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Praveena R. Diagnosing parasitic infestation in a patient with tuberculosis. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i3.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This report describes a case of diarrhea, abdominal pain, and strongyloidiasis in a 33-year-old woman. She had co-existing abdominal tuberculosis. The role of repeated stool microscopy in patients with a compromised immune system with a high index of clinical suspicion for the parasite is important. Strongyloidiasis was not clinically suspected in this patient and was diagnosed as part of evaluation for diarrhoea. But the case raises the importance not only of testing for strongyloidiasis in tuberculosis patients with symptoms suspicious of strongyloidiasis but also therapy for the parasite in such instances. Treatment with steroids for tuberculosis may also worsen the symptoms of strongyloidiasis.
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De Liberato C, Iatta R, Scarito MA, Grifoni G, Dante G, Otranto D. Strongyloides stercoralis in a dog litter: Evidence suggesting a transmammary transmission. Acta Trop 2022; 231:106465. [PMID: 35427536 DOI: 10.1016/j.actatropica.2022.106465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Strongyloides stercoralis is a soil-transmitted helminth with an unusual life cycle, causing canine and human strongyloidiasis, mainly endemic in tropical and subtropical areas. Following percutaneous or oral transmission of infective third-stage larvae in the vertebrate host, the parasite can cause autoinfection, leading to life-long infection. At present, the transmammary transmission was only assessed in experimentally infested dogs. Here, we provide observational evidence of S. stercoralis transmammary transmission in puppies suckling from a truffle dog from Central Italy, from where its presence was neglected.
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Affiliation(s)
- Claudio De Liberato
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy.
| | - Roberta Iatta
- Dipartimento Interdisciplinare di Medicina, Università di Bari, Piazza Giulio Cesare 11, Bari 70124, Italy
| | - Maria Alessia Scarito
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy
| | - Goffredo Grifoni
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy
| | - Giampiero Dante
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy
| | - Domenico Otranto
- Dipartimento di Medicina Veterinaria, Università di Bari, Str. prov. per Casamassima km 3, Valenzano 70010, Italy
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Mendez P, Walsh B, Hallem EA. Using newly optimized genetic tools to probe Strongyloides sensory behaviors. Mol Biochem Parasitol 2022; 250:111491. [PMID: 35697205 PMCID: PMC9339661 DOI: 10.1016/j.molbiopara.2022.111491] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
The oft-neglected human-parasitic threadworm, Strongyloides stercoralis, infects roughly eight percent of the global population, placing disproportionate medical and economic burden upon marginalized communities. While current chemotherapies treat strongyloidiasis, disease recrudescence and the looming threat of anthelminthic resistance necessitate novel strategies for nematode control. Throughout its life cycle, S. stercoralis relies upon sensory cues to aid in environmental navigation and coordinate developmental progression. Odorants, tastants, gases, and temperature have been shown to shape parasite behaviors that drive host seeking and infectivity; however, many of these sensory behaviors remain poorly understood, and their underlying molecular and neural mechanisms are largely uncharacterized. Disruption of sensory circuits essential to parasitism presents a promising strategy for future interventions. In this review, we describe our current understanding of sensory behaviors - namely olfactory, gustatory, gas sensing, and thermosensory behaviors - in Strongyloides spp. We also highlight the ever-growing cache of genetic tools optimized for use in Strongyloides that have facilitated these findings, including transgenesis, CRISPR/Cas9-mediated mutagenesis, RNAi, chemogenetic neuronal silencing, and the use of fluorescent biosensors to measure neuronal activity. Bolstered by these tools, we are poised to enter an era of rapid discovery in Strongyloides sensory neurobiology, which has the potential to shape pioneering advances in the prevention and treatment of strongyloidiasis.
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Affiliation(s)
- Patricia Mendez
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, USA; Molecular Biology Interdepartmental PhD Program, University of California Los Angeles, Los Angeles, CA, USA.
| | - Breanna Walsh
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, USA; Molecular Biology Interdepartmental PhD Program, University of California Los Angeles, Los Angeles, CA, USA; Medical Scientist Training Program, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Elissa A Hallem
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, USA; Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA.
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Kim T, Lim S. Seropositivity Rates of Strongyloides stercoralis Antibody in the Southeastern Region of Republic of Korea: A Single-Center Retrospective Study. THE KOREAN JOURNAL OF PARASITOLOGY 2022; 60:181-185. [PMID: 35772736 PMCID: PMC9256283 DOI: 10.3347/kjp.2022.60.3.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Abstract
Strongyloides stercoralis infection is not endemic in the Republic of Korea (Korea) with a positivity rate of <1% in stool examination. However, there is a risk of hyperinfection in immunosuppressed individuals. It is necessary to determine the seropositivity of S. stercoralis antibodies in Korea. This study investigated the seropositivity of S. stercoralis antibodies in the southeastern area of Korea. From January 2019 to June 2021, serum samples were collected from participants who visited the study center in the southeastern region of Korea for routine health check-ups. We determined serum levels of specific anti-Strongyloides IgG antibodies in 834 samples by enzyme-linked immunosorbent assay. We observed that 92 samples (11.0%) tested showed a positive response. The age of the participants was 51±10.7 years, and 43.4% of them were men. The antibody positivity rate based on the location of the participants' residence were 12.3% (Gyoungsangnam-do), 10.2% (Busan), and 10.1% (Ulsan), respectively. Total eosinophil count was associated with positive test results (154.8±152.0 per mm3 versus 202.1±178.9 per mm3, P=0.006). Logistic regression analysis revealed that blood eosinophil count, age above 50 years, and residence in Sacheon were factors associated with the positive status of S. stercoralis antibody. Our finding suggests that it is necessary to test for S. stercoralis in actual clinical settings in Korea.
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Affiliation(s)
- Taehwa Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan 50612,
Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612,
Korea
| | - Seungjin Lim
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612,
Korea
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan 50612,
Korea
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Meira Dias O, Belousova N, Sharif N, Brasg I, Singer LG, Tikkanen J, Chaparro C, Rotstein C. Strongyloides hyper-infection in a lung transplant recipient: Case report and review of the literature. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:150-156. [PMID: 36337355 PMCID: PMC9608110 DOI: 10.3138/jammi-2021-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 06/16/2023]
Abstract
CASE PRESENTATION A 63-year-old man with a left single lung transplant for end-stage combined restrictive and obstructive lung disease developed persistent pulmonary infiltrates and recurrent gram-negative bacteremia post-transplant. Bronchoalveolar lavage fluid revealed a nematode on Papanicolau staining compatible with Strongyloides stercoralis larvae on day 50 post-transplant. Although Strongyloides serology performed post-transplant was negative, a retrospective review of the medical record revealed marked peripheral blood eosinophilia on several occasions before transplantation. Despite reduction in immunosuppression and treatment with albendazole and ivermectin, the patient developed another episode of Escherichia coli bacteremia. He died 3 months post-transplant from pulmonary and neurological complications. DIAGNOSIS Strongyloides hyper-infection. DISCUSSION Strongyloides hyper-infection syndrome is known to occur in immunocompromised patients, but it has only been reported once in a lung transplant recipient. This case illustrates the importance of screening for parasitic infections before transplantation in patients with marked eosinophilia, especially among immigrants from countries in which Strongyloides is endemic. Hyper-infection syndrome may appear years after infection in the context of immunosuppression or immunodeficiency. This case also highlights the association between Strongyloides hyper-infection and bacteremia with enteric organisms.
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Affiliation(s)
- Olívia Meira Dias
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Natalia Belousova
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nadia Sharif
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ian Brasg
- Multi-Organ Transplant Program, Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Lianne G Singer
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jussi Tikkanen
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Cecilia Chaparro
- Toronto Lung Transplant Program, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Coleman Rotstein
- Multi-Organ Transplant Program, Division of Infectious Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Tameru K, Tsegaye B, Shikur M, Ergete W, Tasew G, Abera A, Wolday D. Case Report: Disseminated Strongloides stercoralis Presenting as an Ulcerated Gastric Mass in an HIV-1-infected Patient. Am J Trop Med Hyg 2022; 106:tpmd210791. [PMID: 35533694 PMCID: PMC9209934 DOI: 10.4269/ajtmh.21-0791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 03/06/2022] [Indexed: 11/07/2022] Open
Abstract
Disseminated Strongloides stercoralis is a common phenomenon among patients with immunosuppression. In this report, we present a case of disseminated Strongloides stercoralis presenting as a gastric mass in a 42-year-old male patient with a known history of HIV-1 infection and type 2 diabetes mellitus (T2DM). The patient presented with symptoms and signs suggestive of acute on chronic erosive gastritis, which included persistent vomiting. Endoscopic examination revealed a gastric mass with no signs of malignancy or dysplasia. There was noted to be chronic inflammation along with morphologic features consistent with the larvae and eggs of Strongloides nematodes in a biopsied gastric mass tissue and duodenum. The disease subsequently resulted in death despite the administration of ivermectin.
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Affiliation(s)
| | | | | | - Wondwossen Ergete
- Department of Pathology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Geremew Tasew
- Bacterial, Fungal and Zoonotic Diseases Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Adugna Abera
- Bacterial, Fungal and Zoonotic Diseases Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Dawit Wolday
- Mekelle University College of Health Sciences, Mekelle, Ethiopia
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57
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Jember TH, Amor A, Nibret E, Munshea A, Flores-Chavez M, Ta-Tang TH, Saugar JM, Benito A, Anegagrie M. Prevalence of Strongyloides stercoralis infection and associated clinical symptoms among schoolchildren living in different altitudes of Amhara National Regional State, northwest Ethiopia. PLoS Negl Trop Dis 2022; 16:e0010299. [PMID: 35482629 PMCID: PMC9049318 DOI: 10.1371/journal.pntd.0010299] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Strongyloides stercoralis is a parasite that causes strongyloidiasis in humans. It is prevalent in the tropics and sub-tropics where poor sanitation is a common problem. The true prevalence of S. stercoralis in Ethiopia is underestimated due to the lack of a “Gold” standard diagnostic method. Moreover, its prevalence across altitudinal gradient in Amhara Region has not been studied. Methods A cross-sectional study was conducted among 844 schoolchildren in Amhara Region from April to December 2019. A stool sample was collected from each study participant and processed using formol ether concentration technique (FECT), spontaneous tube sedimentation technique (STST), Baermann concentration technique (BCT), agar plate culture (APC) and real-time polymerase chain reaction (RT-PCR). Data were entered using EpiData and analyzed by SPSS version 23 statistical software. Prevalence of S. stercoralis infection was determined using a single diagnostic technique and combination of techniques. Association of clinical variables with S. stercoralis infection was assessed by logistic regression and independent variables with p<0.05 were considered statistically significant. Results Prevalence of soil-transmitted helminths (STHs) and S. mansoni infections was 38.0% and 20.4%, respectively. Among STHs, the prevalence of hookworm infection was 32.8%. Prevalence of S. stercoralis infection was 39.0%, 28.8%, 10.9%, 10.3%, 4.0% and 2.0% by the respective, combinations of the five methods, RT-PCR, APC, BCT, STST and FECT. The highest prevalence rates, 48.2%, 45.0% and 41.1% of S. stercoralis were recorded in the age group of 12–14 years, males and rural dwellers, respectively. Prevalence rates of S. stercoralis infection in highland, semi-highland and lowland areas were 40.4%, 41.8% and 25.9%, respectively. Having abdominal pain (AOR = 2.48; 95% CI:1.65–3.72), cough (AOR = 1.63;95%CI:1.09–2.42), urticaria (AOR = 2.49;95%CI:1.50–4.01) and being malnourished (AOR = 1.44;95%:1.10–2.01) were significantly associated with strongyloidiasis. Conclusion Prevalence of S. stercoralis infection was high and varied across different altitudes in Amhara Region. Some clinical syndromes were found to be significantly associated with S. stercoralis infection. Therefore, proper diagnosis and preventive strategies against S. stercoralis infection are highly recommended to be devised and implemented in Amhara Region. Prevalence of S. stercoralis is under-reported in many resource-poor countries including Ethiopia. We carried out a school-based cross-sectional study among 844 schoolchildren across highlands, semi-highlands and lowland areas of Amhara Region. We used an approach made of five diagnostic methods, namely, FECT, STST, BCT, APC, and RT-PCR. The total prevalence of S. stercoralis was 39.0%. The highest S. stercoralis prevalence (41.8%) was observed in the semi-highland areas of the region. Strongyloidiasis was significantly higher among 12–14 years age groups, males, and rural dweller children. Clinical symptoms such as presence of abdominal pain, cough, skin rash and malnourishment were significantly associated with strongyloidiasis. We recommend that preventive strategies against strongyloidiasis in Amhara Region should be implemented.
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Affiliation(s)
- Tadesse Hailu Jember
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- * E-mail:
| | - Arancha Amor
- Mundo Sano Foundation and Institute of Health Carlos III, Madrid, Spain
| | - Endalkachew Nibret
- Biology Department, Science College, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abaineh Munshea
- Biology Department, Science College, Bahir Dar University, Bahir Dar, Ethiopia
| | - Maria Flores-Chavez
- Mundo Sano Foundation and National Centre for Microbiology Institute of Health Carlos III, Madrid, Spain
| | - Thuy-Huong Ta-Tang
- National Center of Tropical Medicine, Institute of Health Carlos III, Biomedical Research Networking Center of Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - Jose M Saugar
- National Centre of Microbiology, Institute of Health Carlos III, (CIBERINFEC), Madrid, Spain
| | - Agustín Benito
- National Centre of Tropical Medicine, Institute of Health Carlos III, (CIBERINFEC), Madrid, Spain
| | - Melaku Anegagrie
- Mundo Sano Foundation and Institute of Health Carlos III, Madrid, Spain
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Legrand N, McGregor S, Bull R, Bajis S, Valencia BM, Ronnachit A, Einsiedel L, Gessain A, Kaldor J, Martinello M. Clinical and Public Health Implications of Human T-Lymphotropic Virus Type 1 Infection. Clin Microbiol Rev 2022; 35:e0007821. [PMID: 35195446 PMCID: PMC8941934 DOI: 10.1128/cmr.00078-21] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Human T-lymphotropic virus type 1 (HTLV-1) is estimated to affect 5 to 10 million people globally and can cause severe and potentially fatal disease, including adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The burden of HTLV-1 infection appears to be geographically concentrated, with high prevalence in discrete regions and populations. While most high-income countries have introduced HTLV-1 screening of blood donations, few other public health measures have been implemented to prevent infection or its consequences. Recent advocacy from concerned researchers, clinicians, and community members has emphasized the potential for improved prevention and management of HTLV-1 infection. Despite all that has been learned in the 4 decades following the discovery of HTLV-1, gaps in knowledge across clinical and public health aspects persist, impeding optimal control and prevention, as well as the development of policies and guidelines. Awareness of HTLV-1 among health care providers, communities, and affected individuals remains limited, even in countries of endemicity. This review provides a comprehensive overview on HTLV-1 epidemiology and on clinical and public health and highlights key areas for further research and collaboration to advance the health of people with and at risk of HTLV-1 infection.
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Affiliation(s)
- Nicolas Legrand
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Skye McGregor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Rowena Bull
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sahar Bajis
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | | | - Amrita Ronnachit
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lloyd Einsiedel
- Central Australian Health Service, Alice Springs, Northern Territory, Australia
| | - Antoine Gessain
- Institut Pasteur, Epidemiology and Physiopathology of Oncogenic Viruses Unit, Paris, France
| | - John Kaldor
- Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Naidu YV, Calderon Candelario RA, Kett DH. Strongyloides stercoralis hyperinfection syndrome: a known entity in an unknown provenance. BMJ Case Rep 2022; 15:e242698. [PMID: 35410944 PMCID: PMC9003812 DOI: 10.1136/bcr-2021-242698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/04/2022] Open
Abstract
A 49-year-old man was admitted with altered mental status, high-grade fevers, tachycardia and leucocytosis. Cerebrospinal fluid (CSF) was purulent with a markedly elevated nucleated cell count with neutrophilic predominance, elevated protein and low glucose. CSF gram stain was negative. Patient received vancomycin, cefepime, ampicillin and acyclovir for presumed meningitis. He was intubated for protection of airway and underwent bronchoscopy. Microscopic examination of the bronchoalveolar lavage noted Strongyloides filariform larvae. Ivermectin was prescribed. Other laboratory tests showed a positive HIV test associated with a low CD4 count. Stool ova and parasite also revealed Strongyloides and repeat lumbar puncture identified larvae in the CSF. Albendazole was added for adjunctive therapy. However, the patient suffered a large intraparenchymal haemorrhage extending into the ventricles and he expired 36 days after admission.
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Affiliation(s)
- Yogeeta V Naidu
- Division of Pulmonary & Critical Care, Jackson Memorial Hospital, Miami, Florida, USA
| | - Rafael A Calderon Candelario
- Division of Pulmonary & Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel H Kett
- Department of Pulmonary & Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Abstract
Strongyloidiasis has been estimated to affect over 600 million people worldwide. It is caused by Strongyloides stercoralis, a roundworm endemic to the tropics and subtropics, especially areas where sanitation is suboptimal Autochthonous transmission has been documented in rural areas of the USA and Europe. Humans are infected when larvae penetrate the skin or are ingested. Autoinfection, in which larvae generated in the host go on to re-infect the host, leads to a state of chronic asymptomatic infection often with eosinophilia. Hyperinfection syndrome may develop when patients develop immune suppression, due to medications such as corticosteroids or following solid-organ transplantation. Hyperinfection is characterized by exponential increase in parasitic burden, leading to tissue invasion and life-threatening disease and associated bloodstream infections due to enteric organisms. Cases following use of corticosteroids for COVID-19 pneumonia have been described. Strongyloidiasis can be diagnosed by direct visualization of larvae in stool or other body fluids, or by serology. Ivermectin is highly effective in treating the disease. Patients with exposure to endemic areas and those expected to become immune suppressed should be screened and treated before starting immune suppressive agents. Empiric treatment should be considered when timely testing is not readily available.
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61
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Qu J, Zong Z. Strongyloidiasis in a Patient Diagnosed by Metagenomic Next-Generation Sequencing: A Case Report. Front Med (Lausanne) 2022; 9:835252. [PMID: 35463003 PMCID: PMC9022660 DOI: 10.3389/fmed.2022.835252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/28/2022] [Indexed: 12/11/2022] Open
Abstract
Background Strongylodiasis may be asymptomatic or cause mild gastrointestinal symptoms, and may be a fatal disseminated disease or Strongyloides hyperinfection syndrome. Non-specific clinical manifestations, such as pneumonia and gastroenteritis, pose a diagnostic dilemma. Case Presentation We report a case of a 67-year-old Chinese male who presented with abdominal pain, fever, headache, vomiting, constipation, and slight cough with sputum for nearly 2 months. He had been in good health and had no history of glucocorticoid use. He was diagnosed with enterococcal meningitis and intestinal obstruction at a local hospital and improved after treatment with vancomycin, but symptoms of headache and abdominal pain soon recurred. The metagenomic next-generation sequencing (mNGS) of the cerebrospinal fluid using Illumina X10 sequencer revealed seven sequence reads matching Strongyloides stercoralis. Strongyloidiasis was suspected. Microscopic examination of gastric fluid revealed the presence of S. stercoralis larvae, which was confirmed by PCR to amplify both S. stercoralis ribosomal DNA gene and mitochondrial cytochrome c oxidase subunit 1 gene and sequencing amplicons. Strongyloidiasis was diagnosed. Albendazole (400 mg, twice daily) was used, and the patient recovered gradually. Conclusion mNGS may be a useful tool for detecting uncommon infectious disease. The case would help clinicians to raise awareness of strongyloidiasis in non-endemic areas and reduce fatality.
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Affiliation(s)
- Junyan Qu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiyong Zong
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
- Center for Pathogen Research, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Zhiyong Zong,
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Rodari P, Tamarozzi F, Tais S, Degani M, Perandin F, Buonfrate D, Nicastri E, Lepore L, Giancola ML, Carrara S, Tavelli A, Cozzi-Lepri A, D'Arminio Monforte A, Silva R, Angheben A. Prevalence of Chagas disease and strongyloidiasis among HIV-infected Latin American immigrants in Italy – The CHILI study. Travel Med Infect Dis 2022; 48:102324. [DOI: 10.1016/j.tmaid.2022.102324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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Yousaf O, Carreon A, Mohsin I. A Rare Cause of Pedunculated Polyps Caused by Strongyloides. Eur J Case Rep Intern Med 2022; 9:003008. [PMID: 35402330 PMCID: PMC8988497 DOI: 10.12890/2021_003008] [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: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Strongyloidiasis is a systemic disease caused by the nematode Strongyloides stercoralis. Strongyloides is unique among parasites in that it can remain undetected for decades. Although patients may present with the typical symptoms of a skin rash, cough or diarrhoea, a rare manifestation of infection is pseudopolyposis in the colon. This case highlights the unique finding of pseudopolyposis in a patient with strongyloidiasis with negative stool studies. Case description We present the case of an 81-year-old man with a delayed diagnosis of strongyloidiasis. The patient initially presented to the clinic for evaluation of productive cough and was treated empirically for bronchitis. He subsequently developed vomiting and diarrhoea with imaging revealing circumferential wall thickening of the ascending colon, consistent with colitis. Although stool tests were negative, the patient was treated with antibiotics, and then underwent a colonoscopy which revealed multiple polyps. Biopsy results confirmed Strongyloides infection. The patient was treated with ivermectin and improved. Discussion This case describes the unique finding of colonic pseudopolyposis in a patient infected with Strongyloides in rural southwest Virginia. Strongyloidiasis is often misdiagnosed due to its non-specific gastrointestinal symptoms and the chronic nature of the disease. Although stool studies are routinely negative for parasitic infection, CT scan findings suggestive of colitis should be followed by colonoscopy with biopsy of any abnormal lesion in the right clinical context. Determining the definitive diagnosis in a timely manner is crucial for establishing the specific treatment and for resolution of the disease. LEARNING POINTS CT scan findings suggestive of colitis should be followed by colonoscopy with biopsy of any abnormal lesion in the right clinical context; stool studies may be negative, as in this case.Internists should know the incidence, even if it is low, of certain parasitic infections in their local area.Strongyloides infection in the colon can mimic colitis and initiating the wrong treatment can lead to worse outcomes.
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Hokama A, Fujita J. Response to "Strongyloides stercoralis in Acute Severe Ulcerative Colitis-A Triggering Nuisance or an Opportunistic Bystander?". Inflamm Bowel Dis 2022; 28:e38. [PMID: 34788803 DOI: 10.1093/ibd/izab261] [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: 12/09/2022]
Affiliation(s)
- Akira Hokama
- Department of Endoscopy, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Is Gastric Involvement by Strongyloides stercoralis in an Immunocompetent Patient a Common Finding? A Case Report and Review of the Literature. Acta Parasitol 2022; 67:94-101. [PMID: 34143401 PMCID: PMC8938382 DOI: 10.1007/s11686-021-00438-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/07/2021] [Indexed: 12/04/2022]
Abstract
Purpose Gastric infection with Strongyloides stercoralis (SS) usually occurs in immunocompromised patients. The unexpected observation of this parasite in an otherwise healthy young lady who had undergone upper endoscopy and biopsy sampling of the gastro-duodenal mucosa, prompted us to review the literature to ascertain the conditions favouring gastric colonization by SS. Methods Pathology files of gastroduodenal biopsies received at St. Mary’s hospital, Northern Uganda, between 2007 and 2017 were reviewed. Pubmed search was performed under the headings “Strongyloides stercoralis”, “Gastric parasitosis”. Results Histology of the only gastroduodenal biopsy with SS infection showed parasite eggs, immature rhabditiform larvae, and numerous adult worms in gastric pits and rhabditiform larvae in interepithelial parasitic tunnels, causing reactive changes of the glandular epithelium. There was no significant acute inflammatory cell infiltrate surrounding the parasites. Literature review showed that gastric SS infection appears to be very uncommon and was, as expected, largely prevalent in immunodeficient individuals (84.2% of published cases). The rare gastric SS infection is a complication of systemic strongyloidiasis, either hyperinfective, or disseminated form. It is also commonly associated with duodenal infection at microscopical examination. Conclusion Involvement of gastric mucosa in the absence of duodenal strongyloidiasis appears to be quite rare and false-negative histopathological exams are reported if only the stomach is biopsied.
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Talukder MR, Pham H, Woodman R, Wilson K, Taylor K, Kaldor J, Einsiedel L. The Association between Diabetes and Human T-Cell Leukaemia Virus Type-1 (HTLV-1) with Strongyloides stercoralis: Results of a Community-Based, Cross-Sectional Survey in Central Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042084. [PMID: 35206272 PMCID: PMC8872355 DOI: 10.3390/ijerph19042084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
In central Australia, an area that is endemic for the human T-cell leukaemia virus type-1 (HTLV-1), the prevalence of Strongyloides stercoralis and its association with other health conditions are unknown. A cross-sectional community-based survey was conducted in seven remote Aboriginal communities in central Australia, from 2014 to 2018. All residents aged ≥10 years were invited to complete a health survey and to provide blood for Strongyloides serology, HTLV-1 serology and HTLV-1 proviral load (PVL). Risk factors for Strongyloides seropositivity and associations with specific health conditions including diabetes and HTLV-1 were determined using logistic regression. Overall Strongyloides seroprevalence was 27% (156/576) (children, 22% (9/40); adults (≥15 years), 27% (147/536), varied widely between communities (5–42%) and was not associated with an increased risk of gastrointestinal, respiratory or dermatological symptoms. Increasing age, lower HTLV-1 PVL (<1000 copies per 105 peripheral blood leucocytes) compared to the HTLV-1 uninfected group and community of residence were significant risk factors for Strongyloides seropositivity in an adjusted model. A modest reduction in the odds of diabetes among Strongyloides seropositive participants was found (aOR 0.58, 95% CI 0.35, 1.00; p = 0.049); however, this was lost when body mass index was included in the adjusted model (aOR 0.48, 95% CI 0.48, 1.47; p = 0.542). Strongyloides seropositivity had no relationship with anaemia. Exploring social and environmental practices in communities with low Strongyloides seroprevalence may provide useful lessons for similar settings.
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Affiliation(s)
- Mohammad Radwanur Talukder
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
| | - Hai Pham
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA 5001, Australia;
| | - Kim Wilson
- National Serology Reference Laboratory, Melbourne, VIC 3065, Australia;
| | - Kerry Taylor
- Poche Centre for Indigenous Health and Wellbeing, Alice Springs, NT 0870, Australia;
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Lloyd Einsiedel
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
- Alice Springs Hospital, Alice Springs, NT 0870, Australia
- Correspondence:
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67
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Sanyang AM, Joof E, Sey AP, Sambou S, Mohamed Z, Sanneh B. Prevalence and risk factors of strongyloidiasis among schoolchildren in Sabach Sanjal and Upper Badibou districts in the North Bank East Region of The Gambia. Parasite Epidemiol Control 2022; 15:e00228. [PMID: 35005262 PMCID: PMC8716566 DOI: 10.1016/j.parepi.2021.e00228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background Strongyloidiasis is a parasitic disease that mainly affects humans and is caused by a roundworm called Strongyloides stercoralis. It is endemic in humid tropical regions that include Africa, Latin America and Southern Asia. Among the public health important soil-transmitted helminths (STHs) classified as neglected tropical diseases, S. stercoralis is the most neglected. A study of schistosomiasis and STHs mapping was conducted and S. stercoralis larvae were detected using the utilized diagnostic method; thus, this current study described the prevalence and risk factors of S. stercoralis infection in districts of Sabach Sanjal and Upper Badibou in The Gambia. Methods The cross-sectional study enrolled 851 schoolchildren, ages 7 to 14 years old. The participants were enrolled from 17 schools in Sabach Sanjal and Upper Badibou Districts. The WHO random sampling technique n/50 (25 boys and 25 girls) was used. Stool samples were collected from each participant and Kato-Katz smear method was used to screen for S. stercoralis infection. Results Out of the total 851 pupils, 76 pupils (8.9%) were positive for S. stercoralis infection. The mean age of infected persons was 10.1 years (±2.2). The prevalence of infection was higher among females (9.2%) than males (8.7%). Rates of infection for age categories 7–10 years and 11–14 years were 12.4% and 4.2%, respectively. Rates of infection by districts were 12.3% for Sabach Sanjal and 7.1% for Upper Badibou. Schoolchildren from Sabach Sanjal were 1.6 times more likely to have strongyloidiasis compared to those from Upper Badibou (aOR = 1.64, p-value = 0.058). Schoolchildren aged 7–10 years were 3.2 times more likely to have strongyloidiasis infection compared to the 11–14-year-olds (aOR = 3.20, p-value <0.001). Schoolchildren who ‘sometimes’ have water or tissue after defaecation have more infection rate compared to those who ‘always’ have water or tissue after defaecation. However, this difference was not statistically significant (aOR = 1.36, p-value = 0.308). Conclusion The study revealed the prevalence of strongyloidiasis in Sabach Sanjal and Upper Badibou districts of The Gambia. Kato-Katz technique might be inadequate for detecting S. stercoralis; thus, more studies are needed to determine the true prevalence of the disease in these two districts through the combined use of highly sensitive techniques such as Baermann, Koga Agar Culture and polymerase chain reaction.
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Affiliation(s)
- Abdoulie M Sanyang
- National Public Health Laboratories, Ministry of Health, Bertil Herding High way, Kotu, the Gambia
| | - Ebrima Joof
- National Public Health Laboratories, Ministry of Health, Bertil Herding High way, Kotu, the Gambia.,School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Alhagie Papa Sey
- National Public Health Laboratories, Ministry of Health, Bertil Herding High way, Kotu, the Gambia
| | - Sana Sambou
- Epidemiology and Disease Control Unit, Ministry of Health, Bertil Herding Highway, Kotu, the Gambia
| | - Zeehaida Mohamed
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Bakary Sanneh
- National Public Health Laboratories, Ministry of Health, Bertil Herding High way, Kotu, the Gambia
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An unexpected cause of proximal small intestinal obstruction. Acta Gastroenterol Belg 2022; 85:114-115. [PMID: 35305006 DOI: 10.51821/85.1.9344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A 63-year-old caucasian male with history of tonsil cancer, under induction chemotherapy, reported food intolerance and vomiting with duration of one month. Symptoms had increased over the last days and were associated with a weight loss of 10 Kg during the past three months. The patient lived all of is life in an urban environment. General physical examination revealed cachexia and dehydration. Gastrointestinal symptoms persisted despite intravenous pantoprazole, prokinetic drugs and nasogastric tube insertion. On investigation, patient presented normocytic and normochromic anemia (9.2 g/dL), lymphocytosis (11.78 x109/L) with neutrophilia (70.7%) and eosinophilia (7.7%), hypoalbuminemia (2.8 g/dL) and elevated C-reactive protein (25.5 mg/dL). Upper endoscopy revealed deformation of bulb and second part of the duodenum with mucosal edema, superficial ulceration and friability (Figure 1a). Biopsies were taken from the bulb and second portion of the duodenum. Computer tomography demonstrated gastric distention, duodenal wall thickening and lumen narrowing in the second and third portion of the duodenum (Figure 2). These findings were indicative of a functionally relevant duodenum stenosis. Histopathologic evaluation of biopsy specimens from the duodenum revealed moderate accumulation of eosinophilic granulocytes and nematode larvae within mucosal crypts (Figure 1b). What is the diagnosis?
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Mazzaro MC, Santos ÉAD, Melo GBD, Marques PD, Souza LV, Elias-Oliveira J, Silva BCD, Gryschek RCB, Paula FMD, Rodrigues RM. Importance of detection of Strongyloides stercoralis DNA in fecal samples from patients with type 2 diabetes mellitus. Clinics (Sao Paulo) 2022; 77:100060. [PMID: 35834919 PMCID: PMC9283877 DOI: 10.1016/j.clinsp.2022.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/21/2022] [Accepted: 05/30/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The association between diabetes and Strongyloides infection remains controversial. This study aimed to detect Strongyloides stercoralis DNA in the feces of patients with Diabetes Mellitus type 2 (DM2). METHODS Fecal samples were analyzed via the Lutz, Rugai, and agar plate culture methods. PCR amplification was performed using two targets (PCR-genus and PCR-species) located on the S. stercoralis 18S ribosomal. RESULTS The positivity for S. stercoralis using parasitological methods was 1.1%. PCR-genus (14.13%) demonstrated a higher positivity than PCR-species (9.78%). CONCLUSION The results confirm the greater positivity of the molecular diagnosis in relation to parasitological methods, reinforcing its use as an additional tool for the diagnosis of S. stercoralis infection in patients with DM2 living in endemic areas for this helminthiasis.
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Affiliation(s)
| | | | - Gessica Baptista de Melo
- Laboratório de Investigação Médica, Hospital de Clínicase Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Priscila Duarte Marques
- Laboratório de Investigação Médica, Hospital de Clínicase Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Laura Vilela Souza
- Laboratório de Parasitologia, Universidade Federal de Jataí, Jataí, GO, Brazil
| | | | | | - Ronaldo César Borges Gryschek
- Laboratório de Investigação Médica, Hospital de Clínicase Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, Brazil
| | - Fabiana Martins de Paula
- Laboratório de Investigação Médica, Hospital de Clínicase Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, Brazil
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Šterbenc A, Šoba B, Glinšek Biškup U, Fister M, Mikuž U, Noč M, Luzar B. Diagnostic challenge of Strongyloides stercoralis hyperinfection syndrome: a case report. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2022. [DOI: 10.15570/actaapa.2022.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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71
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Boyle E, Coppock D. Polymicrobial bacteremia and Strongyloides hyperinfection syndrome: Vigilance in patients on corticosteroids. IDCases 2022; 28:e01520. [PMID: 35615701 PMCID: PMC9125627 DOI: 10.1016/j.idcr.2022.e01520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022] Open
Abstract
Strongyloidiasis is a worldwide parasitic infection. Many who develop infection remain asymptomatic. Due to Stronygloides autoinfection cycle it can result in chronic infection over decades. Immunosuppression particularly with corticosteroids has been associated with a rapid acceleration of the autoinfection cycle known as Strongyloides hyperinfection syndrome. The hyperinfection syndrome has severe complications and is associated with significant patient mortality. Here we report a case of hyperinfection complicated by polymicrobial bacteremia and intestinal ileus and review the literature regarding the hyperinfection syndrome.
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72
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Zeynalyan AA, Kolasani B, Naik C, Sigakis CJG, Silhan L, Mathai SK. Rapidly progressive respiratory failure after helminth larvae ingestion. BMC Pulm Med 2021; 21:422. [PMID: 34930198 PMCID: PMC8686539 DOI: 10.1186/s12890-021-01788-w] [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: 03/06/2021] [Accepted: 12/07/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Self-administration of helminths has gained attention among patients as a potential but unproven therapy for autoimmune disease. We present a case of rapidly progressive respiratory failure in a patient with systemic sclerosis (SSc) and pulmonary arterial hypertension (PAH) as a result of self-administration of parasitic organisms. CASE A 45-year-old woman with a history of interstitial lung disease and PAH due to limited cutaneous SSc presented to pulmonary clinic with worsening dyspnea, cough, and new onset hypoxemia. Three months prior to presentation she started oral helminth therapy with Necator americanus as an alternative treatment for SSc. Laboratory evaluation revelaed eosinophilia and elevated IgE levels. IgG antibodies to Strongyloides were detected. High resolution computed tomography of the chest revealed progressive ILD and new diffuse ground glass opacities. Transthoracic echocardiogram and right heart catheterization illustrated worsening PAH and right heart failure. The patient was admitted to the hospital and emergently evaluated for lung transplantation but was not a candidate for transplantation due to comorbidities. Despite aggressive treatment for PAH and right heart failure, her respiratory status deteriorated, and the patient transitioned to comfort-focused care. CONCLUSION Although ingestion of helminths poses a risk of infection, helminth therapy has been investigated as a potential treatment for autoimmune diseases. In this case, self-prescribed helminth ingestion precipitated fatal acute worsening of lung inflammation, hypoxemia, and right heart dysfunction, highlighting the risk of experimental helminth therapy in patients, especially those with underlying respiratory disease.
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Affiliation(s)
- Anahit A Zeynalyan
- Department of Internal Medicine, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas, 75246, USA.
| | - Balaji Kolasani
- Department of Internal Medicine - Pulmonary Research, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Chetan Naik
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
| | | | | | - Susan K Mathai
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
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Bagwell K, Vasudevan J, Mondy K. Recurrent Strongyloides stercoralis infection in an HIV+ patient. IDCases 2021; 26:e01325. [PMID: 34786343 PMCID: PMC8577494 DOI: 10.1016/j.idcr.2021.e01325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022] Open
Abstract
Although infection with Strongyloides stercoralis is often subclinical, some infections persist for decades due to the parasite’s autoinfective lifecycle. Hyperinfection syndrome, however, characterized by a massive increase in parasite burden as a result of host immunosuppression causes a myriad of clinical symptoms and is associated with high mortality. Use of corticosteroids and infection with HTLV-1 virus are the biggest traditional risk factors for hyperinfection syndrome, though its development can occur with virtually any degree of immunosuppression. Recurrent hyperinfection syndrome, though rare, has also been demonstrated in persons with ongoing immunosuppression, prompting many experts to recommend continued prophylactic treatment in at risk populations. We present the case of a recurrent S. stercoralis hyperinfection occurring four years after previous treatment with anti-helminthic therapy in a patient with AIDS with intermittent adherence to antiretroviral therapy (ART), highlighting diagnostic and treatment issues in the management of recurrent S. stercoralis infection.
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Affiliation(s)
- Kelli Bagwell
- University of Texas at Austin Dell Medical School, Department of Internal Medicine, 1500 Red River St, Austin, TX 78701, USA
| | - Jaya Vasudevan
- University of Texas at Austin Dell Medical School, Department of Internal Medicine, 1500 Red River St, Austin, TX 78701, USA
| | - Kristin Mondy
- University of Texas at Austin Dell Medical School, Department of Infectious Diseases, 1500 Red River St, Austin, TX 78701, USA
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Fallahzadeh MA, Rico NT, Vahhab E, He H, Elhamahmi DA, Sandkovsky U. Strongyloides stercoralis and cytomegalovirus coinfection in a patient with a transplanted kidney. Proc AMIA Symp 2021; 35:190-192. [DOI: 10.1080/08998280.2021.1997262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | - Nina T. Rico
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Transplant Nephrology, Baylor University Medical Center, Dallas, Texas
| | - Elham Vahhab
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Huang He
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Dina Abdelwahab Elhamahmi
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Transplant Nephrology, Baylor University Medical Center, Dallas, Texas
| | - Uriel Sandkovsky
- Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- Division of Infectious Diseases, Baylor University Medical Center, Dallas, Texas
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Costa IN, Bosqui LR, Corral MA, Costa-Cruz JM, Gryschek RCB, de Paula FM. Diagnosis of human strongyloidiasis: Application in clinical practice. Acta Trop 2021; 223:106081. [PMID: 34364894 DOI: 10.1016/j.actatropica.2021.106081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 12/28/2022]
Abstract
This review considers the advantages and disadvantages of parasitological techniques, methods of detecting antibodies and antigens, as well as molecular biology techniques in the diagnosis of human strongyloidiasis. In addition, it elucidates the potential of different techniques for rapid and effective detection of clinical cases, thus enabling early treatment and preventing fatal consequences of this helminthiasis.
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Suwannatrai AT, Thinkhamrop K, Suwannatrai K, Pratumchart K, Wangdi K, Kelly M, Restrepo AMC, Gray DJ, Clements ACA, Tangkawattana S, Sripa B. Opisthorchis viverrini and Strongyloides stercoralis mono- and co-infections: Bayesian geostatistical analysis in an endemic area, Thailand. Acta Trop 2021; 223:106079. [PMID: 34363777 DOI: 10.1016/j.actatropica.2021.106079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/19/2022]
Abstract
Parasitic infections caused by Opisthorchis viverrini and Strongyloides stercoralis remain a major public health threat in the Greater Mekong Sub-region. An understanding of climate and other environmental influences on the geographical distribution and emergence of parasitic diseases is a crucial step to guide targeted control and prevention programs. A parasitological survey was conducted from 2008 to 2013 and included 12,554 individuals (age between 20 and 60 years) from 142 villages in five districts in Khon Kaen Province, Thailand. Geographical information systems, remote sensing technologies and a Bayesian geostatistical framework were used to develop models for O. viverrini and S. stercoralis mono- and co-infections in areas where both parasites are known to co-occur. The results indicate that male sex, increased age, altitude, precipitation, and land surface temperature have influenced the infection rate and geographical distribution of mono- and co-infections of O. viverrini and S. stercoralis in this area. Males were 6.69 times (95% CrI: 5.26-8.58) more likely to have O. viverrini - S. stercoralis co-infection. We observed that O. viverrini and S. stercoralis mono-infections display distinct spatial pattern, while co-infection is predicted in the center and southeast of the study area. The observed spatial clustering of O. viverrini and S. stercoralis provides valuable information for the spatial targeting of prevention interventions in this area.
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Affiliation(s)
- Apiporn T Suwannatrai
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Health and Epidemiology Geoinformatics Research (HEGER), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
| | - Kavin Thinkhamrop
- Health and Epidemiology Geoinformatics Research (HEGER), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand; Cholangiocarcinoma Screening and Care Program (CASCAP), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Data Management and Statistical Analysis Center (DAMASAC), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Kulwadee Suwannatrai
- Department of Biology, Faculty of Science and Technology, Sakon Nakhon Rajabhat University, Sakon Nakhon, Thailand
| | - Khanittha Pratumchart
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Health and Epidemiology Geoinformatics Research (HEGER), Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Matthew Kelly
- Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Angela M Cadavid Restrepo
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia; Telethon Kids Institute, Nedlands, WA, Australia
| | | | - Banchob Sripa
- WHO Collaborating Centre for Research and Control of opisthorchiasis, Tropical Disease Research Center, Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Pintos-Pascual I, López-Dosil M, Castillo-Núñez C, Múñez-Rubio E. Eosinophilia and abdominal pain after severe pneumonia due to COVID 19. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2021; 39:478-480. [PMID: 34446397 PMCID: PMC8382595 DOI: 10.1016/j.eimce.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/16/2020] [Indexed: 11/13/2022]
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78
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Chavez IN, Brown TM, Assié A, Bryant AS, Samuel BS, Hallem EA. Skin-penetrating nematodes exhibit life-stage-specific interactions with host-associated and environmental bacteria. BMC Biol 2021; 19:221. [PMID: 34620172 PMCID: PMC8499433 DOI: 10.1186/s12915-021-01153-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Skin-penetrating nematodes of the genus Strongyloides infect over 600 million people, posing a major global health burden. Their life cycle includes both a parasitic and free-living generation. During the parasitic generation, infective third-stage larvae (iL3s) actively engage in host seeking. During the free-living generation, the nematodes develop and reproduce on host feces. At different points during their life cycle, Strongyloides species encounter a wide variety of host-associated and environmental bacteria. However, the microbiome associated with Strongyloides species, and the behavioral and physiological interactions between Strongyloides species and bacteria, remain unclear. Results We first investigated the microbiome of the human parasite Strongyloides stercoralis using 16S-based amplicon sequencing. We found that S. stercoralis free-living adults have an associated microbiome consisting of specific fecal bacteria. We then investigated the behavioral responses of S. stercoralis and the closely related rat parasite Strongyloides ratti to an ecologically diverse panel of bacteria. We found that S. stercoralis and S. ratti showed similar responses to bacteria. The responses of both nematodes to bacteria varied dramatically across life stages: free-living adults were strongly attracted to most of the bacteria tested, while iL3s were attracted specifically to a narrow range of environmental bacteria. The behavioral responses to bacteria were dynamic, consisting of distinct short- and long-term behaviors. Finally, a comparison of the growth and reproduction of S. stercoralis free-living adults on different bacteria revealed that the bacterium Proteus mirabilis inhibits S. stercoralis egg hatching, and thereby greatly decreases parasite viability. Conclusions Skin-penetrating nematodes encounter bacteria from various ecological niches throughout their life cycle. Our results demonstrate that bacteria function as key chemosensory cues for directing parasite movement in a life-stage-specific manner. Some bacterial genera may form essential associations with the nematodes, while others are detrimental and serve as a potential source of novel nematicides. Supplementary Information The online version contains supplementary material available at 10.1186/s12915-021-01153-7.
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Affiliation(s)
- Ivan N Chavez
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Taylor M Brown
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, 90095, USA.,Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Adrien Assié
- Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, 77030, USA.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Astra S Bryant
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Buck S Samuel
- Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, TX, 77030, USA.,Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Elissa A Hallem
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, 90095, USA. .,Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
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79
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Lorenzo H, Carbonell C, Vicente Santiago MB, López-Bernus A, Pendones Ulerio J, Muñoz Bellido JL, Muro A, Belhassen-García M. Influence of the drugs used in migrant patients with severe acute respiratory syndrome coronavirus 2 and the development of symptomatic strongyloidiasis. Trans R Soc Trop Med Hyg 2021; 116:440-445. [PMID: 34614186 PMCID: PMC8500139 DOI: 10.1093/trstmh/trab152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 11/12/2022] Open
Abstract
Background The use of dexamethasone in patients infected with Strongyloides stercoralis can cause severe complications. It is necessary to investigate the relationship between coronavirus disease 2019 (COVID-19) and strongyloidiasis infection. Methods A retrospective, longitudinal, descriptive study was undertaken to review all patients admitted with a diagnosis of COVID-19 infection at the Complejo Asistencial Universitario de Salamanca, Spain, during 1 March–31 December 2020. Results A total of 2567 patients received a diagnosis of COVID-19. Eighty-six patients from endemic areas were included. Seven patients had strongyloidiasis. Five patients were female. The mean age (±SD) was 39 (±10.8) y. Six patients were Latin-American and only one patient was from Africa. Six patients had previous symptoms compatible with strongyloidiasis infections. Only three patients received dexamethasone (6 mg once daily) for 10 d. In all cases, the clinical courses of the patients were satisfactory. No patient died or was admitted to the ICU. Conclusions Screening programmes using serological techniques should be implemented in COVID-19 patients to prevent strongyloidiasis. Our study suggested that drugs used against COVID-19 in patients with strongyloidiasis did not affect the evolution of the disease. However, more studies are necessary to elucidate the role of dexamethasone in COVID-19 patients infected with Strongyloides.
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Affiliation(s)
- Helena Lorenzo
- Servicio de Microbiología y Parasitología, Complejo Asistencial Universitario de Salamanca (CAUSA), Salamanca 37007, Spain
| | - Cristina Carbonell
- Servicio de Medicina Interna, Unidad de Infecciosas, CAUSA, Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca 37007, Spain
| | - María Belén Vicente Santiago
- Infectious and Tropical Diseases Group (e-INTRO), CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca, Salamanca 37007, Spain
| | - Amparo López-Bernus
- Servicio de Medicina Interna, Unidad de Infecciosas, CAUSA, CIETUS, IBSAL, Salamanca 37007, Spain
| | | | - Juan Luis Muñoz Bellido
- Servicio de Microbiología y Parasitología, CAUSA, CIETUS, IBSAL, Departamento de Ciencias Biomédicas y del Diagnóstico, Universidad de Salamanca, CSIC, Salamanca 37007, Spain
| | - Antonio Muro
- e-INTRO, CIETUS, IBSAL, Facultad de Farmacia, Universidad de Salamanca, Salamanca 37007, Spain
| | - Moncef Belhassen-García
- Servicio de Medicina Interna, Unidad de Infecciosas, CAUSA, e-INTRO, CIETUS, IBSAL, Salamanca 37007, Spain
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80
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Garg D, Jasmine S. Triple Whammy! Steroids, Strongyloidiasis and Septic Meningitis. Ann Indian Acad Neurol 2021; 24:461-463. [PMID: 34447029 PMCID: PMC8370160 DOI: 10.4103/aian.aian_414_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/11/2020] [Accepted: 05/24/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Divyani Garg
- Department of Neurology, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Sudha Jasmine
- Department of General Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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81
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Endemic parasitic infections in donors and recipients of stem cell and solid organ transplants: focus on strongyloidiasis and Chagas disease. Curr Opin Infect Dis 2021; 34:323-332. [PMID: 34074878 DOI: 10.1097/qco.0000000000000741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The aim of the article is to review recent recommendations on the management of Strongyloidiasis and Chagas disease (ChD) in the context of stem-cell or solid-organ transplantation. RECENT FINDINGS An update on laboratory screening, detection of acute disease or reactivation and recommended preventive or therapeutic options in the transplant recipients and donors is presented. Recent epidemiological data showing new estimates on the worldwide burden of both diseases and changes in the classical distribution around the globe should increase awareness and will impact the evaluation and management of transplant recipients and donors in endemic and nonendemic regions. SUMMARY Strongyloidiasis and ChD are potentially life threatening if unnoticed in the context of stem-cell or solid-organ transplantation and should be considered in endemic and nonendemic areas. Effective strategies for detection, monitoring, prevention and management are available for both diseases.
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82
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Eslahi AV, Olfatifar M, Houshmand E, Johkool MG, Zibaei M, Foroutan M, Hosseini H, Badri M. Prevalence of Strongyloides stercoralis in the immunocompetent and immunocompromised individuals in Iran: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2021; 116:87-99. [PMID: 34302179 DOI: 10.1093/trstmh/trab104] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/27/2021] [Accepted: 07/01/2021] [Indexed: 01/25/2023] Open
Abstract
Strongyloidiasis is a neglected tropical disease mostly distributed in tropical and subtropical regions. The current study evaluated the prevalence of Strongyloides stercoralis in immunocompetent and immunodeficient patients in Iran. The available online literature published from June 1994 to October 2020 was obtained from multiple English databases (PubMed, Science Direct, Scopus, Web of Science and Google Scholar) and four Persian databases (Magiran, Iran Medex, Iran Doc and SID). All statistical analyses were performed using R software (version 3.6) meta-package and p-values <0.05 were considered significant. From 1051 articles, 74 studies (248 656 individuals) met the inclusion criteria. The pooled prevalence of S. stercoralis was 2% (95% confidence interval [CI] 1 to 3) and 4% (95% CI 1 to 8) in immunocompetent and immunodeficient patients, respectively. In immunodeficient cases, the pooled prevalence of studies utilizing serology, culture and microscopic methods was 10% (95% CI 2 to 23), 1% (95% CI 0 to 6) and 1% (95% CI 0 to 1), respectively. In immunocompetent cases, the pooled prevalence of studies utilizing microscopic, culture and molecular methods was 2% (95% CI 1 to 3), 2% (95% CI 1 to 4) and 2% (95% CI 0 to 6), respectively. We propose an appropriate screening and control program along with comprehensive research regarding the frequency of strongyloidiasis in the country.
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Affiliation(s)
- Aida Vafae Eslahi
- Clinical Research Development Unit, Velayat Hospital, Qazvin University of Medical Sciences, Shahid Bahonar Boulevard, Qazvin, Iran
| | - Meysam Olfatifar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran Province, Tehran, Velenjak, 7th Floor, Bldg No.2 SBUMS, Arabi Ave, Tehran, Iran
| | - Elham Houshmand
- Department of Parasitology, Faculty of Veterinary Medicine, Islamic Azad University, Rasht Branch, Guilan, Iran
| | - Morteza Ghanbari Johkool
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Shahid Bahonar Boulevard, Qazvin, Iran
| | - Mohammad Zibaei
- Department of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Taleghani Boulevard, Taleghani square, Karaj, Iran
| | - Masoud Foroutan
- Department of Medical Parasitology, Faculty of Medicine, Abadan University of Medical Sciences, Zolfaghari 30m st, Abadan, Iran
| | - Hamid Hosseini
- Department of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Taleghani Boulevard, Taleghani square, Karaj, Iran
| | - Milad Badri
- Medical Microbiology Research Center, Qazvin University of Medical Sciences, Shahid Bahonar Boulevard, Qazvin, Iran
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84
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Requião-Moura LR, Daher EDF, Moreira Albino CR, de Oliveira Brilhante S, da Silva Junior GB, Costa SD, de Sandes-Freitas TV. Tropical Infections in the Context of Kidney Transplantation in Latin America. Am J Trop Med Hyg 2021; 105:564-572. [PMID: 34181579 PMCID: PMC8592343 DOI: 10.4269/ajtmh.19-0926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/12/2021] [Indexed: 11/07/2022] Open
Abstract
Reports on tropical infections among kidney transplant (KT) recipients have increased in recent years, mainly because of the growing number of KT programs located in tropical and subtropical areas, and greater mobility or migration between different areas of the world. Endemic in emerging and developing regions, like most countries in Latin America, tropical infections are an important cause of morbidity and mortality in this population. Tropical infections in KT recipients may exhibit different pathways for acquisition compared with those in nonrecipients, such as transmission through a graft and reactivation of a latent infection triggered by immunosuppression. Clinical presentation may differ compared with that in immunocompetent patients, and there are also particularities in diagnostic aspects, treatment, and prognosis. KT patients must be screened for latent infections and immunized properly. Last, drug-drug interactions between immunosuppressive agents and drugs used to treat tropical infections are an additional challenge in KT patients. In this review, we summarize the management of tropical infections in KT patients.
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Affiliation(s)
- Lúcio R. Requião-Moura
- Renal Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Nephrology Division, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Silvana Daher Costa
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
| | - Tainá Veras de Sandes-Freitas
- Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
- Hospital Geral de Fortaleza, Fortaleza, Ceará, Brazil
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85
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Effectiveness and Safety of a Single-Dose Ivermectin Treatment for Uncomplicated Strongyloidiasis in Immunosuppressed Patients (ImmunoStrong Study): The Study Protocol. Pathogens 2021; 10:pathogens10070812. [PMID: 34199000 PMCID: PMC8308528 DOI: 10.3390/pathogens10070812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/14/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022] Open
Abstract
Strongyloidiasis affects an estimated 600 million people worldwide, especially in tropical and subtropical areas. Single-dose ivermectin treatment has shown to be effective among immunocompetent patients with uncomplicated strongyloidiasis. Here, we present the protocol of the ImmunoStrong study, a prospective observational study aiming to evaluate the effectiveness and safety of a single-dose ivermectin for treatment of uncomplicated strongyloidiasis in immunosuppressed patients. The secondary objectives are to assess accuracy of molecular techniques for the follow-up of these patients and to determine the population pharmacokinetics of ivermectin. The information retrieved by this study will cover relevant information gaps in the strongyloidiasis management among immunosuppressed patients.
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86
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Kalantari N, Chehrazi M, Ghaffari S, Gorgani-Firouzjaee T. Serological assays for the diagnosis of Strongyloides stercoralis infection: a systematic review and meta-analysis of diagnostic test accuracy. Trans R Soc Trop Med Hyg 2021; 114:459-469. [PMID: 32052848 DOI: 10.1093/trstmh/trz135] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/04/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022] Open
Abstract
The standard method for the diagnosis of Strongyloides stercoralis, stool examinations, is inconvenient and, therefore, serological methods have been proposed. This study aimed to evaluate the accuracy of serological assays for the diagnosis of strongyloidiasis using a systematic review and meta-analysis model. Four electronic databases were reviewed. We used a random effects model and 95% CIs to determine the overall sensitivity, specificity and diagnostic odds ratio (DOR). Heterogeneity was intended with Cochran Q χ2 test and I2 statistic. The accuracy of serological assays resulted in a sensitivity of 71.7% (95% CI: 56.07 to 83.4%), a specificity of 89.9% (95% CI: 80.8 to 94.9%) and a DOR of 22.5 (95% CI: 10.8 to 46.9). The forest plot showed high heterogeneity regarding sensitivity (I2=90.4%, 95% CI: 87.4 to 93.3%; Q=228.1, p=0.000) and specificity (I2=98.9%, 95% CI: 98.8 to 99.1%; Q=2066.4, p=0.000). Fagan's nomogram showed that the probability of someone having the infection and with a positive test result was 49%. Deeks' funnel plots showed no evidence of potential publication bias for the studies (p=0.26). The current review suggests that serological techniques have acceptable sensitivity and specificity and therefore can be recommended for the screening of S. stercoralis infection.
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Affiliation(s)
- Narges Kalantari
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I. R. Iran
- Department of Laboratory Sciences, Faculty of Paramedical Sciences, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Medicine, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I. R. Iran
| | - Salman Ghaffari
- Department of Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
| | - Tahmineh Gorgani-Firouzjaee
- Department of Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
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87
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Hoppenfeld MS, Kennedy V, Sheth K, Chang A, Nelson J, Fairchild RM. Strongyloides Hyperinfection After Immunosuppression in an Immigrant From El Salvador: A Case for Early Diagnosis and Treatment. J Clin Rheumatol 2021; 27:e128-e131. [PMID: 30074914 DOI: 10.1097/rhu.0000000000000884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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88
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De la Cruz Mayhua JC, Rizvi B. Strongyloides Hyperinfection Causing Gastrointestinal Bleeding and Bacteremia in an Immunocompromised Patient. Cureus 2021; 13:e15902. [PMID: 34322346 PMCID: PMC8310433 DOI: 10.7759/cureus.15902] [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] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
Strongyloidiasis is a parasitic infestation caused by Strongyloides stercoralis (S. stercoralis). Most cases are asymptomatic or mildly symptomatic with respiratory, gastrointestinal, or non-specific cutaneous symptoms. However, in immunocompromised patients, such as patients on chronic corticosteroids, malignancy, or human immunodeficiency virus (HIV) infection, hyperinfection syndrome can occur. The following is a case of Strongyloides hyperinfection in an individual taking prednisone for uveitis who developed upper gastrointestinal (GI) bleed and gram-negative bacteremia.
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Affiliation(s)
| | - Bisharah Rizvi
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
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89
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Ahmad H, Arifin N, Nolan TJ, Lok JB, Anuar NS, Noordin R. Strongyloides-Specific IgE Phage cDNA Clones and Development of a Novel ELISA for Strongyloidiasis. Diagnostics (Basel) 2021; 11:diagnostics11060985. [PMID: 34071716 PMCID: PMC8228214 DOI: 10.3390/diagnostics11060985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/05/2022] Open
Abstract
Strongyloidiasis, caused mainly by the nematode Strongyloides stercoralis, is prevalent worldwide and potentially fatal in immunosuppressed patients. We report on a new IgE biomarker to diagnose Strongyloides infection. Sera from two groups infected with Strongyloides served as positive samples: Group 1A, in which infection was confirmed by stool-microscopy and/or stool-polymerase chain reaction (PCR) and was seropositive by an IgG-enzyme linked immunosorbent assay (ELISA) and an IgG4 rapid test, and Group 1B in which infection was confirmed by stool-PCR but was seronegative. Negative samples (controls) comprised infections with other parasites (Group II) and healthy donors (Group III). Immunoscreenings of an S. stercoralis complementary DNA (cDNA) library were performed, and the cDNA clone with the highest diagnostic potential (clone A133) was selected for recombinant protein production and then evaluated using IgE Western blot and ELISA. The Western blot showed that the recombinant protein (rA133) was 100% reactive with Group IA (n = 10) and Group IB (n = 5), and 96% non-reactive with Groups II and III (n = 25). Subsequently, the IgE-ELISA was developed and showed 100% diagnostic sensitivity in Groups IA (n = 32) and IB (n = 11); and 99.3% specificity in Groups II and III (n = 144). In conclusion, this study has identified rA133 as a novel recombinant protein with potential diagnostic value, and that the IgE-ELISA incorporating this protein may be useful for patient diagnosis and epidemiological studies.
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Affiliation(s)
- Hussain Ahmad
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Gelugor 11800, Malaysia; (H.A.); (N.A.); (N.S.A.)
- Department of Microbiology, Abdul Wali Khan University, Mardan 23200, Pakistan
| | - Norsyahida Arifin
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Gelugor 11800, Malaysia; (H.A.); (N.A.); (N.S.A.)
| | - Thomas J. Nolan
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (T.J.N.); (J.B.L.)
| | - James B. Lok
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; (T.J.N.); (J.B.L.)
| | - Nor Suhada Anuar
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Gelugor 11800, Malaysia; (H.A.); (N.A.); (N.S.A.)
| | - Rahmah Noordin
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Gelugor 11800, Malaysia; (H.A.); (N.A.); (N.S.A.)
- Correspondence:
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90
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Huang ZD, Wang CX, Shi TB, Wu BJ, Chen Y, Li WB, Fang XY, Zhang WM. Salmonella Osteomyelitis in Adults: A Systematic Review. Orthop Surg 2021; 13:1135-1140. [PMID: 33942967 PMCID: PMC8274199 DOI: 10.1111/os.12912] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/01/2020] [Accepted: 11/29/2020] [Indexed: 12/04/2022] Open
Abstract
The aim of this systematic review was to characterize the clinical features of adults with Salmonella osteomyelitis and summarize diagnosis and treatment methods to provide guidance for clinicians. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. We conducted a literature search in the PubMed, EMBASE, and Cochrane Library databases. Article screening and data extraction were performed by two reviewers individually. All the included studies were independently evaluated by two reviewers using the Methodological Index for Non‐Randomized Studies (MINORS) criteria. A total of 67 articles published between 1970 and 2019 were selected, which include 69 patients with an average age of 47.5 years (range, 18–79).The majority of cases (47.76%) occurred in immunocompetent adults without common risk factors. Aspiration and biopsy cultures were all positive in Salmonella osteomyelitis patients who underwent aspiration or biopsy. All infections were monomicrobial, and a total of 12 different serotypes were identified. The three most commonly reported Salmonella serotypes were Salmonella typhi (19 cases), Salmonella typhimurium (12 cases), and Salmonella enteritidis (11 cases). Only 12 of the 67 cases in our data (17.91%) had diarrhea symptoms, and 44 of the 67 cases (65.67%) had fever symptoms. Fifty‐nine of the 67 cases (88.06%) had local inflammatory manifestations, such as erythema, swelling, and tenderness in the affected area. The commonly reported involved sites were the vertebrae, femur, and tibia. Antibiotic therapy alone was utilized in 30 cases, and 24 patients (80.00%) were eventually cured. In total, 75.68% of patients achieved satisfactory results after treatment with surgery and antibiotics. Third‐generation cephalosporins were most commonly utilized, and antibiotic treatment was administered for an average of 11.3 weeks (95% CI, 8.31–14.37 weeks). Salmonella osteomyelitis should be considered in patients without any common risk factors. Aspiration or biopsy can facilitate the identification of pathogens to guide antibiotic choice. Empirical therapy with a third‐generation cephalosporin is recommended until the susceptibility of the strain is determined.
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Affiliation(s)
- Zi-da Huang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chao-Xin Wang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Teng-Bin Shi
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Bai-Jian Wu
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yang Chen
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Bo Li
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xin-Yu Fang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wen-Ming Zhang
- First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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91
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Olivera MJ. Dexamethasone and COVID-19: Strategies in Low- and Middle-Income Countries to Tackle Steroid-Related Strongyloides Hyperinfection. Am J Trop Med Hyg 2021; 104:1611-1612. [PMID: 33720844 PMCID: PMC8103443 DOI: 10.4269/ajtmh.20-1085] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/01/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 can trigger a systemic inflammatory response that in some cases leads to severe lung involvement, multisystem dysfunction, and death. Dexamethasone therapy, because of its potent anti-inflammatory effects, has been proposed for the management of hospitalized patients with severe COVID-19. The subject of this article is to discuss potential strategies to tackle Strongyloides hyperinfection in hospitalized patients with COVID-19 receiving dexamethasone therapy in low- and middle-income countries. In this context, dexamethasone treatment has been found to be generally safe. However, its use in people coinfected with undetected Strongyloides stercoralis increases the risk for Strongyloides hyperinfection/dissemination a potentially fatal complication. Infection caused by S. stercoralis may remain asymptomatic or with mild symptoms in humans for several years. Early detection and specific treatment prevent a fatal evolution of this complication, but the challenge is to screen before corticosteroid therapy. In some cases, presumptive treatment may be justified. Ivermectin is the gold standard for treatment.
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Affiliation(s)
- Mario J. Olivera
- Address correspondence to Mario J Olivera, Grupo de Parasitología, Instituto Nacional de Salud, Ave. Calle 26 51-20, Bogotá DC, Colombia 111321. E-mail:
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92
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Yeoh DK, Ford TJ, Chua J, Bennamoun M, Blyth CC, Campbell AJ, Hamsanathan P, Harkin B, King J, Matthews L, McLeod C, Warren R, Bowen AC, Thompson MJ, Schultz A. Acute haemoptysis, fever and abdominal pain in an adolescent from northern Australia. Thorax 2021; 76:951-953. [PMID: 33888573 DOI: 10.1136/thoraxjnl-2020-216257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/11/2020] [Accepted: 03/07/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Daniel K Yeoh
- Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Timothy J Ford
- Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Joanna Chua
- Department of Microbiology, PathWest Laboratory Medicine Western Australia, Nedlands, Western Australia, Australia
| | - Miriam Bennamoun
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher C Blyth
- Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine Western Australia, Nedlands, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Anita J Campbell
- Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Prasanthy Hamsanathan
- Department of General Paediatrics, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Ben Harkin
- Department of Paediatrics and Child Health, Kimberley Region, Western Australia Country Health Service, Broome, Western Australia, Australia
| | - Jovanka King
- Department of Allergy and Clinical Immunology, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Lisa Matthews
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Charlie McLeod
- Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Rebecca Warren
- Royal Flying Doctor Service of Australia, Broome, Western Australia, Australia
| | - Asha C Bowen
- Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
| | - Melanie J Thompson
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Paediatrics and Child Health, Kimberley Region, Western Australia Country Health Service, Broome, Western Australia, Australia
| | - André Schultz
- Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Wal-yan Respiratory Research Centre, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
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93
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Alibrahim F, AlAlwan A, Al Thiab K, Alawaji A, Alwan B, Taher L, Bosaeed M. Strongyloides and hookworms co-infection in a liver transplant patient. IDCases 2021; 24:e01060. [PMID: 33763328 PMCID: PMC7973314 DOI: 10.1016/j.idcr.2021.e01060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/09/2021] [Indexed: 10/25/2022] Open
Abstract
We here present a female patient who is a recipient of liver transplantation from a cadaveric donor. She developed abdominal pain, nausea, vomiting, and diarrhea for two weeks of duration, after four months of the transplant. Upper gastrointestinal (GI) endoscopy and stool analysis for ova and parasite showed Necator americanus / Ancylostoma duodenale (Hookworm) ova /larvae and Strongyloides stercoralis Larvae. She had a dramatic clinical response to Ivermectin and Albendazole combination, which was given until the clearance of her stool exam. She was discharged from the hospital in good condition, and her infection is considered as a donor-derived transmission of these parasites. To the best of our knowledge, this is the first case report of Strongyloides stercoralis and hookworm co-infection in a liver transplant patient. Parasitic infection should be considered in the differential diagnosis of diarrheal illness of cadaveric transplant patients, even if it is not prevalent in the region.
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Affiliation(s)
- Fatimah Alibrahim
- Infectious Disease Division, Department of Internal Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abduljaleel AlAlwan
- Department of Hepatobiliary Sciences and Organ Transplant Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center's (KAIMRC), Riyadh, Saudi Arabia
| | - Khalefa Al Thiab
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmad Alawaji
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Bassam Alwan
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Leena Taher
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammad Bosaeed
- Infectious Disease Division, Department of Internal Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center's (KAIMRC), Riyadh, Saudi Arabia
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94
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Shield J, Braat S, Watts M, Robertson G, Beaman M, McLeod J, Baird RW, Hart J, Robson J, Lee R, McKessar S, Nicholson S, Mayer-Coverdale J, Biggs BA. Seropositivity and geographical distribution of Strongyloides stercoralis in Australia: A study of pathology laboratory data from 2012-2016. PLoS Negl Trop Dis 2021; 15:e0009160. [PMID: 33690623 PMCID: PMC7978363 DOI: 10.1371/journal.pntd.0009160] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/19/2021] [Accepted: 01/20/2021] [Indexed: 11/18/2022] Open
Abstract
Background There are no national prevalence studies of Strongyloides stercoralis infection in Australia, although it is known to be endemic in northern Australia and is reported in high risk groups such as immigrants and returned travellers. We aimed to determine the seropositivity (number positive per 100,000 of population and percent positive of those tested) and geographical distribution of S. stercoralis by using data from pathology laboratories. Methodology We contacted all seven Australian laboratories that undertake Strongyloides serological (ELISA antibody) testing to request de-identified data from 2012–2016 inclusive. Six responded. One provided positive data only. The number of people positive, number negative and number tested per 100,000 of population (Australian Bureau of Statistics data) were calculated including for each state/territory, each Australian Bureau of Statistics Statistical Area Level 3 (region), and each suburb/town/community/locality. The data was summarized and expressed as maps of Australia and Greater Capital Cities. Principal findings We obtained data for 81,777 people who underwent serological testing for Strongyloides infection, 631 of whom were from a laboratory that provided positive data only. Overall, 32 (95% CI: 31, 33) people per 100,000 of population were seropositive, ranging between 23/100,000 (95% CI: 19, 29) (Tasmania) and 489/100,000 population (95%CI: 462, 517) (Northern Territory). Positive cases were detected across all states and territories, with the highest (260-996/100,000 and 17–40% of those tested) in regions across northern Australia, north-east New South Wales and north-west South Australia. Some regions in Greater Capital Cities also had a high seropositivity (112-188/100,000 and 17–20% of those tested). Relatively more males than females tested positive. Relatively more adults than children tested positive. Children were under-represented in the data. Conclusions/Significance The study confirms that substantial numbers of S. stercoralis infections occur in Australia and provides data to inform public health planning. Strongyloides stercoralis, a parasitic roundworm, is endemic in many countries world-wide. In Australia, groups at risk for strongyloidiasis include Aboriginal and/or Torres Strait Islander people, who acquired this parasite locally, and immigrants and returned travellers who acquired the infection outside Australia. We obtained deidentified results of ELISA IgG antibody tests for Strongyloides from diagnostic pathology laboratories during 2012 to 2016 and calculated the number of people who were positive at least once and the number who never had a positive result. We drew maps showing the number positive per 100,000 of population, the percent positive of those tested, and the number tested/100,000 for each region and the number positive in each suburb of residence according to the Australian Bureau of Statistics. The highest seropositivity (260-996/100,000 of population) was in Northern Australia, north-west South Australia and north-east New South Wales where many Aboriginal and Torres Strait Islander people live in remote communities. There were also some regions in Greater Capital Cities with a high number of people positive per 100,000 of population (112-188/100,000), likely reflecting higher populations of immigrants and returned travellers who were infected outside Australia.
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Affiliation(s)
- Jennifer Shield
- Departments of Medicine and Infectious Diseases at the Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
- Department of Pharmacy and Applied Science, La Trobe University, Bendigo, Victoria, Australia
- * E-mail:
| | - Sabine Braat
- Departments of Medicine and Infectious Diseases at the Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Matthew Watts
- Centre for Infectious Diseases and Microbiology, Pathology West-ICPMR and Marie Bashir Institute, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Miles Beaman
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - James McLeod
- Territory Pathology, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Robert W. Baird
- Territory Pathology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia
| | - Julie Hart
- PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
| | - Jennifer Robson
- Sullivan Nicolaides Pathology, Bowen Hills, Queensland, Australia
| | - Rogan Lee
- Centre for Infectious Diseases and Microbiology, Pathology West-ICPMR and Marie Bashir Institute, University of Sydney, Westmead Hospital, Westmead, New South Wales, Australia
| | | | - Suellen Nicholson
- Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Victoria, Australia
| | | | - Beverley-Ann Biggs
- Departments of Medicine and Infectious Diseases at the Doherty Institute, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Disease Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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95
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Abstract
Parasites can cause respiratory symptoms through focal or diffuse lung involvement, depending on the location of the parasite and the host's immune response. Pulmonary involvement can be a major feature of some parasitic infections or a complication during transpulmonary larval migration. Parasites should be included in the differential diagnosis of common lung diseases, especially in the presence of peripheral eosinophilia or extrapulmonary symptoms (abdominal pain, diarrhea, jaundice, skin lesions).
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Affiliation(s)
- Teena Huan Xu
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, One Baylor Plaza. BCM 285, Houston, TX 77030, USA
| | - Nair Lovaton
- Department of Pediatrics, Faculty of Medicine, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru
| | - Jose Serpa
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, One Baylor Plaza. BCM 285, Houston, TX 77030, USA
| | - Theresa J Ochoa
- Department of Pediatrics, Faculty of Medicine, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima 15102, Peru.
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96
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Mirzaei L, Ashrafi K, Atrkar Roushan Z, Mahmoudi MR, Shenavar Masooleh I, Rahmati B, Saadat F, Mirjalali H, Sharifdini M. Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran: a closer look at risk factors. Epidemiol Health 2021; 43:e2021009. [PMID: 33494130 PMCID: PMC8060525 DOI: 10.4178/epih.e2021009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/20/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the prevalence of Strongyloides stercoralis and other intestinal parasites in patients receiving immunosuppressive drugs in northern Iran and to investigate related risk factors. METHODS This cross-sectional study was conducted among 494 patients receiving immunosuppressive drugs, including cancer patients undergoing chemotherapy (n=188) and those treated with prolonged corticosteroid administration (n=306). All fresh fecal samples were examined using the direct wet-mount, formalin ethyl acetate concentration, and agar plate culture techniques. RESULTS In total, 16.8% of patients were positive for at least 1 intestinal parasite; the helminthic and protozoan infection rates were 5.1% and 12.3%, respectively. The infection rate was significantly higher in corticosteroid-treated individuals (19.6%) than cancer patients (12.2%) (p<0.05). The prevalence rate of S. stercoralis among patients receiving chemotherapy and those treated with corticosteroids were 4.3% and 5.2%, respectively. The prevalence rate of S. stercoralis infection was significantly higher in older patients (p<0.05). CONCLUSIONS Strongyloidiasis is one of the most common parasites among patients receiving immunosuppressive drugs in northern Iran. Early diagnosis and proper treatment of these patients are necessary to minimize the complications of severe strongyloidiasis.
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Affiliation(s)
- Leila Mirzaei
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Keyhan Ashrafi
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Atrkar Roushan
- Department of Biostatistics, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad Reza Mahmoudi
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Irandokht Shenavar Masooleh
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Behnaz Rahmati
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Farshid Saadat
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamed Mirjalali
- Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meysam Sharifdini
- Department of Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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97
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Ashiri A, Rafiei A, Beiromvand M, Khanzadeh A, Alghasi A. Screening of Strongyloides stercoralis infection in high-risk patients in Khuzestan Province, Southwestern Iran. Parasit Vectors 2021; 14:37. [PMID: 33422116 PMCID: PMC7796600 DOI: 10.1186/s13071-020-04549-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strongyloidiasis, one of the neglected tropical diseases (NTDs), can be fatal in immunocompromised patients. Available data on Strongyloides stercoralis infection in high-risk patients in Iran are limited. The aim of the present study was to determine the prevalence of S. stercoralis infection and associated risk factors among high-risk patients as well as to evaluate the sensitivity of the diagnostic tests used in the diagnose of S. stercoralis infection. METHODS This cross-sectional study was performed from 2019 to 2020 among 300 high-risk patients in Khuzestan Province, southwestern Iran. Patients with autoimmune diseases, uncontrolled diabetes, HIV/AIDS, cancer, organ transplant, hematological malignancy, asthma and chronic obstructive pulmonary disease (COPD) were examined using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test. Since agar plate culture was considered the reference diagnostic test, culture-positive samples were confirmed by PCR amplification and the sequencing of the nuclear 18S rDNA (SSU) hypervariable region (HVRIV) of the parasite. RESULTS The prevalence of S. stercoralis infection was 1%, 1.3%, 2%, 2.7%, and 8.7% using direct smear examination, formalin-ether concentration, Baermann funnel technique, agar plate culture, and ELISA test, respectively. All culture-positive samples were confirmed by SSU-PCR. According to the results, the most sensitive test was ELISA, with 100% sensitivity, followed by the Baermann funnel technique with the sensitivity of 75%. Direct smear examination, formalin-ether concentration technique, and Baermann funnel technique had the highest PPV (100%) while the ELISA test had the highest NPV (100%). Significant eosinophilia was observed in the patients whose culture test was positive (7/8; P < 0.05). In the present study, the majority of the positive cases by the agar plate culture had a history of prolonged exposure to soil and of asthma and COPD and were > 60 years old. CONCLUSIONS Given that the ELISA test had the highest NPV, the screening of all high-risk patients for S. stercoralis infection in endemic areas is recommended prior to starting corticosteroid therapy with the ELISA test. The results indicate the importance of paying attention to patients with unknown eosinophilia in endemic areas. Ivermectin should be available to strongyloidiasis patients in the endemic areas.
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Affiliation(s)
- Alireza Ashiri
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran.,Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
| | - Abdollah Rafiei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran.,Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
| | - Molouk Beiromvand
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran. .,Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran.
| | | | - Arash Alghasi
- Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran
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98
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Salvador F, Treviño B, Chamorro-Tojeiro S, Pou D, Herrero-Martínez JM, Rodríguez-Guardado A, Oliveira-Souto I, Torrús D, Goikoetxea J, Zubero Z, Velasco M, Bosch-Nicolau P, Aznar ML, López-Vélez R, Pérez-Molina JA. Epidemiological and clinical profile of immunosuppressed patients with imported strongyloidiasis: a substudy from a larger cohort of the +REDIVI Spanish Collaborative Network. Pathog Glob Health 2020; 115:121-124. [PMID: 33380280 DOI: 10.1080/20477724.2020.1857491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The aim of this study was to describe the clinical and epidemiological profile of immunosuppressed patients with imported strongyloidiasis in a non-endemic setting, and to compare these results with non-immunosuppressed patients. This is a case-control substudy from a larger observational retrospective study that included all patients with strongyloidiasis registered in the +REDIVI Spanish Collaborative Network. Overall, 1245 patients with imported strongyloidiasis were included. From these, 80 (6.4%) patients had some kind of immunosuppression. Three (3.8%) patients had a hyperinfection syndrome, and 34 (52.3%) patients had eosinophilia. The percentages of positive results of the formalin-ether technique, the fecal culture and serology were 12.3%, 21.1% and 95.4%, respectively. When comparing the main characteristics, immunosuppressed patients had higher proportion of severe clinical manifestations and lower proportion of eosinophilia. No differences were found regarding yield of microbiological techniques and treatment response. These results stress the importance of strongyloidiasis screening among immunosuppressed patients coming from endemic areas. Serological tests have an acceptable sensitivity to be used as a screening tool.
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Affiliation(s)
- Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Begoña Treviño
- Tropical Medicine and International Health Unit, Drassanes-Vall d'Hebron, PROSICS Barcelona, Barcelona, Spain
| | - Sandra Chamorro-Tojeiro
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Diana Pou
- Tropical Medicine and International Health Unit, Drassanes-Vall d'Hebron, PROSICS Barcelona, Barcelona, Spain
| | | | | | - Inés Oliveira-Souto
- Tropical Medicine and International Health Unit, Drassanes-Vall d'Hebron, PROSICS Barcelona, Barcelona, Spain
| | - Diego Torrús
- Infectious Diseases Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | - Josune Goikoetxea
- Infectious Diseases Unit, Hospital Universitario Cruces, Barakaldo, Spain
| | - Zuriñe Zubero
- Department of Internal Medicine, Hospital de Basurto, Bilbao, Spain
| | - María Velasco
- Department of Internal Medicine, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Pau Bosch-Nicolau
- Department of Infectious Diseases, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, PROSICS Barcelona, Barcelona, Spain
| | - Mª Luisa Aznar
- Tropical Medicine and International Health Unit, Drassanes-Vall d'Hebron, PROSICS Barcelona, Barcelona, Spain
| | - Rogelio López-Vélez
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - José A Pérez-Molina
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, Madrid, Spain
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99
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Chadwick DR, Sutherland RK, Raffe S, Pool E, Beadsworth M. British HIV Association guidelines on the management of opportunistic infection in people living with HIV: the clinical management of gastrointestinal opportunistic infections 2020. HIV Med 2020; 21 Suppl 5:1-19. [PMID: 33271637 DOI: 10.1111/hiv.13004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D R Chadwick
- Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, UK
| | - R K Sutherland
- Regional Infectious Diseases Unit, NHS Lothian, Edinburgh, UK
| | - S Raffe
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Erm Pool
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - Mbj Beadsworth
- Tropical and Infectious Disease Unit, Royal Liverpool University Hospital (Liverpool University Hospitals Foundation Trust), Liverpool, UK
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100
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Pintos-Pascual I, López-Dosil M, Castillo-Núñez C, Múñez-Rubio E. Eosinophilia and abdominal pain after severe pneumonia due to COVID 19. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30332-3. [PMID: 33279276 PMCID: PMC7654363 DOI: 10.1016/j.eimc.2020.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/11/2020] [Accepted: 10/16/2020] [Indexed: 01/16/2023]
Affiliation(s)
- Ilduara Pintos-Pascual
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Puerta de Hierro Majadahonda, Madrid, España.
| | - Marcos López-Dosil
- Servicio de Microbiología Clínica, Hospital Puerta de Hierro Majadahonda, Madrid, España
| | | | - Elena Múñez-Rubio
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Puerta de Hierro Majadahonda, Madrid, España
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