1
|
Sprecher VP, Hofmann D, Savathdy V, Xayavong P, Norkhankhame C, Huy R, Khieu V, Sayasone S, Hattendorf J, Keiser J. Efficacy and safety of moxidectin compared with ivermectin against Strongyloides stercoralis infection in adults in Laos and Cambodia: a randomised, double-blind, non-inferiority, phase 2b/3 trial. THE LANCET. INFECTIOUS DISEASES 2024; 24:196-205. [PMID: 37949090 DOI: 10.1016/s1473-3099(23)00507-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Infection with the soil-transmitted helminth Strongyloides stercoralis affects up to 600 million people globally, most of whom live in rural areas with poor sanitation. If untreated, infection leads to long-lasting morbidity and might even be life-threatening. Moxidectin might be a promising alternative to ivermectin, the only currently recommended single-dose treatment. We aimed to assess whether moxidectin is non-inferior in terms of efficacy and safety compared with ivermectin. METHODS In this randomised, double-blind, parallel-group, non-inferiority, phase 2b/3 trial in communities in Laos and Cambodia, adults aged 18-65 years were screened for the presence of S stercoralis larvae in their stool via sextuplicate quantitative Baermann assays. Using computer-generated group allocation (block randomisation stratified by infection intensity), parasitologically (two or more positive Baermann assays) and clinically eligible participants were randomly assigned (1:1) to receive single oral doses of either moxidectin (8 mg) and ivermectin-matched placebo, or ivermectin (200 μg/kg bodyweight) and moxidectin-matched placebo. The primary endpoint was cure rate assessed at 14-21 days after treatment, using the available-case population analysed according to intention-to-treat principles. Moxidectin was considered non-inferior to ivermectin if the lower limit of the two-sided 95% CI of the difference was greater than the non-inferiority margin of -10 percentage points. Safety endpoints were assessed before treatment, and at 2-3 h, 24 h, and 14-21 days after treatment. This trial is registered at ClinicalTrials.gov, NCT04056325 and NCT04848688. FINDINGS Between Dec 6, 2020, and May 21, 2022, 4291 participants were screened, 726 of whom were enrolled and randomly assigned to moxidectin (n=363) or ivermectin (n=363). For the participants with primary outcome data, we observed a cure rate of 93·6% (95% CI 90·5 to 96·0; 324 of 346 participants) in the moxidectin group and 95·7% (93·0 to 97·6; 335 of 350 participants) in the ivermectin group, resulting in a between-group difference of -2·1 percentage points (95% CI -5·5 to 1·3). The most common adverse events were abdominal pain (32 [9%] of 363 with moxidectin vs 34 [9%] of 363 with ivermectin) and headache (25 [7%] vs 30 [8%]), which were predominantly mild and transient. INTERPRETATION Moxidectin was non-inferior to ivermectin in terms of efficacy in the treatment of strongyloidiasis. Additionally, both drugs had a similar safety profile. The fixed dose and lower cost of moxidectin compared with ivermectin make it a valuable alternative for people with strongyloidiasis. FUNDING Swiss National Science Foundation.
Collapse
Affiliation(s)
- Viviane P Sprecher
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Daniela Hofmann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | | | | | - Rekol Huy
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | | | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| |
Collapse
|
2
|
Rodrigues JGM, Miranda GS, Camelo GMA, Rodrigues VF, Silva JKAO, Gouveia CBG, Porto WJN, Wanderley FS, Geiger SM, Negrão-Corrêa DA. Modifications to the parasitological technique of Rugai increase the diagnostic sensitivity for strongyloidiasis. Parasitol Res 2024; 123:101. [PMID: 38233532 DOI: 10.1007/s00436-023-08111-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Abstract
Strongyloidiasis is a neglected tropical disease caused mainly by Strongyloides stercoralis, a nematode that can persist for decades in the human host with a very low parasitic burden and without specific symptoms. Hence, it is difficult to diagnose and control. Larval concentration and culture methods with fecal samples show higher sensitivity for the diagnosis of Strongyloides-infected individuals; however, these techniques are not routinely used, primarily due to the challenges associated with processing a substantial volume of fecal samples. In the current study, we comparatively evaluated the sensitivity and applicability of modifications made to the Rugai parasitological method for the diagnosis of strongyloidiasis in fecal samples of experimentally infected rats and in 68 individuals from an urban community close to Maceió, Brazil. The presence and quantity of parasite larvae in the feces were comparatively evaluated using different parasitological techniques. In the experimental model, we demonstrated that the modified Rugai technique (RMOD) allowed for significantly higher recovery of larvae than the original Rugai technique (RO). Moreover, the sediment was cleaner and easier to evaluate using optical microscopy. Compared to other parasitological techniques, such as agar-plate culture (A-PC) and spontaneous sedimentation (SS), the RMOD technique showed higher sensitivity in the detection of larvae in all infected groups and presented comparatively better performance, especially in rats with a low parasite burden. In the human population, among the 68 stool samples evaluated, Strongyloides larvae were detected in the feces of six individuals with an estimated prevalence of 8.82%. However, the performance of each parasitological method was remarkably different. SS identified Strongyloides larvae in only two individuals and A-PC in three, whereas RMOD was able to identify six infected individuals, resulting in sensitivities of 33.3%, 50%, and 100%, respectively. In conclusion, the modifications introduced to the Rugai technique resulted in improved sensitivity for the detection of Strongyloides spp. infections, especially in stool samples with a low parasite burden, in comparison with other routinely used parasitological techniques.
Collapse
Affiliation(s)
- João Gustavo Mendes Rodrigues
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Guilherme Silva Miranda
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Department of Biology, Federal Institute of Education, Science and Technology of Maranhão, São Raimundo das Mangabeiras, Brazil
| | - Genil Mororó Araújo Camelo
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Vanessa Fernandes Rodrigues
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Caio Brandão Goes Gouveia
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Flaviana Santos Wanderley
- Laboratory of Parasitic Infectious Diseases, State University of Health Sciences of Alagoas, Maceió, Brazil
| | - Stefan Michael Geiger
- Institute of Biological Sciences, Department of Parasitology, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | |
Collapse
|
3
|
Buonfrate D, Bradbury RS, Watts MR, Bisoffi Z. Human strongyloidiasis: complexities and pathways forward. Clin Microbiol Rev 2023; 36:e0003323. [PMID: 37937980 PMCID: PMC10732074 DOI: 10.1128/cmr.00033-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/11/2023] [Indexed: 11/09/2023] Open
Abstract
Strongyloidiasis is a World Health Organization neglected tropical disease usually caused by Strongyloides stercoralis, a parasitic worm with a complex life cycle. Globally, 300-600 million people are infected through contact with fecally contaminated soil. An autoinfective component of the life cycle can lead to chronic infection that may be asymptomatic or cause long-term symptoms, including malnourishment in children. Low larval output can limit the sensitivity of detection in stool, with serology being effective but less sensitive in immunocompromise. Host immunosuppression can trigger catastrophic, fatal hyperinfection/dissemination, where large numbers of larvae pierce the bowel wall and disseminate throughout the organs. Stable disease is effectively treated by single-dose ivermectin, with disease in immunocompromised patients treated with multiple doses. Strategies for management include raising awareness, clarifying zoonotic potential, the development and use of effective diagnostic tests for epidemiological studies and individual diagnosis, and the implementation of treatment programs with research into therapeutic alternatives and medication safety.
Collapse
Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Richard S. Bradbury
- School of Health and Life Sciences, Federation University Australia, Berwick, Victoria, Australia
| | - Matthew R. Watts
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research – New South Wales Health Pathology and Sydney Institute for Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Zeno Bisoffi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| |
Collapse
|
4
|
Gryschek RCB, Corral MA, Sitta RB, Gottardi M, Pierrotti LC, Costa SF, Abdala E, Chieffi PP, de Paula FM. Strongyloides infection screening in transplant candidates: What is the best strategy? Transpl Infect Dis 2023; 25:e14153. [PMID: 37750481 DOI: 10.1111/tid.14153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The potential that Strongyloides stercoralis infection has to cause major morbidity and high mortality when the disseminated form occurs in transplant patients is of particular concern. METHODS In this study, the objective was to observe S. stercoralis infection in patients who are candidates for transplantation by using parasitological, serological, and molecular techniques and to propose an algorithm for the detection of that infection in transplant candidates. RESULTS By parasitological techniques, 10% of fecal samples were positive. Anti-Strongyloides antibodies immunoglobulin G were detected in 19.3% and 20.7% of patients by immunofluorescence assay and enzyme-linked immunosorbent assay, respectively. S. stercoralis DNA was observed in 17.3% of samples by conventional polymerase chain reaction and 32.7% of samples by quantitative polymerase chain reaction (qPCR). CONCLUSION The set of results allows us to reinforce that a positive result by parasitological techniques and/or qPCR indicates that the specific treatment should be applied. However, the improvement of diagnostic techniques may suggest changes in the screening for strongyloidiasis in these patients.
Collapse
Affiliation(s)
- Ronaldo Cesar Borges Gryschek
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Marcelo Andreetta Corral
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Renata Barnabé Sitta
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Maiara Gottardi
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Ligia Camera Pierrotti
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Silvia Figueiredo Costa
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Edson Abdala
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Pedro Paulo Chieffi
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Sao Paulo, Brazil
| | - Fabiana Martins de Paula
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| |
Collapse
|
5
|
Crego-Vicente B, Febrer-Sendra B, Nindia A, Pessela A, Aixut S, Martínez-Campreciós J, Mediavilla A, Silgado A, Sulleiro E, Treviño B, Molina I, Muro A, Salvador F, Fernández-Soto P. First field study using Strong-LAMP for diagnosis of strongyloidiasis in Cubal, Angola. Parasit Vectors 2023; 16:393. [PMID: 37907997 PMCID: PMC10619288 DOI: 10.1186/s13071-023-06009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Strongyloides stercoralis infection is a common neglected tropical disease distributed worldwide, mainly in tropical and subtropical climates. The impact of S. stercoralis infections on human health ranges from mild asymptomatic infections to chronic strongyloidiasis unnoticeable until the host is immunosuppressed. In severe strongyloidiasis, a syndrome of hyperinfection and larval dissemination to various organs can occur with high mortality rates. The diagnosis of strongyloidiasis is challenging because of the absence of a single standard reference test with high sensitivity and specificity, which also makes it difficult to estimate the accuracy of other diagnostic tests. This study aimed to evaluate, for the first time, the use of an easy-to-perform loop-mediated isothermal amplification (LAMP) colorimetric assay (named Strong-LAMP) for the molecular screening of strongyloidiasis in stool samples from patients in a low-resource endemic area in Cubal, Angola. To compare different LAMP application scenarios, the performance of the Strong-LAMP under field conditions in Angola was reassessed in a well-equipped reference laboratory in Spain and compared with a quantitative polymerase chain reaction (qPCR) method. METHODS A total of 192 stool samples were collected from adult population in Cubal, Angola, and examined by parasitological methods (direct saline microscopy and Baermann's technique). DNA was extracted from each stool sample using a commercial kit and tested by the colorimetric Strong-LAMP assay for the detection of Strongyloides spp. under field conditions. Furthermore, all samples were shipped to a well-equipped laboratory in Spain, reanalysed by the same procedure and compared with a qPCR method. The overall results after testing were compared. RESULTS Strongyloides stercoralis larvae were identified by direct saline microscopy and Baermann in a total of 10/192 (5.2%) and 18/192 (9.4%) stool samples, respectively. Other helminth and protozoan species were also identified. The Strong-LAMP-positive results were visually detected in 69/192 (35.9%) stool samples. The comparison of Strong-LAMP results in field conditions and at a reference laboratory matched in a total of 146/192 (76.0%) samples. A total of 24/192 (12.5%) stool samples tested positive by qPCR. CONCLUSIONS This is the first study in which colorimetric Strong-LAMP has been clinically evaluated in a resource-poor strongyloidiasis endemic area. Strong-LAMP has been shown to be more effective in screening for strongyloidiasis than parasitological methods under field conditions and qPCR in the laboratory. Our Strong-LAMP has proven to be a field-friendly and highly accurate molecular test for the diagnosis of strongyloidiasis.
Collapse
Affiliation(s)
- Beatriz Crego-Vicente
- Infectious and Tropical Diseases Research Group (e-INTRO), Biomedical Research Institute of Salamanca-Research Centre for Tropical Diseases at the University of Salamanca (IBSAL-CIETUS), Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Begoña Febrer-Sendra
- Infectious and Tropical Diseases Research Group (e-INTRO), Biomedical Research Institute of Salamanca-Research Centre for Tropical Diseases at the University of Salamanca (IBSAL-CIETUS), Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | | | | | | | - Joan Martínez-Campreciós
- Hospital Nossa Senhora da Paz, Cubal, Angola
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Mediavilla
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | - Aroa Silgado
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | - Elena Sulleiro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | - Begoña Treviño
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | - Israel Molina
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain
| | - Antonio Muro
- Infectious and Tropical Diseases Research Group (e-INTRO), Biomedical Research Institute of Salamanca-Research Centre for Tropical Diseases at the University of Salamanca (IBSAL-CIETUS), Faculty of Pharmacy, University of Salamanca, Salamanca, Spain
| | - Fernando Salvador
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
- International Health Unit Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS, Barcelona, Spain.
| | - Pedro Fernández-Soto
- Infectious and Tropical Diseases Research Group (e-INTRO), Biomedical Research Institute of Salamanca-Research Centre for Tropical Diseases at the University of Salamanca (IBSAL-CIETUS), Faculty of Pharmacy, University of Salamanca, Salamanca, Spain.
| |
Collapse
|
6
|
Rojas OC, Montoya AM, Villanueva-Lozano H, Carrion-Alvarez D. Severe strongyloidiasis: a systematic review and meta-analysis of 339 cases. Trans R Soc Trop Med Hyg 2023; 117:682-696. [PMID: 37300462 DOI: 10.1093/trstmh/trad032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/15/2022] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Strongyloidiasis is a parasitosis representing a significant public health problem in tropical countries. It is often asymptomatic in immunocompetent individuals but its mortality rate increases to approximately 87% in severe forms of the disease. We conducted a systematic review, including case reports and case series, of Strongyloides hyperinfection and dissemination from 1998 to 2020 searching PubMed, EBSCO and SciELO. Cases that met the inclusion criteria of the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist were analysed. Statistical analysis was performed using Fisher's exact test and Student's t-test and a Bonferroni correction for all the significant values. A total of 339 cases were included in this review. The mortality rate was 44.83%. The presence of infectious complications, septic shock and a lack of treatment were risk factors for a fatal outcome. Eosinophilia and ivermectin treatment were associated with an improved outcome.
Collapse
Affiliation(s)
- Olga C Rojas
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Facultad de Medicina, Dr Eleuterio Gonzalez Gonzalitos-Francisco I. Madero s/n 64460, Monterrey, Nuevo Leon, Mexico
| | - Alexandra M Montoya
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Facultad de Medicina, Dr Eleuterio Gonzalez Gonzalitos-Francisco I. Madero s/n 64460, Monterrey, Nuevo Leon, Mexico
| | - Hiram Villanueva-Lozano
- Departamento de Medicina Interna, Hospital Regional ISSSTE Monterrey, Av. Adolfo López Mateos, 122 Burócratas Federales 64380, Monterrey, Nuevo León, Mexico
| | - Diego Carrion-Alvarez
- Departamento de Medicina Interna, Hospital Regional ISSSTE Monterrey, Av. Adolfo López Mateos, 122 Burócratas Federales 64380, Monterrey, Nuevo León, Mexico
- Departamento de Ciencias Basicas, Universidad de Monterrey. N.L. Mexico. Av. Ignacio Morones Prieto 4500, San Pedro, Garza García, Nuevo Leon, Mexico
| |
Collapse
|
7
|
Zulfiqar S, Gasser RB, Ghodsian S, Almukhtar M, Holland C, Rostami A. Strongyloides coinfection in COVID-19 patients treated with corticosteroids: A systematic review. Rev Med Virol 2023; 33:e2469. [PMID: 37353858 DOI: 10.1002/rmv.2469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/03/2023] [Accepted: 06/06/2023] [Indexed: 06/25/2023]
Abstract
The COVID-19 pandemic linked to the virus SARS-CoV-2, which began in China, affected ∼765 million people as of 30 April 2023. The widespread use of corticosteroids for the symptomatic treatment of COVID-19 could lead to the reactivation of infections of opportunistic pathogens, including Strongyloides. We sought to determine the clinical symptoms and demographic characteristics of SARS-CoV-2-Strongyloides co-infection, particularly in patients with severe disease and being treated with immunosuppressive drugs. To do this, we undertook a systematic review of the literature, and searched public accessible scientific databases-the Web of Science, Scopus, PubMed/Medline and Embase -for eligible studies (1 December 2019 to 30 August 2022). The review protocol is registered in PROSPERO (CRD42022377062). Descriptive statistical analyses were used to present the clinical and laboratory parameters of the co-infection; for this, we calculated prevalence using the following formula: positive cases/total number of cases × 100. Of a total of 593 studies identified, 17 studies reporting 26 co-infected patients met the criteria for inclusion in this review. The median age of these patients was 55.14 years. Most of cases (53.8%) were treated with dexamethasone, followed by methylprednisolone (26.9%). Eighteen of 26 patients were immigrants living in European countries or the USA; most of these immigrants originated from Latin America (58%) and South-East Asia (11%). The commonest symptoms of co-infection were abdominal pain (50%), fever (46.1%), dyspnoea (30.7%) and cough (30.7%), and frequently reported laboratory findings were high absolute eosinophil count (38.4%), high white blood cell count (30.7%), high C-reactive protein (23.0%) and high neutrophil count (19.2%). Two of the 26 patients (7.7%) had fatal outcomes. Most of the SARS-CoV-2-Strongyloides coinfected cases were immigrants living in developed countries, emphasising the need for clinicians in these countries to be aware of clinical and laboratory parameters associated with such co-infections, as well as the key importance of rapid and accurate diagnostic tests for timely and effective diagnosis and patient management.
Collapse
Affiliation(s)
- Sana Zulfiqar
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Robin B Gasser
- Department of Veterinary Biosciences, Melbourne Veterinary School, Faculty of Science, The University of Melbourne, Parkville, Victoria, Australia
| | - Sahar Ghodsian
- Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mustafa Almukhtar
- Takhar Family Medicine and Urgent Care, Sacramento, California, United States
| | - Celia Holland
- Department of Zoology, School of Natural Sciences, Trinity College Dublin, the University of Dublin, College Green Dublin, Ireland
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
8
|
Montreuil N, Sternberg CA, Abaribe O, Ayoade FO. Disseminated Strongyloides stercoralis infection in the setting of Escherichia coli meningitis and bacteraemia in a patient living with HIV on high-dose corticosteroid therapy. BMJ Case Rep 2023; 16:e256105. [PMID: 37643819 PMCID: PMC10465900 DOI: 10.1136/bcr-2023-256105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Strongyloidiasis, a helminth infection caused by Strongyloides stercoralis, can be complicated by hyperinfection, especially in the setting of immunosuppression; however, many patients go undiagnosed. One clue to diagnosis is unexplained gram-negative bacteraemia or meningitis in patients who are immunosuppressed. Serology can be helpful but may be negative in these patients who are immunocompromised.We present the case of a white cisgender man from Central America in his 40s, living with HIV, with a CD4 count of 77 cells/µL. He was diagnosed with Strongyloides hyperinfection after an increase in his steroid dose. He also had Escherichia coli meningitis and bacteraemia. Strongyloidiasis was diagnosed by stool microscopy despite a negative serology test.This case highlights the challenges in diagnosing strongyloidiasis in the setting of immunosuppression. A high index of clinical suspicion is warranted for patients living with HIV on high-dose corticosteroids. Up to three stool microscopy studies for Strongyloides should be sent in addition to serology.
Collapse
Affiliation(s)
- Nadine Montreuil
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Candice A Sternberg
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Obinna Abaribe
- Department of Medicine, Infectious Disease Doctors Medical Group APC, Plano, Texas, USA
| | - Folusakin O Ayoade
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
9
|
Hürlimann E, Hofmann D, Keiser J. Ivermectin and moxidectin against soil-transmitted helminth infections. Trends Parasitol 2023; 39:272-284. [PMID: 36804383 DOI: 10.1016/j.pt.2023.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/19/2023]
Abstract
Ivermectin and moxidectin, two macrocyclic lactones, are potent antiparasitic drugs currently registered and mainly used against filarial diseases; however, their potential value for improved soil-transmitted helminth (STH) control has been acknowledged. This review provides insights on recent studies evaluating the efficacy of ivermectin and moxidectin as single or coadministered therapy against human soil-transmitted helminthiases (including Strongyloides stercoralis infections) and on pharmacokinetic/pharmacodynamic parameters measured in treated populations. Furthermore, we discuss current gaps for research, highlight advantages - but also existing challenges - for uptake of ivermectin and/or moxidectin treatment schemes into routine STH control in endemic countries.
Collapse
Affiliation(s)
- Eveline Hürlimann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Daniela Hofmann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland.
| |
Collapse
|
10
|
Costache C, Colosi IA, Neculicioiu VS, Florian DI, Petrushev B, Vasvari A, Seicean A. A Rare Case of Strongyloides stercoralis Hyperinfection in a Diabetic Patient from Romania—Case Report and Review of the Literature. Pathogens 2023; 12:pathogens12040530. [PMID: 37111416 PMCID: PMC10146644 DOI: 10.3390/pathogens12040530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
Severe cases of strongyloidiasis are most often associated with multiple causes of immune suppression, such as corticoid treatment and HTLV (human T-lymphotropic virus) coinfection. Diabetes is not traditionally considered a risk factor for the development of severe strongyloidiasis. We report a rare case of autochthonous severe strongyloidiasis in Romania, a European country with a temperate climate. A 71-year-old patient with no prior travel history was admitted with multiple gastrointestinal complaints and recent weight loss. CT (computed tomography) scans indicated duodenal wall thickening, and duodenal endoscopy evidenced mucosal inflammation, ulcerations and partial duodenal obstruction at D4. Microscopic examination of stool samples and biopsy specimens from the gastric and duodenal mucosa revealed an increased larval burden characteristic of Strongyloides stercoralis hyperinfection. Sequential treatment with albendazole and ivermectin achieved parasitological cure and complete recovery. The novelty of our case stems from the scarcity of severe strongyloidiasis cases reported in Europe and especially in Romania, the absence of other risk factors in our patient aside from diabetes, the involvement of the gastric mucosa and the rare presentation as partial duodenal obstruction. This case highlights the importance of considering strongyloidiasis as a differential diagnosis, even in temperate climates where cases are sporadic, in cases in which immune suppression is not evident and in the absence of eosinophilia. The case is presented in the context of the first literature review examining the relationship between severe strongyloidiasis and diabetes, emphasizing diabetes as a possible risk factor for severe strongyloidiasis.
Collapse
Affiliation(s)
- Carmen Costache
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioana Alina Colosi
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Vlad Sever Neculicioiu
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence:
| | - Diana Ioana Florian
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Bobe Petrushev
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Alexandra Vasvari
- Department of Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
- Department of Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| |
Collapse
|
11
|
Cai DH, Wang J, Fang XL. Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case report. BMC Infect Dis 2022; 22:749. [PMID: 36153480 PMCID: PMC9509572 DOI: 10.1186/s12879-022-07670-2] [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: 05/05/2022] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Strongyloidiasis, caused by Strongyloides stercoralis (S. stercoralis), is endemic worldwide, especially in countries with warm and humid climates. Strongyloides stercoralis hyperinfection syndrome (SHS) is an extremely serious manifestation of strongyloidiasis, which results from an acute exacerbation of auto-infection and is often fatal.
Case presentation
We present a case of SHS mimicking pseudomembranous enteritis with a final definitive diagnosis of a triple infection including S. stercoralis, Escherchia coli (E. coli) and Pneumocytis jirovecii (P. jirovecii) that occurred in a microscopic polyangiitis (MPA) patient after immunosuppressive therapy. SHS, together with E. coli bacteremia and Pneumocytis jirovecii pneumonia (PJP) in the same patient, is rare in clinical practice, which is first reported worldwide, to our knowledge. After the diagnosis was confirmed, the treatment protocol was quickly adjusted; however, the patient’s life could not be saved.
Conclusion
This case reminds us of the necessity to consider strongyloidiasis as a differential diagnosis in immunocompromised populations who live in or have visited to S. stercoralis endemic areas, especially patients with suspected pseudomembranous enteritis, even if stool examination, serological tests, and eosinophilia are negative. For this group, it is advisable to complete the relevant endoscopy and/or PCR as soon as possible. The fundamental solution to prevent this catastrophic outcome is to implement effective preventive measures at multiple levels, including physicians, patients, and relevant authorities.
Collapse
|
12
|
Domínguez VR, Pérez-López C, Sánchez CV, Contreras CU, Guerrero AI, Abenza Abildúa MJ. Strongyloides hyperinfection syndrome due to corticosteroid therapy after resection of meningioma: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE21667. [PMID: 35855010 PMCID: PMC9274291 DOI: 10.3171/case21667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/04/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Strongyloidiasis is an underdiagnosed and preventable life-threatening disease caused by infection with the helminth Strongyloides stercoralis. Chronic asymptomatic infection can be sustained for decades, and immunosuppression can lead to disseminated infection, with a mortality rate of 70%–100%. In the neurosurgical population, corticosteroids are the most consistent cause of hyperinfection. OBSERVATIONS The authors present the case of a 33-year-old woman of Paraguayan origin who was diagnosed with sphenoid planum meningioma and treated with a high dose of corticosteroids on the basis of the diagnosis. She underwent surgery, and pathological anatomy reflected grade I meningioma. After the surgery, she started with a history of dyspnea, productive cough, fever, and urticarial rash. Later, she presented with intestinal pseudo-obstruction and bacterial meningitis with hydrocephalus. Serology was positive for Strongyloides (enzyme-linked immunosorbent assay), and she was diagnosed with hyperinfection syndrome. Ivermectin 200 µg/kg daily was established. LESSONS It may be of interest to rule out a chronic Strongyloides infection in patients from risk areas (immigrants or those returning from recent trips) before starting treatment with corticosteroids.
Collapse
Affiliation(s)
| | - Carlos Pérez-López
- Departments of Neurosurgery and
- Neuroradiology, Hospital Universitario la Paz, Madrid, Spain
| | | | | | | | - María José Abenza Abildúa
- Neuroradiology, Hospital Universitario la Paz, Madrid, Spain
- Department of Neurology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| |
Collapse
|
13
|
Kurcheid J, Gordon CA, Clarke NE, Wangdi K, Kelly M, Lal A, Mutombo PN, Wang D, Mationg ML, Clements ACA, Muhi S, Bradbury RS, Biggs B, Page W, Williams G, McManus DP, Gray D. Neglected tropical diseases in Australia: a narrative review. Med J Aust 2022; 216:532-538. [DOI: 10.5694/mja2.51533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Johanna Kurcheid
- Australian National University Canberra ACT
- Swiss Tropical and Public Health Institute Basel Switzerland
| | | | - Naomi E Clarke
- Australian National University Canberra ACT
- Kirby Institute University of New South Wales Sydney NSW
| | | | | | - Aparna Lal
- Australian National University Canberra ACT
| | - Polydor N Mutombo
- National Centre for Naturopathic Medicine Southern Cross University Lismore NSW
| | | | | | | | - Stephen Muhi
- Victorian Infectious Diseases Service Royal Melbourne Hospital Melbourne VIC
| | | | - Beverley‐Ann Biggs
- Victorian Infectious Diseases Service Royal Melbourne Hospital Melbourne VIC
| | | | | | | | | |
Collapse
|
14
|
Müller F, Chandra S, Bogoch II, Rashid M, Redditt V. Intestinal parasites in stool testing among refugees at a primary care clinic in Toronto, Canada. BMC Infect Dis 2022; 22:249. [PMID: 35282824 PMCID: PMC8918311 DOI: 10.1186/s12879-022-07226-4] [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: 11/24/2021] [Accepted: 02/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Enteric parasites are endemic in many of the countries from which refugees originate. Clinical guidelines vary in approaches to screening for and treating intestinal parasites in refugee receiving countries. This study aims to investigate the prevalence and species of intestinal parasites identified in stool ova and parasite (O&P) specimens in a sample of newly arrived refugees in Toronto, Canada. Methods We conducted a retrospective chart review of 1042 refugee patients rostered at a specialized primary care clinic in Toronto from December 2011 to September 2016. Patients who completed recommended stool O&P analyses were included. Basic sociodemographic and clinical variables and results of stool O&P were examined. Results 419 patients (40.2%) had a stool O&P positive for any protozoan or helminth species. Sixty-nine patients (6.6%) had clinically significant parasite species (excluding B hominis, D fragilis, and E dispar, given their lower risk for causing symptoms/complications): 2.3% had clinically significant protozoans and 4.2% had helminths on stool analysis. Conclusion Given the relatively low prevalence of clinically significant parasites identified, our findings do not support universal screening for enteric parasites with stool O&P among refugee claimants/asylum seekers. However, stool analysis should be considered in certain clinical situations, as part of a more tailored approach.
Collapse
|
15
|
Bitterman A, Martins CP, Cices A, Nadendla MP. Comparison of Trials Using Ivermectin for COVID-19 Between Regions With High and Low Prevalence of Strongyloidiasis: A Meta-analysis. JAMA Netw Open 2022; 5:e223079. [PMID: 35311963 PMCID: PMC8938718 DOI: 10.1001/jamanetworkopen.2022.3079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE A widely cited meta-analysis of randomized clinical trials has claimed ivermectin as an effective treatment for prevention of mortality in COVID-19. However, an unrecognized interaction variable with the relative risk (RR) of mortality may substantially change the appropriate interpretation of this analysis. OBJECTIVE To evaluate the association between regional prevalence of strongyloidiasis and ivermectin trial results for the outcome of mortality by testing the hypothesis that strongyloidiasis prevalence interacts with the RR of mortality. DATA SOURCES Original meta-analysis as well as a manual review of all references in a dedicated ivermectin trial database (c19ivermectin) from January 1, 2019, to November 6, 2021. STUDY SELECTION Randomized clinical trials using ivermectin as a treatment for COVID-19 and reporting the outcome of mortality. Studies were excluded in the event of publications revealing suspected trial fraud and/or randomization failure. DATA EXTRACTION AND SYNTHESIS Study characteristics and RR estimates were extracted from each source. Estimates were pooled using random-effects meta-analysis. Differences by strongyloidiasis prevalence were estimated using subgroup meta-analysis and meta-regression. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed. MAIN OUTCOMES AND MEASURES Relative risk of mortality in ivermectin trials in regions of high vs low strongyloidiasis prevalence and correlation coefficient of meta-regression analysis between RR of mortality and regional prevalence of strongyloidiasis. RESULTS A total of 12 trials comprising 3901 patients were included in the analysis. Four trials (33%) took place in regions of high strongyloidiasis prevalence and 8 (67%) trials took place in regions of low strongyloidiasis prevalence. Ivermectin trials that took place in areas of low regional strongyloidiasis prevalence were not associated with a statistically significant decreased risk of mortality (RR, 0.84 [95% CI, 0.60-1.18]; P = .31). By contrast, ivermectin trials that took place in areas of high regional strongyloidiasis prevalence were associated with a significantly decreased risk of mortality (RR, 0.25 [95% CI, 0.09-0.70]; P = .008). Testing for subgroup differences revealed a significant difference between the results of groups with low and high strongyloidiasis prevalence (χ21 = 4.79; P = .03). The estimate for τ2 (the variance of the study effect sizes) was 0 (95% CI, 0.0000-0.2786), and the estimate for I2 (percentage of variability that is explained by between-study heterogeneity) was 0 (95% CI, 0-43.7%). The meta-regression analysis revealed an RR decrease of 38.83% (95% CI, 0.87%-62.25%) for each 5% increase in strongyloidiasis prevalence. CONCLUSIONS AND RELEVANCE In this meta-analysis of 12 trials including 3901 patients, strongyloidiasis prevalence was found to interact with the RR of mortality for ivermectin as a treatment for COVID-19. No evidence was found to suggest ivermectin has any role in preventing mortality among patients with COVID-19 in regions where strongyloidiasis was not endemic.
Collapse
Affiliation(s)
- Avi Bitterman
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Ahuva Cices
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | |
Collapse
|
16
|
Ye L, Taylor GP, Rosadas C. Human T-Cell Lymphotropic Virus Type 1 and Strongyloides stercoralis Co-infection: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:832430. [PMID: 35237633 PMCID: PMC8882768 DOI: 10.3389/fmed.2022.832430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe distribution of human T cell lymphotropic virus type 1 (HTLV-1) overlaps with that of Strongyloides stercoralis. Strongyloides stercoralis infection has been reported to be impacted by co-infection with HTLV-1. Disseminated strongyloidiasis and hyperinfection syndrome, which are commonly fatal, are observed in HTLV-1 co-infected patients. Reduced efficacy of anti-strongyloidiasis treatment in HTLV-1 carriers has been reported. The aim of this meta-analysis and systematic review is to better understand the association between HTLV-1 and S. stercoralis infection.MethodsPubMed, Embase, MEDLINE, Global Health, Healthcare Management Information Consortium databases were searched. Studies regarding the prevalence of S. stercoralis, those evaluating the frequency of mild or severe strongyloidiasis, and treatment response in people living with and without HTLV-1 infection were included. Data were extracted and odds ratios were calculated. Random-effect meta-analysis was used to assess the pooled OR and 95% confidence intervals.ResultsFourteen studies were included after full-text reviewing of which seven described the prevalence of S. stercoralis and HTLV-1. The odds of S. stercoralis infection were higher in HTLV-1 carriers when compared with HTLV-1 seronegative subjects (OR 3.2 95%CI 1.7–6.2). A strong association was found between severe strongyloidiasis and HTLV-1 infection (OR 59.9, 95%CI 18.1–198). Co-infection with HTLV-1 was associated with a higher rate of strongyloidiasis treatment failure (OR 5.05, 95%CI 2.5–10.1).ConclusionStrongyloides stercoralis infection is more prevalent in people living with HTLV-1. Co-infected patients are more likely to develop severe presentation and to fail treatment. Screening for HTLV-1 and Strongyloides sp. should be routine when either is diagnosed.
Collapse
Affiliation(s)
- Lingqing Ye
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Graham P. Taylor
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
- National Centre for Human Retrovirology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- *Correspondence: Graham P. Taylor
| | - Carolina Rosadas
- Section of Virology, Department of Infectious Disease, Imperial College London, London, United Kingdom
| |
Collapse
|
17
|
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.
Collapse
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:
| |
Collapse
|
18
|
Sirka C, Rout A, Patra S, Nayak H. Strongyloides hyperinfection syndrome in dermatology in-patients: A case series. Indian Dermatol Online J 2022; 13:94-97. [PMID: 35198475 PMCID: PMC8809149 DOI: 10.4103/idoj.idoj_118_21] [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: 02/19/2021] [Revised: 06/09/2021] [Accepted: 07/05/2021] [Indexed: 12/03/2022] Open
Abstract
Strongyloides stercoralis is a common intestinal pathogen, which often causes disseminated infection in patients on long term immunosuppressive therapy. The features of this syndrome range from subtle abdominal discomfort to fatal infection. Many of the immunologically mediated dermatological conditions need prolonged treatment with Immunosuppressants. Hence there is increased risk of this infestation. In dermatology in-patients, strongyloides stercoralis hyperinfection can be confused with a number of conditions, such as steroid-induced gastritis, corticosteroid withdrawal, electrolyte imbalance, lepra reactions, and erythrodermic enteropathy. In a country like India, where barefoot walking is still prevalent, this condition has been reported less often. We report a series of five patients who were diagnosed with strongyloides hyperinfection syndrome during their admission in the dermatology department during the last year. This case series aims at creating awareness among the dermatologists, so that, this, potentially fatal but easily preventable and treatable condition, can be managed properly.
Collapse
|
19
|
Hofmann D, Smit C, Sayasone S, Pfister M, Keiser J. Optimizing moxidectin dosing for Strongyloides stercoralis infections: Insights from pharmacometric modeling. Clin Transl Sci 2021; 15:700-708. [PMID: 34889057 PMCID: PMC8932710 DOI: 10.1111/cts.13189] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Abstract
Moxidectin is a frontrunner drug candidate in the treatment of strongyloidiasis. A dose of 8 mg is recommended to treat this indication, which shows a reasonably good efficacy and tolerability profile. Yet, owing to the unique life cycle of Strongyloides stercoralis (S. stercoralis) that entails internal autoinfection, a curative treatment would be desirable. Population‐based pharmacometric modeling that would help to identify an ideal dosing strategy are yet lacking. The aims of this study were to (i) explore the exposure‐efficacy response relationship of moxidectin in treating S. stercoralis and (ii) evaluate whether moxidectin treatment outcomes in terms of cure rates at baseline as compared to post‐treatment could be optimized. Our pharmacodynamic model suggests high predictive power (area under the concentration time curve‐receiver operating characteristic [AUC‐ROC] 0.817) in the probability of being cured by linking an exposure metric (i.e., AUC0‐24 or maximum concentration [Cmax]) to baseline infection intensity. Pharmacometric simulations indicate that with a minimum dose of 4 mg a maximum cure rate of ~ 95% is established in the low infection intensity group (larvae per gram [LPG] ≥0.4–1), whereas in the moderate‐to‐high intensity group (LPG >1) the cure rate plateaus at ~ 87%, following an 8 mg dose. To enhance efficacy further, studies using repeated dosing based on the duration of the autoinfection cycle, for example a two‐dose regimen 3 weeks apart should be considered. Simulations revealed similar Cmax in both treatment courses of a two‐dose regimen; hence safety should not be a concern. Collectively, our results provide evidence‐based guidance for enhanced dosing strategies and should be considered when designing future treatment strategies.
Collapse
Affiliation(s)
- Daniela Hofmann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Cornelis Smit
- Pediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Somphou Sayasone
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.,Lao Tropical and Public Health Institute, Vientiane, Lao People's Democratic Republic
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital (UKBB), Basel, Switzerland.,Certara, Princeton, New Jersey, USA
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| |
Collapse
|
20
|
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.
Collapse
|
21
|
Roldán Gonzáles WH, Meisel DMCL, de Paula FM, Gryschek RCB. Diagnostic accuracy of somatic and excretory-secretory antigens from Strongyloides venezuelensis infective larvae for the immunodiagnosis of human strongyloidiasis. Parasitology 2021; 148:1522-1527. [PMID: 35060455 PMCID: PMC11010145 DOI: 10.1017/s0031182021001207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/06/2022]
Abstract
To evaluate the diagnostic accuracy of three types of antigenic preparations from Strongyloides venezuelensis infective larvae for detection of serum IgG anti-Strongyloides antibodies by enzyme-linked immunosorbent assay (ELISA). Soluble somatic fractions (SSF) and membrane somatic fractions (MSF) and excretory−secretory (E/S) products from S. venezuelensis infective larvae were evaluated against 71 sera from individuals with strongyloidiasis, 105 sera from healthy individuals, and 84 sera from individuals with other helminth infections. Using an ELISA cut-off for 100% sensitivity, E/S products were 97.88% specific followed by MSF (93.12%) and then by SSF (85.2%). The occurrence of cross-reactivity with other helminths was 4.76% (4/84) with E/S products, 8.33% (7/84) with MSF, and 17.86% (15/84) with SSF. For a cut-off for 100% specificity, E/S products showed a sensitivity of 88.73% whereas MSF and SSF showed sensitivities of 59.15% and 53.52%, respectively. In conclusion, E/S products were the best antigenic option for the serodiagnosis of human strongyloidiasis.
Collapse
Affiliation(s)
- William Henry Roldán Gonzáles
- Laboratório de Imunopatologia da Esquistossomose (Laboratório de Investigação Médica, LIM-06) Hospital das Clínicas, Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
| | - Dirce Mary Correia Lima Meisel
- Laboratório de Imunopatologia da Esquistossomose (Laboratório de Investigação Médica, LIM-06) Hospital das Clínicas, Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
| | - Fabiana Martins de Paula
- Laboratório de Imunopatologia da Esquistossomose (Laboratório de Investigação Médica, LIM-06) Hospital das Clínicas, Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ronaldo Cesar Borges Gryschek
- Laboratório de Imunopatologia da Esquistossomose (Laboratório de Investigação Médica, LIM-06) Hospital das Clínicas, Faculdade de Medicina Universidade de São Paulo, São Paulo, Brazil
- Instituto de Medicina Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
22
|
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.
Collapse
|
23
|
Kawano-Dourado L, Lee JS. Management of Connective Tissue Disease-Associated Interstitial Lung Disease. Clin Chest Med 2021; 42:295-310. [PMID: 34024405 DOI: 10.1016/j.ccm.2021.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The presence of interstitial lung disease (ILD) negatively affects prognosis among patients with an underlying connective tissue disease (CTD). The initial approach to care should determine whether the CTD-ILD needs pharmacologic treatment or not. There is little direct evidence to guide who and how to treat. At present, any severe, active, and/or progressive ILD should be pharmacologically treated. Immunosuppressants and/or corticosteroids are the mainstay of pharmacologic therapy for all CTD-ILDs, whereas antifibrotics may be beneficial in some scenarios. A comprehensive and multidisciplinary approach to management is also an important aspect of patient care.
Collapse
Affiliation(s)
- Leticia Kawano-Dourado
- HCor Research Institute, Hospital do Coracao, Rua Abilio Soares, 250, 12º andar, Sao Paulo, Sao Paulo 04005-909, Brazil; Pulmonary Division, Heart Institute (InCor), Medical School, University of Sao Paulo, Sao Paulo, Brazil; INSERM UMR 1152, University of Paris, Paris, France.
| | - Joyce S Lee
- Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver - Anschutz Medical Campus, 12631 East 17th Avenue, C-323, Academic Office 1, Room 7223, Aurora, CO 80045, USA
| |
Collapse
|
24
|
Hofmann D, Sayasone S, Sengngam K, Chongvilay B, Hattendorf J, Keiser J. Efficacy and safety of ascending doses of moxidectin against Strongyloides stercoralis infections in adults: a randomised, parallel-group, single-blinded, placebo-controlled, dose-ranging, phase 2a trial. THE LANCET. INFECTIOUS DISEASES 2021; 21:1151-1160. [PMID: 33798487 DOI: 10.1016/s1473-3099(20)30691-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/30/2020] [Accepted: 07/30/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Strongyloidiasis represents a major public health issue, particularly in resource-limited countries. Preliminary studies suggest that moxidectin might serve as an alternative to the only available treatment option, ivermectin. We aimed to evaluate the efficacy and safety of ascending doses of moxidectin in Strongyloides stercoralis-infected patients. METHODS We did a randomised, parallel-group, single-blinded, placebo-controlled, dose-ranging, phase 2a trial in four villages in northern Laos. Eligible adults (aged 18-65 years) with S stercoralis infection intensities of at least 0·4 larvae per g of stool in at least two stool samples were randomly assigned (1:1:1:1:1:1:1) by use of computerised, stratified, block randomisation into seven treatment groups: 2 mg of moxidectin, 4 mg of moxidectin, 6 mg of moxidectin, 8 mg of moxidectin, 10 mg of moxidectin, 12 mg of moxidectin, or placebo. Participants and primary outcome assessors were masked to treatment allocation, but study site investigators were not. Participants received a single oral dose of their allocated dose of moxidectin in 2 mg tablets, or four placebo tablets. Three stool samples were collected at baseline and two stool samples were collected 28 days after treatment from each participant. A Baermann assay was used to quantify S stercoralis infection and Kato-Katz thick smears were used to qualitatively identify coinfections with additional helminths species. The primary endpoint was cure rate against S stercoralis and was analysed in an available case analysis set, defined as all randomly assigned participants with primary endpoint data. Predicted cure rates and associated CIs were estimated with hyperbolic Emax models. Safety was evaluated in the intention-to-treat population. This trial is registered at ClinicalTrials.gov, NCT04056325, and is complete. FINDINGS Between Nov 27, 2019, and March 15, 2020, 785 adults were screened for trial eligibility. Of these, 223 participants were randomly assigned to treatment groups and 209 completed the study and were analysed for the primary outcome. 2 mg of moxidectin had a predicted cure rate of 75% (95% CI 59-87; 22 [73%] of 30 cured) against S stercoralis compared with a predicted cure rate of 14% (5-31; four [14%] of 29 cured) for placebo. With escalating doses, the probability of cure increased from 83% (95% CI 76-88; 26 [90%] of 29 cured) at 4 mg to 86% (79-90; 27 [84%] of 32 cured) at 6 mg, and to 87% (80-92; 24 [83%] of 29 cured) at 8 mg, levelling off at 88% (80-93; 29 [97%] of 30 cured) at 10 mg and 88% (80-93; 26 [87%] of 30 cured) at 12 mg. Moxidectin was well tolerated across all treatment groups, with no serious adverse events being recorded and all reported symptoms being classified as mild. INTERPRETATION 4-12 mg of moxidectin showed promising tolerability and efficacy profiles in the treatment of S stercoralis infections in adults. Because 8 mg of moxidectin is used for the treatment of onchocerciasis and has been evaluated for other helminth infections, we recommend this dose for phase 2b and phase 3 trials of strongyloidiasis therapy. FUNDING Fondazione Adiuvare.
Collapse
Affiliation(s)
- Daniela Hofmann
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Somphou Sayasone
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Lao Tropical and Public Health Institute, Vientiane, Laos
| | | | | | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Jennifer Keiser
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Pane S, Sacco A, Iorio A, Romani L, Putignani L. Strongyloides stercoralis Infestation in a Child: How a Nematode Can Affect Gut Microbiota. Int J Mol Sci 2021; 22:ijms22042131. [PMID: 33669932 PMCID: PMC7924877 DOI: 10.3390/ijms22042131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/17/2021] [Accepted: 02/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Strongyloidiasis is a neglected tropical disease caused by the intestinal nematode Strongyloides stercoralis and characterized by gastrointestinal and pulmonary involvement. We report a pediatric case of strongyloidiasis to underline the response of the host microbiota to the perturbation induced by the nematode. Methods: We performed a 16S rRNA-metagenomic analysis of the gut microbiota of a 7-year-old female during and after S. stercolaris infection, investigating three time-point of stool samples’ ecology: T0- during parasite infection, T1- a month after parasite infection, and T2- two months after parasite infection. Targeted-metagenomics were used to investigate ecology and to predict the functional pathways of the gut microbiota. Results: an increase in the alpha-diversity indices in T0-T1 samples was observed compared to T2 and healthy controls (CTRLs). Beta-diversity analysis showed a shift in the relative abundance of specific gut bacterial species from T0 to T2 samples. Moreover, the functional prediction of the targeted-metagenomics profiles suggested an enrichment of microbial glycan and carbohydrate metabolisms in the T0 sample compared with CTRLs. Conclusions: The herein report reinforces the literature suggestion of a putative direct or immune-mediated ability of S. stercolaris to promote the increase in bacterial diversity.
Collapse
Affiliation(s)
- Stefania Pane
- Department of Diagnostic and Laboratory Medicine, Unit of Parasitology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.P.); (A.S.)
| | - Anna Sacco
- Department of Diagnostic and Laboratory Medicine, Unit of Parasitology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.P.); (A.S.)
| | - Andrea Iorio
- Department of Diagnostic and Laboratory Medicine, Unit of Parasitology and Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Lorenza Romani
- Immunology and Infectious Diseases Unit, University Department of Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Lorenza Putignani
- Department of Diagnostic and Laboratory Medicine, Unit of Parasitology and Multimodal Laboratory Medicine Research Area, Unit of Human Microbiome, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
- Correspondence: ; Tel.: +39-06-6859-4127
| |
Collapse
|
27
|
Broad specificity of immune helminth scFv library to identify monoclonal antibodies targeting Strongyloides. Sci Rep 2021; 11:2502. [PMID: 33510342 PMCID: PMC7843650 DOI: 10.1038/s41598-021-82125-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 01/04/2021] [Indexed: 12/24/2022] Open
Abstract
Antibodies have different chemical properties capable of targeting a diverse nature of antigens. Traditionally, immune antibody libraries are perceived to be disease-specific with a skewed repertoire. The complexity during the generation of a combinatorial antibody library allows for a skewed but diverse repertoire to be generated. Strongyloides stercoralis is a parasite that causes strongyloidiasis, a potentially life-threatening disease with a complex diagnosis that impedes effective control and treatment of the disease. This study describes the isolation of monoclonal antibodies against S. stercoralis NIE recombinant protein using an immune antibody phage display library derived from lymphatic filaria-infected individuals. The isolated antibody clones showed both lambda and kappa light chains gene usage, with diverse amino acid distributions. Structural analysis showed that electropositivity and the interface area could determine the binding affinity of the clones with NIE. The successful identification of S. stercoralis antibodies from the filarial immune library highlights the breadth of antibody gene diversification in an immune antibody library that can be applied for closely related infections.
Collapse
|
28
|
Lee JD, Yen CM, Wang JJ, Lin RJ, Chung LY. A school-based soil-transmitted helminths survey in the Guadalcanal Province, the Solomon Islands. Trop Doct 2020; 51:167-170. [PMID: 33215977 DOI: 10.1177/0049475520970055] [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: 11/17/2022]
Abstract
Infections by soil-transmitted helminths are a major public health problem worldwide, especially among schoolchildren in low-income countries. Little information is described about their prevalence in the Solomon Islands. From 2017 to 2018, a school-based soil-transmitted helminths survey in the Guadalcanal Province was conducted. A total of 454 schoolchildren were selected; the Merthiolate-iodine-formaldehyde concentration and stain was used. The prevalence was 17% of one or more parasites, including hookworm (8.8%), Strongyloides stercoralis (5.7%), Ascaris lumbricoides (4.2%) and Trichuris trichiura (3.5%). STH infection was significantly correlated with parents' occupations, hand washing, shoe wearing as well as gastrointestinal symptoms. To prevent STH transmission for schoolchildren in the Solomon Islands completely, combined preventive strategies seem necessary.
Collapse
Affiliation(s)
- June-Der Lee
- PhD, Department of Parasitology and Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung.,Graduate Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung.,Department of Medical Research, 89234Kaohsiung Medical University Hospital, Kaohsiung
| | - Chuan-Min Yen
- PhD, Department of Parasitology and Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung
| | - Jiun-Jye Wang
- PhD, Department of Parasitology and Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung
| | - Rong-Jyh Lin
- PhD, Department of Parasitology and Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung
| | - Li-Yu Chung
- PhD, Department of Parasitology and Institute of Medicine, 38023Kaohsiung Medical University, Kaohsiung
| |
Collapse
|
29
|
Ahmad H, Balachandra D, Arifin N, Nolan TJ, Lok JB, Hayat Khan A, Yunus MH, Noordin R. Diagnostic Potential of an IgE-ELISA in Detecting Strongyloidiasis. Am J Trop Med Hyg 2020; 103:2288-2293. [PMID: 32996454 DOI: 10.4269/ajtmh.20-0265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Strongyloides stercoralis infection is prevalent worldwide and can cause lifelong infection in immunocompetent individuals, and potentially death in immunosuppressed patients. The diagnosis is hindered by the low sensitivity of microscopic examination, thus making serology an important complementary test to improve the detection rate. However, there were reports that some Strongyloides-infected individuals were negative with specific IgG and IgG4 assays, and other helminth infections were positive with commercial Strongyloides IgG-ELISAs. Thus, there is a need to develop better serodiagnostic methods for strongyloidiasis. We investigated the diagnostic potential of IgE-ELISAs using Strongyloides larval lysate. Sera from two groups infected with Strongyloides served as the positive reference, that is, 1) positive by commercial IgG-ELISAs and IgG4 rapid test, and stool samples positive by microscopy and/or PCR (group IA; n = 20); and 2) negative by IgG-ELISAs and IgG4 rapid test, but stool samples were PCR positive (group IB sera; n = 11). Sera from another two groups served as negative reference (controls), that is, 1) infected with other parasites (group II; n = 73) and 2) healthy donors (group III; n = 22). Results showed a 100% diagnostic sensitivity in detecting sera from groups IA and IB. The latter group of individuals probably had early infection because their IgG and IgG4 assays were negative. The optical density values of group IB sera were also significantly lower than those of group IA (P < 0.003). The IgE-ELISA was 100% specific when tested against sera from groups II and III. This study highlights the diagnostic potential of IgE-ELISA using larval lysate to detect strongyloidiasis, especially those with probable early infection.
Collapse
Affiliation(s)
- Hussain Ahmad
- Department of Microbiology, Abdul Wali Khan University Mardan, Khyber Pakhtunkhwa, Pakistan.,Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Penang, Malaysia
| | - Dinesh Balachandra
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Penang, Malaysia
| | - Norsyahida Arifin
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Penang, Malaysia
| | - Thomas J Nolan
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James B Lok
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amjad Hayat Khan
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Penang, Malaysia
| | - Muhammad Hafiznur Yunus
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Penang, Malaysia
| | - Rahmah Noordin
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, Penang, Malaysia
| |
Collapse
|
30
|
Descriptive Investigation of Strongyloidiasis Infection and Characterization of Strongyloides stercoralis Using Morphological and Molecular-Based Methods. Case Rep Infect Dis 2020; 2020:5431491. [PMID: 32884851 PMCID: PMC7455842 DOI: 10.1155/2020/5431491] [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: 05/25/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Abstract
Strongyloidiasis is caused by the nematode Strongyloides stercoralis which has the unique ability to reproduce and complete its entire life cycle within the human host through its autoinfection cycle. Diagnosis of this infection is important because of its potential to cause fatal hyperinfection syndrome or disseminated infections in those with defective cellular immunity. Parasitological methods based on faecal microscopy and culture often fail to detect low-intensity infections. A multiplex polymerase chain reaction (PCR) assay was developed for the detection of S. stercoralis, Ascaris lumbricoides, and Enterobius vermicularis by designing primers specific for the ITS1 region of ribosomal DNA of S. stercoralis and A. lumbricoides and 18S region of rRNA of E. vermicularis. A 61-year-old patient presented with chronic gastrointestinal and respiratory symptoms and weight loss with a stool microscopy positive for helminth larvae. Stool cultures with the Harada–Mori technique yielded L3 larvae which were identified as S. stercoralis based on morphology. The multiplex PCR performed on DNA extracted from stool elicited the expected band at 129 bp on gel electrophoresis of the PCR yield providing molecular evidence of intestinal strongyloidiasis. The patient's gastrointestinal symptoms improved with a six-day course of albendazole (400 mg twice daily). Negative posttreatment stool microscopy, culture, and PCR confirmed successful clearance of infection. Molecular-based PCR assay is a promising tool to diagnose and assess the therapeutic efficacy of anthelmintics in intestinal helminthiases such as strongyloidiasis.
Collapse
|
31
|
Subcutaneous ivermectin for the treatment of the hyperinfection syndrome by Strongyloides stercoralis. BIOMEDICA 2020; 40:228-232. [PMID: 32673452 PMCID: PMC7505505 DOI: 10.7705/biomedica.5140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Indexed: 11/21/2022]
Abstract
La estrongiloidiasis es una enfermedad causada por el nematodo Strongyloides stercoralis, endémico en las regiones rurales de los países tropicales y subtropicales. Los pacientes inmunosuprimidos tienen un mayor riesgo de infección con este parásito y pueden terminar desarrollando un síndrome de hiperinfección que conlleva un alto riesgo de muerte. En el tratamiento se utiliza la ivermectina, pero, ni en Colombia ni en el mundo, existe una presentación parenteral del medicamento para uso en humanos, lo cual es un problema en aquellos pacientes que puedan tener comprometida la absorción intestinal, como es el caso de aquellos con obstrucciones intestinales. Se reporta el caso de un síndrome de hiperinfección por S. stercoralis en Colombia tratado con ivermectina subcutánea; la idea al presentarlo es incentivar los estudios de farmacocinética y farmacodinamia que analicen esta vía de administración como alternativa para el tratamiento de pacientes con riesgo de fracaso terapéutico con la vía oral.
Collapse
|
32
|
Karanam L SK, Basavraj GK, Papireddy CKR. Strongyloides stercoralis Hyper infection Syndrome. Indian J Surg 2020; 83:582-586. [PMID: 32419745 PMCID: PMC7223413 DOI: 10.1007/s12262-020-02292-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/24/2020] [Indexed: 12/19/2022] Open
Abstract
Strongyloides stercoralis is a helminth, widely distributed in tropical and subtropical countries. Its infestation in humans usually does not produce symptoms. However, in some patients, severe and life-threatening forms of this infection can occur, especially in immunocompromised individuals. Severe parasitic infection is triggered by any imbalance in the host’s immunity favouring the auto-infective cycle. This results in an increase in the intraluminal parasitic burden. In addition, tissue infestation is also very common. Clinical presentation is variable, and it is very difficult to diagnose clinically. Diagnosis requires a high index of suspicion. In some cases, the diagnosis is established only on histopathological examination of the excised tissue by the pathologist. Here, the authors report a case of an elderly male diabetic patient, who presented to the emergency department with the features of acute abdomen. On exploratory laparotomy, he was found to have the features suggestive of gangrene of small bowel. Resection of the gangrenous bowel was done, and end-to-end anastomosis was done as the rest of the bowel appeared to be normal. However, the patient died of multi-organ failure and septicaemia on the second postoperative day. The resected intestine showed tissue infestation of Strongyloides stercoralis on histopathological examination. In this review article, the authors summarize a case of hyper infection syndrome of strongyloidiasis and discuss the various aspects of Strongyloides stercoralis infection with emphasis on life cycle of the parasite and different clinical features of the disease.
Collapse
Affiliation(s)
- Sampath Kumar Karanam L
- Department of General Surgery, Narayana Medical College, Chinthareddy Palem, Nellore, Andhra Pradesh 524003 India
| | - Gopi Krishna Basavraj
- Department of General Surgery, Narayana Medical College, Chinthareddy Palem, Nellore, Andhra Pradesh 524003 India
| | | |
Collapse
|
33
|
Tomori M, Mukaigawara M, Narita M. Acute Esophageal Necrosis Associated with Strongyloides stercoralis Hyperinfection. Am J Trop Med Hyg 2020; 100:1037-1038. [PMID: 31088606 PMCID: PMC6493964 DOI: 10.4269/ajtmh.18-0664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Maiko Tomori
- Department of Medicine, Okinawa Chubu Hospital, Uruma, Okinawa, Japan.,Department of Anesthesiology, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Mitsuru Mukaigawara
- Department of Medicine, Okinawa Miyako Hospital, Miyakojima, Okinawa, Japan.,Department of Medicine, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
| | - Masashi Narita
- Department of Medicine, Okinawa Chubu Hospital, Uruma, Okinawa, Japan
| |
Collapse
|
34
|
Noordin R, Arifin N, Balachandra D, Ahmad H. Serodiagnosis of Strongyloides stercoralis infection. J Microbiol Methods 2020. [DOI: 10.1016/bs.mim.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
35
|
Abstract
Infectious diseases are one of the main causes of morbidity and mortality worldwide. With new pathogens continuously emerging, known infectious diseases reemerging, increasing microbial resistance to antimicrobial agents, global environmental change, ease of world travel, and an increasing immunosuppressed population, recognition of infectious diseases plays an ever-important role in surgical pathology. This becomes particularly significant in cases where infectious disease is not suspected clinically and the initial diagnostic workup fails to include samples for culture. As such, it is not uncommon that a lung biopsy becomes the only material available in the diagnostic process of an infectious disease. Once the infectious nature of the pathological process is established, careful search for the causative agent is advised. This can often be achieved by examination of the hematoxylin and eosin-stained sections alone as many organisms or their cytopathic effects are visible on routine staining. However, ancillary studies such as histochemical stains, immunohistochemistry, in situ hybridization, or molecular techniques may be needed to identify the organism in tissue sections or for further characterization, such as speciation.
Collapse
Affiliation(s)
- Annikka Weissferdt
- Associate Professor, Department of Pathology, Division of Pathology and Laboratory Medicinec, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| |
Collapse
|
36
|
Ahmadpour E, Ghanizadegan MA, Razavi A, Kangari M, Seyfi R, Shahdust M, Yazdanian A, Safarpour H, Bannazadeh Baghi H, Zarean M, Hosseini SA, Norouzi R, Ebrahimi M, Bangoura B. Strongyloides stercoralis infection in human immunodeficiency virus-infected patients and related risk factors: A systematic review and meta-analysis. Transbound Emerg Dis 2019; 66:2233-2243. [PMID: 31359566 DOI: 10.1111/tbed.13310] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/23/2019] [Accepted: 07/24/2019] [Indexed: 02/03/2023]
Abstract
Strongyloidiasis is caused by nematode infections of the genus Strongyloides, mainly Strongyloides stercoralis, and affects tens of millions of people around the world. S. stercoralis hyperinfection and disseminated strongyloidiasis are unusual but potentially fatal conditions mostly due to Gram-negative bacteremia and sepsis, primarily affecting immunocompromised patients. Infections with immunosuppressive viruses such as human immunodeficiency virus (HIV) and Human T-cell leucemia virus type 1 (HTLV-1) have been reported as risk factors for strongyloidiasis. Hyperinfection syndrome has been described in HIV-positive patients following the use of corticosteroids or during immune reconstitution inflammatory syndrome (IRIS). In this research, we conducted a global systematic review and meta-analysis to assess the seroprevalence and odds ratios (ORs) of S. stercoralis infections in HIV-infected patients. A total of 3,649 records were screened, 164 studies were selected and evaluated in more detail, and 94 studies were included in the meta-analysis. The overall pooled prevalence of S. stercoralis infection in HIV positive patients was 5.1% (CI95%: 4%-6.3%), and a meta-analysis on six studies showed that with a pooled OR of 1.79 (CI95%: 1.18%-2.69%) HIV-positive men are at a higher risk of S. stercoralis infections (p < .0052) compared to HIV positive women.
Collapse
Affiliation(s)
- Ehsan Ahmadpour
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Atefeh Razavi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahsa Kangari
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Rouhollah Seyfi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Shahdust
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Yazdanian
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanie Safarpour
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Bannazadeh Baghi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Zarean
- Department of Parasitology and Mycology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Roghayeh Norouzi
- Department of Pathobiology, Faculty of Veterinary Medicine, University of Tabriz, Tabriz, Iran
| | - Mina Ebrahimi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Berit Bangoura
- Department of Veterinary Sciences, College of Agriculture and Natural Resources, University of Wyoming, Laramie, WY, USA
| |
Collapse
|
37
|
Masoori L, Meamar AR, Bandehpour M, Hemphill A, Razmjou E, Mokhtarian K, Roozbehani M, Badirzadeh A, Jalallou N, Akhlaghi L, Falak R. Fatty acid and retinol-binding protein: A novel antigen for immunodiagnosis of human strongyloidiasis. PLoS One 2019; 14:e0218895. [PMID: 31329601 PMCID: PMC6645452 DOI: 10.1371/journal.pone.0218895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/11/2019] [Indexed: 11/19/2022] Open
Abstract
The tenacious human parasitic helminth Strongyloides stercoralis is a significant health problem worldwide. The current lack of a definitive diagnostic laboratory test to rule out this infection necessitates designing more specific diagnostic methods. Fatty acid and retinol-binding protein (FAR) plays a crucial role in the development and reproduction of nematodes. We generated a recombinant form of this protein and determined its applicability for immunodiagnosis of S. stercoralis. The L3 form of S. stercoralis was harvested and used for RNA extraction and cDNA synthesis. The coding sequence of S. stercoralis FAR (SsFAR) was cloned into pET28a(+) vector, expressed in E. coli BL21 and purified. ELISA and immunoblotting were employed to determine the specificity and sensitivity of rSsFAR using a set of defined sera. In addition, we analyzed the phylogenetic relationship of SsFAR with different FAR sequences from other nematodes. The cloned SsFAR had an open reading frame of 447 bp encoding 147 amino acids, with a deduced molecular mass of 19 kD. The SsFAR amino acid sequence was 93% identical to FAR of S. ratti. For differential immunodiagnosis of strongyloidiasis, rSsFAR exhibited 100% sensitivity and 97% specificity. However, cross-reactivity with FAR proteins of other parasites, namely Toxocara canis and Echinococcus granulosus, was noted. Our results provide a novel approach for immunodiagnosis of S. stercoralis infections using rSsFAR with reliable sensitivity and specificity.
Collapse
Affiliation(s)
- Leila Masoori
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Meamar
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- * E-mail: (ARM); (RF)
| | - Mojgan Bandehpour
- Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Andrew Hemphill
- Institute of Parasitology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Elham Razmjou
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kobra Mokhtarian
- Clinical Biochemistry Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mona Roozbehani
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Badirzadeh
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Jalallou
- Department of Medical Laboratory Sciences, Faculty of Allied Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Lame Akhlaghi
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Falak
- Immunology Research center, Iran University of Medical Science, Tehran, Iran
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- * E-mail: (ARM); (RF)
| |
Collapse
|
38
|
Balkhair A, Taher HB, Al Busaidi I, Al Amin M, Al-Khirbash A, Al Adawi B, Al-Siyabi T. Disseminated strongyloidiasis complicated by alveolar hemorrhage, meningitis, and septic shock treated with albendazole and subcutaneous ivermectin. Int J Infect Dis 2019; 86:44-46. [PMID: 31279610 DOI: 10.1016/j.ijid.2019.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022] Open
Abstract
The case of a patient with disseminated strongyloidiasis following chemotherapy for lymphoplasmacytic lymphoma is presented.
Collapse
Affiliation(s)
- A Balkhair
- Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Oman.
| | - H B Taher
- Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Oman
| | - I Al Busaidi
- Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Oman
| | - M Al Amin
- Department of Medicine, Infectious Diseases Unit, Sultan Qaboos University Hospital, Oman
| | - A Al-Khirbash
- Department of Pharmacy, Sultan Qaboos University Hospital, Oman
| | - B Al Adawi
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Oman
| | - T Al-Siyabi
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Oman
| |
Collapse
|
39
|
Crowe BR, Duenas SM, Serrano A, Kingsbery J, Williams R. Strongyloides stercoralis Hyperinfection and Concomitant Cytomegalovirus Gastroenteritis in an Immunocompromised Host. ACG Case Rep J 2019; 6:e00135. [PMID: 31620532 PMCID: PMC6722353 DOI: 10.14309/crj.0000000000000135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 05/13/2019] [Indexed: 11/17/2022] Open
Abstract
Strongyloides stercoralis infection typically presents with nonspecific gastrointestinal symptoms and no definitive or pathognomonic endoscopic findings. Disease burden can vary depending on a patient's immune status. Immunocompromised patients with strongyloidiasis can develop tremendous disease burden, extraintestinal dissemination, and are at risk for coinfection with other organisms. We present the case of an immunocompromised patient presenting with multiple gastrointestinal complaints found to have S. stercoralis hyperinfection and concomitant cytomegalovirus gastroenteritis.
Collapse
Affiliation(s)
- Brooks R. Crowe
- Department of Internal Medicine, New York University School of Medicine, New York, NY
| | - Sean M. Duenas
- Department of Internal Medicine, New York University School of Medicine, New York, NY
| | - Antonio Serrano
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Joseph Kingsbery
- Department of Internal Medicine, New York University School of Medicine, New York, NY
| | - Renee Williams
- Department of Internal Medicine, New York University School of Medicine, New York, NY
| |
Collapse
|
40
|
Hakeem I, Moritz C, Khan F, Garrett E, Narayanan M. Strongyloidiasis hyperinfection after renal transplant presenting as diffuse alveolar hemorrhage with respiratory failure. Proc AMIA Symp 2019; 32:413-416. [PMID: 31384205 PMCID: PMC6650283 DOI: 10.1080/08998280.2019.1596440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/09/2019] [Accepted: 03/14/2019] [Indexed: 01/07/2023] Open
Abstract
Strongyloides stercoralis is a helminthic enteric parasite estimated to infect at least 30 to 100 million people globally. It is transmitted via contaminated soil with a unique ability to complete its entire life cycle in the human host. It is common in humid, tropical, and subtropical regions of the world and is endemic in the Southeastern United States. Strongyloidiasis hyperinfection has been described in a variety of conditions that impair host immunity, including immunosuppression after transplantation. The syndrome has a high mortality rate but may initially present with nonspecific symptoms. A high degree of clinical suspicion coupled with early detection and aggressive therapeutic measures is paramount to a successful outcome.
Collapse
Affiliation(s)
- Imtiyaz Hakeem
- Division of Nephrology and Hypertension, Scott & White Medical CenterTempleTexas
| | - Charles Moritz
- Division of Nephrology and Hypertension, Scott & White Medical CenterTempleTexas
| | - Faiza Khan
- Division of Nephrology and Hypertension, Scott & White Medical CenterTempleTexas
| | - Erin Garrett
- Department of Anatomic Pathology, Scott & White Medical CenterTempleTexas
| | - Mohanram Narayanan
- Division of Nephrology and Hypertension, Scott & White Medical CenterTempleTexas
- Corresponding author: Mohanram Narayanan, MD, Chief,Section of Clinical Transplantation, Division of Nephrology and Hypertension, Scott & White Medical Center2601 Thornton LaneTempleTX 76502 (e-mail:)
| |
Collapse
|
41
|
Strongyloides stercoralis: Spatial distribution of a highly prevalent and ubiquitous soil-transmitted helminth in Cambodia. PLoS Negl Trop Dis 2019; 13:e0006943. [PMID: 31220075 PMCID: PMC6586258 DOI: 10.1371/journal.pntd.0006943] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/21/2019] [Indexed: 12/13/2022] Open
Abstract
Background Strongyloides stercoralis is a neglected soil-transmitted helminth that occurs worldwide, though it is particularly endemic in tropical and subtropical areas. It can cause long-lasting and potentially fatal infections due to its ability to replicate within its host. S. stercoralis causes gastrointestinal and dermatological morbidity. The objective of this study was to assess the S. stercoralis infection risk and, using geostatistical models, to predict its geographical distribution in Cambodia. Methodology / Principal findings A nation-wide, community-based parasitological survey was conducted among the Cambodian population, aged 6 years and older. S. stercoralis was diagnosed using a serological diagnostic test that detects IgG antibodies in urine. Data on demography, hygiene and knowledge about helminth infection were collected. S. stercoralis prevalence among 7,246 participants with a complete data record was 30.5%, ranging from 10.9% to 48.2% across provinces. The parasite was ubiquitous in Cambodia; only five south-eastern provinces had prevalence rates below 20%. Infection risk increased with age for both men and women, although girls under the age of 13 and women aged 50 years and over had lower odds of infection than their male counterparts. Open defecation was associated with higher odds of infection, while having some knowledge of the health problems caused by worms was a protective factor. Infection risk was positively associated with nighttime maximum temperature, minimum rainfall, and distance to water; it was negatively associated with land occupied by rice fields. Conclusions / Significance S. stercoralis infection is rampant in Cambodia. Control programs delivering ivermectin are needed to manage the parasite. However, the high cost of this drug in Cambodia currently precludes the implementation of control initiatives. Donations, subsidies or affordable generics are needed so that S. stercoralis, which infects almost a third of the Cambodian population, can be addressed through an adequate control program. The threadworm, Strongyloides stercoralis, is a highly neglected worm infection, transmitted through infective larvae in the soil. Threadworms occur worldwide, particularly in tropical climates. It may cause long-lasting and potentially fatal infections due to the parasite’s ability to replicate within its host. This study aimed to assess the risk of threadworm infection at national level in Cambodia. We conducted a nation-wide, community-based parasitological survey of the Cambodian population, aged 6 years and over. The threadworm was diagnosed using a serological diagnostic test that detects antibodies in urine. Data on demography, hygiene and knowledge about helminth infection were collected. The purpose of this study was to predict the risk of S. stercoralis infection in unsurveyed locations, assess risk factors for infection, and map its geographical distribution in Cambodia. About one third (30.5%) of the enrolled study participants (n = 7,246) were infected with threadworms. At provincial level, the lowest and highest infection rates were 10.9% and 48.2%, respectively. Prevalence rates below 20% were found in just five south-eastern provinces. The risk of a threadworm infection increased with age for both men and women. Open defecation was associated with higher risk of infection, while having some knowledge of the health problems caused by worms was a protective factor. Infection risk was positively associated with environmental factors, such as nighttime maximum temperature, minimum rainfall, and distance to water; it was negatively associated with land occupied by rice fields. Threadworm infection is highly prevalent in Cambodia and adequate control measures, including access to treatment, are warranted to address the burden of this Neglected Tropical Disease (NTD) in Cambodia.
Collapse
|
42
|
Vasquez-Rios G, Pineda-Reyes R, Ruiz EF, Terashima A, Mejia F. Strongyloides stercoralis infection after the use of emergency corticosteroids: a case report on hyperinfection syndrome. J Med Case Rep 2019; 13:121. [PMID: 31030665 PMCID: PMC6487532 DOI: 10.1186/s13256-019-2022-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 02/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In clinical practice, identification of a case of severe asthma exacerbation prompts initiation of corticosteroids. However, not all that wheezes is asthma. CASE PRESENTATION A 61-year-old man from the Peruvian Amazon presented with progressive dyspnea, abdominal pain, and cough for the past week. His medical history was remarkable for asthma since childhood; he was treated with beta-agonists, ipratropium, and orally administered corticosteroids. On evaluation, he was febrile and ill-appearing. His chest examination revealed diffuse wheezing and bilateral crackles. He was diagnosed as having community-acquired pneumonia and asthma exacerbation and was started on empiric antibiotics, nebulized beta-agonists, and orally administered corticosteroids. His clinical status continued deteriorating and he became critically ill despite broad-spectrum antibiotics and antifungals. Considering the epidemiological background of our patient, bronchoalveolar and fecal samples were obtained to investigate soil-transmitted helminths. Larvae of Strongyloides stercoralis were found in both specimens. Ivermectin was initiated and corticosteroids were discontinued. He experienced remarkable improvement of clinical condition over the next weeks. The literature on this topic was reviewed. CONCLUSION Cases of severe asthma exacerbation warrant careful evaluation before the initiation of corticosteroids, especially in patients at risk for parasitic infections. A high index of suspicion is critical. Alternative etiologies of respiratory decompensation should be considered in patients who fail to improve with broad-spectrum antibiotics and antifungals.
Collapse
Affiliation(s)
- George Vasquez-Rios
- Department of Internal Medicine, Saint Louis University School of Medicine, Saint Louis, MO USA
- Laboratory of Parasitology, Tropical Medicine Institute Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Roberto Pineda-Reyes
- Laboratory of Parasitology, Tropical Medicine Institute Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eloy F. Ruiz
- CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angelica Terashima
- Laboratory of Parasitology, Tropical Medicine Institute Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Fernando Mejia
- Laboratory of Parasitology, Tropical Medicine Institute Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
43
|
Deng MH, Zhong LY, Kamolnetr O, Limpanont Y, Lv ZY. Detection of helminths by loop-mediated isothermal amplification assay: a review of updated technology and future outlook. Infect Dis Poverty 2019; 8:20. [PMID: 30905322 PMCID: PMC6432754 DOI: 10.1186/s40249-019-0530-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 03/07/2019] [Indexed: 02/06/2023] Open
Abstract
Background Helminths are endemic in more than half of the world’s countries, raising serious public health concerns. Accurate diagnosis of helminth infection is crucial to control strategies. Traditional parasitological methods, serological tests and PCR-based assays are the major means of the diagnosis of helminth infection, but they are time-consuming and/or expensive, and sometimes provide inaccurate results. Loop mediated isothermal amplification (LAMP) assay, a sensitive, simple and rapid method was therefore developed for detection of helminths. This study aims to discuss the current status of application of LAMP on helminths detection and to make a comprehensive evaluation about this updated technology and its future outlook by comparing with several other diagnostic methods. Main body This review summarizes LAMP assay applied for helminth detection and helminthiasis surveillance. The basic principle of LAMP is introduced to help better understand its characteristics and each reported assay is assessed mainly based on its detection sensitivity, specificity and limitations, in comparison with other common diagnostic tests. Moreover, we discuss the limitations of the assays so as to clarify some potential ways of improvement. Conclusions Here, we summarize and discuss the advantages, disadvantages and promising future of LAMP in heliminth detection, which is expected to help update current knowledge and future perspectives of LAMP in highly sensitive and specific diagnosis and surveillance of helminthiasis and other parasitic diseases, and can contribute to the elimination of the diseases from endemic areas. Electronic supplementary material The online version of this article (10.1186/s40249-019-0530-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Miao-Han Deng
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China.,Key Laboratory of Tropical Disease Control (Sun Yat-sen University), Ministry of Education, Guangzhou, 510080, China
| | - Lan-Yi Zhong
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China.,Key Laboratory of Tropical Disease Control (Sun Yat-sen University), Ministry of Education, Guangzhou, 510080, China
| | - Okanurak Kamolnetr
- Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Yanin Limpanont
- Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand.
| | - Zhi-Yue Lv
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080, China. .,Key Laboratory of Tropical Disease Control (Sun Yat-sen University), Ministry of Education, Guangzhou, 510080, China. .,Provincial Engineering Technology Research Center for Biological Vector Control, Guangzhou, 510080, China. .,Fifth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 519000, China.
| |
Collapse
|
44
|
Nnaoma C, Chika-Nwosuh O, Engell C. The Worm that Clogs the Lungs: Strongyloides Hyper-Infection Leading to Fatal Acute Respiratory Distress Syndrome (ARDS). AMERICAN JOURNAL OF CASE REPORTS 2019; 20:377-380. [PMID: 30898993 PMCID: PMC6439959 DOI: 10.12659/ajcr.914640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Strongyloides stercoralis is an intestinal helminth. Parasitism is caused by penetration of the larvae through the skin. It is endemic in tropical and subtropical regions of the world and in the United States occurs in the southeastern region. It has a tendency to remain dormant or progress to a state of hyper-infection during immunosuppression. CASE REPORT We present the case of a 70-year-old Nigerian who developed fatal ARDS secondary to Strongyloides infection after been treated with steroids for treatment of autoimmune necrotizing myopathy. Despite adequate management with mechanical ventilation and appropriate antifungal therapy, the patient died on day 19 of hospitalization. CONCLUSIONS S. stercoralis is known to affect every organ in the body. ARDS is often an overlooked complication of Strongyloides hyper-infection, which is often deadly. Immediate diagnosis and treatment are important for patient survival.
Collapse
Affiliation(s)
- Christopher Nnaoma
- Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, NJ, U.S.A
- Corresponding Author: Christopher Nnaoma, e-mai:
| | | | - Christian Engell
- Department of Infectious Diseases, Newark Beth Israel Medical Center, Newark, NJ, U.S.A
| |
Collapse
|
45
|
Masoori L, Falak R, Mokhtarian K, Bandehpour M, Razmjou E, Jalallou N, Jafarian F, Akhlaghi L, Meamar AR. Production of recombinant 14-3-3 protein and determination of its immunogenicity for application in serodiagnosis of strongyloidiasis. Trans R Soc Trop Med Hyg 2019; 113:326-331. [DOI: 10.1093/trstmh/trz006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 11/16/2018] [Accepted: 02/03/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- Leila Masoori
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Falak
- Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Kobra Mokhtarian
- Clinical Biochemistry Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mojgan Bandehpour
- Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Razmjou
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Nahid Jalallou
- Department of Medical Laboratory Sciences, Faculty of Allied Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Farzane Jafarian
- Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Mazandaran, Iran
| | - Lame Akhlaghi
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Meamar
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
46
|
Vasquez-Rios G, Pineda-Reyes R, Pineda-Reyes J, Marin R, Ruiz EF, Terashima A. Strongyloides stercoralis hyperinfection syndrome: a deeper understanding of a neglected disease. J Parasit Dis 2019; 43:167-175. [PMID: 31263320 DOI: 10.1007/s12639-019-01090-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/23/2019] [Indexed: 12/22/2022] Open
Abstract
Strongyloides stercoralis hyperinfection syndrome (SHS) is a life-threatening condition that warrants early detection and management. We describe the pathogenesis, organ-specific clinical manifestations, and risk factors associated to this condition. A comprehensive review of the literature was conducted in PubMed, LILACS, EBSCO and SciELO by using the keywords: "hyperinfection syndrome"; "Strongyloides stercoralis"; "disseminated strongyloidiasis"; "systemic strongyloidiasis", "pathogenesis" and "pathophysiology". Relevant articles on this topic were evaluated and included by consensus. Also, a secondary search of the literature was performed. Articles in English and Spanish language were included. SHS has been described in tropical and sub-tropical regions. However, there is growing evidence of cases detected in developed countries favored by increasing migration and the advance in immunosuppressive therapies for oncologic and inflammatory diseases. SHS is characterized by massive multiplication of larvae, typically in immunocompromised hosts. Clinical manifestations vary according to the organ involved and include diarrhea, intestinal bleeding, alveolar hemorrhages, heart failure, jaundice, bacteremia among others. Despite advances in the understanding of this condition, fatality rates are near 90%. Clinicians should consider SHS in the differential diagnosis of acutely ill patients with multiple organ damage and epidemiological risk factors. Adverse outcomes are common, especially with delayed anti-parasitic treatment.
Collapse
Affiliation(s)
- George Vasquez-Rios
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Roberto Pineda-Reyes
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Juan Pineda-Reyes
- 2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ricardo Marin
- 2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eloy F Ruiz
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Angélica Terashima
- 1Laboratory of Parasitology, Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.,2Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
47
|
Gétaz L, Castro R, Zamora P, Kramer M, Gareca N, Torrico-Espinoza MDC, Macias J, Lisarazu-Velásquez S, Rodriguez G, Valencia-Rivero C, Perneger T, Chappuis F. Epidemiology of Strongyloides stercoralis infection in Bolivian patients at high risk of complications. PLoS Negl Trop Dis 2019; 13:e0007028. [PMID: 30653489 PMCID: PMC6353209 DOI: 10.1371/journal.pntd.0007028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/30/2019] [Accepted: 11/26/2018] [Indexed: 12/21/2022] Open
Abstract
Background Strongyloidiasis can be fatal in immunocompromised patients, but few epidemiological studies investigated the burden of this neglected tropical disease among these populations, particularly in low- and middle-income countries such as Bolivia. This study aimed to fill in this gap by estimating prevalence rate and risk factors associated with strongyloidiasis among patients at high risk of complications Methods A cross-sectional study was carried out in Santa Cruz (elevation 400 meters, tropical climate) and Cochabamba (elevation 2,500 meters, temperate climate), among patients with cancer, HIV infection and rheumatic or hematologic disease, using four coproparasitological techniques and one serological (ELISA) test. Results In total, 1,151 patients participated in this study, including individuals who were HIV-positive (30%) or with rheumatic (29%), oncologic (32%) or hematologic (9%) diseases. The serological and coproparasitological prevalence was 23.0% (95% confidence interval [CI], 20.7–25.5; n = 265/1151) and 7.6% (95% CI, 6.2–9.3; n = 88/1151), respectively, with an estimated actual prevalence of 20.2% (95% CI, 17.9–22.5). Positive serology and positive coproparasitology were associated with younger age and lower education levels. There was no significant difference in prevalence between Cochabamba and Santa Cruz as defined by coproparasitology (6.4% vs. 8.9%; p = 0.11) or serology (24.0% vs. 22.0%; p = 0.4). Among 64 patients in Cochabamba who had never travelled to the tropical lowlands, 5 (7.8%) had a positive coproparasitology. Conclusions Strongyloidiasis is widely prevalent in Bolivia among vulnerable patients at increased risk of life-threatening complications. Transmission of the parasite occurs both in tropical lowlands and temperate elevation (≥ 2,500 m). Control strategies to prevent transmission and complications of this serious parasitic disease should be urgently reinforced. Strongyloidiasis is an understudied chronic intestinal infection and one of the most overlooked of the neglected tropical diseases, particularly in countries such as Bolivia. The strongyloidiasis usually remains paucisymptomatic for decades in immunocompetent persons, but may lead to severe conditions with high mortality rates in immunocompromised individuals. We carried out a study to explore the epidemiology of strongyloidiasis among Bolivian patients with cancer, HIV infection, and rheumatic or hematologic diseases. Our study highlighted that strongyloidiasis was widely prevalent in tropical and inter-Andean temperate areas of Bolivia among patients at high risk of life-threatening complications. One in five participants was infected. We showed that strongyloidiasis was highly prevalent in both tropical and temperate regions. Improved access to adequate diagnosis, treatment, and preventive measures are therefore urgently required in Bolivia, and most likely elsewhere in the region. Treatment of uncomplicated strongyloidiasis is simple, highly effective, and potentially life-saving.
Collapse
Affiliation(s)
- Laurent Gétaz
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- * E-mail:
| | - Rosario Castro
- Division of Infectious Diseases, Hospital Clínico VIEDMA, Cochabamba, Bolivia
| | - Pablo Zamora
- Division of Parasitology, Centro Nacional de Enfermedades Tropicales (CENETROP), Santa Cruz, Bolivia
| | - Marcelo Kramer
- Center for Rheumatic Diseases M. Kramer, Santa Cruz, Bolivia
| | - Nestor Gareca
- Division of Rheumatology, Hospital Clínico VIEDMA, Cochabamba, Bolivia
| | | | - José Macias
- Division of Hematology & Oncology, Clinica Los Olivos, Cochabamba, Bolivia
| | - Susana Lisarazu-Velásquez
- Centro Departamental de Vigilancia y Referencia de Enfermedades de Transmisión Sexual ITS/VIH/SIDA (CDVIR), Santa Cruz, Bolivia
| | - Gloria Rodriguez
- Instituto Oncológico del Oriente Boliviano (IOOB), Santa Cruz, Bolivia
| | | | - Thomas Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, and Faculty of Medicine, University of Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| |
Collapse
|
48
|
Nordheim E, Olafsson Storrø M, Natvik AK, Birkeland Kro G, Midtvedt K, Varberg Reisaeter A, Hagness M, Fevang B, Pettersen FO. Donor-derived strongyloidiasis after organ transplantation in Norway. Transpl Infect Dis 2018; 21:e13008. [PMID: 30295406 DOI: 10.1111/tid.13008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/28/2018] [Accepted: 10/02/2018] [Indexed: 01/07/2023]
Abstract
Strongyloides stercoralis is an intestinal helminth which in humans can cause asymptomatic chronic infection maintained for decades through its auto-infective cycle. During solid organ transplantation, recipients may unintentionally receive an organ infected with strongyloides. This is a very rare complication but may have deadly outcome if not detected. We hereby report two transplant recipients whom developed Strongyloides hyperinfection syndrome after organ transplantation from the same deceased donor. Recipient 1 was kidney transplanted and presented at day 65 post engraftment with diarrhea and subsequent septicemia and gastric retention. Larvae were detected in gastric aspirate. Recipient 2 was simultaneously kidney and pancreas transplanted and presented at day 90 post engraftment also with gastric retention and septicemia. Larvae were demonstrated on duodenal biopsy and stool sample. The clinical course was complicated with severe duodenal bleedings, gastric retention, meningitis, and prolonged hospitalization. Retrospective testing of pre-transplant donor serum was positive for Strongyloides stercoralis antibodies. As a result of disease severity and gastric retention albenazole was administered via a jejunal tube and ivermectin subcutaneously in both recipients. S stercoralis was successfully eradicated and the transplants ended up with unaffected graft function. Following these two cases, we started systematic screening of all deceased donors for serum Strongyloides IgG in October 2016. After having screened 150 utilized donors one tested positive for Strongyloides, which initiated prophylactic ivermectin treatment to organ recipients. No symptoms or disease developed. Our center will continue to screen all donors as prophylactic treatment may avert this potentially lethal complication in cases of donor-derived Strongyloides infection.
Collapse
Affiliation(s)
- Espen Nordheim
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Monica Olafsson Storrø
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ane Kristine Natvik
- Department of Infectious Diseases, Oslo University Hospital - Ullevål, Oslo, Norway
| | - Grete Birkeland Kro
- Department of Microbiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anna Varberg Reisaeter
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Morten Hagness
- Department of Transplantation Medicine, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Børre Fevang
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Oslo, Norway.,Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Frank O Pettersen
- Regional Advisory Unit for Imported and Tropical Diseases, Department of Infectious Diseases, Oslo University Hospital - Ullevål, Oslo, Norway
| |
Collapse
|
49
|
Clinical-Pathological Conference Series from the Medical University of Graz : Case No 168: A 28-year-old Syrian refugee with severe abdominal pain and eosinophilia. Wien Klin Wochenschr 2018; 130:581-588. [PMID: 30324299 PMCID: PMC6209003 DOI: 10.1007/s00508-018-1395-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/24/2018] [Indexed: 12/13/2022]
|
50
|
Arifin N, Hanafiah KM, Ahmad H, Noordin R. Serodiagnosis and early detection of Strongyloides stercoralis infection. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:371-378. [PMID: 30482708 DOI: 10.1016/j.jmii.2018.10.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/11/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
Abstract
Strongyloidiasis is a major neglected tropical disease with the potential of causing lifelong infection and mortality. One of the ways for effective control of this disease is developing improved diagnostics, particularly using serological approaches. A serological test can achieve high diagnostic sensitivity and specificity, has the potential for point-of-care translation, and can be used as a screening tool for early detection. More research is needed to find clinically important antibody biomarkers for early disease detection, mapping, and epidemiological surveillance. This article summarizes human strongyloidiasis and the available diagnostic tools for the disease, focusing on describing the current antibody assays for strongyloidiasis. Finally, prospects of developing a more effective serodiagnostic tool for strongyloidiasis are discussed.
Collapse
Affiliation(s)
- Norsyahida Arifin
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, 11800 Penang, Malaysia
| | | | - Hussain Ahmad
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, 11800 Penang, Malaysia; Department of Microbiology, Abdul Wali Khan University Mardan, KPK, Pakistan
| | - Rahmah Noordin
- Institute for Research in Molecular Medicine (INFORMM), Universiti Sains Malaysia, 11800 Penang, Malaysia.
| |
Collapse
|