada.
| | - M John Gill
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada
- Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada
| | - Stephen Vaughan
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada
- Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada
| | - Bonnie Meatherall
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada
- Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada
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La Hoz RM, Morris MI. Intestinal parasites including Cryptosporidium, Cyclospora, Giardia, and Microsporidia, Entamoeba histolytica, Strongyloides, Schistosomiasis, and Echinococcus: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13618. [PMID: 31145496 DOI: 10.1111/ctr.13618] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 01/08/2023]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of intestinal parasites in the pre- and post-transplant period. Intestinal parasites are prevalent in the developing regions of the world. With increasing travel to and from endemic regions, changing immigration patterns, and the expansion of transplant medicine in developing countries, they are increasingly recognized as a source of morbidity and mortality in solid-organ transplant recipients. Parasitic infections may be acquired from the donor allograft, from reactivation, or from de novo acquisition post-transplantation. Gastrointestinal multiplex assays have been developed; some of the panels include testing for Cryptosporidium, Cyclospora, Entamoeba histolytica, and Giardia, and the performance is comparable to conventional methods. A polymerase chain reaction test, not yet widely available, has also been developed to detect Strongyloides in stool samples. New recommendations have been developed to minimize the risk of Strongyloides donor-derived events. Deceased donors with epidemiological risk factors should be screened for Strongyloides and recipients treated if positive as soon as the results are available. New therapeutic agents and studies addressing the optimal treatment regimen for solid-organ transplant recipients are unmet needs.
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Affiliation(s)
- Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Michele I Morris
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida
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Ahmed SA, El-Moselhy A, El-Moammaly A, El-Shewy K. Strongyloides stercoralis in Patients on Corticosteroids Therapy Using Enzyme-Linked Immunosorbent Assay and Gelatin Particles Indirect Agglutination Tests: A Diagnostic Approach. Acta Parasitol 2019; 64:394-405. [PMID: 31069645 DOI: 10.2478/s11686-019-00060-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/24/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Patients on corticosteroids therapy (POCT) are more likely to flare up concealed Strongyloides infection and develop Strongyloides hyperinfection syndrome and/or dissemination. Such critical complications can lead to high mortality rates. Rapid detection methods are, therefore, necessary to detect Strongyloides infection in POCT with the advantage of being applicable in a developing country. METHODS Two hundred POCT have been enrolled in this study to determine the rate of infection with Strongyloides. Three different groups of POCT (Strongyloides infected, non-infected, infected with other parasites) were used to evaluate the antibodies detection capability of two serological techniques (enzyme-linked immunosorbent assay (ELISA) and gelatin particles indirect agglutination (GPIAT) against the results of the gold standard agar plate culture (APC). RESULTS With APC, the infection rate of Strongyloides stercoralis in POCT was 9.5% (19/200). POCT with Strongyloides infection displayed related risk factors (job, rural settlements, and soil contact) for infection combined with the subtropical nature of Ismailia Governorate. With regard to serology, ELISA detection results were poor compared to APC with sensitivity and specificity of 42.1% and 82.6%, respectively, and positive and negative predictive values of 72% and 30%. GPIAT appeared to be closely related to APC with sensitivity and specificity of 89.4% and 81.8%, respectively, and positive and negative predictive values of 80.9% and 96.7%. Statistical moderate correlation was detected between GPIAT and ELISA. CONCLUSION The GPIAT technique is more convenient, easier, cheaper and faster to rule out the infection of Strongyloides in POCT. It might be the test of choice for routine immunodiagnosis of human strongyloidiasis.
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Affiliation(s)
- Shahira A Ahmed
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt.
| | - Amany El-Moselhy
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Amal El-Moammaly
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Khalid El-Shewy
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
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Camargo JF, Simkins J, Anjan S, Guerra G, Vianna R, Salama S, Albright C, Shipman E, Montoya J, Morris MI, Abbo LM. Implementation of a Strongyloides screening strategy in solid organ transplant donors and recipients. Clin Transplant 2019; 33:e13497. [PMID: 30773692 DOI: 10.1111/ctr.13497] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 01/09/2019] [Accepted: 02/09/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Strongyloides stercoralis infects 100 million people worldwide. Mortality rates in hyperinfection syndrome exceed 50%. Donor-derived Strongyloides infection has occurred after heart, kidney, kidney-pancreas and liver transplantation; yet, only 10% of the US organ procurement organizations currently screen donors for strongyloidiasis. METHODS We report a fatal case of donor-derived disseminated Strongyloides infection in a liver transplant recipient. Following this case, we implemented universal screening and treatment of donors and recipients. We reviewed our local epidemiology and outcomes after protocol implementation. RESULTS From a total of 355 deceased donors accepted at our center between January 2016, and March 2018, 14 (3.9%) had positive Strongyloides serology. Except for the index case, all other recipients of Strongyloides antibody-positive donors within that period (including 10 kidneys, 3 livers, one combined liver/kidney, and one kidney/pancreas from eight seropositive donors) received post-transplant prophylaxis with ivermectin, and to date are alive and doing well without signs of infection. Between October 2015, and September 2016, a total of 441 deceased donor solid organ transplants were performed at our center. 220 of these recipients had pretransplant Strongyloides serology available, and 23 of them were seropositive (10.5%). Within the first two years after the implementation of universal screening and treatment of donors and recipients, we had no cases of Strongyloides reactivation in our center. CONCLUSIONS Implementation of a Strongyloides screening and treatment protocol in our center was an effective strategy to prevent both recipient- and donor-derived strongyloidiasis. Transplant centers should consider implementation of Strongyloides preventive strategies.
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Affiliation(s)
- Jose F Camargo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Jacques Simkins
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Shweta Anjan
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Sam Salama
- Life Alliance Organ Recovery Agency, Miami, Florida
| | | | | | | | - Michele I Morris
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Lilian M Abbo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
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Shrestha P, O'Neil SE, Taylor BS, Bode-Omoleye O, Anstead GM. Hemoptysis in the Immunocompromised Patient: Do Not Forget Strongyloidiasis. Trop Med Infect Dis 2019; 4:tropicalmed4010035. [PMID: 30759812 PMCID: PMC6473255 DOI: 10.3390/tropicalmed4010035] [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] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/26/2019] [Accepted: 01/29/2019] [Indexed: 11/16/2022] Open
Abstract
Strongyloidiasis, due to infection with the nematode Strongyloides stercoralis, affects millions of people in the tropics and subtropics. Strongyloides has a unique auto-infective lifecycle such that it can persist in the human host for decades. In immunosuppressed patients, especially those on corticosteroids, potentially fatal disseminated strongyloidiasis can occur, often with concurrent secondary infections. Herein, we present two immunocompromised patients with severe strongyloidiasis who presented with pneumonia, hemoptysis, and sepsis. Both patients were immigrants from developing countries and had received prolonged courses of corticosteroids prior to admission. Patient 1 also presented with a diffuse abdominal rash; a skin biopsy showed multiple intradermal Strongyloides larvae. Patient 1 had concurrent pneumonic nocardiosis and bacteremia with Klebsiella pneumoniae and Enterococcus faecalis. Patient 2 had concurrent Aspergillus and Candida pneumonia and developed an Aerococcus meningitis. Both patients had negative serologic tests for Strongyloides; patient 2 manifested intermittent eosinophilia. In both patients, the diagnosis was afforded by bronchoscopy with lavage. The patients were successfully treated with broad-spectrum antibiotics and ivermectin. Patient 1 also received albendazole. Strongyloidiasis should be considered in the differential diagnosis of hemoptysis in immunocompromised patients with possible prior exposure to S. stercoralis.
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Affiliation(s)
- Prakash Shrestha
- Covenant Medical Group, Infectious Diseases, Division of Internal Medicine, Lubbock, TX 79410, USA.
| | - Sean E O'Neil
- Texas Center for Infectious Diseases, San Antonio, TX 78223, USA.
| | - Barbara S Taylor
- Department of Medicine, Division of Infectious Diseases, University of Texas Health, San Antonio, TX 78229, USA.
| | | | - Gregory M Anstead
- Department of Medicine, Division of Infectious Diseases, University of Texas Health, San Antonio, TX 78229, USA.
- Medicine Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, San Antonio, TX 78229, USA.
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Vasquez-Rios G, Pineda-Reyes R, Pineda-Reyes J, Marin R, Ruiz EF, Terashima A. Strongyloides stercoralis hyperinfection syndrome: a deeper understanding of a neglected disease. J Parasit Dis 2019; 43:167-175. [PMID: 31263320 DOI: 10.1007/s12639-019-01090-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/23/2019] [Indexed: 12/22/2022] Open
Abstract
Strongyloides stercoralis hyperinfection syndrome (SHS) is a life-threatening condition that warrants early detection and management. We describe the pathogenesis, organ-specific clinical manifestations, and risk factors associated to this condition. A comprehensive review of the literature was conducted in PubMed, LILACS, EBSCO and SciELO by using the keywords: "hyperinfection syndrome"; "Strongyloides stercoralis"; "disseminated strongyloidiasis"; "systemic strongyloidiasis", "pathogenesis" and "pathophysiology". Relevant articles on this topic were evaluated and included by consensus. Also, a secondary search of the literature was performed. Articles in English and Spanish language were included. SHS has been described in tropical and sub-tropical regions. However, there is growing evidence of cases detected in developed countries favored by increasing migration and the advance in immunosuppressive therapies for oncologic and inflammatory diseases. SHS is characterized by massive multiplication of larvae, typically in immunocompromised hosts. Clinical manifestations vary according to the organ involved and include diarrhea, intestinal bleeding, alveolar hemorrhages, heart failure, jaundice, bacteremia among others. Despite advances in the understanding of this condition, fatality rates are near 90%. Clinicians should consider SHS in the differential diagnosis of acutely ill patients with multiple organ damage and epidemiological risk factors. Adverse outcomes are common, especially with delayed anti-parasitic treatment.
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Affiliation(s)
- George Vasquez-Rios
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Roberto Pineda-Reyes
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Pineda-Reyes
- 2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Marin
- 2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eloy F Ruiz
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angélica Terashima
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
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Winnicki W, Eder M, Mazal P, Mayer FJ, Sengölge G, Wagner L. Prevalence of Strongyloides stercoralis infection and hyperinfection syndrome among renal allograft recipients in Central Europe. Sci Rep 2018; 8:15406. [PMID: 30337607 PMCID: PMC6194009 DOI: 10.1038/s41598-018-33775-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 10/05/2018] [Indexed: 01/07/2023] Open
Abstract
Strongyloides stercoralis is not hyperendemic in European countries but has been increasing in prevalence due to migration and travel. The infection is characterized by a mostly asymptomatic course or nonspecific symptoms in healthy subjects. However, immunosuppression or chemotherapy have been described as leading triggers for Strongyloides stercoralis hyperinfection syndrome and may have a fatal course. A post hoc analysis was performed among renal transplant patients during a 5-year period. Plasma samples of two hundred kidney allograft recipients were retrospectively analyzed for Strongyloides stercoralis seropositivity by established ELISA testing. Positive Strongyloides stercoralis serology was found in 3% of allograft recipients. One patient developed a life-threatening hyperinfection syndrome. His Strongyloides IgG signal had been elevated for years before the outbreak of the disease. Stronglyoides infections in transplant recipients are an important issue that physicians also in Central Europe should be aware of, given the risk of hyperinfection syndrome and the challenges in clinical diagnosis. Our study suggests that recipient and donor screening should be recommended in kidney transplantation programs in Central Europe as Strongyloides infection rates increase and its prevalence may be underestimated. Further research is needed to understand why some Strongyloides stercoralis seropositive individuals develop hyperinfection syndrome and others do not.
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Affiliation(s)
- Wolfgang Winnicki
- Department of Internal Medicine III; Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria.
| | - Michael Eder
- Department of Internal Medicine III; Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Peter Mazal
- Department of Clinical Pathology, Medical University of Vienna, Vienna, Austria
| | - Florian J Mayer
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Gürkan Sengölge
- Department of Internal Medicine III; Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | - Ludwig Wagner
- Department of Internal Medicine III; Division of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
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Detection of immune complexes and evaluation of alcoholic individuals' serological profile in the diagnosis of strongyloidiasis. Parasitol Int 2018; 67:644-650. [DOI: 10.1016/j.parint.2018.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 02/06/2023]
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Eamudomkarn C, Sithithaworn P, Kamamia C, Yakovleva A, Sithithaworn J, Kaewkes S, Techasen A, Loilome W, Yongvanit P, Wangboon C, Saichua P, Itoh M, M. Bethony J. Diagnostic performance of urinary IgG antibody detection: A novel approach for population screening of strongyloidiasis. PLoS One 2018; 13:e0192598. [PMID: 29985913 PMCID: PMC6037348 DOI: 10.1371/journal.pone.0192598] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/25/2018] [Indexed: 11/18/2022] Open
Abstract
The diagnosis of strongyloidiasis by coprological methods has a low sensitivity, underestimating the prevalence of Strongyloides stercoralis in endemic areas. Serodiagnostic tests for strongyloidiasis have shown robust diagnostic properties. However, these methods require a blood draw, an invasive and labor-intensive sample collection method, especially in the resource-limited settings where S. stercoralis is endemic. Our study examines a urine-based assay for strongyloidiasis and compares its diagnostic accuracy with coprological and serological methods. Receiver operating characteristic (ROC) curve analyses determined the diagnostic sensitivity (D-Sn) and specificity (D-Sp) of the urine ELISA, as well as estimates its positive predictive value and diagnostic risk. The likelihood ratios of obtaining a positive test result (LR+) or a negative test result (LR-) were calculated for each diagnostic positivity threshold. The urine ELISA assay correlated significantly with the serological ELISA assay for strongyloidiasis, with a D-Sn of 92.7% and a D-Sp of 40.7%, when compared to coprological methods. Moreover, the urine ELISA IgG test had a detection rate of 69%, which far exceeds the coprological method (28%). The likelihood of a positive diagnosis of strongyloidiasis by the urine ELISA IgG test increased significantly with increasing units of IgG detected in urine. The urine ELISA IgG assay for strongyloidiasis assay has a diagnostic accuracy comparable to serological assay, both of which are more sensitive than coprological methods. Since the collection of urine is easy and non-invasive, the urine ELISA IgG assay for strongyloidiasis could be used to screen populations at risk for strongyloidiasis in S. stercoralis endemic areas.
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Affiliation(s)
- Chatanun Eamudomkarn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
| | - Paiboon Sithithaworn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- * E-mail: ,
| | - Christine Kamamia
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University, Washington, D.C., United States of America
| | - Anna Yakovleva
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University, Washington, D.C., United States of America
| | - Jiraporn Sithithaworn
- Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
- Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand
| | - Sasithorn Kaewkes
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anchalee Techasen
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Watcharin Loilome
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Puangrat Yongvanit
- Cholangiocarcinoma Research Institute (CARI), Khon Kaen University, Khon Kaen, Thailand
- Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chompunoot Wangboon
- Biomedical Science Program, Graduate School, Khon Kaen University, Khon Kaen, Thailand
| | - Prasert Saichua
- Tropical Medicine Program, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Makoto Itoh
- Department of Infection and Immunology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Jeffrey M. Bethony
- Department of Microbiology, Immunology & Tropical Medicine, George Washington University, Washington, D.C., United States of America
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Buonfrate D, Requena-Mendez A, Angheben A, Cinquini M, Cruciani M, Fittipaldo A, Giorli G, Gobbi F, Piubelli C, Bisoffi Z. Accuracy of molecular biology techniques for the diagnosis of Strongyloides stercoralis infection-A systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12:e0006229. [PMID: 29425193 PMCID: PMC5823464 DOI: 10.1371/journal.pntd.0006229] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/22/2018] [Accepted: 01/10/2018] [Indexed: 12/11/2022] Open
Abstract
Background Strongyloides stercoralis infection is a neglected tropical disease which can lead to severe symptoms and even death in immunosuppressed people. Unfortunately, its diagnosis is hampered by the lack of a gold standard, as the sensitivity of traditional parasitological tests (including microscopic examination of stool samples and coproculture) is low. Hence, alternative diagnostic methods, such as molecular biology techniques (mostly polymerase chain reaction, PCR) have been implemented. However, there are discrepancies in the reported accuracy of PCR. Methodology A systematic review with meta-analysis was conducted in order to evaluate the accuracy of PCR for the diagnosis of S. stercoralis infection. The protocol was registered with PROSPERO International Prospective Register of Systematic Reviews (record: CRD42016054298). Fourteen studies, 12 of which evaluating real-time PCR, were included in the analysis. The specificity of the techniques resulted high (ranging from 93 to 95%, according to the reference test(s) used). When all molecular techniques were compared to parasitological methods, the sensitivity of PCR was assessed at 71.8% (95% CI 52.2–85.5), that decreased to 61.8% (95% CI 42.0–78.4) when serology was added among the reference tests. Similarly, sensitivity of real-time PCR resulted 64.4% (95% CI 46.2–77.7) when compared to parasitological methods only, 56.5% (95% CI 39.2–72.4) including serology. Conclusions PCR might not be suitable for screening purpose, whereas it might have a role as a confirmatory test. Strongyloides stercoralis is a worm that can potentially kill affected immunosuppressed individuals. The parasite is not easily detected with stool microscopy, hence novel tests have been implemented, such as polymerase chain reaction (PCR), that can detect the DNA of the parasite. This work aims at evaluating the performance of PCR for the diagnosis of S. stercoralis through a revision of diagnostic studies available in literature. According to the results of this work, PCR for S. stercoralis still misses a relevant proportion of infected people, while a positive result confirms the presence of the infection.
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Affiliation(s)
- Dora Buonfrate
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Ana Requena-Mendez
- Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Spain
| | - Andrea Angheben
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Michela Cinquini
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Mario Cruciani
- Centre of Community Medicine and Infectious Diseases Service, ULSS 9 Scaligera, Verona, Italy
| | | | - Giovanni Giorli
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Federico Gobbi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Chiara Piubelli
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
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Martinez-Perez A, Roure Díez S, Belhassen-Garcia M, Torrús-Tendero D, Perez-Arellano JL, Cabezas T, Soler C, Díaz-Menéndez M, Navarro M, Treviño B, Salvador F. Management of severe strongyloidiasis attended at reference centers in Spain. PLoS Negl Trop Dis 2018; 12:e0006272. [PMID: 29474356 PMCID: PMC5846793 DOI: 10.1371/journal.pntd.0006272] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 03/12/2018] [Accepted: 01/25/2018] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Strongyloides stercoralis is a globally distributed nematode that causes diverse clinical symptoms in humans. Spain, once considered an endemic country, has experienced a recent increase in imported cases. The introduction of serology helps diagnosis and is currently replacing microbiological techniques in some settings, but its sensitivity is variable and can be low in immunocompromised patients. Diagnosis can only be confirmed by identification of larvae. Often, this "gold standard" can only be achieved in severe cases, such as disseminated S.stercoralis infection, or S.stercoralis hyperinfection syndrome, where parasite load is high. In addition, these clinical presentations are not well-defined. Our aim is to describe severe cases of S.stercoralis, their epidemiological profile, and their clinical details. METHODS An observational retrospective study of disseminated S.stercoralis infection, or hyperinfection syndrome. Inclusion criteria: aged over 18, with a diagnosis of disseminated S.stercoralis infection, or hyperinfection syndrome, confirmed by visualization of larvae. Patients were identified through revision of clinical records for the period 2000-2015, in collaboration with eight reference centers throughout Spain. RESULTS From the period 2000-2015, eighteen cases were identified, 66.7% of which were male, with a median age of 40 (range 21-70). Most of them were foreigners (94.4%), mainly from Latin America (82.3%) or Western Africa (17.6%). Only one autochthonous case was identified, from 2006. Immunosuppressive conditions were present in fourteen (77%) patients, mainly due steroids use and to retroviral coinfections (four HIV, two HTLV). Transplant preceded the clinical presentation in four of them. Other comorbidities were coinfection with HBV, Trypanosoma cruzi, Mycobacterium leprae or Aspergillus spp. All presented with digestive disorders, with 55.6% also presenting malaise. 44.4% of cases had fever, 27.8% skin complaints, and 16.7% respiratory or neurological disorders. One patient presented anemia, and one other nephrotic syndrome. Diagnosis was confirmed by identification of larvae in fresh stool samples (n = 16; 88.9%), concentration techniques (n = 6; 33.3%), larval culture (n = 5; 29.4%), or digestive biopsies (n = 8; 44%). S.stercoralis forms were identified during necropsy in one case. In addition, ten (55%) had a positive serology. All the cases were treated with ivermectin, six (33%) also received albendazole and one case received thiabendazole followed by ivermectin. All needed inpatient management, involving a mean hospitalization stay of 25 days (range 1-164). Two cases received intensive care and eventually died. CONCLUSIONS Only eighteen cases of disseminated S.stercoralis infection/hyperinfection syndrome were identified from the 15-year period, most of which were considered to have been imported cases. Among those, immunosuppression was frequent, and mortality due to S.stercoralis was lower than previously described.
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Affiliation(s)
| | - Silvia Roure Díez
- Hospital Universitari Germans Trias i Pujol, Enfermedades Infecciosas, PROSICS Metropolitana Nord, Badalona, Spain
| | - Moncef Belhassen-Garcia
- Hospital Universitario de Salamanca, Servicio Medicina Interna, Sección Enfermedades Infecciosas, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Salamanca, Spain
| | - Diego Torrús-Tendero
- Hospital General Universitario de Alicante, Enfermedades Infecciosas, Medicina Tropical, Alicante, Spain
| | - Jose Luis Perez-Arellano
- Complejo Hospitalario Universitario Insular Gran Canaria, CHUIMI, Unidad de Enfermedades Infecciosas y Medicina Tropical, Las Palmas de Gran Canaria, Spain
| | - Teresa Cabezas
- Hospital de Poniente, Microbiology, Medicina Tropical, Almeria, Spain
| | - Cristina Soler
- Hospital Santa Caterina, Enfermedades Infecciosas, Unitat de Salut Internacional i Medicina Tropical, Salt/Girona, Spain
| | - Marta Díaz-Menéndez
- Hospital Universitario La Paz-Carlos III, Enfermedades Infecciosas, Unidad de Medicina Tropical y del Viajero, Madrid, Spain
| | - Miriam Navarro
- Spanish Society of Tropical Medicine and International Health SEMTSI, Madrid, Spain
| | - Begoña Treviño
- Vall de Hebrón University Hospital, Tropical Medicine Unit, Barcelona, Spain
| | - Fernando Salvador
- Infectious Diseases Department, Vall de Hebrón University Hospital, PROSICS, Barcelona, Spain
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de Alegría MLAR, Colmenares K, Espasa M, Amor A, Lopez I, Nindia A, Kanjala J, Guilherme D, Sulleiro E, Barriga B, Gil E, Salvador F, Bocanegra C, López T, Moreno M, Molina I. Prevalence of Strongyloides stercoralis and Other Intestinal Parasite Infections in School Children in a Rural Area of Angola: A Cross-Sectional Study. Am J Trop Med Hyg 2017; 97:1226-1231. [PMID: 28820707 DOI: 10.4269/ajtmh.17-0159] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Strongyloides stercoralis is widely distributed in the tropics and subtropics. The aim of this study was to determine the prevalence of S. stercoralis and other intestinal parasites and identify the risk factors for infection with S. stercoralis in a rural area of Angola. A cross-sectional study was conducted in school-age children (SAC) in Cubal, Angola. A questionnaire collecting clinical and epidemiological variables was used, and two stool samples were collected. A concentration technique (Ritchie) and a technique for detection of larvae migration (Baermann) were performed. Of 230 SAC, 56.1% were female and the mean age was 9.3 years (SD 2.45). Severe malnutrition, according to body mass index (BMI)-for-age, was observed in 20.4% of the SAC, and anemia was found in 59.6%. Strongyloides stercoralis was observed in 28 of the 230 (12.8%) SAC. Eggs of other helminths were observed in 51 (22.2%) students: Hymenolepis spp. in 27 students (11.7%), hookworm in 14 (6.1%), Schistosoma haematobium in four (1.7%), Enterobius vermicularis in four (1.7%), Ascaris lumbricoides in three (1.3%), Taenia spp. in two (0.9%), and Fasciola hepatica in one (0.4%). Protozoa were observed in 17 (7.4%) students. Detection of S. stercoralis was higher using the Baermann technique versus using formol-ether (11.3 vs. 3%). Overall prevalence of S. stercoralis in the school population of 16 studied schools in the municipal area of Cubal was greater than 10%. This fact must be considered when designing deworming mass campaigns. The use of specific tests in larvae detection is needed to avoid overlooking this parasite.
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Affiliation(s)
- María Luisa Aznar Ruiz de Alegría
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain.,Hospital Nossa Senhora da Paz, Cubal, Angola
| | - Karen Colmenares
- Department of Epidemiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mateu Espasa
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | - Arancha Amor
- Mundo Sano Foundation, Buenos Aires, Argentina.,National Center of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| | - Isabel Lopez
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | | | | | | | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | - Begoña Barriga
- Department of Epidemiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eva Gil
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | - Cristina Bocanegra
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | | | | | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
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Requena-Méndez A, Buonfrate D, Gomez-Junyent J, Zammarchi L, Bisoffi Z, Muñoz J. Evidence-Based Guidelines for Screening and Management of Strongyloidiasis in Non-Endemic Countries. Am J Trop Med Hyg 2017; 97:645-652. [PMID: 28749768 DOI: 10.4269/ajtmh.16-0923] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Strongyloidiasis is an intestinal parasitic infection becoming increasingly important outside endemic areas, not only because of the high prevalence found in migrant populations, but also because immunosuppressed patients may suffer a potentially fatal disseminated disease. The aim of these guidelines is to provide evidence-based guidance for screening and treatment of strongyloidiasis in non-endemic areas. A panel of experts focused on three main clinical questions (who should be screened and how, how to treat), and reviewed pertinent literature available in international databases of medical literature and in documents released by relevant organizations/societies. A consensus of the experts' opinion was sought when specific issues were not covered by evidence. In particular, six systematic reviews were retrieved and constituted the main support for this work. The evidence and consensus gathered led to recommendations addressing various aspects of the main questions. Grading of evidence and strength of recommendation were attributed to assess the quality of supporting evidence. The screening of individuals at risk of the infection should be performed before they develop any clinical complication. Moreover, in immunosuppressed patients, the screening should be mandatory. The screening is based on a simple and widely accessible technology and there is now a universally accepted treatment with a high efficacy rate. Therefore, the screening could be implemented as part of a screening program for migrants although further cost-effectiveness studies are required to better evaluate this strategy from a public health point of view.
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Affiliation(s)
- Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Dora Buonfrate
- Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Joan Gomez-Junyent
- Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Lorenzo Zammarchi
- Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Universita Degli Studi di Firenze, Florence, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar, Verona, Italy
| | - José Muñoz
- Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
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Shah K, Ferastraoaru D, Jariwala S. Eosinophilia associated with Strongyloides infection, severe asthma, and central bronchiectasis. Ann Allergy Asthma Immunol 2017; 118:510-511. [PMID: 28254204 DOI: 10.1016/j.anai.2017.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Kishan Shah
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - Denisa Ferastraoaru
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Sunit Jariwala
- Division of Allergy and Immunology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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50
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Strongyloidiasis Current Status with Emphasis in Diagnosis and Drug Research. J Parasitol Res 2017; 2017:5056314. [PMID: 28210503 PMCID: PMC5292188 DOI: 10.1155/2017/5056314] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/08/2016] [Indexed: 12/27/2022] Open
Abstract
Strongyloidiasis is a parasitic neglected disease caused by the nematode Strongyloides stercoralis affecting 30 to 100 million people worldwide. Complications, strongly associated with alcoholism, organ transplants, and HTLV-1 virus, often arise due to late diagnosis, frequently leading to patient death. Lack of preemptive diagnosis is not the only difficulty when dealing with this parasite, since there are no gold standard diagnostic techniques, and the ones used have problems associated with sensitivity, resulting in false negatives. Treatment is also an issue as ivermectin and benzimidazoles administration leads to inconsistent cure rates and several side effects. Researching new anti-Strongyloides drugs is a difficult task since S. stercoralis does not develop until the adult stages in Mus musculus (with the exception of SCID mice), the main experimental host model. Fortunately, alternative parasite models can be used, namely, Strongyloides ratti and S. venezuelensis. However, even with these models, there are other complications in finding new drugs, which are associated with specific in vitro assay protocol steps, such as larvae decontamination. In this review, we highlight the challenges associated with new drug search, the compounds tested, and a list of published in vitro assay methodologies. We also point out advances being made in strongyloidiasis diagnosis so far.
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