1
|
Oliveira CDL, de Souza JN, Souza ABDS, Barreto NMPV, Ribeiro ID, Sampaio LM, Araújo WAC, dos Santos JSB, Teixeira MCA, Soares NM. Ineffectiveness of TF-Test® and Coproplus® Methods in Strongyloides stercoralis Infection Diagnosis. Acta Parasitol 2022; 67:732-739. [PMID: 35048284 DOI: 10.1007/s11686-021-00484-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/12/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE S. stercoralis diagnosis is currently performed by parasitological methods, mainly by Baermann-Moraes (BM), although Agar Plate Culture (APC) presents a higher sensitivity. New techniques, such as TF-Test® and Coproplus® have been suggested as more practical alternatives. The aim of this study was to evaluate the sensitivity of TF-Test® and Coproplus®, compared with APC, BM and Spontaneous Sedimentation (SS) methods. METHODS One-hundred and forty male alcoholic patients, who provided three stools samples collected on alternate days, were included in this study. The most frequently found parasite was S. stercoralis, 20% (28/140), and the most sensitive method was APC, 96.4% (27/28), followed by BM, 89.3% (25/28) and SS, 57.1% (16/28). TF-Test® and Coproplus® presented a sensitivity of 46.4 (13/28) and 39.3% (11/28), respectively. In samples with a parasitic load of 1-10 larvae/g of feces, which occurred in 39.3% (11/28) of the infected patients, both the TF-Test® and Coproplus® methods demonstrated sensitivities of 18.2% (2/11), while APC and BM methods reached a sensitivity of 100% (11/11) (p < 0.05). For other intestinal helminth infections, TF-Test® and Coproplus® sensitivities were 22.2 (4/18) and 11.1% (2/18), respectively, this being lower than the SS, 66.7% (12/18) (p < 0.05). On the other hand, for protozoa infection diagnosis, TF-Test® and Coproplus® presented the highest sensitivities, 62.2 (46/74) and 43.2% (32/74), respectively. CONCLUSION TF-Test® and Coproplus® methods presented the lowest sensitivities for S. stercoralis and other helminth infection diagnosis; therefore, they can be indicated for use in parasitological diagnosis, only when associated with other more effective methods of helminth identification.
Collapse
|
2
|
Lucas Dato A, Pacheco-Tenza MI, Borrajo Brunete E, Martínez López B, García López M, González Cuello I, Gregori Colomé J, Navarro Cots M, Saugar JM, García-Vazquez E, Ruiz-Maciá JA, Llenas-García J. Strongyloidiasis in Southern Alicante (Spain): Comparative Retrospective Study of Autochthonous and Imported Cases. Pathogens 2020; 9:pathogens9080601. [PMID: 32717912 PMCID: PMC7460300 DOI: 10.3390/pathogens9080601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Strongyloidiasis is a parasitic disease with global prevalence. In Spain, autochthonous cases are concentrated in the Mediterranean basin. We aimed to analyze clinical and epidemiological characteristics of Strongyloides stercoralis infection in Vega Baja del Segura (Spain), comparing autochthonous versus imported cases. METHODS Observational retrospective study of all strongyloidiasis cases from January 2009 to January 2019. Cases were diagnosed by stool larvae visualization, positive culture, PCR, Strongyloides serology, and/or compatible histology. RESULTS We included 36 patients (21 men) with a mean age of 60.8 years ±17.6; 15 cases were autochthonous and 21 imported 80.9% from Latin America. Autochthonous cases were associated with older age (mean 71.3 vs. 53.3 years; p = 0.002), male sex (odds ratio (OR) 5.33; 95% confidence interval (CI) 1.15-24.68; p = 0.041), and agricultural activity (OR 13.5; 95% CI 2.4-73.7; p = 0.002). Fourteen were asymptomatic, three autochthonous cases presented with hyperinfection syndrome, and two patients died. There was no difference between autochthonous versus imported origin in eosinophilia at diagnosis (93.3% vs. 75%; p = 0.207), treatment received, or clinical response (85.7% vs. 88.9% cured; p = 1). CONCLUSION In our region, imported strongyloidiasis coexists with autochthonous cases, which are mainly in older male farmers who are diagnosed at more advanced stages. Systematic screening programs are needed.
Collapse
Affiliation(s)
- Ana Lucas Dato
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Correspondence: (A.L.D.); (J.L.-G.)
| | - María Isabel Pacheco-Tenza
- Internal Medicine Department, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Emilio Borrajo Brunete
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Microbiology Department, Hospital Vega Baja, 03314 Orihuela, Spain
| | - Belén Martínez López
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - María García López
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - Inmaculada González Cuello
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - Joan Gregori Colomé
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
| | - María Navarro Cots
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Microbiology Department, Hospital Vega Baja, 03314 Orihuela, Spain
| | - José María Saugar
- Parasitology Department, Centro Nacional de Microbiología, Instituto Carlos III, 28903 Madrid, Spain;
| | - Elisa García-Vazquez
- Infectious Diseases Unit, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
- Instituto Murciano de Investigación Biosanitaria (IMIB), Universidad de Murcia, 30120 Murcia, Spain
| | - José Antonio Ruiz-Maciá
- Pathological Department, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Jara Llenas-García
- Internal Medicine Department, Hospital Vega Baja, 03314 Orihuela, Spain; (B.M.L.); (M.G.L.); (I.G.C.); (J.G.C.)
- Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), 46020 Valencia, Spain; (E.B.B.); (M.N.C.)
- Clinical Medicine Department, Universidad Miguel Hernández de Elche, 03202 Elche, Spain
- Correspondence: (A.L.D.); (J.L.-G.)
| |
Collapse
|
3
|
Martinez-Pérez A, Soriano-Pérez MJ, Salvador F, Gomez-Junyent J, Villar-Garcia J, Santin M, Muñoz C, González-Cordón A, Salas-Coronas J, Sulleiro E, Somoza D, Treviño B, Pecorelli R, Llaberia-Marcual J, Lozano-Serrano AB, Quinto L, Muñoz J, Requena-Méndez A. Clinical Features Associated with Strongyloidiasis in Migrants and the Potential Impact of Immunosuppression: A Case Control Study. Pathogens 2020; 9:pathogens9060507. [PMID: 32585975 PMCID: PMC7350355 DOI: 10.3390/pathogens9060507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023] Open
Abstract
Strongyloides stercoralis is a widely distributed nematode more frequent in tropical areas and particularly severe in immunosuppressed patients. The aim of this study was to determine factors associated with strongyloidiasis in migrants living in a non-endemic area and to assess the response to treatment and follow-up in those diagnosed with the infection. We performed a multicenter case-control study with 158 cases and 294 controls matched 1:2 by a department service. Participants were recruited simultaneously at six hospitals or clinics in Spain. A paired-match analysis was then performed looking for associations and odds ratios in sociodemographic characteristics, pathological background, clinical presentation and analytical details. Cases outcomes after a six-month follow-up visit were also registered and their particularities described. Most cases and controls came from Latin America (63%-47%) or sub-Saharan Africa (26%-35%). The number of years residing in Spain (9.9 vs. 9.8, p = 0.9) and immunosuppression status (30% vs. 36.3%, p = 0.2) were also similar in both groups. Clinical symptoms such as diffuse abdominal pain (21% vs. 13%, p = 0.02), and epigastralgia (29% vs. 18%, p < 0.001); along with a higher eosinophil count (483 vs. 224 cells/mL in cases and controls, p < 0.001) and the mean total Immunoglobulin E (IgE) (354 U/L vs. 157.9 U/L; p < 0.001) were associated with having strongyloidiasis. Finally, 98.2% percent of the cases were treated with ivermectin in different schedules, and 94.5% met the cure criteria at least six months after their first consultation. Abdominal pain, epigastralgia, eosinophilia, increased levels of IgE and Latin American origin remain the main features associated with S. stercoralis infection, although this association is less evident in immunosuppressed patients. The appropriate follow-up time to evaluate treatment response based on serology titers should be extended beyond 6 months if the cure criteria are not achieved.
Collapse
Affiliation(s)
- Angela Martinez-Pérez
- CAP Casanova, Consorci d’Atenció Primaria en Salut Barcelona Esquerra, 08036 Barcelona, Spain;
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (L.Q.); (J.M.)
| | - Manuel Jesús Soriano-Pérez
- Tropical Medicine Unit, Hospital de Poniente, El Ejido, 04700 Almería, Spain; (M.J.S.-P.); (J.S.-C.); (A.B.L.-S.)
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain;
| | - Joan Gomez-Junyent
- Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL; University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.G.-J.); (M.S.)
| | | | - Miguel Santin
- Department of Infectious Diseases, Bellvitge University Hospital-IDIBELL; University of Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (J.G.-J.); (M.S.)
| | - Carme Muñoz
- Department of Microbiology, Hospital Sant Pau, 08001 Barcelona, Spain; (C.M.); (J.L.-M.)
| | | | - Joaquín Salas-Coronas
- Tropical Medicine Unit, Hospital de Poniente, El Ejido, 04700 Almería, Spain; (M.J.S.-P.); (J.S.-C.); (A.B.L.-S.)
| | - Elena Sulleiro
- Department of Microbiology, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain;
| | - Dolors Somoza
- Department of Microbiology, Hospital Universitari Bellvitge, 08907 Barcelona, Spain;
| | - Begoña Treviño
- Tropical Medicine Unit Vall d’Hebron-Drassanes, PROSICS Barcelona, 08035 Barcelona, Spain;
| | - Rosángela Pecorelli
- Internal Medicine Department, Hospital Universitario General de Catalunya, 08915 Barcelona, Spain;
| | - Jaume Llaberia-Marcual
- Department of Microbiology, Hospital Sant Pau, 08001 Barcelona, Spain; (C.M.); (J.L.-M.)
| | - Ana Belén Lozano-Serrano
- Tropical Medicine Unit, Hospital de Poniente, El Ejido, 04700 Almería, Spain; (M.J.S.-P.); (J.S.-C.); (A.B.L.-S.)
| | - Llorenç Quinto
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (L.Q.); (J.M.)
- Centro de Investigação em Saúde de Manhiça, 1929 Maputo, Mozambique
| | - Jose Muñoz
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (L.Q.); (J.M.)
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (L.Q.); (J.M.)
- Division of Infectious Diseases, Department of Medicine-Solna, Karolinska Institutet, 17177 Solna, Sweden
- Correspondence: ; Tel.: +34-652-870-779
| | | |
Collapse
|
4
|
Ottino L, Buonfrate D, Paradies P, Bisoffi Z, Antonelli A, Rossolini GM, Gabrielli S, Bartoloni A, Zammarchi L. Autochthonous Human and Canine Strongyloides stercoralis Infection in Europe: Report of a Human Case in An Italian Teen and Systematic Review of the Literature. Pathogens 2020; 9:E439. [PMID: 32503315 PMCID: PMC7350350 DOI: 10.3390/pathogens9060439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022] Open
Abstract
Autochthonous human and canine strongyloidiasis is reported in Europe but is unclear whether the transmission of infection still occurs. We report a previously unpublished human case in an Italian teen and perform a systematic review of literature on autochthonous human and canine strongyloidiasis in Europe to investigate the current dynamic of transmission. Overall, 109 papers published after 1987 were included and one previously unpublished Italian case was added. Eighty case reports were retrieved and 42 of them (52.5%) had severe strongyloidiasis. Most cases were diagnosed in Spain, Italy and France. The median age was 58, the most represented age group was 61-70 years, 11 patients were under 30, and 7 of them were diagnosed after 2000. Epidemiological studies on human strongyloidiasis showed prevalence ranging from 0.56% to 28%. Overall, agriculture work, mine work and walking barefoot were the most commonly reported risk factors for infection. Canine strongyloidiasis was reported mainly in Italy (68 cases), but a few cases occurred also in Iceland, Finland, England, Germany, France, Switzerland, Russia, Slovakia, Romania and Greece. Autochthonous strongyloidiasis is still reported in Europe and sporadic transmission still occurs. Health care professionals should be aware of this issue to identify infected subjects and avoid adverse outcomes, especially in immunosuppressed patients. Further investigations are needed to clarify the zoonotic transmission of this nematode.
Collapse
Affiliation(s)
- Letizia Ottino
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
| | - Dora Buonfrate
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy; (D.B.); (Z.B.)
| | - Paola Paradies
- Department of Emergency and Organs Transplantation, Veterinary Section, Campus of Veterinary Medicine, University of Bari, 70124 Bari, Italy;
| | - Zeno Bisoffi
- IRCCS Sacro Cuore Don Calabria Hospital, Negrar, 37024 Verona, Italy; (D.B.); (Z.B.)
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Microbiology and Virology Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Simona Gabrielli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, 50134 Florence, Italy
- Referral Center for Tropical Diseases of Tuscany, Careggi University Hospital, 50134 Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (L.O.); (A.A.); (G.M.R.); (A.B.)
- Infectious and Tropical Diseases Unit, Careggi University and Hospital, 50134 Florence, Italy
- Referral Center for Tropical Diseases of Tuscany, Careggi University Hospital, 50134 Florence, Italy
| |
Collapse
|
5
|
Requena-Méndez A, Salas-Coronas J, Salvador F, Gomez-Junyent J, Villar-Garcia J, Santin M, Muñoz C, González-Cordón A, Cabezas Fernández MT, Sulleiro E, Arenas MDM, Somoza D, Vazquez-Villegas J, Treviño B, Rodríguez E, Valls ME, Llaberia-Marcual J, Subirá C, Muñoz J. High Prevalence of Strongyloidiasis in Spain: A Hospital-Based Study. Pathogens 2020; 9:pathogens9020107. [PMID: 32053864 PMCID: PMC7167856 DOI: 10.3390/pathogens9020107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 01/20/2023] Open
Abstract
Introduction: Strongyloidiasis is a prevailing helminth infection ubiquitous in tropical and subtropical areas, however, seroprevalence data are scarce in migrant populations, particularly for those coming for Asia. Methods: This study aims at evaluating the prevalence of S. stercoralis at the hospital level in migrant populations or long term travellers being attended in out-patient and in-patient units as part of a systematic screening implemented in six Spanish hospitals. A cross-sectional study was conducted and systematic screening for S. stercoralis infection using serological tests was offered to all eligible participants. Results: The overall seroprevalence of S. stercoralis was 9.04% (95%CI 7.76-10.31). The seroprevalence of people with a risk of infection acquired in Africa and Latin America was 9.35% (95%CI 7.01-11.69), 9.22% (7.5-10.93), respectively. The number of individuals coming from Asian countries was significantly smaller and the overall prevalence in these countries was 2.9% (95%CI -0.3-6.2). The seroprevalence in units attending potentially immunosuppressed patients was significantly lower (5.64%) compared with other units of the hospital (10.20%) or Tropical diseases units (13.33%) (p < 0.001). Conclusions: We report a hospital-based strongyloidiasis seroprevalence of almost 10% in a mobile population coming from endemic areas suggesting the need of implementing strongyloidiasis screening in hospitalized patients coming from endemic areas, particularly if they are at risk of immunosuppression.
Collapse
Affiliation(s)
- Ana Requena-Méndez
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.S.); (J.M.)
- Department of Global Public Health, Karolinska Institutet, 171 77 Solna, Sweden
- Correspondence: ; Tel.: +34-652-870-779
| | - Joaquin Salas-Coronas
- Tropical Medicine Unit. Hospital de Poniente, El Ejido, 04700 Almería, Spain; (J.S.-C.); (M.T.C.F.)
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain;
| | - Joan Gomez-Junyent
- Department of Infectious Diseases, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (J.G.-J.), (M.S.)
| | - Judith Villar-Garcia
- Infectious Diseases Department, Hospital del Mar-IMIM, 08003 Barcelona, Spain; (J.V.-G.); (M.d.M.A.)
| | - Miguel Santin
- Department of Infectious Diseases, Hospital Universitari Bellvitge, 08907 Barcelona, Spain; (J.G.-J.), (M.S.)
| | - Carme Muñoz
- Department of Microbiology, Hospital Sant Pau, 08041 Barcelona, Spain; (C.M.); (J.L.-M.)
| | | | | | - Elena Sulleiro
- Department of Microbiology, Vall d’Hebron University Hospital, PROSICS Barcelona, 08035 Barcelona, Spain;
| | - Maria del Mar Arenas
- Infectious Diseases Department, Hospital del Mar-IMIM, 08003 Barcelona, Spain; (J.V.-G.); (M.d.M.A.)
| | - Dolors Somoza
- Department of Microbiology. Hospital Universitari Bellvitge, 08907 Barcelona, Spain;
| | | | - Begoña Treviño
- Tropical Medicine Unit Vall d’Hebron-Drassanes, PROSICS Barcelona, 08035 Barcelona, Spain;
| | - Esperanza Rodríguez
- Parasitology Department, Centro Nacional de Microbiologia—Instituto de Salud Carlos III, 28020 Madrid, Spain;
| | | | - Jaume Llaberia-Marcual
- Department of Microbiology, Hospital Sant Pau, 08041 Barcelona, Spain; (C.M.); (J.L.-M.)
| | - Carme Subirá
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.S.); (J.M.)
| | - Jose Muñoz
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, 08036 Barcelona, Spain; (C.S.); (J.M.)
| |
Collapse
|
6
|
Motamedi M, Haghighi L, Omidian M, Sarkari B. Coinfection of Strongyloides stercoralis and Aspergillus sp. Interdiscip Perspect Infect Dis 2020; 2020:8649409. [PMID: 32565789 PMCID: PMC7271055 DOI: 10.1155/2020/8649409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Strongyloides stercoralis has the ability to proliferate in its hosts for a long time. In most patients with a competent immune system, the infection remains asymptomatic. OBJECTIVES Herein, we report a case of concomitant infection of Strongyloides and Aspergillus. Similar cases reported previously were reviewed in the literature and discussed in terms of diagnosis, clinical presentation, and treatment. METHODS The patient was a 55-year-old man who had a medical history of two masses in his lung and was treated with corticosteroids six months before the presentation. RESULTS Using the parasitological methods, massive actively motile larvae of S. stercoralis were seen in the patient's faecal sample. Aspergillus infection was isolated from his fresh bronchoalveolar lavage (BAL) sample and confirmed by observing the septate, dichotomously branched hyphae in direct microscopic examination and also the isolation of the fungus from the culture medium. Molecular analysis revealed that the fungal species isolated from the patient are A. flavus and A. niger. Conclusion. The case highlights the features of concomitant infection of S. stercoralis and Aspergillus in immunocompromised patients and the importance of screening patients for strongyloidiasis before initiation of immunosuppressive therapy.
Collapse
Affiliation(s)
- Marjan Motamedi
- 1Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Lida Haghighi
- 1Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Omidian
- 1Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bahador Sarkari
- 1Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- 2Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Science, Shiraz, Iran
| |
Collapse
|
7
|
Ahmed SA, El-Moselhy A, El-Moammaly A, El-Shewy K. Strongyloides stercoralis in Patients on Corticosteroids Therapy Using Enzyme-Linked Immunosorbent Assay and Gelatin Particles Indirect Agglutination Tests: A Diagnostic Approach. Acta Parasitol 2019; 64:394-405. [PMID: 31069645 DOI: 10.2478/s11686-019-00060-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/24/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Patients on corticosteroids therapy (POCT) are more likely to flare up concealed Strongyloides infection and develop Strongyloides hyperinfection syndrome and/or dissemination. Such critical complications can lead to high mortality rates. Rapid detection methods are, therefore, necessary to detect Strongyloides infection in POCT with the advantage of being applicable in a developing country. METHODS Two hundred POCT have been enrolled in this study to determine the rate of infection with Strongyloides. Three different groups of POCT (Strongyloides infected, non-infected, infected with other parasites) were used to evaluate the antibodies detection capability of two serological techniques (enzyme-linked immunosorbent assay (ELISA) and gelatin particles indirect agglutination (GPIAT) against the results of the gold standard agar plate culture (APC). RESULTS With APC, the infection rate of Strongyloides stercoralis in POCT was 9.5% (19/200). POCT with Strongyloides infection displayed related risk factors (job, rural settlements, and soil contact) for infection combined with the subtropical nature of Ismailia Governorate. With regard to serology, ELISA detection results were poor compared to APC with sensitivity and specificity of 42.1% and 82.6%, respectively, and positive and negative predictive values of 72% and 30%. GPIAT appeared to be closely related to APC with sensitivity and specificity of 89.4% and 81.8%, respectively, and positive and negative predictive values of 80.9% and 96.7%. Statistical moderate correlation was detected between GPIAT and ELISA. CONCLUSION The GPIAT technique is more convenient, easier, cheaper and faster to rule out the infection of Strongyloides in POCT. It might be the test of choice for routine immunodiagnosis of human strongyloidiasis.
Collapse
Affiliation(s)
- Shahira A Ahmed
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt.
| | - Amany El-Moselhy
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Amal El-Moammaly
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Khalid El-Shewy
- Department of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| |
Collapse
|
8
|
Barroso M, Salvador F, Sánchez-Montalvá A, Bosch-Nicolau P, Molina I. Strongyloides stercoralis infection: A systematic review of endemic cases in Spain. PLoS Negl Trop Dis 2019; 13:e0007230. [PMID: 30860995 PMCID: PMC6413904 DOI: 10.1371/journal.pntd.0007230] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/10/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Strongyloides stercoralis infection, a neglected tropical disease, is widely distributed. Autochthonous cases have been described in Spain, probably infected long time ago. In recent years the number of diagnosed cases has increased due to the growing number of immigrants, travelers and refugees, but endemically acquired cases in Spain remains undetermined. METHODOLOGY We systematically searched the literature for references on endemic strongyloidiasis cases in Spain. The articles were required to describe Strongyloides stercoralis infection in at least one Spanish-born person without a history of travel to endemic areas and be published before 31st May 2018. Epidemiological data from patients was collected and described individually as well as risk factors to acquisition of the infection, diagnostic technique that lead to the diagnosis, presence of eosinophilia and clinical symptoms at diagnosis. FINDINGS Thirty-six studies were included, describing a total of 1083 patients with an average age of 68.3 years diagnosed with endemic strongyloidiasis in Spain. The vast majority of the cases were described in the province of Valencia (n = 1049). Two hundred and eight of the 251 (82.9%) patients in whom gender was reported were male, and most of them had current or past dedication to agriculture. Seventy percent had some kind of comorbidity. A decreasing trend in the diagnosed cases per year is observed from the end of last decade. However, there are still nefigw diagnoses of autochthonous cases of strongyloidiasis in Spain every year. CONCLUSIONS With the data provided by this review it is likely that in Spain strongyloidiasis might have been underestimated. It is highly probable that the infection remains undiagnosed in many cases due to low clinical suspicion among Spanish population without recent travel history in which the contagion probably took place decades ago.
Collapse
Affiliation(s)
- Maria Barroso
- Primary Health Centre La Marina, Autonomous University of Barcelona, Barcelona, Spain
| | - Fernando Salvador
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
| | - Pau Bosch-Nicolau
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Vall d'Hebron University Hospital, PROSICS Barcelona, Spain
| |
Collapse
|