51
|
Anselmi M, Guevara A, Vicuña Y, Vivero S, Prandi R, Caicedo C, Marquez M, Bisoffi Z, Buonfrate D. Community Epidemiology Approach to Parasitic Infection Screening in a Remote Community in Ecuador. Am J Trop Med Hyg 2020; 101:650-653. [PMID: 31333160 DOI: 10.4269/ajtmh.19-0187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The Awa indigenous people of Ecuador live in remote areas and were included in health programs only recently. The first screening for parasitic infections in the Awa communities was implemented in the context of community epidemiology. During the site visits in each community, the health-care staff collected the samples for stool microscopy and serology for Strongyloides. A total of 705 individuals consented for the study, representing 40% of the Awa population living in the targeted communities; 184 (26%) participants supplied a stool sample. Giardia intestinalis was found in about 11% of samples. Prevalence of Ascaris lumbricoides and Trichuris trichiura was 54.9% and 36.9%, respectively. No hookworm eggs were found. In addition, Strongyloides stercoralis larvae were found in eight individuals (4.3%), whereas serology was positive in 22.7% of the individuals tested. The community-based approach resulted in an impressive participation. There was a high prevalence of parasites associated with relevant morbidity.
Collapse
Affiliation(s)
- Mariella Anselmi
- Centre for Tropical Diseases, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy.,Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Angel Guevara
- Carrera de Medicina, Instituto de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador
| | - Yosselin Vicuña
- Carrera de Medicina, Instituto de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador
| | - Sandra Vivero
- Carrera de Medicina, Instituto de Biomedicina, Universidad Central del Ecuador, Quito, Ecuador
| | - Rosanna Prandi
- Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Cintia Caicedo
- Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Monica Marquez
- Centro de Epidemiologia Comunitaria y Medicina Tropical (CECOMET), Esmeraldas, Ecuador
| | - Zeno Bisoffi
- Infectious Diseases and Tropical Medicine Section, Diagnostic and Public Health Department, University of Verona, Verona, Italy.,Centre for Tropical Diseases, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Dora Buonfrate
- Centre for Tropical Diseases, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| |
Collapse
|
52
|
Sequeira-Aymar E, diLollo X, Osorio-Lopez Y, Gonçalves AQ, Subirà C, Requena-Méndez A. [Recommendations for the screening for infectious diseases, mental health, and female genital mutilation in immigrant patients seen in Primary Care]. Aten Primaria 2020; 52:193-205. [PMID: 31029458 PMCID: PMC7063148 DOI: 10.1016/j.aprim.2019.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 12/15/2022] Open
Abstract
Immigrant health status may be improved if certain health conditions are identified early through the implementation of a screening program. This document presents the recommendations resulting from the Screening in immigrant population project (CRIBMI) aimed at implementing a screening program for infectious diseases (HIV, HBV, HCV, tuberculosis, strongyloidiasis, schistosomiasis and Chagas disease), as well as female genital mutilation and mental health (MH) in migrant population at Primary Care level. Screening recommendations were based on: coming from an endemic country for strongyloidiasis, schistosomiasis, and Chagas diseases; on a threshold level of prevalence for HIV (> 1%), HBV (> 2%), and HCV (> 2%), and on incidence (> 50 cases/100,000-inhabitants) for active tuberculosis in immigrants with < 5 years in Europe. Exploring the risk of FGM is recommended in women from countries where this practice is prevalent. Evaluation of MH status is recommended for people from areas of conflict and violence.
Collapse
Affiliation(s)
- Ethel Sequeira-Aymar
- CAPSBE Casanova, Grupo transversal de investigación en AP IDIBAPS, grupo COCOOPSI CAMFIC, Barcelona, España.
| | - Ximena diLollo
- Fundació Clínic per la Recerca Biomédica, Barcelona, España; Instituto de Salud Global de Barcelona, Barcelona, España
| | - Yolanda Osorio-Lopez
- ESMES (equipo Salut Mental Sense Sostre) y programa SATMI (Programa d'atenció en Salut Mental per població immigrada), Parc Sanitari Sant Joan de Déu, Barcelona, España
| | - Alessandra Queiroga Gonçalves
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Tarragona, España; Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L'Ebre, Institut Català de la Salut, Tortosa, Tarragona, España
| | - Carme Subirà
- Servicio de Medicina Tropical, Hospital Clínic de Barcelona, Barcelona, España; Instituto de Salud Global de Barcelona, Barcelona, España
| | - Ana Requena-Méndez
- Servicio de Medicina Tropical, Hospital Clínic de Barcelona, Barcelona, España; Instituto de Salud Global de Barcelona, Barcelona, España
| |
Collapse
|
53
|
Mukaigawara M, Narita M, Shiiki S, Takayama Y, Takakura S, Kishaba T. Clinical Characteristics of Disseminated Strongyloidiasis, Japan, 1975-2017. Emerg Infect Dis 2020; 26:401-408. [PMID: 32091375 PMCID: PMC7045830 DOI: 10.3201/eid2603.190571] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Clinical characteristics of disseminated strongyloidiasis, the severest form of strongyloidiasis, are not well described. We conducted a retrospective, consecutive chart review of patients with disseminated strongyloidiasis admitted to Okinawa Chubu Hospital in Okinawa, Japan, during January 1975-December 2017. The 70 patients were classified into 3 clinical phenotypes: dissemination (32 patients [45.7%]), occult dissemination with meningitis caused by enteric organisms (12 patients [17.1%]), and occult dissemination with culture-negative suppurative meningitis (26 patients [37.1%]). Associated mortality rates were 56.3%, 16.7%, and 11.5%, respectively, and sepsis occurred in 40.6%, 58.3%, and 11.5% of cases, respectively. Common symptoms included fever (52.9% of patients), headache (32.9%), and altered mental status (24.3%). Patients were treated with thiabendazole (before 2003) or ivermectin (after 2003). Our findings show that disseminated strongyloidiasis has clinical phenotypes in terms of severity and that identification of occult dissemination, a mild form with prominent neurologic manifestations, is lifesaving.
Collapse
|
54
|
Paul M, Meena S, Gupta P, Jha S, Rekha US, Kumar VP. Clinico-epidemiological spectrum of strongyloidiasis in India: Review of 166 cases. J Family Med Prim Care 2020; 9:485-491. [PMID: 32318369 PMCID: PMC7114037 DOI: 10.4103/jfmpc.jfmpc_1182_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 01/24/2020] [Accepted: 01/30/2020] [Indexed: 12/28/2022] Open
Abstract
Strongyloidiasis is frequently asymptomatic but can cause disseminated disease and variable presentations. Diagnosis is often delayed or misdirected either due to poor degree of clinical suspicion or clinical imitation of other gastrointestinal conditions. This infection is not infrequent and several cases from all over India have been reported barring few states from central India. We reviewed 166 cases published in English literature from India; from 2001 till 2018 including 2 recent cases from our institute. The mean age of presentation was 35 years with male female ratio of 2.8:1. The duration of disease at the time of presentation varied from 15 days to 10 years. Most important predisposing factor identified in the study was HIV (13.3%) and steroid therapy (6.6%). Most common modality of diagnosis was by stool microscopy (69.3%). Radiological investigations were ordered in 33.7% patients before stool microscopy. Ivermectin was the most common treatment regimen with cure rate of 97.6%. Better awareness and early clinical suspicion of the disease with stool microscopy and adequate therapy are necessary to improve the outcome. Strongyloidiasis is rather widely prevalent infection with variable symptomatology and calls for a close coordination from family physicians and microbiologists.
Collapse
Affiliation(s)
- Manisha Paul
- Department of Microbiology, All India Institute of Microbiology, Rishikesh, Uttarakhand, India
| | - Suneeta Meena
- Department of Microbiology, All India Institute of Microbiology, Rishikesh, Uttarakhand, India
| | - Pratima Gupta
- Department of Microbiology, All India Institute of Microbiology, Rishikesh, Uttarakhand, India
| | - Sweta Jha
- Department of Microbiology, All India Institute of Microbiology, Rishikesh, Uttarakhand, India
| | - U Sasi Rekha
- Department of Microbiology, All India Institute of Microbiology, Rishikesh, Uttarakhand, India
| | - V Pradeep Kumar
- Department of Microbiology, All India Institute of Microbiology, Rishikesh, Uttarakhand, India
| |
Collapse
|
55
|
Cipriano A, Dias R, Marinho R, Correia S, Lopes V, Cardoso T, Aragão I. Donor-derived fatal hyperinfection strongyloidiasis in renal transplant recipient. IDCases 2020; 19:e00703. [PMID: 32021802 PMCID: PMC6992991 DOI: 10.1016/j.idcr.2020.e00703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 11/16/2022] Open
Abstract
Strongyloides stercoralis is a nematode, endemic in tropical and subtropical areas. Strongyloidiasis has been reported in recipients of hematopoietic stem cells, kidney, liver, heart, intestine, and pancreas, eventually presenting as disseminated strongyloidiasis and hyperinfection syndrome (SHS) which is associated with high mortality. We report one case of a recent renal transplant recipient, who presented with gastrointestinal and respiratory symptoms, evolving into shock. The identification of Strongyloides stercoralis in the bronchoalveolar lavage (BAL) lead us to the diagnosis of SHS. Treatment with subcutaneous ivermectin was started, however the patient did not survive. Retrospective serum donor analysis allowed us to identify the donor as the source of infection.
Collapse
Affiliation(s)
- Ana Cipriano
- Infectious Disease Department, Centro Hospitalar do Porto, Portugal
| | - Rita Dias
- Internal Medicine Department, Centro Hospitalar do Porto, Portugal
| | - Ricardo Marinho
- Internal Medicine Department, Centro Hospitalar do Porto, Portugal
| | - Sofia Correia
- Nephrology and Transplant Unit, Centro Hospitalar do Porto, Portugal
| | - Virgínia Lopes
- Clinical Microbiology Department, Centro Hospitalar do Porto, Portugal
| | - Teresa Cardoso
- Department of Intensive Care Unit, Centro Hospitalar Porto, Porto, Portugal
| | - Irene Aragão
- Department of Intensive Care Unit, Centro Hospitalar Porto, Porto, Portugal
| |
Collapse
|
56
|
Miglioli-Galvão L, Pestana JOM, Lopes-Santoro G, Torres Gonçalves R, Requião Moura LR, Pacheco Silva Á, Camera Pierrotti L, David Neto E, Santana Girão E, Costa de Oliveira CM, Saad Abboud C, Dias França JÍ, Devite Bittante C, Corrêa L, Aranha Camargo LF. Severe Strongyloides stercoralis infection in kidney transplant recipients: A multicenter case-control study. PLoS Negl Trop Dis 2020; 14:e0007998. [PMID: 32004346 PMCID: PMC7015428 DOI: 10.1371/journal.pntd.0007998] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/12/2020] [Accepted: 12/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Severe Strongyloides stercoralis infection in kidney transplant recipients is associated with considerable morbidity and mortality, although little is known about the risk factors for such infection. METHODOLOGY/PRINCIPAL FINDINGS This was a retrospective, multicenter, case-control study in which we assessed the risk factors for and clinical outcomes of severe S. stercoralis infections in kidney transplant recipients in Brazil. We included 138 kidney transplant recipients: 46 cases and 92 controls. Among the cases, the median number of days from transplantation to diagnosis was 117 (interquartile range [IQR], 73.5-965) and the most common clinical findings were gastrointestinal symptoms (in 78.3%) and respiratory symptoms (in 39.1%), whereas fever and eosinophilia were seen in only 32.6% and 43.5%, respectively. The 30-day all-cause mortality among the cases was 28.3% overall and was significantly higher among the cases of infection occurring within the first three months after transplantation (47% vs. 17.2%, P = 0.04). The independent risk factors were receiving a transplant from a deceased donor (odds ratio [OR] = 6.16, 95% confidence interval [CI] = 2.05-18.5), a history of bacterial infection (OR = 3.04, 95% CI = 1.2-7.5), and a cumulative corticosteroid dose (OR = 1.005, 95% CI = 1.001-1.009). The independent predictors of mortality were respiratory failure (OR = 98.33, 95% CI = 4.46-2169.77) and concomitant bacteremia (OR = 413.00, 95% CI = 4.83-35316.61). CONCLUSIONS/SIGNIFICANCE Severe S. stercoralis infections are associated with considerable morbidity and mortality after kidney transplantation. In endemic areas, such infection may occur late after transplantation, although it seems to be more severe when it occurs earlier after transplantation. Specific risk factors and clinical manifestations can identify patients at risk, who should receive prophylaxis or early treatment.
Collapse
Affiliation(s)
- Lísia Miglioli-Galvão
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
- * E-mail:
| | | | - Guilherme Lopes-Santoro
- Department of Preventive Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Álvaro Pacheco Silva
- Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Kidney Unit, Universidade Federal de São Paulo,São Paulo, Brazil
| | | | - Elias David Neto
- Kidney Transplant Unit, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Cely Saad Abboud
- Infectious Diseases Unit, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | - João Ítalo Dias França
- Department of Epidemiology and Statistics, Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
| | | | - Luci Corrêa
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luís Fernando Aranha Camargo
- Infectious Diseases Unit, Universidade Federal de São Paulo, São Paulo, Brazil
- Infectious Diseases Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
| |
Collapse
|
57
|
Martyn E, Gration B, Somasundaram C, Chiodini PL. Strongyloides, HTLV-1 and small bowel obstruction. BMJ Case Rep 2019; 12:12/12/e232461. [PMID: 31822534 PMCID: PMC6904184 DOI: 10.1136/bcr-2019-232461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
An 81-year-old Jamaican man who has been resident in the UK for many years presented with one week history of generalised abdominal pain, postprandial vomiting, anorexia, weight loss and abdominal distension. He was managed conservatively for acute small bowel obstruction. Investigations revealed a duodenal stricture. Live Strongyloides stercoralis larvae were observed in stool samples and duodenal biopsy confirmed the presence of the parasite at multiple life cycle stages within the lamina propria. He was diagnosed with Strongyloides hyperinfection with underlying human T-cell lymphotropic virus type 1 and treated with a prolonged course of ivermectin with ongoing monitoring for relapse. This case demonstrates a rare but potentially fatal cause of small bowel obstruction.
Collapse
Affiliation(s)
- Emily Martyn
- Microbiology Department, North Middlesex University Hospital NHS Trust, London, UK
| | - Betty Gration
- Division of Infection, University College London Hospitals, London, UK
| | - Chitra Somasundaram
- Gastroenterology Department, North Middlesex University Hospital NHS Trust, London, UK
| | - Peter L Chiodini
- Department of Clinical Parasitology, Hospital for Tropical Diseases, London, UK
| |
Collapse
|
58
|
Wang WL, Zhang QW, Tang S, Chen F, Zhang JB. Co-infection with Strongyloides stercoralis hyperinfection syndrome and Klebsiella in a nephrotic syndrome patient: A case report. Medicine (Baltimore) 2019; 98:e18247. [PMID: 31804353 PMCID: PMC6919406 DOI: 10.1097/md.0000000000018247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
RATIONALE Patients with chronic Strongyloides stercoralis infection are usually asymptomatic; therefore, their condition is easily overlooked. In immunosuppressed patients, mortality is high because of disseminated infection and hyperinfection. This report describes a fatal S stercoralis hyperinfection in a patient with nephrotic syndrome after treatment with steroids. PATIENT CONCERNS A 70-year-old male presented with a history of progressive edema, skin infection, persistent fever, cough, intermittent abdominal pain, and progressive respiratory failure after steroid treatment. DIAGNOSIS Nephrotic syndrome; cellulitis; S stercoralis hyperinfection; Klebsiella pneumonia. INTERVENTIONS During the first hospital admission, the patient was administered full-dose glucocorticoid and antibiotic therapy after suffering from cellulitis. During the second admission, he was diagnosed and treated for normal digestive discomfort and a bacterial infection. The patient had progressive respiratory failure and was placed on a ventilator. He was immediately treated with albendazole when S stercoralis was found in samples of his sputum and feces. OUTCOMES The patient died despite treatment with albendazole and antibiotic therapy. LESSONS It is essential to consider the possibility of S stercoralis infection in immunosuppressed patients with nephrotic syndrome. Given the lack of classic manifestations and high mortality rate of advanced disease, continuous monitoring, early diagnosis, and proper treatment are imperative.
Collapse
|
59
|
Abstract
Most of the 30 to 100 million people infected with Strongyloides stercoralis have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. The use of corticosteroids and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses that are like other nematodes. Definitive diagnosis of S stercoralis infection is based on stool examinations for larvae. S stercoralis remains largely neglected.
Collapse
Affiliation(s)
- Alejandro Krolewiecki
- Institute for Tropical Diseases Research, Universidad Nacional de Salta/CONICET, Alvarado 751, Oran 4530, Salta, Argentina
| | - Thomas B Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Building 4 - Room B1-03, 4 Center Drive, Bethesda, MD 20892-0425, USA.
| |
Collapse
|
60
|
[Acute renal failure and rare severe complication of systemic steroid treatment in a 73-year-old woman]. Internist (Berl) 2019; 60:1201-1208. [PMID: 31511906 DOI: 10.1007/s00108-019-00677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article reports about a 73-year-old woman of Bosnian descent who presented with acute renal failure. A renal biopsy was diagnostic for a postinfect necrotizing and extracapillary proliferative glomerulonephritis. The patient reported a febrile infection fever 2 weeks previously. The diagnostics did not reveal any indications of an ongoing infection. The glomerulonephritis responded to treatment with systemic steroids. The patient was readmitted to hospital 6 weeeks later in a severely ill condition. A gastric biopsy revealed a Strongyloides stercoralis infestation. Due to the systemic steroid therapy the patient had developed a so-called hyperinfection syndrome and died despite treatment on the intensive care unit. This case illustrates the need for awareness of this rare parasitosis, particularly in patients from endemic areas. A likely causal relationship with the glomerulonephritis is discussed and an overview of the diagnostics, course of the disease and treatment of this parasitosis is given.
Collapse
|
61
|
Strongyloides stercoralis: Spatial distribution of a highly prevalent and ubiquitous soil-transmitted helminth in Cambodia. PLoS Negl Trop Dis 2019; 13:e0006943. [PMID: 31220075 PMCID: PMC6586258 DOI: 10.1371/journal.pntd.0006943] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/21/2019] [Indexed: 12/13/2022] Open
Abstract
Background Strongyloides stercoralis is a neglected soil-transmitted helminth that occurs worldwide, though it is particularly endemic in tropical and subtropical areas. It can cause long-lasting and potentially fatal infections due to its ability to replicate within its host. S. stercoralis causes gastrointestinal and dermatological morbidity. The objective of this study was to assess the S. stercoralis infection risk and, using geostatistical models, to predict its geographical distribution in Cambodia. Methodology / Principal findings A nation-wide, community-based parasitological survey was conducted among the Cambodian population, aged 6 years and older. S. stercoralis was diagnosed using a serological diagnostic test that detects IgG antibodies in urine. Data on demography, hygiene and knowledge about helminth infection were collected. S. stercoralis prevalence among 7,246 participants with a complete data record was 30.5%, ranging from 10.9% to 48.2% across provinces. The parasite was ubiquitous in Cambodia; only five south-eastern provinces had prevalence rates below 20%. Infection risk increased with age for both men and women, although girls under the age of 13 and women aged 50 years and over had lower odds of infection than their male counterparts. Open defecation was associated with higher odds of infection, while having some knowledge of the health problems caused by worms was a protective factor. Infection risk was positively associated with nighttime maximum temperature, minimum rainfall, and distance to water; it was negatively associated with land occupied by rice fields. Conclusions / Significance S. stercoralis infection is rampant in Cambodia. Control programs delivering ivermectin are needed to manage the parasite. However, the high cost of this drug in Cambodia currently precludes the implementation of control initiatives. Donations, subsidies or affordable generics are needed so that S. stercoralis, which infects almost a third of the Cambodian population, can be addressed through an adequate control program. The threadworm, Strongyloides stercoralis, is a highly neglected worm infection, transmitted through infective larvae in the soil. Threadworms occur worldwide, particularly in tropical climates. It may cause long-lasting and potentially fatal infections due to the parasite’s ability to replicate within its host. This study aimed to assess the risk of threadworm infection at national level in Cambodia. We conducted a nation-wide, community-based parasitological survey of the Cambodian population, aged 6 years and over. The threadworm was diagnosed using a serological diagnostic test that detects antibodies in urine. Data on demography, hygiene and knowledge about helminth infection were collected. The purpose of this study was to predict the risk of S. stercoralis infection in unsurveyed locations, assess risk factors for infection, and map its geographical distribution in Cambodia. About one third (30.5%) of the enrolled study participants (n = 7,246) were infected with threadworms. At provincial level, the lowest and highest infection rates were 10.9% and 48.2%, respectively. Prevalence rates below 20% were found in just five south-eastern provinces. The risk of a threadworm infection increased with age for both men and women. Open defecation was associated with higher risk of infection, while having some knowledge of the health problems caused by worms was a protective factor. Infection risk was positively associated with environmental factors, such as nighttime maximum temperature, minimum rainfall, and distance to water; it was negatively associated with land occupied by rice fields. Threadworm infection is highly prevalent in Cambodia and adequate control measures, including access to treatment, are warranted to address the burden of this Neglected Tropical Disease (NTD) in Cambodia.
Collapse
|
62
|
Tuyizere A, Ndayambaje A, Walker TD, Bayingana C, Ntirenganya C, Dusabejambo V, Hale DC. Prevalence of Strongyloides stercoralis infection and other soil-transmitted helminths by cross-sectional survey in a rural community in Gisagara District, Southern Province, Rwanda. Trans R Soc Trop Med Hyg 2019; 112:97-102. [PMID: 29726969 PMCID: PMC5961251 DOI: 10.1093/trstmh/try036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Strongyloides stercoralis is one of the most neglected tropical diseases. Sparse, dated central African and Rwandan data on seroprevalence are available to guide public health efforts and clinical care. Methods In February 2016 we conducted a community-based cross-sectional study among 539 asymptomatic participants in a rural area in the Gisagara District, Southern Province, Rwanda. Direct faecal smear (DFS) and modified Koga agar plate culture (APC) were used to detect S. stercoralis infection in a single stool sample. Data on other soil-transmitted helminths diagnosed by DFS were also recorded. Results Four intestinal helminth infections were diagnosed, with S. stercoralis (17.4%) and hookworms (8.2%) seen most often. APC, compared with DFS, increased the diagnosis rate for S. stercoralis from 1.9% to 17.4% (p<0.01). The prevalence was higher in farmers and those with lower socio-economic status. Females were less often infected than males (odds ratio 0.6 [95% confidence interval 0.3 to 0.9], p=0.02). Conclusions S. stercoralis is highly prevalent among the general population in a rural area of Gisagara District, Southern Province, Rwanda. Access to effective diagnosis and treatment is needed for this neglected disease.
Collapse
Affiliation(s)
- Aloys Tuyizere
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda.,Department of Internal Medicine, University Teaching Hospital of Butare, Huye, Rwanda
| | - Alphonse Ndayambaje
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda.,Department of Internal Medicine, University Teaching Hospital of Butare, Huye, Rwanda
| | - Timothy D Walker
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda.,Department of Internal Medicine, University Teaching Hospital of Butare, Huye, Rwanda.,School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Claude Bayingana
- Department of Clinical Biology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda.,Department of Laboratory Medicine, University Teaching Hospital of Butare, Huye, Rwanda
| | - Cyprien Ntirenganya
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda.,Department of Internal Medicine, University Teaching Hospital of Butare, Huye, Rwanda
| | - Vincent Dusabejambo
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda.,Department of Internal Medicine, University Teaching Hospital of Kigali, Kigali, Rwanda
| | - DeVon C Hale
- Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda.,Department of Internal Medicine, University Teaching Hospital of Butare, Huye, Rwanda.,Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
63
|
Ashiri A, Beiromvand M, Khanzadeh A. Strongyloides stercoralis infection in a patient with rheumatoid arthritis and type 2 diabetes mellitus: a case-based review. Clin Rheumatol 2019; 38:3093-3098. [DOI: 10.1007/s10067-019-04611-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/11/2019] [Accepted: 05/15/2019] [Indexed: 12/12/2022]
|
64
|
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] [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.
Collapse
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
| | | | | | | |
Collapse
|
65
|
Al-Obaidi M, Hasbun R, Vigil KJ, Edwards AR, Chavez V, Hall DR, Dar WA, De Golovine A, Ostrosky-Zeichner L, Bynon JS, Nigo M. Seroprevalence of Strongyloides stercoralis and Evaluation of Universal Screening in Kidney Transplant Candidates: A Single-Center Experience in Houston (2012-2017). Open Forum Infect Dis 2019; 6:5452022. [PMID: 31363770 PMCID: PMC6656655 DOI: 10.1093/ofid/ofz172] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023] Open
Abstract
Background Disseminated strongyloidiasis in solid organ transplant recipients is a rare but devastating infection. In our center, we implemented a universal screening of all candidates for kidney transplantation. We assessed the seroprevalence and utility of universal screening for strongyloidiasis in our center. Methods Patients were identified from our transplant referral list (from July 2012 to June 2017). Demographics, pretransplant laboratory, and serological screenings were retrospectively collected. For Strongyloides-seropositive (SSp) patients, data on travel history, symptoms, treatment, and stool ova and parasite examinations were extracted. Logistic regression and multiple imputation for missing data were performed. Results A total of 1689 patients underwent serological screening, of whom 168 (9.9%) were SSp. Univariate analysis revealed that SSp patients had higher rates of eosinophilia, diabetes mellitus, latent tuberculosis and were likely to be either Hispanic or Asian (P < .05). In multivariate analysis, eosinophilia (P = .01), diabetes mellitus (P = .02), and Asian race (P = .03) were associated with being SSp, but 45 (27%) of the SSp patients did not have any of these 3 factors, and 18 SSp patients (11%) had no epidemiological risk factors. All patients received ivermectin, and none developed disseminated strongyloidiasis. Of patients who underwent serological screening on multiple occasions, 6.8% seroconverted while waiting for kidney transplantation. Conclusions We found a high rate of Strongyloides seropositivity among our kidney transplantation candidates. No epidemiological risk factors effectively predicted SSp status in our population, and universal screening identified a large number of patients without such factors. Serial screening should be considered when a long wait time is expected before transplantation.
Collapse
Affiliation(s)
- Mohanad Al-Obaidi
- Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Rodrigo Hasbun
- Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Karen J Vigil
- Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Angelina R Edwards
- Division of Renal Disease and Hypertension, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Violeta Chavez
- Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston
| | - David R Hall
- Division of Immunology and Organ Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Wasim A Dar
- Division of Immunology and Organ Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Aleksandra De Golovine
- Division of Renal Disease and Hypertension, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston
| | - John S Bynon
- Division of Immunology and Organ Transplantation, McGovern Medical School, University of Texas Health Science Center at Houston
| | - Masayuki Nigo
- Division of Infectious Diseases, McGovern Medical School, University of Texas Health Science Center at Houston
| |
Collapse
|
66
|
Shrestha P, O'Neil SE, Taylor BS, Bode-Omoleye O, Anstead GM. Hemoptysis in the Immunocompromised Patient: Do Not Forget Strongyloidiasis. Trop Med Infect Dis 2019; 4:tropicalmed4010035. [PMID: 30759812 PMCID: PMC6473255 DOI: 10.3390/tropicalmed4010035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/26/2019] [Accepted: 01/29/2019] [Indexed: 11/16/2022] Open
Abstract
Strongyloidiasis, due to infection with the nematode Strongyloides stercoralis, affects millions of people in the tropics and subtropics. Strongyloides has a unique auto-infective lifecycle such that it can persist in the human host for decades. In immunosuppressed patients, especially those on corticosteroids, potentially fatal disseminated strongyloidiasis can occur, often with concurrent secondary infections. Herein, we present two immunocompromised patients with severe strongyloidiasis who presented with pneumonia, hemoptysis, and sepsis. Both patients were immigrants from developing countries and had received prolonged courses of corticosteroids prior to admission. Patient 1 also presented with a diffuse abdominal rash; a skin biopsy showed multiple intradermal Strongyloides larvae. Patient 1 had concurrent pneumonic nocardiosis and bacteremia with Klebsiella pneumoniae and Enterococcus faecalis. Patient 2 had concurrent Aspergillus and Candida pneumonia and developed an Aerococcus meningitis. Both patients had negative serologic tests for Strongyloides; patient 2 manifested intermittent eosinophilia. In both patients, the diagnosis was afforded by bronchoscopy with lavage. The patients were successfully treated with broad-spectrum antibiotics and ivermectin. Patient 1 also received albendazole. Strongyloidiasis should be considered in the differential diagnosis of hemoptysis in immunocompromised patients with possible prior exposure to S. stercoralis.
Collapse
Affiliation(s)
- Prakash Shrestha
- Covenant Medical Group, Infectious Diseases, Division of Internal Medicine, Lubbock, TX 79410, USA.
| | - Sean E O'Neil
- Texas Center for Infectious Diseases, San Antonio, TX 78223, USA.
| | - Barbara S Taylor
- Department of Medicine, Division of Infectious Diseases, University of Texas Health, San Antonio, TX 78229, USA.
| | | | - Gregory M Anstead
- Department of Medicine, Division of Infectious Diseases, University of Texas Health, San Antonio, TX 78229, USA.
- Medicine Service, Division of Infectious Diseases, South Texas Veterans Healthcare System, San Antonio, TX 78229, USA.
| |
Collapse
|
67
|
Agbata EN, Morton RL, Bisoffi Z, Bottieau E, Greenaway C, Biggs BA, Montero N, Tran A, Rowbotham N, Arevalo-Rodriguez I, Myran DT, Noori T, Alonso-Coello P, Pottie K, Requena-Méndez A. Effectiveness of Screening and Treatment Approaches for Schistosomiasis and Strongyloidiasis in Newly-Arrived Migrants from Endemic Countries in the EU/EEA: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010011. [PMID: 30577567 PMCID: PMC6339107 DOI: 10.3390/ijerph16010011] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 01/08/2023]
Abstract
We aimed to evaluate the evidence on screening and treatment for two parasitic infections-schistosomiasis and strongyloidiasis-among migrants from endemic countries arriving in the European Union and European Economic Area (EU/EEA). We conducted a systematic search of multiple databases to identify systematic reviews and meta-analyses published between 1 January 1993 and 30 May 2016 presenting evidence on diagnostic and treatment efficacy and cost-effectiveness. We conducted additional systematic search for individual studies published between 2010 and 2017. We assessed the methodological quality of reviews and studies using the AMSTAR, Newcastle⁻Ottawa Scale and QUADAS-II tools. Study synthesis and assessment of the certainty of the evidence was performed using GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We included 28 systematic reviews and individual studies in this review. The GRADE certainty of evidence was low for the effectiveness of screening techniques and moderate to high for treatment efficacy. Antibody-detecting serological tests are the most effective screening tests for detection of both schistosomiasis and strongyloidiasis in low-endemicity settings, because they have higher sensitivity than conventional parasitological methods. Short courses of praziquantel and ivermectin were safe and highly effective and cost-effective in treating schistosomiasis and strongyloidiasis, respectively. Economic modelling suggests presumptive single-dose treatment of strongyloidiasis with ivermectin for all migrants is likely cost-effective, but feasibility of this strategy has yet to be demonstrated in clinical studies. The evidence supports screening and treatment for schistosomiasis and strongyloidiasis in migrants from endemic countries, to reduce morbidity and mortality.
Collapse
Affiliation(s)
- Eric N. Agbata
- Faculty of Health Science, University of Roehampton London, London SW15 5PU, UK
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
- Correspondence:
| | - Rachael L. Morton
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW 2050, Australia; (R.L.M.); (A.T.); (N.R.)
| | - Zeno Bisoffi
- Centre for Tropical Diseases (CTD), IRCCS Sacro Cuore Don Calabria Negrar, Negrar, 37024 Verona, Italy;
- Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, 155 Nationalestraat, 2000 Antwerp, Belgium;
| | - Christina Greenaway
- Division of Infectious Diseases and Clinical Epidemiology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Beverley-A. Biggs
- Department of Medicine at the Doherty Institute, University of Melbourne, Parkville, VIC 3010, Australia;
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital RMH, Parkville VIC 3050, Australia
| | - Nadia Montero
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito 170509, Ecuador; (N.M.); (I.A.-R.)
| | - Anh Tran
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW 2050, Australia; (R.L.M.); (A.T.); (N.R.)
| | - Nick Rowbotham
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW 2050, Australia; (R.L.M.); (A.T.); (N.R.)
| | - Ingrid Arevalo-Rodriguez
- Centro de Investigación en Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito 170509, Ecuador; (N.M.); (I.A.-R.)
- Clinical Biostatistics Unit, Hospital Universitario Ramon y Cajal (IRYCIS); CIBER Epidemiology and Public Health (CIBERESP), 28034 Madrid, Spain
| | - Daniel T. Myran
- Bruyere Research Institute, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Gustav III: s Boulevard 40, 169 73 Solna, Sweden;
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Biomedical Research Institute Sant Pau (IIB Sant Pau-CIBERESP), 08025 Barcelona, Spain;
| | - Kevin Pottie
- Centre for Global Health Institute of Population Health, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Ana Requena-Méndez
- ISGlobal, Barcelona Institute for Global Health (ISGlobal-CRESIB, Hospital Clínic-University of Barcelona), E-08036 Barcelona, Spain;
| |
Collapse
|
68
|
Buonfrate D, Gobbi F, Bisoffi Z. Helminths in organ transplantation. THE LANCET. INFECTIOUS DISEASES 2018; 17:581-582. [PMID: 28555581 DOI: 10.1016/s1473-3099(17)30270-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Dora Buonfrate
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona 37024, Italy.
| | - Federico Gobbi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona 37024, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona 37024, Italy
| |
Collapse
|
69
|
Ramos-Poblete J, Kasper E, Mu A. A long way from Laos. PLoS Negl Trop Dis 2018; 12:e0006534. [PMID: 30161135 PMCID: PMC6116920 DOI: 10.1371/journal.pntd.0006534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jade Ramos-Poblete
- Division of Infectious Diseases, University of California San Francisco, Fresno Medical Education Program, Fresno, California, United States of America
| | - Erica Kasper
- Division of Infectious Diseases, University of California San Francisco, Fresno Medical Education Program, Fresno, California, United States of America
| | - Anandit Mu
- Division of Infectious Diseases, University of California San Francisco, Fresno Medical Education Program, Fresno, California, United States of America
- * E-mail:
| |
Collapse
|
70
|
Adenusi AA, Akinyemi MI, Akinsanya D. Domiciliary Cockroaches as Carriers of Human Intestinal Parasites in Lagos Metropolis, Southwest Nigeria: Implications for Public Health. J Arthropod Borne Dis 2018; 12:141-151. [PMID: 30123808 PMCID: PMC6091797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 05/12/2018] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Domiciliary cockroaches are obnoxious pests of significant medical importance. We investigated the prevalence of human intestinal parasites in cockroaches and its attendant public health importance. METHODS Overall, 749 cockroaches (Periplaneta americana, 509, Blattella germanica, 240) caught by trapping from 120 households comprising 3 different housing types in Somolu, Lagos metropolis, southwest Nigeria, in 2015 were screened for human intestinal parasites using standard parasitological techniques. RESULTS The prevalence of human intestinal parasites in cockroaches was 96.4%. There was no statistically significant difference (P> 0.05) in parasite prevalences between P. americana (95.7%) and B. germanica (97.9%). Parasite species identified and their prevalence were as follows: Entamoeba histolytica/dispar (44.1%), E. coli (37.8%), Giardia lamblia (18.7%), Cryptosporidium sp. (13.8%), Ascaris lumbricoides (61.3%), Trichuris trichiura (55.8%), hookworms (11.6%), Strongyloides stercoralis (11.7%), Taenia/Echinococcus spp. (10.5%), Enterobius vermicularis (17.2%) and Hymenolepis nana (11.6%). Parasite prevalence and burdens varied with housing type; the prevalence was significantly higher statistically (P< 0.05) in cockroaches from low-cost bungalow, LCB (100%) and low-cost, 2-storey, LC2-S (100%) houses than in medium-cost flats, MCF (81.3%). Parasite burdens were also significantly higher statistically (P< 0.05) in cockroaches from LCB or LC2-S than in cockroaches from MCF. Parasite prevalences between cockroach gut and body surfaces were not statistically significant (P> 0.05) but mean parasite burdens in gut were significantly higher statistically (P< 0.05) than on body surfaces. CONCLUSION Cockroaches types carry transmissive stages of human intestinal parasites and may act as reservoirs and potential mechanical vectors for disease transmission.
Collapse
Affiliation(s)
- Adedotun A Adenusi
- Medical Parasitology Unit, Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Idi-Araba, Surulere, Lagos, Nigeria,Corresponding author: Dr Adedotun A. Adenusi, E-mail:
| | - Mary I Akinyemi
- Statistics Unit, Department of Mathematics, University of Lagos, Akoka, Lagos, Nigeria
| | - Dele Akinsanya
- Department of Zoology, University of Lagos, Akoka, Lagos, Nigeria
| |
Collapse
|
71
|
Beknazarova M, Whiley H, Judd JA, Shield J, Page W, Miller A, Whittaker M, Ross K. Argument for Inclusion of Strongyloidiasis in the Australian National Notifiable Disease List. Trop Med Infect Dis 2018; 3:E61. [PMID: 30274457 PMCID: PMC6073110 DOI: 10.3390/tropicalmed3020061] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 05/23/2018] [Accepted: 05/31/2018] [Indexed: 11/25/2022] Open
Abstract
Strongyloidiasis is an infection caused by the helminth, Strongyloides stercoralis. Up to 370 million people are infected with the parasite globally, and it has remained endemic in the Indigenous Australian population for many decades. Strongyloidiasis has been also reported in other Australian populations. Ignorance of this disease has caused unnecessary costs to the government health system, and been detrimental to the Australian people's health. This manuscript addresses the 12 criteria required for a disease to be included in the Australian National Notifiable Disease List (NNDL) under the National Health Security Act 2007 (Commonwealth). There are six main arguments that provide compelling justification for strongyloidiasis to be made nationally notifiable and added to the Australian NNDL. These are: The disease is important to Indigenous health, and closing the health inequity gap between Indigenous and non-Indigenous Australians is a priority; a public health response is required to detect cases of strongyloidiasis and to establish the true incidence and prevalence of the disease; there is no alternative national surveillance system to gather data on the disease; there are preventive measures with high efficacy and low side effects; data collection is feasible as cases are definable by microscopy, PCR, or serological diagnostics; and achievement of the Sustainable Development Goal (SDG) # 6 on clean water and sanitation.
Collapse
Affiliation(s)
- Meruyert Beknazarova
- College of Science and Engineering, Flinders University, Bedford Park, SA 5042, Australia.
| | - Harriet Whiley
- College of Science and Engineering, Flinders University, Bedford Park, SA 5042, Australia.
| | - Jenni A Judd
- School of Health Medical and Applied Sciences, Centre of Indigenous Health Equity Research, Central Queensland University, Bundaberg, QLD 4670, Australia.
| | - Jennifer Shield
- Department of Pharmacy and Applied Science, La Trobe University, Bendigo, VIC 3552, Australia.
| | - Wendy Page
- Miwatj Health Aboriginal Corporation, Nhulunbuy, NT 0881, Australia.
- Public Health and Tropical Medicine, James Cook University, Cairns, QLD 4870, Australia.
| | - Adrian Miller
- Indigenous Research Unit, Griffith University, Nathan, QLD 4111, Australia.
| | - Maxine Whittaker
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia.
| | - Kirstin Ross
- College of Science and Engineering, Flinders University, Bedford Park, SA 5042, Australia.
| |
Collapse
|
72
|
Immunosuppression with Antitumour Necrosis Factor Therapy Leading to Strongyloides Hyperinfection Syndrome. Case Rep Infect Dis 2018; 2018:6341680. [PMID: 30002936 PMCID: PMC5998193 DOI: 10.1155/2018/6341680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 11/18/2022] Open
Abstract
Strongyloides stercoralis is an endemic parasitic infection that can remain asymptomatic for years, but it can cause death in immunosuppressed individuals. Here, we present a case of Strongyloides hyperinfection in a 75-year-old male secondary to sepsis and chronic immunosuppression due to TNF-α inhibitors. Despite aggressive treatment including broad-spectrum antibiotics and antihelminths, his respiratory failure worsened and he died after palliative extubation. S. stercoralis infection remains a diagnostic challenge. Presentation with Strongyloides is often nonspecific, and eosinophilia is absent in hyperinfection. Diagnosis can be delayed, especially in low-prevalence areas where suspicion is low. Strongyloides should be considered in the differential diagnosis in the presence of risk factors including immunosuppressive therapy, and a travel history should be carefully obtained. Patients with recurrent enterobacterial sepsis or respiratory failure with diffuse infiltrates in the setting of eosinophilia should undergo testing for Strongyloides. A multidisciplinary approach can result in earlier diagnosis and favorable outcomes.
Collapse
|
73
|
Wilkins AL, Steer AC, Cranswick N, Gwee A. Question 1: Is it safe to use ivermectin in children less than five years of age and weighing less than 15 kg? Arch Dis Child 2018; 103:514-519. [PMID: 29463522 DOI: 10.1136/archdischild-2017-314505] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/11/2018] [Accepted: 01/15/2018] [Indexed: 12/31/2022]
Affiliation(s)
- Amanda L Wilkins
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
| | - Andrew C Steer
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Noel Cranswick
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Amanda Gwee
- Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| |
Collapse
|
74
|
Xing F, Ye H, Yang J, Chan JFW, Seto WK, Pai PMC, Yuen KY, Hung DLL. Fatal pancytopenia due to albendazole treatment for strongyloidiasis. IDCases 2018; 12:112-116. [PMID: 29942764 PMCID: PMC6010955 DOI: 10.1016/j.idcr.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report 7 cases of strongyloidiasis that had occurred from 2016 through 2017 in a tertiary hospital of southern China. Three of the 7 patients (age 66-77) with farming exposure many years ago developed symptomatic infection while receiving immunosuppressant for underlying medical conditions. The majority of them were treated with albendazole due to unavailability of ivermectin in mainland China. One of the 7 patients, with underlying IgG4 sclerosing cholangitis and secondary biliary cirrhosis was on immunosuppressives and developed severe pancytopenia 15 days after albendazole treatment. He ultimately died of polymicrobial sepsis. This was the second fatal case being reported in the literature as a consequence of albendazole-induced myelosuppression. We have undertaken a review of the literature regarding the use of albendazole for strongyloidiasis and its adverse effect with a focus on myelosuppression as a rare but potentially serious event.
Collapse
Affiliation(s)
- Fanfan Xing
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Hong Kong Special Administrative Region, China
| | - Haiyan Ye
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Hong Kong Special Administrative Region, China
| | - Jin Yang
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Hong Kong Special Administrative Region, China
| | - Jasper Fuk-Woo Chan
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Hong Kong Special Administrative Region, China
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
| | - Wai-Kay Seto
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Hong Kong Special Administrative Region, China
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - Pearl Ming-Chu Pai
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Hong Kong Special Administrative Region, China
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- Department of Clinical Microbiology and Infection Control, The University of Hong Kong – Shenzhen Hospital, Shenzhen, Hong Kong Special Administrative Region, China
- State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong Special Administrative Region, China
- Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
- The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Derek Ling-Lung Hung
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Special Administrative Region, China
- Corresponding author.
| |
Collapse
|
75
|
Palmeirim MS, Hürlimann E, Knopp S, Speich B, Belizario V, Joseph SA, Vaillant M, Olliaro P, Keiser J. Efficacy and safety of co-administered ivermectin plus albendazole for treating soil-transmitted helminths: A systematic review, meta-analysis and individual patient data analysis. PLoS Negl Trop Dis 2018; 12:e0006458. [PMID: 29702653 PMCID: PMC5942849 DOI: 10.1371/journal.pntd.0006458] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 05/09/2018] [Accepted: 04/18/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The soil-transmitted helminths (STH), Ascaris lumbricoides, Trichuris trichiura and hookworms, infect 1.5 billion people worldwide and cause an estimated burden of 3.3 million disability-adjusted life years (DALYs). Current control strategies focus on morbidity reduction through preventive chemotherapy (PC) but the most commonly used recommended drugs (albendazole and mebendazole) are particularly inefficacious against T. trichiura. This, together with the threat of emerging drug resistance, calls for new control strategies, including co-administration with other anthelminthics. Ivermectin plus albendazole is widely used against lymphatic filariasis, but its efficacy and safety against STH infections has not yet been fully understood. METHODS AND FINDINGS We conducted a systematic literature review and meta-analysis on the efficacy and safety of ivermectin-albendazole co-administration in five different databases (i.e. PubMed, ISI Web of Science, ScienceDirect, CENTRAL and clinicaltrials.gov) from 1960 to January 2018. Four studies reporting efficacy of ivermectin-albendazole against STH infections and five studies on its safety met the selection criteria and were included for quantitative analysis. Ivermectin-albendazole was significantly associated with lower risk (risk ratio (RR) = 0.44, 95% confidence interval (CI) = 0.31-0.62) for T. trichiura infection after treatment compared to albendazole alone. The co-administration revealed no or only a marginal benefit on cure and egg reduction rates over albendazole alone for A. lumbricoides and hookworm infections. Adverse events (AEs) occurring after ivermectin-albendazole co-administration were mostly mild and transient. Overall, the number of individuals reporting any AE was not different (RR = 1.09, 95% CI = 0.87-1.36) in co-treated and albendazole-treated patients. However, although not statistically significant, sub-group analysis showed a tendency for slightly more AEs in patients with filariasis treated with ivermectin-albendazole compared to those treated with albendazole alone (RR = 1.29, 95% CI = 0.81-2.05). CONCLUSIONS Our findings suggest a good tolerability and higher efficacy of ivermectin-albendazole against T. trichiura compared to the current standard single-dose albendazole treatment, which supports the use of this co-administration in PC programs. Large-scale definitive randomized controlled trials are required to confirm our results.
Collapse
Affiliation(s)
- Marta S. Palmeirim
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Eveline Hürlimann
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Stefanie Knopp
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Benjamin Speich
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Vicente Belizario
- Department of Parasitology, College of Public Health, University of the Philippines Manila, Metro Manila, Philippines
| | | | | | - Piero Olliaro
- Special Programme for Research & Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
76
|
Buonfrate D, Requena-Mendez A, Angheben A, Cinquini M, Cruciani M, Fittipaldo A, Giorli G, Gobbi F, Piubelli C, Bisoffi Z. Accuracy of molecular biology techniques for the diagnosis of Strongyloides stercoralis infection-A systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12:e0006229. [PMID: 29425193 PMCID: PMC5823464 DOI: 10.1371/journal.pntd.0006229] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/22/2018] [Accepted: 01/10/2018] [Indexed: 12/11/2022] Open
Abstract
Background Strongyloides stercoralis infection is a neglected tropical disease which can lead to severe symptoms and even death in immunosuppressed people. Unfortunately, its diagnosis is hampered by the lack of a gold standard, as the sensitivity of traditional parasitological tests (including microscopic examination of stool samples and coproculture) is low. Hence, alternative diagnostic methods, such as molecular biology techniques (mostly polymerase chain reaction, PCR) have been implemented. However, there are discrepancies in the reported accuracy of PCR. Methodology A systematic review with meta-analysis was conducted in order to evaluate the accuracy of PCR for the diagnosis of S. stercoralis infection. The protocol was registered with PROSPERO International Prospective Register of Systematic Reviews (record: CRD42016054298). Fourteen studies, 12 of which evaluating real-time PCR, were included in the analysis. The specificity of the techniques resulted high (ranging from 93 to 95%, according to the reference test(s) used). When all molecular techniques were compared to parasitological methods, the sensitivity of PCR was assessed at 71.8% (95% CI 52.2–85.5), that decreased to 61.8% (95% CI 42.0–78.4) when serology was added among the reference tests. Similarly, sensitivity of real-time PCR resulted 64.4% (95% CI 46.2–77.7) when compared to parasitological methods only, 56.5% (95% CI 39.2–72.4) including serology. Conclusions PCR might not be suitable for screening purpose, whereas it might have a role as a confirmatory test. Strongyloides stercoralis is a worm that can potentially kill affected immunosuppressed individuals. The parasite is not easily detected with stool microscopy, hence novel tests have been implemented, such as polymerase chain reaction (PCR), that can detect the DNA of the parasite. This work aims at evaluating the performance of PCR for the diagnosis of S. stercoralis through a revision of diagnostic studies available in literature. According to the results of this work, PCR for S. stercoralis still misses a relevant proportion of infected people, while a positive result confirms the presence of the infection.
Collapse
Affiliation(s)
- Dora Buonfrate
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Ana Requena-Mendez
- Barcelona Institute for Global Health, ISGlobal-CRESIB, Universitat de Barcelona, Spain
| | - Andrea Angheben
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Michela Cinquini
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Mario Cruciani
- Centre of Community Medicine and Infectious Diseases Service, ULSS 9 Scaligera, Verona, Italy
| | | | - Giovanni Giorli
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Federico Gobbi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Chiara Piubelli
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Verona, Italy
| |
Collapse
|
77
|
Martinez-Perez A, Roure Díez S, Belhassen-Garcia M, Torrús-Tendero D, Perez-Arellano JL, Cabezas T, Soler C, Díaz-Menéndez M, Navarro M, Treviño B, Salvador F. Management of severe strongyloidiasis attended at reference centers in Spain. PLoS Negl Trop Dis 2018; 12:e0006272. [PMID: 29474356 PMCID: PMC5846793 DOI: 10.1371/journal.pntd.0006272] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 03/12/2018] [Accepted: 01/25/2018] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Strongyloides stercoralis is a globally distributed nematode that causes diverse clinical symptoms in humans. Spain, once considered an endemic country, has experienced a recent increase in imported cases. The introduction of serology helps diagnosis and is currently replacing microbiological techniques in some settings, but its sensitivity is variable and can be low in immunocompromised patients. Diagnosis can only be confirmed by identification of larvae. Often, this "gold standard" can only be achieved in severe cases, such as disseminated S.stercoralis infection, or S.stercoralis hyperinfection syndrome, where parasite load is high. In addition, these clinical presentations are not well-defined. Our aim is to describe severe cases of S.stercoralis, their epidemiological profile, and their clinical details. METHODS An observational retrospective study of disseminated S.stercoralis infection, or hyperinfection syndrome. Inclusion criteria: aged over 18, with a diagnosis of disseminated S.stercoralis infection, or hyperinfection syndrome, confirmed by visualization of larvae. Patients were identified through revision of clinical records for the period 2000-2015, in collaboration with eight reference centers throughout Spain. RESULTS From the period 2000-2015, eighteen cases were identified, 66.7% of which were male, with a median age of 40 (range 21-70). Most of them were foreigners (94.4%), mainly from Latin America (82.3%) or Western Africa (17.6%). Only one autochthonous case was identified, from 2006. Immunosuppressive conditions were present in fourteen (77%) patients, mainly due steroids use and to retroviral coinfections (four HIV, two HTLV). Transplant preceded the clinical presentation in four of them. Other comorbidities were coinfection with HBV, Trypanosoma cruzi, Mycobacterium leprae or Aspergillus spp. All presented with digestive disorders, with 55.6% also presenting malaise. 44.4% of cases had fever, 27.8% skin complaints, and 16.7% respiratory or neurological disorders. One patient presented anemia, and one other nephrotic syndrome. Diagnosis was confirmed by identification of larvae in fresh stool samples (n = 16; 88.9%), concentration techniques (n = 6; 33.3%), larval culture (n = 5; 29.4%), or digestive biopsies (n = 8; 44%). S.stercoralis forms were identified during necropsy in one case. In addition, ten (55%) had a positive serology. All the cases were treated with ivermectin, six (33%) also received albendazole and one case received thiabendazole followed by ivermectin. All needed inpatient management, involving a mean hospitalization stay of 25 days (range 1-164). Two cases received intensive care and eventually died. CONCLUSIONS Only eighteen cases of disseminated S.stercoralis infection/hyperinfection syndrome were identified from the 15-year period, most of which were considered to have been imported cases. Among those, immunosuppression was frequent, and mortality due to S.stercoralis was lower than previously described.
Collapse
Affiliation(s)
| | - Silvia Roure Díez
- Hospital Universitari Germans Trias i Pujol, Enfermedades Infecciosas, PROSICS Metropolitana Nord, Badalona, Spain
| | - Moncef Belhassen-Garcia
- Hospital Universitario de Salamanca, Servicio Medicina Interna, Sección Enfermedades Infecciosas, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca, CAUSA, IBSAL, CIETUS, Universidad de Salamanca, Salamanca, Spain
| | - Diego Torrús-Tendero
- Hospital General Universitario de Alicante, Enfermedades Infecciosas, Medicina Tropical, Alicante, Spain
| | - Jose Luis Perez-Arellano
- Complejo Hospitalario Universitario Insular Gran Canaria, CHUIMI, Unidad de Enfermedades Infecciosas y Medicina Tropical, Las Palmas de Gran Canaria, Spain
| | - Teresa Cabezas
- Hospital de Poniente, Microbiology, Medicina Tropical, Almeria, Spain
| | - Cristina Soler
- Hospital Santa Caterina, Enfermedades Infecciosas, Unitat de Salut Internacional i Medicina Tropical, Salt/Girona, Spain
| | - Marta Díaz-Menéndez
- Hospital Universitario La Paz-Carlos III, Enfermedades Infecciosas, Unidad de Medicina Tropical y del Viajero, Madrid, Spain
| | - Miriam Navarro
- Spanish Society of Tropical Medicine and International Health SEMTSI, Madrid, Spain
| | - Begoña Treviño
- Vall de Hebrón University Hospital, Tropical Medicine Unit, Barcelona, Spain
| | - Fernando Salvador
- Infectious Diseases Department, Vall de Hebrón University Hospital, PROSICS, Barcelona, Spain
| | | |
Collapse
|
78
|
Forrer A, Khieu V, Schär F, Vounatsou P, Chammartin F, Marti H, Muth S, Odermatt P. Strongyloides stercoralis and hookworm co-infection: spatial distribution and determinants in Preah Vihear Province, Cambodia. Parasit Vectors 2018; 11:33. [PMID: 29329561 PMCID: PMC5767026 DOI: 10.1186/s13071-017-2604-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 12/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strongyloides stercoralis and hookworm are two soil-transmitted helminths (STH) that are highly prevalent in Cambodia. Strongyloides stercoralis causes long-lasting infections and significant morbidity but is largely neglected, while hookworm causes the highest public health burden among STH. The two parasites have the same infection route, i.e. skin penetration. The extent of co-distribution, which could result in potential high co-morbidities, is unknown in highly endemic settings like Cambodia. The aim of this study was to predict the spatial distribution of S. stercoralis-hookworm co-infection risk and to investigate determinants of co-infection in Preah Vihear Province, North Cambodia. METHODS A cross-sectional survey was conducted in 2010 in 60 villages of Preah Vihear Province. Diagnosis was performed on two stool samples, using combined Baermann technique and Koga agar culture plate for S. stercoralis and Kato-Katz technique for hookworm. Bayesian multinomial geostatistical models were used to assess demographic, socioeconomic, and behavioural determinants of S. stercoralis-hookworm co-infection and to predict co-infection risk at non-surveyed locations. RESULTS Of the 2576 participants included in the study, 48.6% and 49.0% were infected with S. stercoralis and hookworm, respectively; 43.8% of the cases were co-infections. Females, preschool aged children, adults aged 19-49 years, and participants who reported regularly defecating in toilets, systematically boiling drinking water and having been treated with anthelmintic drugs had lower odds of co-infection. While S. stercoralis infection risk did not appear to be spatially structured, hookworm mono-infection and co-infection exhibited spatial correlation at about 20 km. Co-infection risk was positively associated with longer walking distances to a health centre and exhibited a small clustering tendency. The association was only partly explained by climatic variables, suggesting a role for underlying factors, such as living conditions and remoteness. CONCLUSIONS Both parasites were ubiquitous in the province, with co-infections accounting for almost half of all cases. The high prevalence of S. stercoralis calls for control measures. Despite several years of school-based de-worming programmes, hookworm infection levels remain high. Mebendazole efficacy, as well as coverage of and compliance to STH control programmes should be investigated.
Collapse
Affiliation(s)
- Armelle Forrer
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Virak Khieu
- grid.415732.6National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Fabian Schär
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Penelope Vounatsou
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Frédérique Chammartin
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Hanspeter Marti
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| | - Sinuon Muth
- grid.415732.6National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Peter Odermatt
- 0000 0004 0587 0574grid.416786.aSwiss Tropical and Public Health Institute, Basel, Switzerland
- 0000 0004 1937 0642grid.6612.3University of Basel, Basel, Switzerland
| |
Collapse
|
79
|
Schmidt-Hieber M, Bierwirth J, Buchheidt D, Cornely OA, Hentrich M, Maschmeyer G, Schalk E, Vehreschild JJ, Vehreschild MJGT. Diagnosis and management of gastrointestinal complications in adult cancer patients: 2017 updated evidence-based guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2018; 97:31-49. [PMID: 29177551 PMCID: PMC5748412 DOI: 10.1007/s00277-017-3183-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/11/2017] [Indexed: 12/15/2022]
Abstract
Cancer patients frequently suffer from gastrointestinal complications. In this manuscript, we update our 2013 guideline on the diagnosis and management of gastrointestinal complications in adult cancer patients by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). An expert group was put together by the AGIHO to update the existing guideline. For each sub-topic, a literature search was performed in PubMed, Medline, and Cochrane databases, and strengths of recommendation and the quality of the published evidence for major therapeutic strategies were categorized using the 2015 European Society for Clinical Microbiology and Infectious Diseases (ESCMID) criteria. Final recommendations were approved by the AGIHO plenary conference. Recommendations were made with respect to non-infectious and infectious gastrointestinal complications. Strengths of recommendation and levels of evidence are presented. A multidisciplinary approach to the diagnosis and management of gastrointestinal complications in cancer patients is mandatory. Evidence-based recommendations are provided in this updated guideline.
Collapse
Affiliation(s)
- M Schmidt-Hieber
- Clinic for Hematology, Oncology, Tumor Immunology and Palliative Care, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - J Bierwirth
- Deutsches Beratungszentrum für Hygiene, BZH GmbH, Freiburg, Germany
| | - D Buchheidt
- 3rd Department of Internal Medicine - Hematology and Oncology - Mannheim University Hospital, University of Heidelberg, Heidelberg, Germany
| | - O A Cornely
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
- Clinical Trials Centre Cologne, ZKS Köln, University of Cologne, Cologne, Germany
| | - M Hentrich
- Department III for Internal Medicine, Hematology and Oncology, Rotkreuzklinikum München, Munich, Germany
| | - G Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Ernst-von-Bergmann Klinikum, Potsdam, Germany
| | - E Schalk
- Department of Hematology and Oncology, Medical Center, Otto-von-Guericke University, Magdeburg, Germany
| | - J J Vehreschild
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany
| | - Maria J G T Vehreschild
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany.
- German Center for Infection Research (DZIF), partner site Bonn-Cologne, Cologne, Germany.
- 1st Department of Internal Medicine, Hospital of the University of Cologne, Kerpener Str. 62, 50937, Köln, Germany.
| |
Collapse
|
80
|
Guerrero-Wooley R, Aranda-Aguirre E, Li W, Wilkin A, Palavecino E. Case Report: Strongyloides stercoralis Hyperinfection in a Patient with Chronic Lymphocytic Leukemia. Am J Trop Med Hyg 2017; 97:1629-1631. [PMID: 29140240 DOI: 10.4269/ajtmh.17-0492] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Strongyloides stercoralis is an intestinal nematode that can cause disseminated infection in an immunocompromised host. It is most commonly acquired in developing countries. It was previously a common infection in many parts of the United States, particularly in the Appalachian region, but is rarely identified currently. Here, we describe a patient born and raised in Appalachia, with no history of travel outside the United States, who presented with chronic lymphocytic leukemia and S. stercoralis hyperinfection characterized by acute respiratory failure, altered mental status, and extended-spectrum-beta-lactamase Klebsiella pneumoniae bacteremia. Despite prompt identification of the parasite on sputum microscopy and initiation of therapy with oral ivermectin and meropenem, the patient subsequently died. This case highlights the continued possibility of S. stercoralis infection in patients from Appalachia.
Collapse
Affiliation(s)
- Richelle Guerrero-Wooley
- Section on Infectious Diseases, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Ernesto Aranda-Aguirre
- Section on Infectious Diseases, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Wencheng Li
- Department of Pathology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Aimee Wilkin
- Section on Infectious Diseases, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Elizabeth Palavecino
- Department of Pathology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| |
Collapse
|
81
|
Strongyloides stercoralis is associated with significant morbidity in rural Cambodia, including stunting in children. PLoS Negl Trop Dis 2017; 11:e0005685. [PMID: 29059195 PMCID: PMC5695629 DOI: 10.1371/journal.pntd.0005685] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 11/02/2017] [Accepted: 06/07/2017] [Indexed: 01/01/2023] Open
Abstract
Background Strongyloides stercoralis is a soil-transmitted nematode that can replicate within its host, leading to long-lasting and potentially fatal infections. It is ubiquitous and highly prevalent in Cambodia. The extent of morbidity associated with S. stercoralis infection is difficult to assess due to the broad spectrum of symptoms and, thus, remains uncertain. Methodology/Principal findings Clinical signs were compared among S. stercoralis infected vs. non-infected participants in a cross-sectional survey conducted in 2012 in eight villages of Northern Cambodia, and before and after treatment with a single oral dose of ivermectin (200μg/kg BW) among participants harboring S. stercoralis. Growth retardation among schoolchildren and adolescents was assessed using height-for-age and thinness using body mass index-for-age. S. stercoralis prevalence was 31.1% among 2,744 participants. Urticaria (55% vs. 47%, OR: 1.4, 95% CI: 1.1–1.6) and itching (52% vs. 48%, OR: 1.2, 95% CI: 1.0–1.4) were more frequently reported by infected participants. Gastrointestinal, dermatological, and respiratory symptoms were less prevalent in 103 mono-infected participants after treatment. Urticaria (66% vs. 11%, OR: 0.03, 95% CI: 0.01–0.1) and abdominal pain (81 vs. 27%, OR: 0.07, 95% CI: 0.02–0.2) mostly resolved by treatment. S. stercoralis infection was associated with stunting, with 2.5-fold higher odds in case of heavy infection. Conclusions/Significance The morbidity associated with S. stercoralis confirmed the importance of gastrointestinal and dermatological symptoms unrelated to parasite load, and long-term chronic effects when associated with malnutrition. The combination of high prevalence and morbidity calls for the integration of S. stercoralis into ongoing STH control measures in Cambodia. Strongyloides stercoralis is an intestinal parasite that infects humans by penetrating intact skin. It thrives particularly in tropical countries with poor sanitation. Because it can replicate within its host, it causes long-lasting infections and is potentially fatal in patients with a disseminated infection. S. stercoralis is largely neglected due to the difficulty in detecting it with standard field diagnostic techniques but has recently been found to be very common in Cambodia, with prevalence rates exceeding 40%. It is difficult to identify symptoms associated with infection in endemic areas because co-infections with other helminths or protozoan parasites, which cause similar health problems, are common. We compared clinical signs in infected vs. non-infected participants living in eight villages in Northern Cambodia, and before and after treatment with ivermectin, the drug of choice against S. stercoralis, among 103 patients infected with S. stercoralis only. We also assessed the association between infection and growth retardation among children and adolescents. Of the participants, 31.1% were infected with S. stercoralis. Infected participants were more likely to report itching and urticaria. After treatment, fewer participants reported urticaria, abdominal pain, vomiting and, to a lesser extent, nausea, diarrhea, cough, and tiredness. S. stercoralis infection was associated with growth retardation as expressed by stunting.
Collapse
|
82
|
de Alegría MLAR, Colmenares K, Espasa M, Amor A, Lopez I, Nindia A, Kanjala J, Guilherme D, Sulleiro E, Barriga B, Gil E, Salvador F, Bocanegra C, López T, Moreno M, Molina I. Prevalence of Strongyloides stercoralis and Other Intestinal Parasite Infections in School Children in a Rural Area of Angola: A Cross-Sectional Study. Am J Trop Med Hyg 2017; 97:1226-1231. [PMID: 28820707 DOI: 10.4269/ajtmh.17-0159] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Strongyloides stercoralis is widely distributed in the tropics and subtropics. The aim of this study was to determine the prevalence of S. stercoralis and other intestinal parasites and identify the risk factors for infection with S. stercoralis in a rural area of Angola. A cross-sectional study was conducted in school-age children (SAC) in Cubal, Angola. A questionnaire collecting clinical and epidemiological variables was used, and two stool samples were collected. A concentration technique (Ritchie) and a technique for detection of larvae migration (Baermann) were performed. Of 230 SAC, 56.1% were female and the mean age was 9.3 years (SD 2.45). Severe malnutrition, according to body mass index (BMI)-for-age, was observed in 20.4% of the SAC, and anemia was found in 59.6%. Strongyloides stercoralis was observed in 28 of the 230 (12.8%) SAC. Eggs of other helminths were observed in 51 (22.2%) students: Hymenolepis spp. in 27 students (11.7%), hookworm in 14 (6.1%), Schistosoma haematobium in four (1.7%), Enterobius vermicularis in four (1.7%), Ascaris lumbricoides in three (1.3%), Taenia spp. in two (0.9%), and Fasciola hepatica in one (0.4%). Protozoa were observed in 17 (7.4%) students. Detection of S. stercoralis was higher using the Baermann technique versus using formol-ether (11.3 vs. 3%). Overall prevalence of S. stercoralis in the school population of 16 studied schools in the municipal area of Cubal was greater than 10%. This fact must be considered when designing deworming mass campaigns. The use of specific tests in larvae detection is needed to avoid overlooking this parasite.
Collapse
Affiliation(s)
- María Luisa Aznar Ruiz de Alegría
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain.,Hospital Nossa Senhora da Paz, Cubal, Angola
| | - Karen Colmenares
- Department of Epidemiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mateu Espasa
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | - Arancha Amor
- Mundo Sano Foundation, Buenos Aires, Argentina.,National Center of Tropical Medicine, Institute of Health Carlos III, Madrid, Spain
| | - Isabel Lopez
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | | | | | | | - Elena Sulleiro
- Department of Microbiology, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | - Begoña Barriga
- Department of Epidemiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Eva Gil
- Hospital Nossa Senhora da Paz, Cubal, Angola
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | - Cristina Bocanegra
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | | | | | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| |
Collapse
|
83
|
Vargas P, Krolewiecki AJ, Echazú A, Juarez M, Cajal P, Gil JF, Caro N, Nasser J, Lammie P, Cimino RO. Serologic Monitoring of Public Health Interventions against Strongyloides stercoralis. Am J Trop Med Hyg 2017; 97:166-172. [PMID: 28719325 DOI: 10.4269/ajtmh.16-0857] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Northwestern Argentina is endemic for soil-transmitted helminths, and annual deworming programs are carried out in prioritized areas. High prevalence of Strongyloides stercoralis was reported in this area; therefore, control programs including ivermectin are being evaluated. The NIE-enzyme linked immunosorbent assay (ELISA) was used for this purpose. In this community trial, two groups of patients, classified according to housing and living conditions were evaluated. Simultaneous with baseline survey, Group 1 was moved to new households with access to improved water and sanitation facilities (W and S), where deworming (MDA, massive drug administration) took place within 1 month; whereas Group 2 received MDA but remained living with unimproved W and S. The mean time interval between baseline and the follow-up was 331 days for Group 1 and 508 for Group 2. Anti-NIE levels were measured for each individual before and after interventions and follow-up optical density (OD) ratios were calculated to quantify the variation. A significant decrease of the anti-NIE levels between baseline and follow-up was observed in both groups. Nonetheless, the number of patients that achieved the cure criteria (OD ratio < 0.6) was higher in Group 1 than Group 2 with values of 72.7% (24/33) and 45.0% (18/40), respectively (P = 0.0197). Our results support the conclusion that a combined intervention including deworming and improvements in life conditions is more effective, in terms of the proportion of subjects cured than deworming alone. Furthermore, we found that NIE-ELISA is a useful test for assessing the response to treatment and to evaluate the outcome of control intervention programs.
Collapse
Affiliation(s)
- Paola Vargas
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales (IIET), Universidad Nacional de Salta, Sede Regional Orán, Salta, Argentina
| | - Alejandro J Krolewiecki
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales (IIET), Universidad Nacional de Salta, Sede Regional Orán, Salta, Argentina
| | - Adriana Echazú
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales (IIET), Universidad Nacional de Salta, Sede Regional Orán, Salta, Argentina
| | - Marisa Juarez
- Fundación Mundo Sano, Buenos Aires, Argentina.,Instituto de Investigaciones de Enfermedades Tropicales (IIET), Universidad Nacional de Salta, Sede Regional Orán, Salta, Argentina
| | - Pamela Cajal
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Jose F Gil
- Instituto de Investigaciones de Enfermedades Tropicales (IIET), Universidad Nacional de Salta, Sede Regional Orán, Salta, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Nicolás Caro
- Instituto de Investigaciones de Enfermedades Tropicales (IIET), Universidad Nacional de Salta, Sede Regional Orán, Salta, Argentina
| | - Julio Nasser
- Instituto de Investigaciones de Enfermedades Tropicales (IIET), Universidad Nacional de Salta, Sede Regional Orán, Salta, Argentina.,Cátedra de Química Biológica, Universidad Nacional de Salta (UNSa), Salta, Argentina
| | - Patrick Lammie
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rubén O Cimino
- Instituto de Investigaciones de Enfermedades Tropicales (IIET), Universidad Nacional de Salta, Sede Regional Orán, Salta, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| |
Collapse
|
84
|
Requena-Méndez A, Buonfrate D, Gomez-Junyent J, Zammarchi L, Bisoffi Z, Muñoz J. Evidence-Based Guidelines for Screening and Management of Strongyloidiasis in Non-Endemic Countries. Am J Trop Med Hyg 2017; 97:645-652. [PMID: 28749768 DOI: 10.4269/ajtmh.16-0923] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Strongyloidiasis is an intestinal parasitic infection becoming increasingly important outside endemic areas, not only because of the high prevalence found in migrant populations, but also because immunosuppressed patients may suffer a potentially fatal disseminated disease. The aim of these guidelines is to provide evidence-based guidance for screening and treatment of strongyloidiasis in non-endemic areas. A panel of experts focused on three main clinical questions (who should be screened and how, how to treat), and reviewed pertinent literature available in international databases of medical literature and in documents released by relevant organizations/societies. A consensus of the experts' opinion was sought when specific issues were not covered by evidence. In particular, six systematic reviews were retrieved and constituted the main support for this work. The evidence and consensus gathered led to recommendations addressing various aspects of the main questions. Grading of evidence and strength of recommendation were attributed to assess the quality of supporting evidence. The screening of individuals at risk of the infection should be performed before they develop any clinical complication. Moreover, in immunosuppressed patients, the screening should be mandatory. The screening is based on a simple and widely accessible technology and there is now a universally accepted treatment with a high efficacy rate. Therefore, the screening could be implemented as part of a screening program for migrants although further cost-effectiveness studies are required to better evaluate this strategy from a public health point of view.
Collapse
Affiliation(s)
- Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Dora Buonfrate
- Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Joan Gomez-Junyent
- Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Lorenzo Zammarchi
- Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Universita Degli Studi di Firenze, Florence, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar, Verona, Italy
| | - José Muñoz
- Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
85
|
Paradies P, Iarussi F, Sasanelli M, Capogna A, Lia RP, Zucca D, Greco B, Cantacessi C, Otranto D. Occurrence of strongyloidiasis in privately owned and sheltered dogs: clinical presentation and treatment outcome. Parasit Vectors 2017; 10:345. [PMID: 28728589 PMCID: PMC5520385 DOI: 10.1186/s13071-017-2275-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The increasing number of reports of human infections by Strongyloides stercoralis from a range of European countries over the last 20 years has spurred the interest of the scientific community towards this parasite and, in particular, towards the role that infections of canine hosts may play in the epidemiology of human disease. Data on the epidemiology of canine strongyloidiasis is currently limited, most likely because of the inherent limitations of current diagnostic methods. METHODS Faecal samples were collected directly from the rectal ampulla of 272 animals of varying age and both genders living in Apulia, southern Italy. Dogs included were either privately owned (n = 210), living in an urban area but with unrestricted outdoor access (Group 1), or shelter dogs (n = 62 out of ~400) hosted in a single shelter in the province of Bari in which a history of diarrhoea, weight loss, reduced appetite and respiratory symptoms had been reported (Group 2). Strongyloides stercoralis infection was diagnosed by coproscopy on direct faecal smear and via the Baermann method. RESULTS Six of 272 dogs were positive for S. stercoralis at the Baermann examination; all but one were from the shelter (Group 2) and displayed gastrointestinal clinical signs. The only owned dog (Group 1) infected with S. stercoralis, but clinically healthy, had been adopted from a shelter 1 year prior to sampling. Five infected dogs were treated with fenbendazole (Panacur®, Intervet, Animal Health, 50 mg/kg, PO daily for 5 days), or with a combination of fenbendazole and moxidectin plus imidacloprid spot-on (Im/Mox; Advocate® spot-on, Bayer). Post-treatment clearance of infection was confirmed in three dogs by Baermann examination, whereas treatment failure was documented in two dogs by Baermann and/or post-mortem detection of adult parasites. CONCLUSIONS This study describes, for the first time, the presence of S. stercoralis infection in sheltered dogs from southern Italy. Data indicate that S. stercoralis infection may pose a concern for sheltered animals and raise questions on potential risks of infection for staff of municipal shelters in southern European countries. Given that a single course of treatment with fenbendazole, associated or not with Im/Mox spot-on, may not eliminate the infection, effective treatment protocols should be investigated and control strategies targeting the environment considered for reducing the risk of zoonotic infection.
Collapse
Affiliation(s)
- Paola Paradies
- Department of Emergency and Organ Transplantations, Veterinary Section, University of Bari, 70010, Valenzano, Bari, Italy
| | - Fabrizio Iarussi
- Department of Emergency and Organ Transplantations, Veterinary Section, University of Bari, 70010, Valenzano, Bari, Italy
| | - Mariateresa Sasanelli
- Department of Emergency and Organ Transplantations, Veterinary Section, University of Bari, 70010, Valenzano, Bari, Italy
| | - Antonio Capogna
- Department of Emergency and Organ Transplantations, Veterinary Section, University of Bari, 70010, Valenzano, Bari, Italy
| | - Riccardo Paolo Lia
- Department of Veterinary Medicine, University of Bari, 70010, Valenzano, Bari, Italy
| | - Daniele Zucca
- Institute of Animal Health, University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Beatrice Greco
- Department of Emergency and Organ Transplantations, Veterinary Section, University of Bari, 70010, Valenzano, Bari, Italy
| | - Cinzia Cantacessi
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Domenico Otranto
- Department of Veterinary Medicine, University of Bari, 70010, Valenzano, Bari, Italy.
| |
Collapse
|
86
|
Barda B, Albonico M, Buonfrate D, Ame SM, Ali S, Speich B, Keiser J. Side Benefits of Mass Drug Administration for Lymphatic Filariasis on Strongyloides stercoralis Prevalence on Pemba Island, Tanzania. Am J Trop Med Hyg 2017; 97:681-683. [PMID: 28722622 DOI: 10.4269/ajtmh.17-0050] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Strongyloides stercoralis, although endemic in many countries, is not included in helminth control programs. Few data are available on the prevalence and morbidity linked to this infection. We compared data from two studies conducted in 1998 and 2013 on Pemba Island, Tanzania, involving 525 and 509 schoolchildren, respectively. In 1998, the diagnostic method used was Harada Mori, whereas in 2013 diagnosis was made by both Koga agar plate and Baermann methods. The prevalence registered was 41% in 1998 and 7% in 2013. This data suggest that the prevalence of S. stercoralis on Pemba was significantly reduced 7 years after the last ivermectin administration for preventive chemotherapy and underlines the importance and impact of large-scale preventive chemotherapy, which often goes beyond its actual target. Preventive chemotherapy with ivermectin should be recommended in areas where S. stercoralis is endemic.
Collapse
Affiliation(s)
- Beatrice Barda
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Marco Albonico
- Public Health Laboratory Ivo de Carneri, Chake-Chake, Tanzania.,Center for Tropical Diseases, Negrar Hospital, Verona, Italy
| | - Dora Buonfrate
- Center for Tropical Diseases, Negrar Hospital, Verona, Italy
| | - Shaali M Ame
- Public Health Laboratory Ivo de Carneri, Chake-Chake, Tanzania
| | - Said Ali
- Public Health Laboratory Ivo de Carneri, Chake-Chake, Tanzania
| | - Benjamin Speich
- University of Basel, Basel, Switzerland.,Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jennifer Keiser
- University of Basel, Basel, Switzerland.,Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
| |
Collapse
|
87
|
Finon A, Desoubeaux G, Maruani A. Recurrent Linear Dermatosis in a 9-Year-Old Boy. J Pediatr 2017; 185:246. [PMID: 28396026 DOI: 10.1016/j.jpeds.2017.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Antoine Finon
- Department of Dermatology Unit of Pediatric Dermatology
| | - Guillaume Desoubeaux
- Department of Parasitology Division of Mycology and Tropical Medicine CHRU Tours, France
| | - Annabel Maruani
- Department of Dermatology Unit of Pediatric Dermatology University François Rabelais Tours CHRU Tours, France
| |
Collapse
|
88
|
Vazquez Guillamet LJ, Saul Z, Miljkovich G, Vilchez GA, Mendonca N, Gourineni V, Lillo N, Pinto M, Baig A, Gangcuangco LM. Strongyloides Stercoralis Infection Among Human Immunodeficiency Virus (HIV)-Infected Patients in the United States of America: A Case Report and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:339-346. [PMID: 28366929 PMCID: PMC5386446 DOI: 10.12659/ajcr.902626] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient: Male, 61 Final Diagnosis: Strongyloides stercolaris-associated diarrhea Symptoms: Diarrhea • epigastric pain • nausea • weight loss Medication: Ivermectin Clinical Procedure: Colonic biopsies Specialty: Infectious Diseases
Collapse
Affiliation(s)
| | - Zane Saul
- Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA.,Department of Internal Medicine and Infectious Disease, Associates P.C. Stratford, Stratford, CT, USA
| | - Goran Miljkovich
- Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA.,Department of Internal Medicine and Infectious Disease, Associates P.C. Stratford, Stratford, CT, USA
| | | | - Nikolai Mendonca
- Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Venkata Gourineni
- Section of Gastroenterology, Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Nicholas Lillo
- Section of Gastroenterology, Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| | - Marguerite Pinto
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Aurengzaib Baig
- Department of Internal Medicine, Saba University School of Medicine, The Bottom, Saba, Netherlands
| | - Louie Mar Gangcuangco
- Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA
| |
Collapse
|
89
|
Strongyloides Hyperinfection in a Renal Transplant Patient: Always Be on the Lookout. Case Rep Infect Dis 2017; 2017:2953805. [PMID: 28316848 PMCID: PMC5337848 DOI: 10.1155/2017/2953805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/24/2017] [Accepted: 01/30/2017] [Indexed: 12/05/2022] Open
Abstract
We present a case of a 71-year-old Vietnamese man with chronic kidney disease secondary to adult polycystic kidney disease. He had been a prisoner of war before undergoing a successful cadaveric renal transplant in the United States. He presented to clinic one year after the transplant with gross hematuria, productive cough, intermittent chills, and weight loss. Long standing peripheral eosinophilia of 600–1200/μL triggered further evaluation. A wet mount of stool revealed Strongyloides stercoralis larvae. A computed tomography (CT) of chest showed findings suggestive of extension of the infection to the lungs. The patient was treated with a three-week course of ivermectin with complete resolution of signs, symptoms, peripheral eosinophilia, and the positive IgG serology. Strongyloides infection in renal transplant patient is very rare and often presents with hyperinfection, associated with high mortality rates. The American Transplant Society recommends pretransplant screening with stool examination and Strongyloides stercoralis antibody in recipients and donors from endemic areas or with eosinophilia. It is imperative that healthcare professionals involved in the care of these individuals be cognizant of these recommendations as it is a very preventable and treatable entity.
Collapse
|
90
|
Nyundo AA, Munisi DZ, Gesase AP. Prevalence and Correlates of Intestinal Parasites among Patients Admitted to Mirembe National Mental Health Hospital, Dodoma, Tanzania. J Parasitol Res 2017; 2017:5651717. [PMID: 28611925 PMCID: PMC5458378 DOI: 10.1155/2017/5651717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 04/26/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Neglected tropical diseases continue to be one of the leading causes of morbidity and mortality in the developing world. Psychiatric patients are among groups at risk for parasitic infection although control and monitoring programs largely overlook this population. This study aimed at determining prevalence and factors associated with intestinal parasitic infection among patients admitted to a psychiatric facility. METHOD The study followed cross-sectional design; all the residing patients that met the inclusion criteria were included in the survey. Stool samples were collected and examined by direct wet preparation and formol-ether concentration. Data were analyzed with STATA version 12.1; Chi-square test was computed to determine the level of significance at p value < 0.05. RESULTS Of all 233 patients who returned the stool samples, 29 (12.45%) screened were positive for an intestinal parasite. There was no significant association between parasite carriage and age, sex, or duration of hospital stay. CONCLUSION The study shows that intestinal parasitic infection is common among patients in a psychiatric facility and highlights that parasitic infections that enter through skin penetration may be a more common mode of transmission than the oral route. Furthermore, the study underscores the need for surveillance and intervention programs to control and manage these infections.
Collapse
Affiliation(s)
- Azan A. Nyundo
- 1Department of Internal Medicine and Child Health, Psychiatry Division, School of Medicine, College of Health Science, The University of Dodoma, Dodoma, Tanzania
- 2Department of Anatomy and Histology, College of Health Science, The University of Dodoma, Dodoma, Tanzania
- *Azan A. Nyundo:
| | - David Z. Munisi
- 3Department of Microbiology and Parasitology, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
| | - Ainory P. Gesase
- 2Department of Anatomy and Histology, College of Health Science, The University of Dodoma, Dodoma, Tanzania
| |
Collapse
|
91
|
Strongyloides Hyperinfection Syndrome Combined with Cytomegalovirus Infection. Case Rep Transplant 2016; 2016:1786265. [PMID: 27703835 PMCID: PMC5040796 DOI: 10.1155/2016/1786265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/14/2016] [Accepted: 08/28/2016] [Indexed: 11/17/2022] Open
Abstract
The mortality in Strongyloides hyperinfection syndrome (SHS) is alarmingly high. This is particularly common in bone marrow, renal, and other solid organ transplant (SOT) patients, where figures may reach up to 50–85%. Immunosuppressives, principally corticosteroids, are the primary triggering factor. In general, the clinical features of Strongyloides stercoralis hyperinfection are nonspecific; therefore, a high index of suspicion is required for early diagnosis and starting appropriate therapy. Although recurrent Gram-negative sepsis and meningitis have been previously reported, the combination of both cytomegalovirus (CMV) and strongyloidiasis had rarely been associated. We here describe a patient who survived SHS with recurrent Escherichia coli (E. coli) urosepsis and CMV infection.
Collapse
|
92
|
StrongNet: An International Network to Improve Diagnostics and Access to Treatment for Strongyloidiasis Control. PLoS Negl Trop Dis 2016; 10:e0004898. [PMID: 27607192 PMCID: PMC5015896 DOI: 10.1371/journal.pntd.0004898] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
93
|
Tachamo N, Nazir S, Lohani S, Karmacharya P. Strongyloidiasis in the immunocompetent: an overlooked infection. J Community Hosp Intern Med Perspect 2016; 6:32038. [PMID: 27609726 PMCID: PMC5016755 DOI: 10.3402/jchimp.v6.32038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/12/2016] [Accepted: 07/15/2016] [Indexed: 11/17/2022] Open
Abstract
Strongyloidiasis is a parasitic infestation caused by Strongyloides stercoralis. Most cases are asymptomatic; however, symptomatic patients may present with a wide range of non-specific cutaneous, pulmonary, or gastrointestinal symptoms posing a diagnostic dilemma and delay in diagnosis. We report a case of a 58-year-old female who presented with months of generalized pruritus and abdominal discomfort along with persistent eosinophilia due to strongyloidiasis, which completely resolved with treatment.
Collapse
Affiliation(s)
- Niranjan Tachamo
- Department of Medicine, Reading Health System, West Reading, PA, USA;
| | - Salik Nazir
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - Saroj Lohani
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - Paras Karmacharya
- Department of Medicine, Reading Health System, West Reading, PA, USA
| |
Collapse
|
94
|
Infectious Diseases in Refugee Children: To Screen or Not to Screen. CURRENT PEDIATRICS REPORTS 2016. [DOI: 10.1007/s40124-016-0103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
95
|
Abstract
The majority of the 30-100 million people infected with Strongyloides stercoralis, a soil transmitted intestinal nematode, have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding because of the autoinfective process associated with its unique life cycle. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. Corticosteroid use and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses both local and systemic that remain poorly characterized. Definitive diagnosis of S. stercoralis infection is based on stool examinations for larvae, but newer diagnostics - including new immunoassays and molecular tests - will assume primacy in the next few years. Although good treatment options exist for infection and control of this infection might be possible, S. stercoralis remains largely neglected.
Collapse
|