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Rajamanickam A, Dasan B, Munisankar S, Nott S, Menon PA, Ahamed Shaik F, Chinnaiyan P, Nutman TB, Babu S. Impact of Strongyloides stercoralis infection on complement activation in Type 2 diabetes mellitus: Insights from a clinical and anthelmintic intervention study. PLoS Negl Trop Dis 2024; 18:e0012048. [PMID: 38564496 PMCID: PMC10986927 DOI: 10.1371/journal.pntd.0012048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Numerous studies indicate a potential protective role of helminths in diabetes mellitus (DM) progression. The complement system, vital for host defense, plays a crucial role in tissue homeostasis and immune surveillance. Dysregulated complement activation is implicated in diabetic complications. We aimed to investigate the influence of the helminth, Strongyloides stercoralis (Ss) on complement activation in individuals with type 2 DM (T2D). METHODOLOGY We assessed circulating levels of complement proteins (C1q, C2, C3, C4, C4b, C5, C5a, and MBL (Lectin)) and their regulatory components (Factor B, Factor D, Factor H, and Factor I) in individuals with T2D with (n = 60) or without concomitant Ss infection (n = 58). Additionally, we evaluated the impact of anthelmintic therapy on these parameters after 6 months in Ss-infected individuals (n = 60). RESULTS Ss+DM+ individuals demonstrated reduced levels of complement proteins (C1q, C4b, MBL (Lectin), C3, C5a, and C3b/iC3b) and complement regulatory proteins (Factor B and Factor D) compared to Ss-DM+ individuals. Following anthelmintic therapy, there was a partial reversal of these levels in Ss+DM+ individuals. CONCLUSION Our findings indicate that Ss infection reduces complement activation, potentially mitigating inflammatory processes in individuals with T2D. The study underscores the complex interplay between helminth infections, complement regulation, and diabetes mellitus, offering insights into potential therapeutic avenues.
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Affiliation(s)
| | - Bindu Dasan
- NIH-NIAID-International Center for Excellence in Research, Chennai, India
| | | | - Sujatha Nott
- Infectious Diseases, Dignity Health, Chandler, Arizona, United States of America
| | | | - Fayaz Ahamed Shaik
- NIH-NIAID-International Center for Excellence in Research, Chennai, India
| | | | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Subash Babu
- NIH-NIAID-International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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Salvador F, Treviño B, Sulleiro E, Bosch-Nicolau P, Aznar ML, Goterris L, Espinosa-Pereiro J, Pou D, Sánchez-Montalvá A, Oliveira I, Martínez-Campreciós J, Serre-Delcor N, Sao-Avilés A, Molina I. Epidemiological and clinical trends of imported strongyloidiasis in a referral international health unit, Barcelona, Spain: A 12-year period experience. Travel Med Infect Dis 2024; 58:102690. [PMID: 38246513 DOI: 10.1016/j.tmaid.2024.102690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/20/2023] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Imported strongyloidiasis in non-endemic countries has increasingly been diagnosed. The aim of the present study is to describe the main epidemiological and clinical characteristics of patients with imported strongyloidiasis attended in a referral International Health Unit and to detect trend changes over a 12-year period. METHODS This is an observational retrospective study including all imported strongyloidiasis cases seen at the International Health Unit Vall d'Hebron-Drassanes (Barcelona, Spain) from January 2009 to December 2020. Epidemiological and clinical characteristics from included patients were collected. RESULTS Overall, 865 cases of imported strongyloidiasis were diagnosed, of whom 472 (54.6 %) were men and mean age was 38.7 (SD 13.4) years. Most cases were diagnosed in migrants (830, 96 %). The distribution of the geographic origin was: Latin America (561, 67.6 %), Sub-Saharan Africa (148, 17.8 %), Asia (113, 13.6 %), North Africa (5, 0.6 %), Eastern Europe (2, 0.2 %), and North America (1, 0.1 %). The main reasons for consultation at the Unit were screening of health status (371, 42.9 %), laboratory test alteration (367, 42.4 %), gastrointestinal symptoms (56, 6.5 %), cutaneous symptoms (26, 3 %), and other clinical symptoms (45, 5.2 %). An increase in the number of cases was observed in the last years of the study period. CONCLUSIONS Imported strongyloidiasis has increasingly been diagnosed in our referral unit, mostly due to screening strategies implementation. Most of the patients were young migrants coming from Latin America, with no symptoms at the time of diagnosis. The optimization of screening strategies will increase the detection and treatment of cases, reducing potential complications.
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Affiliation(s)
- Fernando Salvador
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Begoña Treviño
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Sulleiro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Pau Bosch-Nicolau
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Ma Luisa Aznar
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Lidia Goterris
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Juan Espinosa-Pereiro
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Diana Pou
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Adrián Sánchez-Montalvá
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Inés Oliveira
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Joan Martínez-Campreciós
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Núria Serre-Delcor
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Augusto Sao-Avilés
- Information Systems Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Israel Molina
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Gardini G, Froeschl G, Gurrieri F, De Francesco MA, Cattaneo C, Marchese V, Piccinelli G, Corbellini S, Pagani C, Santagiuliana M, Fumarola B, Gulletta M, Perandin F, Castelli F, Matteelli A. Strongyloides stercoralis infection: an underlying cause of invasive bacterial infections of enteric origin. Results from a prospective cross-sectional study of a northern Italian tertiary hospital. Infection 2023; 51:1541-1548. [PMID: 37462896 PMCID: PMC10545639 DOI: 10.1007/s15010-023-02072-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/28/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE OF THE STUDY We assessed the prevalence of S. stercoralis in a cohort of inpatients with invasive bacterial infections of enteric origin to investigate whether the parasite may facilitate these bacterial infections even in the absence of larval hyperproliferation. METHODS We performed a prospective cross-sectional study in a hospital in northern Italy. Subjects admitted due to invasive bacterial infection of enteric origin and potential previous exposure to S. stercoralis were systematically enrolled over a period of 10 months. S. stercoralis infection was investigated with an in-house PCR on a single stool sample and with at least one serological method (in-house IFAT and/or ELISA Bordier). Univariate, bi-variate and logistic regression analyses were performed. RESULTS Strongyloidiasis was diagnosed in 14/57 patients (24.6%; 95% confidence interval 14.1-37.8%) of which 10 were Italians (10/49, 20.4%) and 4 were migrants (4/8, 50.0%). Stool PCR was performed in 43/57 patients (75.4%) and no positive results were obtained. Strongyloidiasis was found to be significantly associated (p ≤ 0.05) with male gender, long international travels to areas at higher endemicity, deep extra-intestinal infectious localization and solid tumors. In the logistic regression model, increased risk remained for the variables deep extra-intestinal infectious localization and oncologic malignancy. CONCLUSIONS Our findings suggest a new role of chronic strongyloidiasis in favoring invasive bacterial infections of enteric origin even in the absence of evident larval dissemination outside the intestinal lumen. Further well-designed studies should be conducted to confirm our results, and possibly establish the underlying mechanisms.
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Affiliation(s)
- Giulia Gardini
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Francesca Gurrieri
- Department of Microbiology and Virology, University Hospital of Brescia, Brescia, Italy
| | | | - Chiara Cattaneo
- Division of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Marchese
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giorgio Piccinelli
- Department of Microbiology and Virology, University Hospital of Brescia, Brescia, Italy
| | - Silvia Corbellini
- Department of Microbiology and Virology, University Hospital of Brescia, Brescia, Italy
| | - Chiara Pagani
- Division of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Benedetta Fumarola
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Maurizio Gulletta
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesca Perandin
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Francesco Castelli
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Matteelli
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
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Lu CJ, Zhang JY, Huang WF. An unusual cause of pneumonia: Strongyloides stercoralis infection. Korean J Intern Med 2023; 38:781-782. [PMID: 37334510 PMCID: PMC10493454 DOI: 10.3904/kjim.2023.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/14/2023] [Accepted: 03/03/2023] [Indexed: 06/20/2023] Open
Affiliation(s)
- Chun-Jing Lu
- Department of Blood Transfusion, Women and Children’s Hospital, School of Medicine, Xiamen University, Xiamen,
Korea
| | - Jin-Yan Zhang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen,
Korea
- The School of Clinical Medicine, Fujian Medical University, Fuzhou,
China
| | - Wei-Feng Huang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen,
Korea
- The School of Clinical Medicine, Fujian Medical University, Fuzhou,
China
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5
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Montreuil N, Sternberg CA, Abaribe O, Ayoade FO. Disseminated Strongyloides stercoralis infection in the setting of Escherichia coli meningitis and bacteraemia in a patient living with HIV on high-dose corticosteroid therapy. BMJ Case Rep 2023; 16:e256105. [PMID: 37643819 PMCID: PMC10465900 DOI: 10.1136/bcr-2023-256105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Strongyloidiasis, a helminth infection caused by Strongyloides stercoralis, can be complicated by hyperinfection, especially in the setting of immunosuppression; however, many patients go undiagnosed. One clue to diagnosis is unexplained gram-negative bacteraemia or meningitis in patients who are immunosuppressed. Serology can be helpful but may be negative in these patients who are immunocompromised.We present the case of a white cisgender man from Central America in his 40s, living with HIV, with a CD4 count of 77 cells/µL. He was diagnosed with Strongyloides hyperinfection after an increase in his steroid dose. He also had Escherichia coli meningitis and bacteraemia. Strongyloidiasis was diagnosed by stool microscopy despite a negative serology test.This case highlights the challenges in diagnosing strongyloidiasis in the setting of immunosuppression. A high index of clinical suspicion is warranted for patients living with HIV on high-dose corticosteroids. Up to three stool microscopy studies for Strongyloides should be sent in addition to serology.
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Affiliation(s)
- Nadine Montreuil
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Candice A Sternberg
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Obinna Abaribe
- Department of Medicine, Infectious Disease Doctors Medical Group APC, Plano, Texas, USA
| | - Folusakin O Ayoade
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Morris CJ, Mosher Z, McKeon A, Jain R. Recurrent Klebsiella bacteremia due to chronic strongyloidiasis in the context of cirrhotic hepatopulmonary syndrome. BMJ Case Rep 2023; 16:e255656. [PMID: 37640414 PMCID: PMC10462951 DOI: 10.1136/bcr-2023-255656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
A woman in her 50s with a medical history of cirrhosis, alcohol use disorder, primary biliary cholangitis and extended spectrum beta lactamase (ESBL) Klebsiella presented with weakness, cough and abdominal pain with positive blood cultures for ESBL Klebsiella, and was treated with intravenous meropenem and patient symptoms improved. Testing for Strongyloides antibodies was positive, so she was treated with ivermectin. Strongyloidiasis-associated Gram-negative rod (GNR) bacteremia are rare conditions; however, it is important to consider an underlying strongyloidiasis in recurrent GNR bacteremia to prevent recurrent hospitalisation and morbidity.
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Affiliation(s)
| | - Zachary Mosher
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Annmarie McKeon
- Penn State College of Medicine, Hershey, Pennsylvania, USA
- Division of Hospitalist Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Rohit Jain
- Penn State College of Medicine, Hershey, Pennsylvania, USA
- Division of Hospitalist Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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Ashiri A, Beiromvand M, Rafiei A, Heidari R, Takesh A. Prevalence of asymptomatic strongyloidiasis co-infection in COVID-19 patients residing in endemic areas. Eur J Med Res 2023; 28:281. [PMID: 37563592 PMCID: PMC10416476 DOI: 10.1186/s40001-023-01262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Fatal forms of strongyloidiasis, hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), are caused by exaggerated autoinfection of the intestinal nematode, Strongyloides stercoralis (S. stercoralis). Corticosteroids, frequently administered to patients with severe COVID-19, can transform chronic asymptomatic strongyloidiasis into the above-mentioned fatal diseases. This study aimed to investigate the prevalence of strongyloidiasis in COVID-19 patients receiving corticosteroids in a hypoendemic region. METHODS The present cross-sectional study enrolled 308 COVID-19 patients admitted to two hospitals in Ahvaz and Abadan in the southwest of Iran between 2020 and 2022. A real-time reverse transcription polymerase chain reaction (RT-PCR) test and chest computed tomography (CT) scan were employed to detect and monitor the disease's severity in the patients, respectively. All patients were evaluated for IgG/IgM against S. stercoralis using Enzyme-linked immunosorbent assay (ELISA) test. Subsequently, individuals with a positive ELISA test were confirmed using parasitological methods, including direct smear and agar plate culture (APC). RESULTS The patients were between 15 and 94 years old, with a mean age of 57.99 ± 17.4 years. Of the 308 patients, 12 (3.9%) had a positive ELISA test, while 296 (96.1%) had negative results. Three of the 12 patients with a positive ELISA result died, and three failed to provide a stool sample. To this end, only six cases were examined parasitologically, in which S. stercoralis larvae were observed in five patients. Significant differences were found between S. stercoralis infection with sex (p = 0.037) and age (p = 0.027). Binary regression analysis revealed that strongyloidiasis was positively associated with sex (odds ratio [OR]: 5.137; 95% confidence interval [CI]: 1.107-23.847), age (OR: 5.647; 95% CI 1.216-26.218), and location (OR: 3.254; 95% CI: 0.864-12.257). CONCLUSIONS Our findings suggest that screening for latent strongyloidiasis in COVID-19 patients in endemic areas using high-sensitivity diagnostic methods, particularly ELISA, before receiving suppressive drugs should be given more consideration.
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Affiliation(s)
- Alireza Ashiri
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Molouk Beiromvand
- Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Abdollah Rafiei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Heidari
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ameneh Takesh
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Vera Torres A, González LP, Mususú WC, Vásquez SV, Cortés Mejía NA, López Panqueva RDP. Case Report: Duodenal Papillary Stenosis Secondary to Strongyloides stercoralis Infection in a Non-Immunocompromised Host. Am J Trop Med Hyg 2023; 109:332-334. [PMID: 37364861 PMCID: PMC10397460 DOI: 10.4269/ajtmh.22-0631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/21/2023] [Indexed: 06/28/2023] Open
Abstract
Strongyloides stercoralis infection is a common infection in tropical and subtropical regions and is considered one of the "neglected tropical diseases." Owing to its life cycle, this infection can remain undetectable for years, preventing an early diagnosis and prompt treatment. We report the case of a 65-year-old woman who presented to us with a history of nausea, abdominal pain, bloating, and weight loss and, after initial radiologic and laboratory workup, was diagnosed with a periampullary mass with no secondary spread. She underwent an uneventful pylorus-preserving pancreatoduodenectomy, and on histopathological study of the lesion, a diagnosis of S. stercoralis infection was confirmed. This case stands out because of the importance of keeping S. stercoralis infections as a differential diagnosis of periampullary masses, particularly when the patient comes from regions where S. stercoralis is prevalent.
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Affiliation(s)
- Alonso Vera Torres
- Hepatobiliary Surgery and Liver Transplantation Services, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Laura Peña González
- Hepatobiliary Surgery and Liver Transplantation Services, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - William Cruz Mususú
- Hepatobiliary Surgery and Liver Transplantation Services, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sergio Valencia Vásquez
- Hepatobiliary Surgery and Liver Transplantation Services, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Nicolás Andrés Cortés Mejía
- Hepatobiliary Surgery and Liver Transplantation Services, University Hospital Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Rocío del Pilar López Panqueva
- Faculty of Medicine, Universidad de los Andes, Bogotá, Colombia
- Pathology and Clinical Laboratory Department, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
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9
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Manh TH, Tran KQL, Ho PT, Vo MM, Pham TQ, Vo TD. Rare Complication of Strongyloidiasis in Vietnam: A Case of Venous Thromboembolism and Duodenal Obstruction. Korean J Gastroenterol 2023; 81:270-275. [PMID: 37350523 DOI: 10.4166/kjg.2023.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/24/2023]
Abstract
Strongyloidiasis, a chronic helminth infection caused by the parasitic nematode Strongyloides stercoralis, has various clinical manifestations. Although rare, duodenal obstructions and venous thromboembolism are possible complications of strongyloidiasis. This paper presents the case of a 47-year-old Vietnamese male with a history of right lower limb edema, anorexia, nausea, vomiting, diarrhea, and abdominal discomfort lasting for four months. Venous Doppler ultrasound detected a thrombus in the right femoral vein, while an abdominal CT scan revealed a mass lesion suggestive of a lower bile duct tumor. Esophageogastroduodenoscopy showed a friable duodenal cap mucosa with multiple ulcers and edematous mucosa of the second part of the duodenum that caused a partial lumen obstruction. The final histological examination of the biopsy specimen revealed chronic duodenitis with larvae consistent with Strongyloides stercoralis. The patient was treated with Ivermectin for two weeks and anticoagulation therapy for three months. After treatment and a six-month follow-up, the patient's gastrointestinal symptoms and leg swelling resolved completely. This is the first documented case of a patient in Vietnam with strongyloidiasis who presented with venous thromboembolism and duodenal obstruction.
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Affiliation(s)
- Tien Huynh Manh
- Department of Internal Medicine, Faculty of Medicine University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Khanh Quoc Le Tran
- Department of Internal Medicine, Faculty of Medicine University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Phat Tan Ho
- Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Man Minh Vo
- Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Thong Quang Pham
- Department of Pathology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Thong Duy Vo
- Department of Internal Medicine, Faculty of Medicine University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
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10
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Barkati S, Greenaway C, Libman M. Strongyloidiasis-related lung involvement: too much of a bad thing. Curr Opin Infect Dis 2023; 36:203-208. [PMID: 37093059 DOI: 10.1097/qco.0000000000000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
PURPOSE OF REVIEW Strongyloidiasis is a soil-transmitted helminthiasis, a neglected tropical disease that affects 300-900 million individuals globally. Strongyloides stercoralis is associated with cutaneous, respiratory, and gastrointestinal clinical manifestations. Chronicity is due to an autoinfective cycle, and host immunosuppression can lead to severe and fatal disease. Lung involvement is significant in severe strongyloidiasis, and Strongyloides has a complex association with a number of lung diseases, which will be discussed in this review. RECENT FINDINGS The treatment of chronic lung diseases such as asthma and chronic obstructive pulmonary disease with corticosteroids is an important risk factor for Strongyloides hyperinfection syndrome (SHS)/disseminated strongyloidiasis. The use of corticosteroids in the treatment of coronavirus disease 2019 (COVID-19) and potentially COVID-19-induced eosinopenia are risk factors for severe strongyloidiasis. Recent findings have demonstrated a significant immunomodulatory role of Strongyloides in both latent and active pulmonary tuberculosis associated to an impaired immune response and poor outcomes in active pulmonary tuberculosis. SUMMARY Strongyloides lung involvement is a common finding in severe infection. Prompt recognition of Strongyloides infection as well as prevention of severe disease by screening or presumptive treatment are important goals in order to improve Strongyloides outcomes in at-risk population.
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Affiliation(s)
- Sapha Barkati
- J.D. MacLean Centre for Tropical Diseases at McGill University
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal
| | - Christina Greenaway
- J.D. MacLean Centre for Tropical Diseases at McGill University
- Division of Infectious Diseases, Department of Medicine
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases at McGill University
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal
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11
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Xiao EY, Pecha RL, Sargsyan Z. Bacteremia, Liver Injury, and Pneumonitis: Strongyloides Unleashed by a Supplement. Am J Med 2023; 136:270-272. [PMID: 36252707 DOI: 10.1016/j.amjmed.2022.09.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Emily Y Xiao
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Robert L Pecha
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Zaven Sargsyan
- Department of Medicine, Baylor College of Medicine, Houston, Texas.
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12
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Oshima R, Matsuhisa T, Kondo T, Sato M, Sato J, Yamamura M. Strongyloidiasis presenting during treatment of low-dose glucocorticoid plus rituximab for anti-signal recognition particle antibody-positive polymyositis: A case report. Mod Rheumatol Case Rep 2023; 7:113-116. [PMID: 36264196 DOI: 10.1093/mrcr/rxac083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
Strongyloidiasis, an intestinal parasitic infection caused by Strongyloides stercoralis, rarely occurs in Japan. When treated with immunosuppressive drugs, two potentially lethal conditions, hyperinfection and dissemination, may develop in asymptomatic carriers of this parasite. We report the development of strongyloidiasis during treatment of polymyositis with glucocorticoids plus rituximab (RTX). A 44-year-old woman had been diagnosed with anti-signal recognition particle antibody-positive polymyositis with interstitial pneumonia 6 years previously, for which she had recently been receiving prednisolone at 5 mg/day and RTX at 375 mg/m2 twice every 3 months. Her condition appeared to be well controlled. She was admitted to our hospital with a 1-month history of chronic diarrhoea and epigastric pain. Standard microscopic examination of a sample of faeces revealed the presence of S. stercoralis; however, serologic testing for parasites was negative. Treatment with ivermectin alleviated her inflammatory diarrhoea and eradicated the faecal parasites. We believe that our patient had an exacerbation of S. stercoralis infection (hyperinfection syndrome) that was exacerbated by low-dose glucocorticoids plus RTX. Strongyloidiasis should be considered in immunocompromised individuals with unexplained diarrhoea, even in non-endemic areas.
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Affiliation(s)
- Ryo Oshima
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takaharu Matsuhisa
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takeshi Kondo
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Motoki Sato
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Juichi Sato
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiro Yamamura
- Department of Rheumatology and Collagen Disease Centre, Okayama Saiseikai General Hospital, Okayama, Japan
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13
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Kathamuthu GR, Rajamanickam A, Sridhar R, Baskaran D, Babu S. Strongyloidiasis stercoralis coinfection is associated with altered iron status biomarkers in tuberculous lymphadenitis. Front Immunol 2022; 13:999614. [PMID: 36341407 PMCID: PMC9632344 DOI: 10.3389/fimmu.2022.999614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/07/2022] [Indexed: 11/26/2022] Open
Abstract
Soil-transmitted helminth [mainly Strongyloidiasis stercoralis (Ss)] and tuberculous lymphadenitis (TBL) coinfection in humans is a significant public health problem. We have previously shown that TBL+Ss+ coinfection significantly alters diverse cytokine, matrix metalloproteinase, and tissue inhibitors of metalloproteinase profiles. However, no data is available to understand the influence of Ss coinfection in TBL disease with respect to iron status biomarkers. Hence, we have studied the effect of Ss coinfection on the circulating levels of iron status (ferritin, transferrin [TF], apotransferrin [ApoT], hepcidin, hemopexin) biomarkers in TBL disease. Our results show that TBL+Ss+ and/or TBL+Ss- individuals are associated with significantly altered biochemical and hematological (red blood cell (RBC) counts, hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) were decreased, and platelets were increased) parameters compared to TBL-Ss+ individuals. Our results also show that TBL+Ss+ coinfection is associated with diminished circulating levels of ferritin, ApoT, hepcidin, and hemopexin compared to TBL+Ss- individuals. TBL+Ss+ and TBL+Ss- groups are associated with altered iron status biomarkers (decreased ferritin [TBL+Ss+ alone] and increased TF, ApoT, hepcidin and hemopexin [TBL+Ss- alone]) compared to TBL-Ss+ group. The heat map expression profile and principal component analysis (PCA) analysis of iron status biomarkers were significantly altered in TBL+Ss+ compared to TBL+Ss- and/or TBL-Ss+ individuals. A significant correlation (positive/negative) was obtained among the biochemical and hematological parameters (white blood cells (WBC)/ferritin, TF, and hepcidin, mean corpuscular hemoglobin concentration (MCHC)/ferritin and hemopexin) with iron status biomarkers. Finally, receiver operating characteristic (ROC) analysis revealed that hemopexin was significantly associated with greater specificity and sensitivity in discriminating TBL+Ss+ and TBL+Ss- coinfected individuals. Thus, our data conclude that Ss coinfection is associated with altered iron status biomarkers indicating that coinfection might alter the host-Mtb interface and could influence the disease pathogenesis.
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Affiliation(s)
- Gokul Raj Kathamuthu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
- Indian Council of Medical Research-National Institute for Research in Tuberculosis (ICMR-NIRT), Chennai, India
- *Correspondence: Gokul Raj Kathamuthu,
| | - Anuradha Rajamanickam
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | | | - Dhanaraj Baskaran
- Indian Council of Medical Research-National Institute for Research in Tuberculosis (ICMR-NIRT), Chennai, India
| | - Subash Babu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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14
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Tan JT, Tseng CW. Strongyloides stercoralis hyperinfection presenting with shock and intermittent eosinophilia: A case report. Medicine (Baltimore) 2022; 101:e30490. [PMID: 36107578 PMCID: PMC9439756 DOI: 10.1097/md.0000000000030490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis. The clinical presentation varies according to the stage of infection. Diagnosing strongyloidiasis is a challenge in clinical practice due to the inconsistency of eosinophilia and the low sensitivity of standard microscopic stool examination. Strongyloides infection presenting with shock is rare. PATIENT CONCERNS In this case, the condition of a 77-year-old immunocompromised patient with intermittent diarrhea progressed to shock and hypoalbuminemia. Reviewing her medical records, we learned that she had experienced intermittent peripheral eosinophilia during the past 10 months. Although a series of examinations were done, the disease progressed and the diagnosis remained uncertain. DIAGNOSIS Using standard microscopic stool examination and gastroduodenscopy with biopsy, a diagnosis of strongyloidiasis was made. INTERVENTIONS After the diagnosis of strongyloidiasis was made, 2 courses of ivermectin were administered. OUTCOMES The patient recovered uneventfully after treatment and there is no recurrence of eosinophilia in 1 year follow-up. LESSONS This report provides a brief review of the current modalities used for diagnosing strongyloidiasis. It emphasizes the low sensitivity of microscopic examination, and highlights the role of gastroduodenoscopy in the diagnosis of strongyloidiasis. This report also assures that patients with strongyloidiasis have a good prognosis when they are treated timely and appropriately.
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Affiliation(s)
- Jih Tze Tan
- School of Medicine, Tzu Chi University, Hualien, Taiwan (R.O.C.)
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan (R.O.C.)
| | - Chih-Wei Tseng
- School of Medicine, Tzu Chi University, Hualien, Taiwan (R.O.C.)
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan (R.O.C.)
- *Correspondence: Chih-Wei Tseng, Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin Township, Chiayi County 622, Taiwan (R.O.C.) (e-mail: )
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15
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Šterbenc A, Šoba B, Glinšek Biškup U, Fister M, Mikuž U, Noč M, Luzar B. Diagnostic challenge of Strongyloides stercoralis hyperinfection syndrome: a case report. Acta Dermatovenerol Alp Pannonica Adriat 2022; 31:79-81. [PMID: 35751537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Strongyloides stercoralis causes chronic, mostly asymptomatic infections but hyperinfection syndrome may occur in immunosuppressed patients, especially in those receiving corticosteroids. We report a case of S. stercoralis hyperinfection syndrome in a solid organ transplant recipient that occurred approximately 2.5 months after heart transplantation. The patient presented to the intensive care unit with acute respiratory distress, bacteremia, and petechial rash on abdomen and toe. Microbiology testing of respiratory samples excluded infection with Pneumocystis jirovecii, respiratory viruses, pathogenic bacteria and fungi. No eosinophilia was found. Histopathological examination of the skin biopsy of the petechial rash provided the first indication of the diagnosis, revealing the presence of isolated filariform S. stercoralis larvae in the dermis. Subsequent microbiology testing confirmed the diagnosis. This case highlights the role of histopathological examination of a skin rash in diagnosing patients with atypical clinical presentation of Strongyloides hyperinfection syndrome.
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Affiliation(s)
- Anja Šterbenc
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Šoba
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Urška Glinšek Biškup
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Miša Fister
- Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Urša Mikuž
- Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Marko Noč
- Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Boštjan Luzar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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16
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Xu L, He Q, Chen L, Lv J, Tang Y, Li Y, Zhang Z, Wen W, Zhong G, Liu H, Fu B. Pulmonary Infection Caused by Strongyloides stercoralis. Acta Parasitol 2022; 67:1044-1048. [PMID: 35175460 DOI: 10.1007/s11686-022-00527-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/01/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Strongyloidiasis is mainly prevalent in developing countries with poor economic and sanitary conditions. The clinical manifestations of Strongyloides stercoralis infection are complex and diverse, lacking specificity, which can easily lead to misdiagnosis and delayed treatment. METHODS An elderly male patient, repeated cough and expectoration for 4 years, with exacerbation and dyspnea for 10 days, was admitted to hospital. Sputum culture and smear were taken for examination. Nematode larvae were found under the microscope. Nematodes were also found in feces. RESULTS Upon confirmation, the patient was diagnosed with a pulmonary infection caused by Strongyloides stercoralis. After treatment with albendazole, the symptoms improved, and the patient was discharged. CONCLUSION In this case report, combination of microscopic examination of sputum and alveolar lavage fluid and CT scan were used to quickly identify the cause of the patient, it provides a diagnostic basis and method for clinical treatment.
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Affiliation(s)
- Lingqing Xu
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511518, Guangdong, People's Republic of China
| | - Qianjun He
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511518, Guangdong, People's Republic of China
| | - Linjuan Chen
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511518, Guangdong, People's Republic of China
| | - Jiaxi Lv
- Department of Clinical Medicine, Fourth Clinical Medical College, Capital Medical University, Beijing, People's Republic of China
| | - Yinxian Tang
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511518, Guangdong, People's Republic of China
| | - Yuzhen Li
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511518, Guangdong, People's Republic of China
| | - Zhongwen Zhang
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511518, Guangdong, People's Republic of China
| | - Weihong Wen
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511518, Guangdong, People's Republic of China
| | - Guoquan Zhong
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511518, Guangdong, People's Republic of China
| | - Hui Liu
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511518, Guangdong, People's Republic of China.
- School of Basic Medical Sciences, Guangzhou Medical University, Panyu, Guangzhou, 511436, Guangdong, People's Republic of China.
| | - Bishi Fu
- Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, 511518, Guangdong, People's Republic of China.
- School of Basic Medical Sciences, Guangzhou Medical University, Panyu, Guangzhou, 511436, Guangdong, People's Republic of China.
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17
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Puerta-Peña M, Calleja Algarra A. Larva Currens in Strongyloides Hyperinfection Syndrome. N Engl J Med 2022; 386:1559. [PMID: 35443110 DOI: 10.1056/nejmicm2115708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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18
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Naidu YV, Calderon Candelario RA, Kett DH. Strongyloides stercoralis hyperinfection syndrome: a known entity in an unknown provenance. BMJ Case Rep 2022; 15:e242698. [PMID: 35410944 PMCID: PMC9003812 DOI: 10.1136/bcr-2021-242698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old man was admitted with altered mental status, high-grade fevers, tachycardia and leucocytosis. Cerebrospinal fluid (CSF) was purulent with a markedly elevated nucleated cell count with neutrophilic predominance, elevated protein and low glucose. CSF gram stain was negative. Patient received vancomycin, cefepime, ampicillin and acyclovir for presumed meningitis. He was intubated for protection of airway and underwent bronchoscopy. Microscopic examination of the bronchoalveolar lavage noted Strongyloides filariform larvae. Ivermectin was prescribed. Other laboratory tests showed a positive HIV test associated with a low CD4 count. Stool ova and parasite also revealed Strongyloides and repeat lumbar puncture identified larvae in the CSF. Albendazole was added for adjunctive therapy. However, the patient suffered a large intraparenchymal haemorrhage extending into the ventricles and he expired 36 days after admission.
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Affiliation(s)
- Yogeeta V Naidu
- Division of Pulmonary & Critical Care, Jackson Memorial Hospital, Miami, Florida, USA
| | - Rafael A Calderon Candelario
- Division of Pulmonary & Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel H Kett
- Department of Pulmonary & Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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19
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Muelas-Fernandez M, Lerida-Urteaga A, Paules-Villar MJ, Vidal-Bel A, Ruiz-Pombo M. Strongyloides hyperinfection in a patient from Venezuela with lower gastrointestinal bleeding. J Travel Med 2022; 29:6287697. [PMID: 34050370 DOI: 10.1093/jtm/taab084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 01/25/2023]
Abstract
We herein present a case of unsuspected Strongyloides stercoralis (Ss) hyperinfection diagnosis. No screening due to origin or immunosuppressed condition had been done and treatment was presumably prescribed lately, with subsequent vital risk for the patient.
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20
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Suwannatrai AT, Thinkhamrop K, Suwannatrai K, Pratumchart K, Wangdi K, Kelly M, Restrepo AMC, Gray DJ, Clements ACA, Tangkawattana S, Sripa B. Opisthorchis viverrini and Strongyloides stercoralis mono- and co-infections: Bayesian geostatistical analysis in an endemic area, Thailand. Acta Trop 2021; 223:106079. [PMID: 34363777 DOI: 10.1016/j.actatropica.2021.106079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/19/2022]
Abstract
Parasitic infections caused by Opisthorchis viverrini and Strongyloides stercoralis remain a major public health threat in the Greater Mekong Sub-region. An understanding of climate and other environmental influences on the geographical distribution and emergence of parasitic diseases is a crucial step to guide targeted control and prevention programs. A parasitological survey was conducted from 2008 to 2013 and included 12,554 individuals (age between 20 and 60 years) from 142 villages in five districts in Khon Kaen Province, Thailand. Geographical information systems, remote sensing technologies and a Bayesian geostatistical framework were used to develop models for O. viverrini and S. stercoralis mono- and co-infections in areas where both parasites are known to co-occur. The results indicate that male sex, increased age, altitude, precipitation, and land surface temperature have influenced the infection rate and geographical distribution of mono- and co-infections of O. viverrini and S. stercoralis in this area. Males were 6.69 times (95% CrI: 5.26-8.58) more likely to have O. viverrini - S. stercoralis co-infection. We observed that O. viverrini and S. stercoralis mono-infections display distinct spatial pattern, while co-infection is predicted in the center and southeast of the study area. The observed spatial clustering of O. viverrini and S. stercoralis provides valuable information for the spatial targeting of prevention interventions in this area.
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Affiliation(s)
- Apiporn T Suwannatrai
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Health and Epidemiology Geoinformatics Research (HEGER), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
| | - Kavin Thinkhamrop
- Health and Epidemiology Geoinformatics Research (HEGER), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand; Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Kulwadee Suwannatrai
- Department of Biology, Faculty of Science and Technology, Sakon Nakhon Rajabhat University, Sakon Nakhon, Thailand
| | - Khanittha Pratumchart
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Health and Epidemiology Geoinformatics Research (HEGER), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Matthew Kelly
- Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Angela M Cadavid Restrepo
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia; Telethon Kids Institute, Nedlands, WA, Australia
| | | | - Banchob Sripa
- WHO Collaborating Centre for Research and Control of opisthorchiasis, Tropical Disease Research Center, Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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21
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Latif Z, Crupie MJ. Chronic strongyloidiasis: a case of B symptoms and recurrent asthma exacerbations. BMJ Case Rep 2020; 13:e238163. [PMID: 33318254 PMCID: PMC7737066 DOI: 10.1136/bcr-2020-238163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2020] [Indexed: 12/15/2022] Open
Abstract
Strongyloidiasis is one of the neglected helminths infection that is often underdiagnosed and undertreated. Due to its variable presentation, its diagnosis is often a challenge. We report a case of an immigrant patient with asthma who later developed eosinophilia. After 3 years of unexplained eosinophilia, he developed B symptoms and had frequent asthma exacerbations. He was later diagnosed with strongyloidiasis and treated with ivermectin. His B symptoms resolved, and his asthma exacerbations decreased significantly. Due to the frequent use of corticosteroids in asthma exacerbations, this case illustrates the importance of Strongyloides screening in asthmatics from high-risk regions. It also displays the importance of further investigating patients with asthma who develop eosinophilia and have frequent exacerbations while on optimal asthma treatment. Having a high index of suspicion is essential when making this diagnosis, as clinical presentation is often variable and does not follow a standard time course.
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Affiliation(s)
- Zara Latif
- Department of Internal Medicine, BIDMC, Boston, Massachusetts, USA
| | - Marc J Crupie
- Department of Family Medicine, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
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22
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Abstract
In this visual case of Strongyloides stercoralis disseminated infection with Enterobacteriaceae-related invasive infection, we demonstrated the in-host S. stercoralis circulation with DNA found in different fluids and specimens, but also in cerebrospinal fluid (CSF), supporting the role of migrant larvae in the Enterobacteriaceae-related invasive and central nervous system infection.
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Affiliation(s)
- Ambroise Le Pogam
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Julien Lopinto
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Adrien Pecriaux
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service Anatomie et Cytologie Pathologiques, Hôpital Saint-Antoine, Paris, France
| | - Muriel Fartoukh
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
| | - Juliette Guitard
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Mycologie-Parasitologie, Hôpital Saint-Antoine, Paris, France
- Sorbonne Université, INSERM UMR S 938, Centre de Recherche Saint Antoine (CRSA), Paris, France
| | - Guillaume Voiriot
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Hôpital Tenon, Paris, France
- * E-mail:
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23
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Prior-Español Á, Roure S, Mateo L, Martínez-Morillo M. Anaemia and Eosinophilia Secondary to Strongyloides in a Patient Treated with Anti-TNF-Alpha. Reumatol Clin (Engl Ed) 2020; 16:508-509. [PMID: 30598411 DOI: 10.1016/j.reuma.2018.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Águeda Prior-Español
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
| | - Silvia Roure
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Lourdes Mateo
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Melania Martínez-Morillo
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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Ashida C, Kinoshita K, Nozaki Y, Funauchi M. Fatal outcome in a patient under immunosuppressant therapy infected with human T-lymphotropic virus type 1 (HTLV-1), cytomegalovirus (CMV) and Strongyloides stercoralis: a case report. BMC Infect Dis 2020; 20:470. [PMID: 32615937 PMCID: PMC7331000 DOI: 10.1186/s12879-020-05195-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/24/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Strongyloidiasis is a gastrointestinal parasitic infection caused by percutaneous infection with Strongyloides stercoralis. Digestive symptoms such as diarrhea and abdominal pain are the main manifestation, but serious infections such as septicemia, purulent meningitis, and bacterial pneumonia may occur in individuals harboring human T-lymphotropic virus type 1 (HTLV-1) or who are immunocompromised. Although coinfection with Strongyloides stercoralis and HTLV-1 can lead to chronic strongyloidiasis and a disseminated form of the disease, there is a high rate of response to the anthelmintic ivermectin. CASE PRESENTATION We report a case of strongyloidiasis infection syndrome that was difficult to differentiate from immune reconstitution inflammatory syndrome (IRIS) for various reasons. The patient had been treated with the corticosteroids tacrolimus (Tac) and mycophenolate mofetil (MMF) for systemic lupus erythematosus (SLE) with lupus nephritis and pancytopenia. When the steroid was reduced, she developed cytomegalovirus (CMV) enteritis, and her respiratory status rapidly deteriorated immediately after the withdrawal of Tac and MMF. It was difficult to distinguish immune reconstitution inflammatory syndrome from strongyloidiasis infection syndrome because stool cultures were negative and eosinophils were not increased. Bronchoscopy revealed viable Strongyloides, leading to a diagnosis of strongyloidiasis infection syndrome, but the patient died despite treatment. CONCLUSIONS Both corticosteroid therapy and HTLV-1 infection can be associated with a decrease of eosinophils, despite the presence of parasitic infection. In conclusion, even if multiple culture tests are negative, the risk of parasitic infection should be assessed in patients receiving immunosuppressants and steroids even in non-endemic areas.
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Affiliation(s)
- Chisato Ashida
- Department of Hematology and Rheumatology, Kindai University School of Medicine, 377-2 Oonohigashi, Osaka-Sayama, Osaka, 589-0014, Japan.
| | - Koji Kinoshita
- Department of Hematology and Rheumatology, Kindai University School of Medicine, 377-2 Oonohigashi, Osaka-Sayama, Osaka, 589-0014, Japan
| | - Yuji Nozaki
- Department of Hematology and Rheumatology, Kindai University School of Medicine, 377-2 Oonohigashi, Osaka-Sayama, Osaka, 589-0014, Japan
| | - Masanori Funauchi
- Department of Hematology and Rheumatology, Kindai University School of Medicine, 377-2 Oonohigashi, Osaka-Sayama, Osaka, 589-0014, Japan
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Rothe K, Katchanov J, Schneider J, Spinner CD, Phillip V, Busch DH, Tappe D, Braren R, Schmid RM, Slotta-Huspenina J. Strongyloides stercoralis hyperinfection syndrome presenting as mechanical ileus after short-course oral steroids for chronic obstructive pulmonary disease (COPD) exacerbation. Parasitol Int 2020; 76:102087. [PMID: 32087332 DOI: 10.1016/j.parint.2020.102087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 12/14/2022]
Abstract
We report a case of a fatal Strongyloides stercoralis hyperinfection syndrome (SHS) in a migrant from Kenya, who had been living in Germany for three decades. A short-course oral steroid treatment for Chronic Obstructive Pulmonary Disease (COPD) exacerbation had been administered four weeks prior to the presentation. The initial clinical and radiological findings suggested a mechanical small bowel obstruction as a cause of ileus. Our case highlights the importance of maintaining a high index of suspicion for strongyloidiasis in patients from endemic areas even years after they left the country of origin. It demonstrates that even a five-day course of prednisolone is able to trigger SHS in patients with underlying strongyloidiasis. History of frequent previous administration of oral prednisolone for COPD exacerbations in our case raises the question why and how the last steroid regimen provoked SHS. SHS can present with multiple gastrointestinal symptoms including ileus and the absence of eosinophilia during the whole course of the disease should not lower the level of suspicion in the appropriate clinical setting.
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Affiliation(s)
- Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany.
| | - Juri Katchanov
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Christoph D Spinner
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Veit Phillip
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk H Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany; German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Rickmer Braren
- Department of Radiology, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
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Elzein F, Albahili H, Bahloul A, Alonazi T, Alghamdi A, Alsufyani E, Musa A, Alsaeed M. Transplant-related strongyloidiasis in solid organ transplant recipients in Saudi Arabia and the Gulf Cooperation Council countries. Int J Infect Dis 2020; 93:133-138. [PMID: 31982623 DOI: 10.1016/j.ijid.2020.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Strongyloidiasis is a devastating disease with a mortality rate exceeding 50% in immunocompromised patients. The disease usually results from reactivation of a latent infection in a transplant patient. Alternatively, donor-derived transmission of Strongyloides may occur. METHODS In this review, we report a case of Strongyloides hyperinfection syndrome in a liver transplant recipient to illustrate the severity of this infection. Following this, PubMed was searched for cases of transplant-related strongyloidiasis in the Gulf Cooperation Council (GCC) countries. Demographic data, the clinical presentation of recipients, and donor information were recorded. Methods of diagnosis, treatment planning, and clinical outcomes were documented. RESULTS A total of 12 transplant-related strongyloidiasis cases were identified. Seventy-five percent of the patients were from Saudi Arabia. Three cases from Kuwait shared common donors. All donors were deceased and native to an area endemic for Strongyloides. Five of the patients shared common donors, raising the possibility of donor-derived infection. Neither the donors nor the recipients underwent screening tests for Strongyloides. Concomitant bacteremia and/or meningitis was seen in 50% of cases (6/12). Moreover, when documented, sepsis was detected in all of the patients who died (three cases). The mortality rate in this series was high (41.7%). CONCLUSIONS Since this is a preventable condition, early diagnosis and treatment is essential. The screening and treatment of potential transplant recipients and donors proved to be an effective preventive measure. There is a growing need for further studies and implementation of screening policies in the GCC countries to prevent this fatal infection.
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Affiliation(s)
- Fatehi Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.
| | - Hamad Albahili
- Liver Transplant Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Abdelkarim Bahloul
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Thamer Alonazi
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Adnan Alghamdi
- Intensive Care Services Department, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Eid Alsufyani
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Abdullatif Musa
- Liver Transplant Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Mohammed Alsaeed
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
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Affiliation(s)
- Robert C Lowe
- From the Department of Medicine, Boston Medical Center (R.C.L.), the Department of Medicine, Boston University School of Medicine (R.C.L.), the Departments of Medicine (J.N.C., A.A.W.), Radiology (T.T.P.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (J.N.C., A.A.W.), Radiology (T.T.P.), and Pathology (J.A.B.), Harvard Medical School - all in Boston
| | - Jacqueline N Chu
- From the Department of Medicine, Boston Medical Center (R.C.L.), the Department of Medicine, Boston University School of Medicine (R.C.L.), the Departments of Medicine (J.N.C., A.A.W.), Radiology (T.T.P.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (J.N.C., A.A.W.), Radiology (T.T.P.), and Pathology (J.A.B.), Harvard Medical School - all in Boston
| | - Theodore T Pierce
- From the Department of Medicine, Boston Medical Center (R.C.L.), the Department of Medicine, Boston University School of Medicine (R.C.L.), the Departments of Medicine (J.N.C., A.A.W.), Radiology (T.T.P.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (J.N.C., A.A.W.), Radiology (T.T.P.), and Pathology (J.A.B.), Harvard Medical School - all in Boston
| | - Ana A Weil
- From the Department of Medicine, Boston Medical Center (R.C.L.), the Department of Medicine, Boston University School of Medicine (R.C.L.), the Departments of Medicine (J.N.C., A.A.W.), Radiology (T.T.P.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (J.N.C., A.A.W.), Radiology (T.T.P.), and Pathology (J.A.B.), Harvard Medical School - all in Boston
| | - John A Branda
- From the Department of Medicine, Boston Medical Center (R.C.L.), the Department of Medicine, Boston University School of Medicine (R.C.L.), the Departments of Medicine (J.N.C., A.A.W.), Radiology (T.T.P.), and Pathology (J.A.B.), Massachusetts General Hospital, and the Departments of Medicine (J.N.C., A.A.W.), Radiology (T.T.P.), and Pathology (J.A.B.), Harvard Medical School - all in Boston
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Hosoda T, Sakamoto M, Orikasa H, Kubomura A, Misaki T, Okabe N. Septic Meningitis and Liver Abscess due to Hypermucoviscous Klebsiella pneumoniae Complicated with Chronic Strongyloidiasis in a Human T-lymphotropic Virus 1 Carrier. Intern Med 2020; 59:129-133. [PMID: 31434825 PMCID: PMC6995716 DOI: 10.2169/internalmedicine.3403-19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Recently, severe cases of infection due to hypermucoviscous Klebsiella pneumonia (hmKP) have been reported in Japan. The Amami Islands in Japan are also endemic regions for Strongyloides stercoralis. Disseminated strongyloidiasis strain often causes severe enterobacteria infection; however, whether or not chronic strongyloidiasis induces it remains unclear. We herein report a 71-year-old man who developed meningitis and liver abscess due to hmKP complicated with chronic strongyloidiasis. He died on the seventh hospital day. Strongyloides stercoralis were only found around the polyp in the cecum. Chronic strongyloidiasis can also induce severe infection due to enterobacteria, especially hypervirulent pathogens like hmKP, through the induction of mucosal rupture.
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Affiliation(s)
- Tomohiro Hosoda
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, Japan
| | - Mitsuo Sakamoto
- Department of Infectious Disease, Kawasaki Municipal Kawasaki Hospital, Japan
| | - Hideki Orikasa
- Department of Pathology, Kawasaki Municipal Kawasaki Hospital, Japan
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Beltrán Rosel A, Sanjoaquín Conde I, Pérez Muñoz A, Alcalá PM, Marta CB, Irigoyen von Sierakowski A. Strongyloides stercoralis: a rare and severe presentation in a pregnant woman. New Microbiol 2020; 43:44-46. [PMID: 31814031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 04/04/2020] [Indexed: 06/10/2023]
Abstract
Strongyloides stercoralis is a parasitic nematode with a worldwide distribution. It can go from an asymptomatic infection to a life-threatening hyperinfection syndrome. Here, we report a case of intestinal obstruction due to S. stercoralis in a pregnant woman. This condition, as well as severe strongyloidiasis in pregnant women, is seldomly reported. In this case, Human T-lymphotropic Virus 1 (HTLV-1) coinfection was confirmed, a well-known risk factor for a more severe presentation of strongyloidiasis. We suggest that HTLV status should be screened in every severe S. stercoralis infection, or when, despite a correct treatment, a relapse is observed.
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Affiliation(s)
| | | | - Ana Pérez Muñoz
- Department of Obstetrics and Gynecology, Lozano Blesa University Hospital. Zaragoza, Spain
| | | | - Carlo B Marta
- Department of Pathology, Lozano Blesa University Hospital. Zaragoza, Spain
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Malpica L, White AC, Leguia C, Freundt N, Barros N, Chian C, Antunez EA, Montes M. Regulatory T cells and IgE expression in duodenal mucosa of Strongyloides stercoralis and human T lymphotropic virus type 1 co-infected patients. PLoS Negl Trop Dis 2019; 13:e0007415. [PMID: 31170141 PMCID: PMC6581271 DOI: 10.1371/journal.pntd.0007415] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 06/18/2019] [Accepted: 04/28/2019] [Indexed: 12/20/2022] Open
Abstract
Background Strongyloides stercoralis is an intestinal nematode unique in its ability to replicate in the human host, allowing ongoing cycles of autoinfection, persisting for decades within the same host. Although usually asymptomatic, overwhelming infections can occur in Strongyloides and HTLV-1 co-infected individuals (SS/HTLV-1). Regulatory T cells (Tregs) are able to blunt specific Th2 responses necessary to control the parasite. We previously reported that peripheral blood Tregs are increased in SS/HTLV-1 and correlate with low Th2 responses. We hypothesized that Tregs are also increased at the site of infection in duodenal mucosa. Methods Paraffin embedded duodenal biopsies were obtained from 10 SS/HTLV-1 patients, 3 controls with non-parasitic chronic duodenitis, and 2 healthy controls. Immunohistochemistry was performed using monoclonal antibodies against human CD3, CD8, IgE and FoxP3. The number of cells were counted using a conventional light microscope. The number of CD3+, CD8+, FoxP3+ and IgE positive cells per 0.35 mm2 was measured using ImagePro Plus software comparing areas adjacent or distant from parasite material. Results In patients with SS/HTLV-1, T lymphocyte counts and CD8+ cells were lower in areas adjacent to the parasite compared to non-adjacent areas (CD3+: adjacent: 6.5 [Interquartile range (IQR: 2.8–12.3)]; non-adjacent: 24.5 [IQR: 20.9–34.4]; Mann-Whitney p = 0.0003; CD8+: adjacent: 4.5 [IQR: 2.3–11.8]; non-adjacent: 21 [IQR: 15.3–42.9]; Mann-Whitney p = 0.0011). Tregs cells in the intestines (FoxP3+ expressing cells) were increased in patients with SS/HTLV-1 compared with patients with chronic duodenitis (SS/HTLV-1: 1.5 [IQR: 0.7–2.3]; duodenitis controls: 0 [range 0–0.7]; healthy controls: 0; Mann-Whitney p = 0.034). There was also a trend towards fewer eosinophils adjacent to the parasites. Among SS/HTLV-1 patients the number of IgE expressing cells was increased for in areas not adjacent to the parasite compared to non-adjacent areas (ANOVA, p = 0.001). Conclusions Our data shows increased Treg cell numbers localized adjacent to the parasites in the duodenum SS/HTLV-1 patients. In addition, other T lymphocytes and IgE expressing cells were decreased adjacent to the parasites, suggesting an important role for Tregs in down-regulating local parasite effector responses. Strongyloidiasis is a parasitic infection found worldwide in warm, moist climates. In most people, Strongyloides causes a mild and chronic infection with few symptoms. However, some patients, including those infected with the Human T Lymphotrophic Virus 1 (HTLV-1), can get uncontrolled disease called hyperinfection, which can be fatal. To help determine why this infection is so serious in co-infected patients, we studied biopsies obtained from the small intestine from patients with both infections and compared them to control biopsies. The biopsies from patients with both Strongyloides and HTLV-1 had increased numbers of white blood cells in their biopsies. In particular they displayed a type of lymphocyte that downregulates immune responses. Some of them had increased numbers of cells called eosinophils in the intestines. These cells can help eliminate Strongyloides. However, they were not found near the parasite, suggesting that something near the parasite was suppressing the host response that would control infection. These studies provide more evidence that HTLV-1 suppresses the host response that controls Strongyloides and that the suppression occurs at the site of infection in the small intestines.
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Affiliation(s)
- Luis Malpica
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - A. Clinton White
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch at Galveston, Texas, United States of America
| | - Cristina Leguia
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Natalia Freundt
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nicolas Barros
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Chian
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Patología, Hospital Nacional Arzobispo Loayza in Lima, Peru
| | - E. Antonio Antunez
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Departamento de Patología, Hospital Nacional Arzobispo Loayza in Lima, Peru
| | - Martin Montes
- Instituto de Medicina Tropical ‘Alexander von Humboldt’, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Internal Medicine, Division of Infectious Diseases, University of Texas Medical Branch at Galveston, Texas, United States of America
- * E-mail:
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Salvador F, Treviño B, Chamorro-Tojeiro S, Sánchez-Montalvá A, Herrero-Martínez JM, Rodríguez-Guardado A, Serre-Delcor N, Torrús D, Goikoetxea J, Zubero Z, Velasco M, Sulleiro E, Molina I, López-Vélez R, Pérez-Molina JA. Imported strongyloidiasis: Data from 1245 cases registered in the +REDIVI Spanish Collaborative Network (2009-2017). PLoS Negl Trop Dis 2019; 13:e0007399. [PMID: 31095570 PMCID: PMC6541302 DOI: 10.1371/journal.pntd.0007399] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/29/2019] [Accepted: 04/17/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Imported strongyloidiasis is increasingly being diagnosed in non-endemic areas. The aim of this study was to describe the epidemiological, clinical and microbiological characteristics of patients with imported strongyloidiasis in Spain. METHODOLOGY This is an observational retrospective study that included all patients diagnosed of strongyloidiasis registered in the +REDIVI Collaborative Network from 2009 to 2017. Demographic, epidemiological and clinical information was collected from the +REDIVI database, and extra information regarding microbiological techniques, treatment and follow-up was requested to participant centers. FINDINGS Overall, 1245 cases were included. Most of them were immigrants (66.9%), and South America was the most frequent area of origin. Detection of larvae in stool samples was observed in 21.9% of the patients, and serological tests allowed making the diagnosis in the rest of the cases. Eosinophilia was present in 82.2% of cases. Treatment with ivermectin (compared with albendazole) was the most strongly associated factor to achieve the cure (OR 2.34). CONCLUSIONS Given the long latency of the infection and the risk of developing a severe presentation, screening of S. stercoralis infection should be mandatory in patients coming from or had traveling to endemic areas, especially in those with immunosuppressant conditions.
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Affiliation(s)
- Fernando Salvador
- Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
- * E-mail:
| | - Begoña Treviño
- Tropical Medicine and International Health Unit Drassanes-Vall d’Hebron, PROSICS Barcelona, Barcelona, Spain
| | | | - Adrián Sánchez-Montalvá
- Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | | | | | - Núria Serre-Delcor
- Tropical Medicine and International Health Unit Drassanes-Vall d’Hebron, PROSICS Barcelona, Barcelona, Spain
| | - Diego Torrús
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | - María Velasco
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Elena Sulleiro
- Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Israel Molina
- Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
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Vasquez-Rios G, Pineda-Reyes R, Ruiz EF, Terashima A, Mejia F. Strongyloides stercoralis infection after the use of emergency corticosteroids: a case report on hyperinfection syndrome. J Med Case Rep 2019; 13:121. [PMID: 31030665 PMCID: PMC6487532 DOI: 10.1186/s13256-019-2022-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In clinical practice, identification of a case of severe asthma exacerbation prompts initiation of corticosteroids. However, not all that wheezes is asthma. CASE PRESENTATION A 61-year-old man from the Peruvian Amazon presented with progressive dyspnea, abdominal pain, and cough for the past week. His medical history was remarkable for asthma since childhood; he was treated with beta-agonists, ipratropium, and orally administered corticosteroids. On evaluation, he was febrile and ill-appearing. His chest examination revealed diffuse wheezing and bilateral crackles. He was diagnosed as having community-acquired pneumonia and asthma exacerbation and was started on empiric antibiotics, nebulized beta-agonists, and orally administered corticosteroids. His clinical status continued deteriorating and he became critically ill despite broad-spectrum antibiotics and antifungals. Considering the epidemiological background of our patient, bronchoalveolar and fecal samples were obtained to investigate soil-transmitted helminths. Larvae of Strongyloides stercoralis were found in both specimens. Ivermectin was initiated and corticosteroids were discontinued. He experienced remarkable improvement of clinical condition over the next weeks. The literature on this topic was reviewed. CONCLUSION Cases of severe asthma exacerbation warrant careful evaluation before the initiation of corticosteroids, especially in patients at risk for parasitic infections. A high index of suspicion is critical. Alternative etiologies of respiratory decompensation should be considered in patients who fail to improve with broad-spectrum antibiotics and antifungals.
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Affiliation(s)
- George Vasquez-Rios
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO USA
- Laboratory of Parasitology, Tropical Medicine Institute Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Roberto Pineda-Reyes
- Laboratory of Parasitology, Tropical Medicine Institute Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eloy F. Ruiz
- CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angelica Terashima
- Laboratory of Parasitology, Tropical Medicine Institute Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Fernando Mejia
- Laboratory of Parasitology, Tropical Medicine Institute Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
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Pan D, Arkell P, Stone NRH, Parkinson B, Tinwell B, Cosgrove CA. Delayed Strongyloides stercoralis hyperinfection syndrome in a renal transplant patient with Pneumocystis jirovecii pneumonia receiving high-dose corticosteroids. Lancet 2019; 393:1536. [PMID: 30983588 DOI: 10.1016/s0140-6736(19)30708-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 12/14/2018] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Daniel Pan
- Clinical Infection Unit, St George's Hospital, London, UK.
| | - Paul Arkell
- Clinical Infection Unit, St George's Hospital, London, UK
| | - Neil R H Stone
- Clinical Infection Unit, St George's Hospital, London, UK
| | | | - Brendan Tinwell
- London Southwest Pathology, St George's Hospital, London, UK
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Abstract
BACKGROUND Strongyloides stercoralis is an intestinal helminth. Parasitism is caused by penetration of the larvae through the skin. It is endemic in tropical and subtropical regions of the world and in the United States occurs in the southeastern region. It has a tendency to remain dormant or progress to a state of hyper-infection during immunosuppression. CASE REPORT We present the case of a 70-year-old Nigerian who developed fatal ARDS secondary to Strongyloides infection after been treated with steroids for treatment of autoimmune necrotizing myopathy. Despite adequate management with mechanical ventilation and appropriate antifungal therapy, the patient died on day 19 of hospitalization. CONCLUSIONS S. stercoralis is known to affect every organ in the body. ARDS is often an overlooked complication of Strongyloides hyper-infection, which is often deadly. Immediate diagnosis and treatment are important for patient survival.
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Affiliation(s)
- Christopher Nnaoma
- Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, NJ, U.S.A
- Corresponding Author: Christopher Nnaoma, e-mai:
| | | | - Christian Engell
- Department of Infectious Diseases, Newark Beth Israel Medical Center, Newark, NJ, U.S.A
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Kathamuthu GR, Munisankar S, Sridhar R, Baskaran D, Babu S. Helminth mediated modulation of the systemic and mycobacterial antigen - stimulated cytokine profiles in extra-pulmonary tuberculosis. PLoS Negl Trop Dis 2019; 13:e0007265. [PMID: 30897083 PMCID: PMC6445485 DOI: 10.1371/journal.pntd.0007265] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/02/2019] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
Background Helminth infections are known to regulate cytokine responses in both pulmonary and latent tuberculosis infection. Whether helminth infections also modulate cytokine responses in extra-pulmonary tuberculosis, specifically tuberculous lymphadenitis (TBL), has not been examined thus far. Methodology Hence, to determine the cytokine profile in helminth-TBL coinfection, we measured the systemic and mycobacterial (TB)–antigen stimulated levels of Type 1, Type 2, Type 17, regulatory and pro-inflammatory cytokines in TBL individuals coinfected with or without Strongyloides stercoralis (Ss) infection. Significant findings TBL-Ss+ individuals have significantly higher bacterial burdens in the affected lymph nodes in comparison to TBL-Ss- individuals. TBL-Ss+ individuals exhibit significantly enhanced plasma levels of Type 2 (IL-5 and IL-13), Type 17 (IL-17 and IL-22) and regulatory (IL-10) cytokines in comparison to TBL-Ss- individuals. In contrast, TBL-Ss+ individuals exhibit significantly diminished plasma levels of pro-inflammatory cytokines (IL-1α and GM-CSF) in comparison to TBL-Ss- individuals. TBL-Ss+ individuals also exhibit significantly diminished unstimulated or mycobacterial—antigen stimulated levels of Type 1, Type 17 or IL-1 family cytokines in comparison to TBL-Ss- individuals but no differences in mitogen stimulated cytokine levels. Conclusion Therefore, our data reveal a profound influence of Ss infection on the bacteriological profile of TBL and suggesting that the underlying modulation of cytokine responses might be a mechanism by which this helminth infection could impart a detrimental effect on the pathogenesis of TBL disease. Strongyloides stercoralis (Ss) infects about 30–100 million people worldwide and it is the main causative agent of strongyloidiasis, a chronic parasitic infection. Similarly, tuberculosis (TB) affects nearly 2 billion people and both Ss and TB are co-endemic as well as share a major global disease burden. Earlier studies have revealed that helminth co-infection can modify the effect produced by the host immunity against Mycobacterium tuberculosis. However, no studies have examined the association of helminth co-infection with extra-pulmonary TB, especially in tuberculous lymphadenitis (TBL). In the present study, we have addressed this gap by measuring the cytokine profile in co-infected helminth-TBL individuals. Our study first shows that TBL-Ss+ co-infection is associated with “higher bacterial burden” in the affected lymph nodes. Our study also shows that co-infection is associated with alterations in plasma cytokines, specifically Type 2, regulatory and Type 17 cytokines were elevated and pro-inflammatory cytokines were reduced. Our study demonstrates significantly diminished unstimulated or TB—antigen stimulated levels of Type 1, Type 17 or IL-1 family of cytokines in TBL-Ss+ coinfected individuals. Hence, we conclude that helminth coinfection can possibly skew the protective immunity in TBL disease or infection.
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Affiliation(s)
- Gokul Raj Kathamuthu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
- * E-mail:
| | - Saravanan Munisankar
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
| | | | - Dhanaraj Baskaran
- National Institute for Research in Tuberculosis (NIRT), Chennai, India
| | - Subash Babu
- National Institutes of Health-NIRT-International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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Naspolini AP, Rocha Barone C, Prieto Herman Reinehr C, Bakos RM. Periumbilical purpura: dermatoscopic findings in disseminated strongyloidiasis. Int J Dermatol 2018; 57:e30-e31. [PMID: 29740812 DOI: 10.1111/ijd.14033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 01/11/2023]
Affiliation(s)
- Ana P Naspolini
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carolina Rocha Barone
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Renato M Bakos
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Tariq H, Kamal MU, Reddy P, Bajantri B, Niazi M, Matela A, Zeana C, Ihimoyan A, Dev A, Chilimuri S. Anemia, intractable vomiting, chronic diarrhea, and syndrome of inappropriate antidiuretic secretion: a diagnostic dilemma: Disseminated strongyloidosis in a patient with newly diagnosed HTLV infection-case report and review of literature. Medicine (Baltimore) 2017; 96:e9229. [PMID: 29384908 PMCID: PMC6392699 DOI: 10.1097/md.0000000000009229] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Strongyloidiasis hyperinfection and disseminated disease have high mortality rates due to several complications and early detection of Strongyloides infection is therefore prudent. PATIENT CONCERNS A 37-year-old male patient came with chronic diarrhea, intractable vomiting and was found to have hyponatremia, and anemia on the initial laboratory tests. DIAGNOSES Further work up revealed syndrome of inappropriate antidiuretic secretion to be the cause of the hyponatremia in addition to gastrointestinal loses. His hospital course was complicated by persistent hyponatremia and later development of partial small bowel obstruction. INTERVENTIONS Considering his symptoms we had a suspicion of small bowel pathology for which he underwent an esophagogastroduodenoscopywith biopsies that revealed strongyloidosis as the cause of his symptoms. He was also found to have human T-cell lymphotropic virus infection, likely contributing to the disseminated disease. OUTCOMES He was started on ivermectin with complete resolution of symptoms and improvement of hyponatremia. LESSONS It is very important to suspect Strongyloides infection in a patient presenting with syndrome ofinappropriate antidiuretic secretion as hyperinfection and disseminated disease can be life threatening without antihelmintic therapy.
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Affiliation(s)
| | | | | | | | - Masooma Niazi
- Department of Pathology, Bronx Lebanon Hospital Center, Bronx, NY
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Salvador F, Sulleiro E, Piron M, Sánchez-Montalvá A, Sauleda S, Molina I. Seroprevalence of Strongyloides stercoralis infection among HTLV-I infected blood donors in Barcelona, Spain: A cross-sectional study. Acta Trop 2017; 176:412-414. [PMID: 28939495 DOI: 10.1016/j.actatropica.2017.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 09/18/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022]
Abstract
Strongyloides stercoralis infection in patients with HTLV-I infection may lead to severe clinical manifestations. The aim of the present study is to determine the seroprevalence of S. stercoralis infection among blood donors who tested positive for HTLV-I infection. A cross-sectional study was performed at the Vall d'Hebron University Hospital (Barcelona, Spain) in 2016. Serum samples from HTLV-I positive patients diagnosed from 2008 to 2015 were retrieved from the Blood Bank, and S. stercoralis serology was performed. Thirty six serum samples from HTLV-I positive patients were retrieved from the Blood Bank. The blood samples came from 36 blood donors, and most of them were born in Latin America (75%), being Peru the most frequent country (11 participants). S. stercoralis serology was positive in one patient, corresponding to a prevalence of 2.8% (3.4% if we exclude donors coming from European countries, where the risk of S. stercoralis infection is highly unlikely).
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Affiliation(s)
- Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain.
| | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron University Hospital,PROSICS Barcelona, Barcelona, Spain
| | - Maria Piron
- Catalan Blood and Tissue Bank (Banc de Sang i Teixits de Catalunya), Transfusion Safety Laboratory, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREhd), Instituto de Salud Carlos III, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Silvia Sauleda
- Catalan Blood and Tissue Bank (Banc de Sang i Teixits de Catalunya), Transfusion Safety Laboratory, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREhd), Instituto de Salud Carlos III, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
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Hernández Cancela RM, Pombo Otero J, Concha-Lopez A. A case of multifocal medulloblastoma in an adult patient. Rev Esp Patol 2017; 50:45-48. [PMID: 29179964 DOI: 10.1016/j.patol.2015.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 11/15/2022]
Abstract
Only five cases of multifocal medulloblastoma in the adult have been reported to date. We present a case in a male patient in his 50th decade of life who presented with three extra-axial lesions associated with a parenchymatous lesion of the right middle cerebellar peduncle. Sputum sample examination revealed larvae compatible with strongyloides stercoralis, which was our main differential diagnosis. Histological and immunohistochemical studies revealed the existence of a desmoplastic medulloblastoma.
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Affiliation(s)
| | - Jorge Pombo Otero
- Department of Pathology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Angel Concha-Lopez
- Department of Pathology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Salvador F, Sulleiro E, Piron M, Sánchez-Montalvá A, Sauleda S, Molina-Morant D, Moure Z, Molina I. Strongyloides stercoralis infection increases the likelihood to detect Trypanosoma cruzi DNA in peripheral blood in Chagas disease patients. Trop Med Int Health 2017; 22:1436-1441. [PMID: 28869694 DOI: 10.1111/tmi.12970] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES In a previous study performed by our group, Strongyloides stercoralis infection in patients with Chagas disease was associated with higher proportion of Trypanosoma cruzi DNA detection in peripheral blood. The aim of the study was to confirm this association in a larger cohort of patients. METHODS Cross-sectional study of all patients with Chagas disease diagnosed from 2005 to 2015 during blood donation at the Catalan Blood Bank. Demographic data and T. cruzi RT-PCR were collected. S. stercoralis infection diagnosis was based on a serological test. RESULTS Two hundred and two blood donors were included. T. cruzi RT-PCR was positive in 72 (35.6%) patients, and S. stercoralis serology was positive in 22 (10.9%) patients. Patients with positive S. stercoralis serology had higher proportion of positive T. cruzi RT-PCR than those with negative serology (54.5% vs. 33.3%, P = 0.050), and the difference increased when taking a serological index cut-off of 2.5, which increases the specificity of the test to detect a confirmed strongyloidiasis (60% vs. 33%, P = 0.017). CONCLUSIONS Patients with Chagas disease with positive S. stercoralis serology had higher proportion of positive T. cruzi RT-PCR in peripheral blood than those with negative serology, which reflects the potential immunomodulatory effects of S. stercoralis in T. cruzi co-infected patients.
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Affiliation(s)
- Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Maria Piron
- Catalan Blood and Tissue Bank, Transfusion Safety Laboratory, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Sauleda
- Catalan Blood and Tissue Bank, Transfusion Safety Laboratory, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain
| | - Daniel Molina-Morant
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Zaira Moure
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
A 59-year-old lady presented with a 1-week history of orthopnoea, paroxysmal nocturnal dyspnoea, night sweats and a productive cough. She had no recent history of travel. Transthoracic echocardiogram revealed preserved left ventricular systolic function with abnormal pericardial thickening and restrictive left ventricular filling consistent with pericardial constriction. Cardiac magnetic resonance imaging confirmed a globally thickened pericardium and showed evidence of pericardial inflammation and constrictive physiology. She did not respond to diuresis, pulsed intravenous steroids or broad spectrum antibiotics and multiple investigations were negative, including autoimmune screen and tuberculosis cultures. Eventually a serum sample was found to be positive for Strongyloides stercoralis and it emerged that this lady had travelled to Egypt 8 years previously, where it is thought that she contracted S stercoralis leading to her developing constrictive pericarditis. This case report summarises the presentation and progression of this case and rare diagnosis.
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Affiliation(s)
| | - Reshma Amin
- East Sussex Healthcare NHS Trust, St Leonards-on-sea, UK
| | - John Baksi
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Robert Gerber
- East Sussex Healthcare NHS Trust, St Leonards-on-sea, UK
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42
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Cañas García-Otero E, Praena-Segovia J, Ruiz-Pérez de Pipaón M, Bosh-Guerra X, Sánchez-Agüera M, Álvarez-Martínez D, Cisneros-Herreros JM. [Clinical approach to imported eosinophilia]. Enferm Infecc Microbiol Clin 2016; 34:661-684. [PMID: 27884406 DOI: 10.1016/j.eimc.2016.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 02/08/2023]
Abstract
Eosinophilia is a common finding in international travelers and immigrants, being an helmintic infection its main etiology. The positive predictive value of eosinophilia for an helmintosis is low in travellers. Eosinophilia may be an incidental finding, or symptomatic, and it represents a clinical challenge due to the low sensitivity and specificity of direct and indirect parasitological diagnostic tests, respectively. It requires a structured approach based on geographical areas, environmental exposures and behavioral risks, and associated symptoms. The initial assessment should include a comprehensive and tailored anamnesis and physical examination, basic laboratory tests, a complete parasitological examination of stool samples and a Strongyloides stercoralis serology, supplemented with other explorations guided by epidemiological and clinical suspicion. Empiric treatment with albendazole and/or ivermectin (plus praziquantel if risk of schistosomiasis) is an option for unidentified persistent eosinophilia after study, and in persons in whom a proper assessment or follow-up can not be assured. In patients at risk for estrongiloidosis who are candidates for immunosuppressive therapies, it is indicated a prior screening and treatment to prevent a future hyperinfestation syndrome.
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Affiliation(s)
- Elías Cañas García-Otero
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España.
| | - Julia Praena-Segovia
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
| | - Maite Ruiz-Pérez de Pipaón
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
| | - Xerach Bosh-Guerra
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
| | - Magdalena Sánchez-Agüera
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
| | - Daniel Álvarez-Martínez
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
| | - José Miguel Cisneros-Herreros
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío y Virgen Macarena, Sevilla, España
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Drago F, Ciccarese G, Brigati C, Parodi A. Strongyloides Autoinfection Manifesting as Larva Currens in an Immunocompetent Patient. J Cutan Med Surg 2016; 20:617-618. [PMID: 27821543 DOI: 10.1177/1203475416650443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
Strongyloides stercoralis hyperinfection syndrome is a rare but fatal disease, which occurs commonly in immunocompromised patients. Strongyloidiasis among patients with chronic kidney disease is rarely reported.A 55-year-old Chinese male presented to hospital with diarrhea and abdominal pain. He developed acute respiratory failure and progressed to diffuse alveolar hemorrhage owing to disseminated strongyloidiasis immediately. The bronchoalveolar lavage revealed filariform larvae of Strongyloides stercoralis.This patient was diagnosed with Strongyloides hyperinfection syndrome. Although albendazole, mechanical ventilator support, fluid resuscitation, vasopressor support, extracorporeal membrane oxygenation, hydrocortisone, and broadspectrum antimicrobials were actively used, the patient eventually died.Similar cases in patients with chronic kidney disease in the literature are also reviewed. Through literature review, we recommend that strongyloidiasis should be routinely investigated in patients with chronic kidney disease who will undergo immunosuppressive therapy.
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Affiliation(s)
- Ting-Ting Qu
- From the Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases (T-TQ), State Key Laboratory for Diagnosis and treatment of Infectious Disease; and Respiratory Department (JW), First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Tanaka T, Hirata T, Parrott G, Higashiarakawa M, Kinjo T, Kinjo T, Hokama A, Fujita J. Relationship Among Strongyloides stercoralis Infection, Human T-Cell Lymphotropic Virus Type 1 Infection, and Cancer: A 24-Year Cohort Inpatient Study in Okinawa, Japan. Am J Trop Med Hyg 2015; 94:365-370. [PMID: 26621566 PMCID: PMC4751948 DOI: 10.4269/ajtmh.15-0556] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/19/2015] [Indexed: 11/07/2022] Open
Abstract
This study evaluated the prevalence of Strongyloides stercoralis infection and human T-cell lymphotropic virus type 1 (HTLV-1) infection in the population. In addition, this study investigated the relationship between S. stercoralis infection or HTLV-1 infection and a patient's risk of developing related cancers. This is a retrospective cohort study of 5,209 patients. The prevalence of S. stercoralis infection was 5.2% among all patients. The prevalence among men (6.3%) was significantly higher than among women (3.6%, P < 0.001). The prevalence of HTLV-1 infection among this population was 13.6% and the prevalence among women (15.5%) was significantly higher than that of men (12.3%, P < 0.001). HTLV-1 seroprevalence was higher in patients with liver cancer (P = 0.003, odds ratio [OR]: 1.91, 95% confidence interval [CI]: 1.24, 2.95) and in those with lymphoma other than adult T-cell leukemia/lymphoma (ATLL) (P = 0.005, adjusted OR: 2.76, 95% CI: 1.36, 5.62) if compared with patients without any neoplasm. The prevalence of both S. stercoralis and HTLV-1 in the Okinawan population has been steadily decreasing over the past 24 years. HTLV-1 infection significantly increases the odds of developing liver cancer and lymphomas other than ATLL.
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Affiliation(s)
- Teruhisa Tanaka
- *Address correspondence to Teruhisa Tanaka, Department of Infectious, Respiratory, and Digestive Medicine, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. E-mail:
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Soin K, Chambers C, Studdiford JS. Rash, diarrhea, and eosinophilia. J Fam Pract 2015; 64:655-658. [PMID: 26551473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Komal Soin
- Kaiser Permanente Waipio Medical Office, Waipahu, HI, USA.
| | - Christopher Chambers
- Department of Family and Community Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - James S Studdiford
- Department of Family and Community Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Kadılar Ö, Bozkurt B, Karakeçe E, Kaya T, Çiftçi İH, Tamer A. [Rare Case of Strongyloides stercoralis with Vitamin B12 Deficiency]. Turkiye Parazitol Derg 2015; 39:238-240. [PMID: 26470934 DOI: 10.5152/tpd.2015.3712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Strongyloidiyasis is endemic in tropical and subtropical regions, and mostly soil transmitted nematode disease that is seen as sporadic cases in Turkey. As may be asymptomatic in healthy individuals, it may even cause death in immunosuppressive people. We report a case of Strongyloides stercoralis infection in a patient, 29 years old young male was admitted to our institution with diarrhea who has got vitamin B12 deficiency and eosinophilia. The case represents an extremely rare and in our knowledge, it is the first case in Sakarya.
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Affiliation(s)
- Özlem Kadılar
- Sağlık Bakanlığı Sakarya Üniversitesi Eğitim ve Araştırma Hastanesi, Tıbbi Biyokimya Anabilim Dalı, Sakarya, Türkiye.
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48
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Zammarchi L, Montagnani F, Tordini G, Gotuzzo E, Bisoffi Z, Bartoloni A, De Luca A. Persistent strongyloidiasis complicated by recurrent meningitis in an HTLV seropositive Peruvian migrant resettled in Italy. Am J Trop Med Hyg 2015; 92:1257-1260. [PMID: 25846292 PMCID: PMC4458834 DOI: 10.4269/ajtmh.14-0716] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 01/21/2015] [Indexed: 11/29/2022] Open
Abstract
We describe a case of persistent strongyloidiasis complicated by recurrent meningitis, in a human T cell lymphotropic virus type 1 (HTLV-1) seropositive Peruvian migrant adult resettled in Italy. He was admitted with signs and symptoms of acute bacterial meningitis, reporting four other meningitis episodes in the past 6 years, with an etiological diagnosis of Escherichia coli and Enterococcus faecium in two cases. He had been previously treated with several antihelmintic regimens not including ivermectin, without eradication of strongyloidiasis, and he had never been tested for HTLV before. During the described episode, the patient was treated for meningitis with broad-spectrum antibiotic therapy and 200 μg/kg/dose oral ivermectin once daily on day 1, 2, 15 and 16 with full recovery and no further episodes of meningitis. The presented case underlines several critical points concerning the management of poorly known neglected diseases such as strongyloidiasis and HTLV infection in low-endemic areas. Despite several admissions for meningitis and strongyloidiasis, the parasitic infection was not adequately treated and the patient was not previously tested for HTLV. The supply of ivermectin and the choice of treatment scheme was challenging since ivermectin is not approved in Italy and there are no standardized guidelines for the treatment of severe strongyloidiasis in HTLV seropositive subjects.
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Affiliation(s)
| | | | | | | | | | - Alessandro Bartoloni
- *Address correspondence to Alessandro Bartoloni, Largo Brambilla 3, 50134 Florence, Italy. E-mail:
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Makker J, Balar B, Niazi M, Daniel M. Strongyloidiasis: A case with acute pancreatitis and a literature review. World J Gastroenterol 2015; 21:3367-3375. [PMID: 25805946 PMCID: PMC4363769 DOI: 10.3748/wjg.v21.i11.3367] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/24/2014] [Accepted: 01/16/2015] [Indexed: 02/06/2023] Open
Abstract
Strongyloides stercoralis, a soil transmitted helminth infection, affects millions with varying prevalence worldwide. A large number of affected hosts are asymptomatic. Symptoms pertaining to pulmonary and gastrointestinal involvement may be present. Manifestations of involvement beyond lung and intestine can be seen with dissemination of infection and lethal hyperinfection. Immunosuppression secondary to use of steroids or other immunosuppressants and coexistence of human T-lymphotropic virus type-1 are the known risk factors for dissemination and hyperinfection. Diagnostic modalities comprise stool examination, serology and molecular testing. Stool tests are inexpensive but are limited by low sensitivity, whereas serologic and molecular tests are more precise but at the expense of higher cost. Treatment with Ivermectin or Albendazole as an alternative is safe and efficacious. We present a rare case of acute pancreatitis secondary to Strongyloides. High index of suspicion in patients specifically from endemic countries of origin and lack of other common etiologies of acute pancreatitis may help in early diagnosis and prompt treatment of this potentially fatal infection.
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Gravellone L, Battaglia C, Caligara F, D'Amato I, Gandini E, Lucatello A, Rizzo MA, Torpia R, Brigante G, Castiglioni A. [Strongyloidiasis in nephrologic patients]. G Ital Nefrol 2015; 32:gin/00204.26. [PMID: 26005937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Strongyloides stercoralis is a nematode causing strongyloidiasis, more frequent in immigrants and in travelers coming from tropical and subtropical areas. Infection is usually asymptomatic, frequently associated with eosinophilia. Immunocompromised patients are at high risk of developing hyperinfection syndrome (HI) or dissemination (SD), life threatening complications. Diagnosis of strongyloidiasis is firstly based on larvae isolation in stool samples; specific therapy involves the use of ivermectin as first choice and albendazole as second choice. We describe two cases of strongyloidiasis. The first one is a disseminated strongyloidiasis occurred in an Ecuadorian male on corticosteroid therapy for nephrotic syndrome due to focal segmental glomerulosclerosis, successfully treated with ivermectin; the second one involves another Ecuadorian male affected by acute kidney failure and nephrotic syndrome in IgA nephropathy with a diagnosis of chronic strongyloidiasis performed before starting the immunosuppressive treatment. The timing of treatment with ivermectin has allowed the complete eradication of the parasite before starting steroid and mycophenolate mofetil therapy, preventing the occurrence of a disseminated infection. Epidemiological data show us how strongyloidiasis is rising at our latitude because of increased number of migrants and travelers coming from endemic areas. So we must always exclude asymptomatic strongyloidiasis before prescribing a steroid or immunosuppressive therapy, in order to avoid developement of disseminated and often fatal disease.
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