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Weitzel T, Dittrich S, Mockenhaupt FP, Lindner AK. Serological diagnosis of strongyloidiasis: An evaluation of three commercial assays. PLoS Negl Trop Dis 2024; 18:e0012319. [PMID: 38968318 DOI: 10.1371/journal.pntd.0012319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Strongyloidiasis is caused by a neglected nematode, manifesting as chronic intestinal infection with potentially severe manifestations. The disease is an emerging problem in non-endemic countries affecting travelers and migrants. Diagnosis of strongyloidiasis is hampered by the lack of standardization and absence of a gold standard. Since adequate direct methods to detect the motile larvae in stool samples are not widely available, other techniques such as serology have been developed. METHODS We evaluated three commercial ELISA kits (DRG Instruments, IVD Research, and Bordier Affinity Products) to detect IgG antibodies against Strongyloides stercoralis assays utilizing serum samples from travelers with microscopically confirmed strongyloidiasis (n = 50) and other imported helminthic infections (n = 159) as well as healthy controls (n = 50). RESULTS The DRG, IVD, and Bordier assays showed sensitivities of 58.0%, 64.0%, and 56.0%, respectively. Specificity values were 96.0%, 96.0%, and 92.0% in healthy controls, and 67.3%, 62.9%, and 76.7% in cases with other helminth infections, respectively. Cross-reactions were mostly observed in cases with other nematodes (37.5%, 42.5%, and 20.0%, respectively), but also in trematode (33.3%, 38.1%, and 19.0%, respectively) and in cestode infections (25.0%, 30.0%, and 32.5%, respectively). CONCLUSION The study demonstrates the diagnostic limitations of serological assays to detect or exclude cases of strongyloidiasis in returning travelers, who frequently present with recent or acute infections.
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Affiliation(s)
- Thomas Weitzel
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Sabine Dittrich
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Frank P Mockenhaupt
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
| | - Andreas K Lindner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of International Health, Charité Center for Global Health, Berlin, Germany
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Santarém VA, Pinto GLB, Ferreira IB, Ribeiro J, Filho RTDS, Meisel DMC, Gryschek RCB, Lescano SAZ, Giuffrida R, Kmetiuk LB, de Paula FM, Biondo AW. A silent threat behind bars: Serosurvey and associated risk factors for strongyloidiasis in female inmates and correctional officers. Acta Trop 2024; 257:107301. [PMID: 38955318 DOI: 10.1016/j.actatropica.2024.107301] [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: 12/14/2023] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
Strongyloidiasis has been a neglected parasitic infection caused by Strongyloides genus parasites. Despite assessment of S. stercoralis exposure in different vulnerable populations, seroprevalence in inmates worldwide remains to be fully established. Due to poor sanitation and lack of personal hygienic practices, incarcerated individuals have been considered prone to spread infectious illnesses. Accordingly, the present study has assessed exposure and associated risk factors for strongyloidiasis in women inmates and correctional officers at the Women's State Penitentiary of Parana, part of the third largest incarceration complex in Brazil at the time. Blood samplings were performed in 2020 and 2021from a total of 503 women inmates and 92 correctional officers. Participants voluntarily responded to an epidemiological questionnaire to assess associated risk factors to strongyloidiasis. Serological analysis was performed by ELISA for anti-S. stercoralis IgG detection. Statistical analysis was performed using R software, adopting a 5% level of significance. The data were submitted to univariate analysis by chi-square or Fisher´s Exact test for assessing the association among seropositivity and the variables. The variables with p-value < 0.2 in the univariate analysis were considered fit to be included in the logistic regression. In overall, 356/503 (70.8%; 95% CI: 66.7-74.6) inmates were seropositive for anti-S. stercoralis antibodies, with no statistically associated risk factor to seropositivity. A total of 57/92 (62.0%; 95% CI: 51.8-71.2) correctional officers were seropositive, and logistic regression revealed that individuals older than 50 years were more likely seropositive. In conclusion, the high endemicity observed herein has indicated a history of previous exposure to S. stercoralis and warned for a systematic strongyloidiasis screening for inmates, to prevent long term morbidity and disseminated infection during incarceration.
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Affiliation(s)
- Vamilton Alvares Santarém
- Graduate College in Animal Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP 19050-920, Brazil
| | - Gabriel Luís Brucinski Pinto
- Graduate College of Cell and Molecular Biology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários, 1540, Juvevê, Curitiba, PR 80035-050, Brazil
| | - Isabella Braghin Ferreira
- Graduate College in Animal Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP 19050-920, Brazil
| | - Juliano Ribeiro
- Graduate College of Cell and Molecular Biology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários, 1540, Juvevê, Curitiba, PR 80035-050, Brazil
| | | | - Dirce Mary Correa Meisel
- Laboratory of Medical Investigation (LIM/06), Clinical Hospital of the University of São Paulo, SP, Brazil
| | | | | | - Rogério Giuffrida
- Graduate College in Animal Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP 19050-920, Brazil
| | - Louise Bach Kmetiuk
- Zoonoses Surveillance Unit, Municipal Secretary of Health, Curitiba, PR, Brazil
| | - Fabiana Martins de Paula
- Laboratory of Medical Investigation (LIM/06), Clinical Hospital of the University of São Paulo, SP, Brazil
| | - Alexander Welker Biondo
- Graduate College of Cell and Molecular Biology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários, 1540, Juvevê, Curitiba, PR 80035-050, Brazil.
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Choi JDW, Kulkarni R, Shanmugalingam A, Kwik C, Sandaradura I, Renthawa J, Watts MR, Toh JWT. An Unusual Case of Lethal Strongyloides stercoralis-Associated Chronic Fulminant Colitis in an Immunocompetent Patient. Case Rep Infect Dis 2024; 2024:4223529. [PMID: 38966249 PMCID: PMC11223904 DOI: 10.1155/2024/4223529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/28/2024] [Accepted: 06/10/2024] [Indexed: 07/06/2024] Open
Abstract
A 70-year-old immunocompetent Lebanese male presented with 3-month history of watery diarrhoea and abdominal pain after recently arriving to Australia from Lebanon. He had a colectomy for an iatrogenic bowel perforation associated with a colonoscopy in Lebanon several months prior. His computed tomography (CT) scan demonstrated pancolitis. Stool culture and polymerase chain reaction (PCR) were positive for Strongyloides stercoralis. Despite Strongyloides treatment and total parenteral nutrition, his pancolitis unexpectedly persisted despite negative stool cultures, and the patient failed to progress over several weeks with worsening abdominal pain. A colectomy was considered. However, due to his recent myocardial infarct requiring cardiac stenting, his anticoagulant and antiplatelets could not be ceased for at least 3 months without significant cardiac risk. After hospitalisation for several weeks in Australia, he was discharged against medical advice and flew back to Lebanon, where he presented with worsening pain and underwent a subtotal colectomy. Unfortunately, he developed multiorgan failure and died 3 weeks following his colectomy. Strongyloides-related pancolitis is a rare condition in immunocompetent adults that has the potential to persist and be lethal, despite microbiological antiparasitic eradication.
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Affiliation(s)
- Joseph Do Woong Choi
- Department of Colorectal SurgeryWestmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, New South Wales, Australia
- Faculty of Medicine and HealthThe University of Sydney, Sydney, NSW, Australia
| | - Rukmini Kulkarni
- Department of Colorectal SurgeryWestmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, New South Wales, Australia
| | - Aswin Shanmugalingam
- Department of Colorectal SurgeryWestmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, New South Wales, Australia
| | - Charlotte Kwik
- Department of Colorectal SurgeryWestmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, New South Wales, Australia
| | - Indy Sandaradura
- Centre for Infectious Diseases and MicrobiologyInstitute of Clinical Pathology and Medical ResearchNew South Wales Health Pathology and Sydney Institute for Infectious DiseasesWestmead HospitalUniversity of Sydney, Sydney, New South Wales, Australia
| | - Jasveen Renthawa
- Department of Tissue Pathology an Diagnostic OncologyInstitute of Clinical Pathology and Medical ResearchWestmead HospitalUniversity of Sydney, Sydney, New South Wales, Australia
| | - Matthew R. Watts
- Faculty of Medicine and HealthThe University of Sydney, Sydney, NSW, Australia
- Centre for Infectious Diseases and MicrobiologyInstitute of Clinical Pathology and Medical ResearchNew South Wales Health Pathology and Sydney Institute for Infectious DiseasesWestmead HospitalUniversity of Sydney, Sydney, New South Wales, Australia
| | - James Wei Tatt Toh
- Department of Colorectal SurgeryWestmead Hospital, Corner Hawkesbury Road and Darcy Roads, Westmead, New South Wales, Australia
- Faculty of Medicine and HealthThe University of Sydney, Sydney, NSW, Australia
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Fakhrieh-Kashan Z, Fotouhi-Ardakani R, Zahabiun F, Sharifdini M, Kia EB. Application of Nested-qPCR-High Resolution Melting (HRM) Technology on Strongyloides stercoralis Isolates from Iran. Acta Parasitol 2024; 69:889-897. [PMID: 38470530 DOI: 10.1007/s11686-024-00821-2] [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: 03/30/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE Strongyloides stercoralis is a parasite with special characteristics presenting it as a unique nematode. Iran is an endemic area for S. stercoralis. In this study, nested-qPCR-high resolution melting (HRM) technology was applied on some human isolates of S. stercoralis from this country by focusing on evolutionary genetics analysis. METHODS Twelve human isolates of S. stercoralis were collected from four endemic provinces of Iran. Genomic DNA was extracted from a single filariform larva for every isolate. Using specific primers targeting partial regions in cox1 gene, nested-qPCR-HRM was performed and melting-curve profiles were analyzed alongside the evaluation of genetic proximity and phylogenetic analysis using MEGA7 and DnaSP5 software. RESULTS The melting temperature (Tm) values of the isolates were 77.9 °C-78.3 °C. All isolates from Guilan, Mazandaran, and Khouzestan Provinces shared Tm values of 78.2 °C to 78.3 °C, while the isolates from Hormozgan Province showed Tm values of 77.9 °C, 78.0 °C, and 78.1 °C. The phylogenetic tree illustrated that the sequences of the current study included nine haplotypes. Tajima's D index analyses showed that cox1 gene in S. stercoralis isolates was negative (Tajima's D = - 0.27). CONCLUSION The isolates were divided into five temperature groups. Although HRM assay compared to PCR sequencing identified more limited genetic changes, it revealed that the mean of Tm of the isolates from Hormozgan Province was lower than those of other provinces and represented specific haplotypes for this geographical region on the phylogenetic tree.
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Affiliation(s)
- Zohreh Fakhrieh-Kashan
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Fotouhi-Ardakani
- Cellular and Molecular Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Farzaneh Zahabiun
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Sharifdini
- Department of Medical Parasitology and Mycology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Eshrat Beigom Kia
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Lupia T, Crisà E, Sangiorgio V, Bosio R, Stroffolini G, Staffilano E, Gregorc V, Corcione S, De Rosa FG. Presumptive pulmonary toxocariasis in a patient affected by acute myeloid leukemia and Hodgkin lymphoma: case report and review of the literature in immunocompromised hosts. LE INFEZIONI IN MEDICINA 2024; 32:103-112. [PMID: 38456027 PMCID: PMC10917563 DOI: 10.53854/liim-3201-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/26/2024] [Indexed: 03/09/2024]
Abstract
Toxocariasis is a zoonosis transmitted by the nematode Toxocara spp. Immunocompromised hosts are more susceptible than general population to bacterial, viral, fungal and parasitic infections. In this population toxocariasis may present as exacerbation or reactivation and could have severe or atypical manifestations being a diagnostic challenge for healthcare providers. We report a case of a presumptive pulmonary toxocariasis during chemotherapy in a patient affected by acute myeloid leukaemia (AML) and Hodgkin lymphoma and we summarize current evidence of pulmonary involvement in immunocompromised population with Toxocara spp infection in a narrative review. The aim of this work is also to revise the current literature on pulmonary involvement during Toxocara spp infection in immunocompromised hosts to improve knowledge on clinical presentation, treatment and outcome. A 66 years old man who had undergone to a cytarabine and idarubicin chemotherapy induction scheme for AML, complained of febrile neutropenia and dry cought. At the chest computed tomography (CT) there were multiple nodular pulmonary lesions with subpleural consolidations. The lung biopsy revealed inflammatory infiltration with diffuse small granulomas with minor eosinophil component. The laboratory analysis showed high immunoglobulin E (IgE) count with normal peripherical eosinophils, among the extended parasitological analysis, Toxocara immunoblot assay resulted positive. In the most accepted hypothesis of a polmunary toxocariasis infection, the patient was treated with a combination of albendazole plus corticosteroids for four weeks, with a positive outcome. Infection complications during chemotherapy are not uncommon, however, this is the first reported case of pulmonary toxocariasis during cytarabine and idarubicin treatment in AML. The revised literature shows male gender and younger age as possible risk factors, nevertheless the majority of cases of seropositivity for Toxocara was reported in solid organ malignancies. In this case, the suspect was mainly based on laboratory total elevated IgE, confirmed by serological, anatomo-pathological and radiological findings. Hypereosinophilia is often not present in chronic infection. In conclusion, pulmonary toxocariasis should be ruled out in patients with pulmonary involvement and high IgE titre, with or without peripheral eosinophilia, especially in those with known immunocompromised status.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, Asti, Italy
| | - Elena Crisà
- Unit of Oncology and Haematology, Candiolo Cancer Institute, Candiolo, Italy
| | - Valentina Sangiorgio
- Pathological Anatomy Unit, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Roberta Bosio
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Giacomo Stroffolini
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Elena Staffilano
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Vanesa Gregorc
- Unit of Oncology and Haematology, Candiolo Cancer Institute, Candiolo, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
- School of Medicine, Infectious Disease & Geographic Medicine, Tufts University, Boston, MA, USA
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, Asti, Italy
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
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Gordon CA, Utzinger J, Muhi S, Becker SL, Keiser J, Khieu V, Gray DJ. Strongyloidiasis. Nat Rev Dis Primers 2024; 10:6. [PMID: 38272922 DOI: 10.1038/s41572-023-00490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Strongyloidiasis is a neglected tropical disease caused primarily by the roundworm Strongyloides stercoralis. Strongyloidiasis is most prevalent in Southeast Asia and the Western Pacific. Although cases have been documented worldwide, global prevalence is largely unknown due to limited surveillance. Infection of the definitive human host occurs via direct skin penetration of the infective filariform larvae. Parasitic females reside in the small intestine and reproduce via parthenogenesis, where eggs hatch inside the host before rhabditiform larvae are excreted in faeces to begin the single generation free-living life cycle. Rhabditiform larvae can also develop directly into infectious filariform larvae in the gut and cause autoinfection. Although many are asymptomatic, infected individuals may report a range of non-specific gastrointestinal, respiratory or skin symptoms. Autoinfection may cause hyperinfection and disseminated strongyloidiasis in immunocompromised individuals, which is often fatal. Diagnosis requires direct examination of larvae in clinical specimens, positive serology or nucleic acid detection. However, there is a lack of standardization of techniques for all diagnostic types. Ivermectin is the treatment of choice. Control and elimination of strongyloidiasis will require a multifaceted, integrated approach, including highly sensitive and standardized diagnostics, active surveillance, health information, education and communication strategies, improved water, sanitation and hygiene, access to efficacious treatment, vaccine development and better integration and acknowledgement in current helminth control programmes.
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Affiliation(s)
- Catherine A Gordon
- Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia.
- Faculty of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia.
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Department of Microbiology and Immunology, Parkville, Victoria, Australia
| | - Sören L Becker
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Darren J Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
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Hasegawa S, Matsumoto E, Carlson JR, Suzuki H. Clinical Characteristics, Treatment, and Outcomes of Veterans with Cerebrospinal Fluid Culture Positive for Gram-Negative Rod Bacteria: A Retrospective Analysis over 18 Years in 125 Veterans Health Administration Hospitals. Curr Microbiol 2024; 81:70. [PMID: 38240847 DOI: 10.1007/s00284-023-03593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
Optimal management for patients with bacterial ventriculitis/meningitis due to Gram-negative rods (GNRs) has yet to be well investigated. We assessed the clinical characteristics, treatment, and outcomes of patients with a positive cerebrospinal fluid (CSF) culture for GNRs. We conducted a retrospective cohort study of all patients with a positive CSF culture within the Veterans Health Administration (VHA) system during 2003-2020. Clinical and microbiological characteristics between the true meningitis and contamination groups were compared. Of the 5919 patients with positive CSF cultures among 125 nationwide VHA acute-care hospitals, 297 (5.0%) were positive for GNRs. Among 262 patients analyzed, 156 (59.5%) were assessed as patients with true meningitis, and 106 (40.5%) were assessed as patients with contaminated CSF cultures. Patients with true meningitis had a significantly higher CSF protein (median 168 vs 57 mg/dL, p < 0.001), CSF white blood cell count (median 525 vs 3/µL, p = 0.008) and percentage of neutrophils in CSF (median 88 vs 4%, p < 0.001). Enterobacterales were more common in the true meningitis group, while unidentified GNR or polymicrobial CSF cultures were more common in the contamination group. The all-cause 90-day mortality was 25.0% (39/156) in patients with true meningitis and 10.4% (11/106) in those with contaminated CSF cultures. None of the 11 patients with contaminated CSF cultures who died were considered due to missed meningitis. More than 40% of patients with a positive CSF culture with GNR did not receive treatment without negative consequences. Careful clinical judgment is required to decide whether to treat such patients.
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Affiliation(s)
- Shinya Hasegawa
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, 601 Highway 6 West, Iowa City, IA, 52246, USA
- Iowa City Veterans Affairs Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, USA
| | - Eiyu Matsumoto
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, 601 Highway 6 West, Iowa City, IA, 52246, USA
- Iowa City Veterans Affairs Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, USA
| | - Jennifer R Carlson
- Iowa City Veterans Affairs Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, USA
| | - Hiroyuki Suzuki
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, 601 Highway 6 West, Iowa City, IA, 52246, USA.
- Iowa City Veterans Affairs Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, USA.
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Fan W, Fu Q, Yu Y. Pulmonary strongyloidiasis and hyperinfection in a Patient with idiopathic inflammatory myopathy:A case report. Heliyon 2024; 10:e23484. [PMID: 38148807 PMCID: PMC10750171 DOI: 10.1016/j.heliyon.2023.e23484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/28/2023] Open
Abstract
Pulmonary strongyloidiasis is a rare infection in patients with autoimmune diseases, and immunosuppression can lead to the development of hyperinfection syndrome with a high mortality rate. We present a case of a 78-year-old male with previous idiopathic inflammatory myopathy (IIM) with interstitial lung disease. He developed hyperinfection syndrome and respiratory failure, and diagnostic metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) confirmed the presence of Strongyloides stercoralis. After treatment with ivermectin, the patient's symptoms improved. Therefore, adequate screening and prophylactic treatment are needed for people at risk of immunosuppression, which can reduce the occurrence of the devastating S. stercoralis hyperinfection syndrome. It also highlights mNGS as a highly accurate test for the detection of difficult to atypical pathogens.
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Affiliation(s)
- Wei Fan
- Department of Rheumatology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Fu
- Department of Rheumatology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuetian Yu
- Department of Critical Care Medicine, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Alipour M, Masoori L, Gholami MD, Khoshmirsafa M, Razmjou E, Jalallou N, Jafarian F, Falak R, Meamar AR. Expression of Heat Shock Protein 70 (HSP70) and Astacin Genes of Strongyloides stercoralis as well as HSP70 and HSP17.1 Genes of S. ratti in Adult and Larval Stages of S. stercoralis. IRANIAN JOURNAL OF PARASITOLOGY 2024; 19:1-8. [PMID: 38654956 PMCID: PMC11033530 DOI: 10.18502/ijpa.v19i1.15187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/14/2023] [Indexed: 04/26/2024]
Abstract
Background Uncovering the roles and characteristics of pathogenesis-related molecules can help us develop novel management methods in parasitology. In this study, we studied the expression levels of Strongyloides stercoralis heat shock protein70 (HSP70) (Sst-hsp-70) and astacin (Sst-ast) as pathogenesis-related genes as well as the expression of S. ratti HSP70 and HSP17.1 (Sra-hsp-70, Sra-hsp-17.1) in the larvae and adult stages of S. stercoralis. Methods A hyperinfection isolate of S. stercoralis from Gilan Province, northern Iran was cultivated on nutrient agar. After a couple of days, parasites in different stages of life were collected, and total RNA was extracted. The expression levels of astacin and HSP genes were compared by real-time PCR. Results Statistically higher expression levels of Sst-ast, Sst-hsp-70, and Sra-hsp-70 genes in L3 larvae than in adults were observed. However, the expression level of Sra-hsp-17.1 was non-significantly lower in the larval stage than in adult worms. Conclusion Higher expression levels of Sst-ast, Sst-hsp-70, and Sra-hsp-70 genes in the larval stages of S. stercoralis suggest the potential role of these enzymes in parasite cutaneous invasion and pathogenesis. However, higher expression of Srahsp-17.1 in adult forms is probably involved in resistance and survival mechanisms. The similarity in gene expression between S. stercoralis and S. ratti can provide helpful hints to better understand strongyloidiasis from various perspectives, including pathogenesis, proper diagnosis, and targeted treatment.
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Affiliation(s)
- Maryam Alipour
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Masoori
- Department of Laboratory Sciences, School of Allied Medical Sciences, Lorestan University of Medical Sciences, Khorramabad, Iran
- Razi Herbal Medicines Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Davoodzadeh Gholami
- Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Khoshmirsafa
- Immunology Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Iran 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 Science, AJA University of Medical Sciences, Tehran, Iran
| | - Farzane Jafarian
- Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Mazandaran, 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
| | - Ahmad Reza Meamar
- Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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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.
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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
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11
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Marquet F, Mora N, Incani RN, Jesus J, Méndez N, Mujica R, Trosel H, Ferrer E. Comparison of different PCR amplification targets for molecular diagnosis of Strongyloides stercoralis. J Helminthol 2023; 97:e88. [PMID: 37974436 DOI: 10.1017/s0022149x23000743] [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: 11/19/2023]
Abstract
Molecular techniques are an alternative for the diagnosis of strongyloidiasis, produced by Strongyloides stercoralis. However, it is necessary to determine the best amplification target for the populations of this parasite present in a geographical area and standardize a polymerase chain reaction (PCR) protocol for its detection. The objectives of this work were the comparison of different PCR targets for molecular detection of S. stercoralis and the standardization of a PCR protocol for the selected target with the best diagnostic results. DNA extraction was performed from parasite larvae by saline precipitation. Three amplification targets of the genes encoding ribosomal RNA 18S (18S rDNA) and 5.8S (5.8S rDNA) and cytochrome oxidase 1 (COX1) of S. stercoralis were compared, and the PCR reaction conditions for the best target were standardized (concentration of reagents and template DNA, hybridization temperature, and number of cycles). The analytical sensitivity and specificity of the technique were determined. DNA extraction by saline precipitation made it possible to obtain DNA of high purity and integrity. The ideal target was the 5.8S rDNA, since the 18S rDNA yielded non-reproducible results and COX1 never amplified under any condition tested. The optimal conditions for the 5.8S rDNA-PCR were: 1.5 mM MgCl2, 100 μM dNTPs, 0.4 μM primers, and 0.75 U DNA polymerase, using 35 cycles and a hybridization temperature of 60 °C. The analytical sensitivity of the PCR was 1 attogram of DNA, and the specificity was 100%. Consequently, the 5.8S rDNA was shown to be highly sensitive and specific for the detection of S. stercoralis DNA.
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Affiliation(s)
- F Marquet
- Instituto de Investigaciones Biomédicas "Dr. Francisco J. Triana Alonso" (BIOMED). Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
| | - N Mora
- Instituto de Investigaciones Biomédicas "Dr. Francisco J. Triana Alonso" (BIOMED). Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
| | - R N Incani
- Departamento de Parasitología, Facultad de Ciencias de la Salud Sede Carabobo, Universidad de Carabobo, Valencia, estado Carabobo, Venezuela
| | - J Jesus
- Departamento de Parasitología, Facultad de Ciencias de la Salud Sede Carabobo, Universidad de Carabobo, Valencia, estado Carabobo, Venezuela
| | - N Méndez
- Departamento de Parasitología, Facultad de Ciencias de la Salud Sede Carabobo, Universidad de Carabobo, Valencia, estado Carabobo, Venezuela
| | - R Mujica
- Instituto de Investigaciones Biomédicas "Dr. Francisco J. Triana Alonso" (BIOMED). Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
| | - H Trosel
- Instituto de Investigaciones Biomédicas "Dr. Francisco J. Triana Alonso" (BIOMED). Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
| | - E Ferrer
- Instituto de Investigaciones Biomédicas "Dr. Francisco J. Triana Alonso" (BIOMED). Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
- Departamento de Parasitología, Facultad de Ciencias de la Salud Sede Aragua, Universidad de Carabobo, Maracay, estado Aragua, Venezuela
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12
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Saengsawang N, Ruang-Areerate P, Kaeothaisong N, Leelayoova S, Mungthin M, Juntanawiwat P, Hanyanunt P, Potisuwan P, Kesakomol P, Butsararattanagomen P, Wichaiwong P, Dungchai W, Ruang-Areerate T. Validation of quantitative loop-mediated isothermal amplification assay using a fluorescent distance-based paper device for detection of Escherichia coli in urine. Sci Rep 2023; 13:18781. [PMID: 37907677 PMCID: PMC10618465 DOI: 10.1038/s41598-023-46001-6] [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: 09/20/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023] Open
Abstract
Uropathogenic Escherichia coli (UPEC) causes up to 90% of urinary tract infections (UTI) which is more prevalent among females than males. In urine, patients with symptomatic UTI usually have a high concentration of bacterial infection, ≥ 105 colony-forming units (CFU) per mL, in which the culture method is regularly the gold standard diagnosis. In this study, a simple and inexpensive distance-based paper device (dPAD) combined with the fluorescent closed tube LAMP assay was validated for simultaneously screening and semi-quantifying the infection level of E. coli in 440 urine samples of patients with UTI. The dPAD could measure the LAMP amplicons and semi-quantify the levels of E. coli infection in heavy (≥ 104 CFU/mL), light (≤ 103 CFU/mL) and no infection. The sensitivity and specificity had reliable performances, achieving as high as 100 and 92.7%, respectively. The one step LAMP assay could be performed within 3 h, which was 7.5 times faster than the culture method. To empower early UTI diagnosis and fast treatment, this inexpensive dPAD tool combined with the fluorescent closed tube LAMP assay is simple, reliably fast and practically portable for point-of-care settings, particularly in resource-limited areas, which can be set up in all levels of healthcare facilities.
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Affiliation(s)
- Natkrittaya Saengsawang
- Analytical Chemistry, Department of Chemistry, Faculty of Science, King Mongkut's University of Technology Thonburi, Bangkok, 10140, Thailand
| | - Panthita Ruang-Areerate
- BIOTEC, National Science and Technology Development Agency (NSTDA), Pathum Thani, 12120, Thailand
| | - Nuanlaong Kaeothaisong
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Saovanee Leelayoova
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Mathirut Mungthin
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Piraporn Juntanawiwat
- Division of Microbiology, Department of Clinical Pathology, Phramongkutklao Hospital, Bangkok, 10400, Thailand
| | - Patomroek Hanyanunt
- Division of Microbiology, Department of Clinical Pathology, Phramongkutklao Hospital, Bangkok, 10400, Thailand
| | - Patsanun Potisuwan
- Division of Microbiology, Department of Clinical Pathology, Phramongkutklao Hospital, Bangkok, 10400, Thailand
| | - Piyanate Kesakomol
- Department of Microbiology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand
| | - Pornphan Butsararattanagomen
- Analytical Chemistry, Department of Chemistry, Faculty of Science, King Mongkut's University of Technology Thonburi, Bangkok, 10140, Thailand
| | - Pattarawadee Wichaiwong
- Analytical Chemistry, Department of Chemistry, Faculty of Science, King Mongkut's University of Technology Thonburi, Bangkok, 10140, Thailand
| | - Wijitar Dungchai
- Analytical Chemistry, Department of Chemistry, Faculty of Science, King Mongkut's University of Technology Thonburi, Bangkok, 10140, Thailand.
| | - Toon Ruang-Areerate
- Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.
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13
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Zhou H, Hu J, Zhou T, Zhang Y, Qin P, Zhang B, Wang R, Luo X, Hu M. Establishment of an Animal Model Scheme of Strongyloides stercoralis-Infected Meriones meridianus. Pathogens 2023; 12:1285. [PMID: 38003750 PMCID: PMC10675186 DOI: 10.3390/pathogens12111285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
Studying parasitic nematodes, which generate a massive hazard to animal health, is more difficult than studying free-living nematodes as appropriate animal models are essential, and the relationship between parasites and hosts is extremely complex. Strongyloides stercoralis is an intestinal nematode parasite that mainly infects dogs, humans and other primates. Currently, S. stercoralis worms needed for research mainly rely on their natural host, the dog. This study explored a method of using Meriones meridianus as a model for S. stercoralis. The immunosuppressed M. meridianus were infected with S. stercoralis subcutaneously, and post-parasitic, first-stage larvae (PP L1) were detected in the faeces, with more larvae in female gerbils. In addition, parasitic females (PFs), third-stage larvae (L3s) and rhabditiform larvae were found primarily in the small intestines and lungs of infected gerbils. The PFs and auto-infective third-stage larvae (aL3s) obtained from M. meridianus are morphologically identical to those obtained from beagles and Meriones unguiculatus. Moreover, the infection of S. stercoralis caused changes to biochemical indicators in the serum and in the physiology of M. meridianus. The results demonstrated that M. meridianus can be infected by S. stercoralis, and this model provides a great tool for exploring the biological processes of this parasite and its interaction with the host.
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Affiliation(s)
- Huan Zhou
- National Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China; (J.H.); (T.Z.); (Y.Z.); (P.Q.); (B.Z.)
- School of Life Sciences, Henan University, Kaifeng 475004, China
| | - Jinyang Hu
- National Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China; (J.H.); (T.Z.); (Y.Z.); (P.Q.); (B.Z.)
| | - Taoxun Zhou
- National Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China; (J.H.); (T.Z.); (Y.Z.); (P.Q.); (B.Z.)
| | - Ying Zhang
- National Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China; (J.H.); (T.Z.); (Y.Z.); (P.Q.); (B.Z.)
| | - Peixi Qin
- National Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China; (J.H.); (T.Z.); (Y.Z.); (P.Q.); (B.Z.)
| | - Biying Zhang
- National Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China; (J.H.); (T.Z.); (Y.Z.); (P.Q.); (B.Z.)
| | - Rui Wang
- College of Veterinary Medicine, Inner Mongolia Agricultural University, Hohhot 010030, China
| | - Xiaoping Luo
- Inner Mongolia Academy of Agriculture and Animal Husbandry Sciences, Hohhot 010030, China
| | - Min Hu
- National Key Laboratory of Agricultural Microbiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China; (J.H.); (T.Z.); (Y.Z.); (P.Q.); (B.Z.)
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14
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Tunali V, Korkmaz M. Emerging and Re-Emerging Parasitic Infections of the Central Nervous System (CNS) in Europe. Infect Dis Rep 2023; 15:679-699. [PMID: 37987400 PMCID: PMC10660548 DOI: 10.3390/idr15060062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 11/22/2023] Open
Abstract
In a rapidly evolving global landscape characterized by increased international travel, migration, and ecological shifts, this study sheds light on the emergence of protozoal and helminthic infections targeting the central nervous system (CNS) within Europe. Despite being traditionally associated with tropical regions, these infections are progressively becoming more prevalent in non-endemic areas. By scrutinizing the inherent risks, potential outcomes, and attendant challenges, this study underscores the intricate interplay between diagnostic limitations, susceptibility of specific population subsets, and the profound influence of climate fluctuations. The contemporary interconnectedness of societies serves as a conduit for introducing and establishing these infections, warranting comprehensive assessment. This study emphasizes the pivotal role of heightened clinician vigilance, judicious public health interventions, and synergistic research collaborations to mitigate the potential consequences of these infections. Though rare, their profound impact on morbidity and mortality underscores the collective urgency required to safeguard the neurological well-being of the European populace. Through this multifaceted approach, Europe can effectively navigate the complex terrain posed with these emergent infections.
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Affiliation(s)
- Varol Tunali
- Department of Parasitology, Faculty of Medicine, Manisa Celal Bayar University, 45030 Manisa, Turkey
- Department of Emergency Medicine, Izmir Metropolitan Municipality Eşrefpaşa Hospital, 35170 Izmir, Turkey
| | - Metin Korkmaz
- Department of Parasitology, Faculty of Medicine, Ege University, 35100 Izmir, Turkey;
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15
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Hamze H, Tai T, Harris D. Strongyloides hyperinfection syndrome precipitated by immunosuppressive therapy for rheumatoid arthritis and COVID-19 pneumonia. Trop Dis Travel Med Vaccines 2023; 9:15. [PMID: 37794447 PMCID: PMC10552379 DOI: 10.1186/s40794-023-00201-0] [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: 05/22/2023] [Accepted: 07/17/2023] [Indexed: 10/06/2023] Open
Abstract
The COVID-19 pandemic has posed clinical and public health challenges worldwide. The use of corticosteroids has become an evidence-based practice to reduce the hyperinflammatory process involved in severe COVID-19 disease. However, this can result in the reactivation of parasitic infestations, even with a short course. We report the case of a 64-year-old Cuban born patient who passed away from S. stercoralis hyperinfection syndrome following treatment with dexamethasone for severe COVID-19 disease on a background of prolonged immunosuppression for rheumatoid arthritis. Clinicians should be aware of the risk of strongyloidiasis as a complication of the treatment for severe COVID-19 and other immunosuppressive therapies. We recommend empiric Strongyloides treatment for those who are from, or who have accumulated risk by travelling to endemic areas, and are being treated with corticosteroids for severe COVID-19 disease.
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Affiliation(s)
- Hasan Hamze
- Department of Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 1Z7, Canada
| | - Teresa Tai
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - David Harris
- Department of Medicine, Division of Infectious Diseases, BC Centre for Excellence in HIV/AIDS (BC-CfE), St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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16
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Yeh MY, Aggarwal S, Carrig M, Azeem A, Nguyen A, Devries S, Destache C, Nguyen T, Velagapudi M. Strongyloides stercoralis Infection in Humans: A Narrative Review of the Most Neglected Parasitic Disease. Cureus 2023; 15:e46908. [PMID: 37954715 PMCID: PMC10639005 DOI: 10.7759/cureus.46908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Strongyloidiasis is a helminth infection affecting 613.9 million people annually, mainly in the tropics and subtropics. The reported seroprevalence in the United States is 4% with most of the cases reported in immigrants. Human T-lympho-tropic virus 1 (HTLV-1) infections, hypogammaglobulinemia, immunosuppressant use - particularly steroid use, alcoholism, and malnutrition have been associated with an increased risk of strongyloidiasis. Recently, cases of strongyloidiasis hyperinfection syndrome have been described in coronavirus disease 2019 (COVID-19) patients treated with steroids as well. This brief review discusses the epidemiology, clinical features, management, and prevention of strongyloidiasis including some facts about the infection in pregnancy, transplant recipients, and COVID-19 patients. We conducted an online search using the PubMed, Scopus, and Google Scholar databases. Strongyloidiasis can be asymptomatic or present with mild symptoms. Strongyloides stercoralis is known to cause autoinfection. In immunocompromised individuals, it can present with severe symptoms, hyperinfection, or disseminated disease. Reported mortality in cases of disseminated Strongyloidiasis is 87.1%. Serology and detection of larvae in stool by direct microscopy are the most commonly used methods to diagnose strongyloidiasis. The drug of choice for the treatment is ivermectin. However, the use of ivermectin in human pregnancy is not well studied, and its teratogenic risks are unknown. Proactive screening of strongyloidiasis is necessary in immunocompromised individuals to prevent severe disease.
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Affiliation(s)
- Mary Y Yeh
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Sanjana Aggarwal
- Medicine, Hamdard Institute of Medical Sciences and Research, New Delhi, IND
| | - Margaret Carrig
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | - Ahad Azeem
- Infectious Diseases, Creighton University School of Medicine, Omaha, USA
| | - Anny Nguyen
- Internal Medicine, Creighton University School of Medicine, Omaha, USA
| | | | - Chris Destache
- Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, USA
| | - Toan Nguyen
- Internal Medicine, Houston Methodist Hospital, Houston, USA
| | - Manasa Velagapudi
- Infectious Diseases, Creighton University School of Medicine, Omaha, USA
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17
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Agrawal A, Kumar AK, Majid M, Yesilyaprak A, Verma B, Arockiam AD, Badwan O, Syed AB, Klein AL. An Unusual Case of Parasitic Constrictive Pericarditis. JACC Case Rep 2023; 22:101983. [PMID: 37790764 PMCID: PMC10544297 DOI: 10.1016/j.jaccas.2023.101983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 10/05/2023]
Abstract
Parasitic constrictive pericarditis is a rare entity. We present a case of a 75-year-old man who presented with dyspnea, ascites, and pedal edema and was found to have constrictive pericarditis on multimodality imaging with positive serology for Strongyloides Stercoralis. Treatment required ivermectin and radical pericardiectomy with significant clinical improvement. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Ankit Agrawal
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ashwin K. Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Muhammad Majid
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abdullah Yesilyaprak
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Beni Verma
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Aro Daniela Arockiam
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Osamah Badwan
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alveena Batool Syed
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Allan L. Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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18
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Corrêa LQ, do Couto BP, de Carvalho EFG, de Sousa JEN, da Silva Ribeiro V, Gonzaga HT, Costa-Cruz JM. Route of dexamethasone administration influences parasite burden in Strongyloides hyperinfection model. J Parasit Dis 2023; 47:520-526. [PMID: 37520210 PMCID: PMC10382442 DOI: 10.1007/s12639-023-01595-6] [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: 02/15/2023] [Accepted: 05/06/2023] [Indexed: 08/01/2023] Open
Abstract
Rodents infected with Strongyloides venezuelensis are experimental models applied to strongyloidiasis research. This study evaluated oral and subcutaneous dexamethasone (DEX) treatments to establish immunosuppression in an experimental model of Strongyloides hyperinfection. Rattus norvegicus Wistar were divided: G I (-): untreated and uninfected animals, G II (+): untreated and infected, G III (o -) orally treated and uninfected, G IV (o +) orally treated and infected, G V (sc -) subcutaneously treated and uninfected, G VI (sc +) subcutaneously treated and infected. For oral administration, DEX was diluted in sterile water (5 µg/ml) and made available to the animals on intervals in experimental days - 5-0, 8-13 and 21-26. For subcutaneous administration, animals received daily injections of DEX disodium phosphate (2 mg/kg). Infection was established by the subcutaneous inoculation of 3000 S. venezuelensis filarioid larvae. Groups were evaluated by egg per gram of feces and parasite females counts and IgG, IgG1 and IgG2a detection. GIV (o +) had egg peaks count on days 13 and 26 and maintained egg elimination until the last experimental day. Parasitic females recovery at day 30 was significantly higher in G IV (o +) when compared to G VI (sc +). Levels of IgG, IgG1 and IgG2a of all groups, except the positive control GII (+), were below the detection threshold. Pharmacological immunosuppression induced by oral administration of DEX produced high parasitic burden, and is a noninvasive method, useful to establish immunosuppression in strongyloidiasis hyperinfection model in rats.
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Affiliation(s)
- Luisa Queiroz Corrêa
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Bruna Patrícia do Couto
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Edson Fernando Goulart de Carvalho
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais Brazil
| | - José Eduardo Neto de Sousa
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Vanessa da Silva Ribeiro
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Henrique Tomaz Gonzaga
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais Brazil
| | - Julia Maria Costa-Cruz
- Laboratório de Diagnóstico de Parasitoses, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia, Minas Gerais Brazil
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19
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Soleymani E, Davoodi L, Shayesteh Azar S, Mirbadiei SR, Parandin F, Azimi A, Mizani A, Khorshidvand Z, Fakhar M. Fatal Disseminated Strongyloidiasis in an Immunosuppressed Patient During COVID-19 Pandemic. Acta Parasitol 2023; 68:711-717. [PMID: 37532918 DOI: 10.1007/s11686-023-00705-x] [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: 04/26/2023] [Accepted: 07/20/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION This report presents a fatal case of disseminated strongyloidiasis in a patient with myasthenia gravis and diabetes mellitus who had received corticosteroid therapy. CASE REPORT The patient was a 67-year-old woman living in a rural area endemic for Strongyloides stercoralis in northern Iran. Disseminated strongyloidiasis was diagnosed in the advanced stage of the disease, with enormous numbers of larvae demonstrated in direct smears prepared from stool samples and stomach biopsy. Despite treatment with ivermectin and antibiotics, the patient succumbed to the severity of the infection. CONCLUSION Clinicians working in endemic areas should be mindful of the possibility of gastric involvement in strongyloidiasis, even if symptoms are nonspecific. We recommend that high-risk individuals be screened for S. stercoralis prior to immunosuppressive therapy in endemic regions to raise awareness and prevent similar cases.
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Affiliation(s)
- Eissa Soleymani
- Department of Infectious Diseases, Faculty of Medicine, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Lotfollah Davoodi
- Department of Infectious Diseases, Faculty of Medicine, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shadi Shayesteh Azar
- Department of Infectious Diseases, Faculty of Medicine, Antimicrobial Resistance Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Reza Mirbadiei
- Department of Parasitology and Mycology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Parandin
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Afshin Azimi
- Department of Parasitology and Mycology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Azadeh Mizani
- Department of Parasitology, Pasteur Institute of Iran, Tehran, Iran
| | - Zohreh Khorshidvand
- Department of Parasitology and Mycology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahdi Fakhar
- Iranian National Registry Centre for Lophomoniasis and Toxoplasmosis, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, P.O Box: 48166-33131, Sari, Iran.
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20
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Montreuil N, Sternberg CA, Abaribe O, Ayoade FO. Disseminated Strongyloides stercoralis infection in the setting of Escherichia coli meningitis and bacteraemia in a patient living with HIV on high-dose corticosteroid therapy. BMJ Case Rep 2023; 16:e256105. [PMID: 37643819 PMCID: PMC10465900 DOI: 10.1136/bcr-2023-256105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Strongyloidiasis, a helminth infection caused by Strongyloides stercoralis, can be complicated by hyperinfection, especially in the setting of immunosuppression; however, many patients go undiagnosed. One clue to diagnosis is unexplained gram-negative bacteraemia or meningitis in patients who are immunosuppressed. Serology can be helpful but may be negative in these patients who are immunocompromised.We present the case of a white cisgender man from Central America in his 40s, living with HIV, with a CD4 count of 77 cells/µL. He was diagnosed with Strongyloides hyperinfection after an increase in his steroid dose. He also had Escherichia coli meningitis and bacteraemia. Strongyloidiasis was diagnosed by stool microscopy despite a negative serology test.This case highlights the challenges in diagnosing strongyloidiasis in the setting of immunosuppression. A high index of clinical suspicion is warranted for patients living with HIV on high-dose corticosteroids. Up to three stool microscopy studies for Strongyloides should be sent in addition to serology.
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Affiliation(s)
- Nadine Montreuil
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Candice A Sternberg
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Obinna Abaribe
- Department of Medicine, Infectious Disease Doctors Medical Group APC, Plano, Texas, USA
| | - Folusakin O Ayoade
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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21
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Wongphutorn P, Worasith C, Kopolrat KY, Homwong C, Sithithaworn J, Eamudomkarn C, Techasen A, Tippayawat P, Pitaksakurat O, Hongsrichan N, Crellen T, Sithithaworn P. Diagnostic performance of Strongyloides-specific IgG4 detection in urine for diagnosis of human strongyloidiasis. Parasit Vectors 2023; 16:298. [PMID: 37641157 PMCID: PMC10464225 DOI: 10.1186/s13071-023-05935-6] [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: 03/12/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Detection of parasite-specific IgG in urine is a sensitive method for diagnosis of strongyloidiasis and gives similar accuracy to serum IgG. However, there are no data concerning detection of IgG subclass in urine. To further explore the utility of diagnosis from urine samples, we evaluated the diagnostic performance of IgG4 in urine compared with parasitological and other immunological methods. METHODS The urine and sera included proven strongyloidiasis (group 1, n = 93), other parasitic infections (group 2, n = 40) and parasite negatives (group 3, n = 93). The performance of Strongyloides-specific IgG4 in urine for diagnosis of strongyloidiasis using fecal examinations as the reference standard was assessed. RESULTS With fecal examination as a gold standard, Strongyloides-specific IgG4 in urine had 91.4% sensitivity and 93.2% specificity while serum IgG4 had 93.6% sensitivity and 91.0% specificity. IgG4 in both urine and serum had almost perfect diagnostic agreements with fecal examination (Cohen's kappa coefficient was > 0.8). Cross-reactivity to Opisthorchis viverrini and Taenia spp. of IgG4 in urine were 7.5% and 12.5% in serum. Concurrent analyses of total IgG in urine and serum showed that the sensitivities (97.9-100%) and specificities (88.7-91.0%) were similar (P > 0.05). The sensitivity for parasitological examination by the formalin-ethyl acetate concentration technique (FECT) was 49.5% and that for agar plate culture technique (APC) it was 92.6%. CONCLUSION Our findings showed that specific IgG4 detection in urine yielded similar diagnostic performance to the same biomarkers in serum. This suggests that accurate diagnosis of strongyloidiasis can be performed using urine samples and IgG4 is a valid choice of diagnostic marker. Further assessment is required to assess the utility of urine IgG4 for measuring the response treatment in strongyloidiasis.
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Affiliation(s)
| | - Chanika Worasith
- Department of Adult Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Kulthida Y Kopolrat
- Faculty of Public Health, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon, Thailand
| | - Chutima Homwong
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | | | - Chatanun Eamudomkarn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Anchalee Techasen
- Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | | | - Opal Pitaksakurat
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Nuttanan Hongsrichan
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Thomas Crellen
- School of Biodiversity One Health and Veterinary Medicine, University of Glasgow, Graham Kerr Building, Glasgow, UK
- Wellcome Centre for Integrative Parasitology, University of Glasgow, Sir Graeme Davies Building, Glasgow, UK
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Paiboon Sithithaworn
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand.
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
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22
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Morris CJ, Mosher Z, McKeon A, Jain R. Recurrent Klebsiella bacteremia due to chronic strongyloidiasis in the context of cirrhotic hepatopulmonary syndrome. BMJ Case Rep 2023; 16:e255656. [PMID: 37640414 PMCID: PMC10462951 DOI: 10.1136/bcr-2023-255656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
A woman in her 50s with a medical history of cirrhosis, alcohol use disorder, primary biliary cholangitis and extended spectrum beta lactamase (ESBL) Klebsiella presented with weakness, cough and abdominal pain with positive blood cultures for ESBL Klebsiella, and was treated with intravenous meropenem and patient symptoms improved. Testing for Strongyloides antibodies was positive, so she was treated with ivermectin. Strongyloidiasis-associated Gram-negative rod (GNR) bacteremia are rare conditions; however, it is important to consider an underlying strongyloidiasis in recurrent GNR bacteremia to prevent recurrent hospitalisation and morbidity.
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Affiliation(s)
| | - Zachary Mosher
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Annmarie McKeon
- Penn State College of Medicine, Hershey, Pennsylvania, USA
- Division of Hospitalist Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Rohit Jain
- Penn State College of Medicine, Hershey, Pennsylvania, USA
- Division of Hospitalist Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
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23
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Ashiri A, Beiromvand M, Rafiei A, Heidari R, Takesh A. Prevalence of asymptomatic strongyloidiasis co-infection in COVID-19 patients residing in endemic areas. Eur J Med Res 2023; 28:281. [PMID: 37563592 PMCID: PMC10416476 DOI: 10.1186/s40001-023-01262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Fatal forms of strongyloidiasis, hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), are caused by exaggerated autoinfection of the intestinal nematode, Strongyloides stercoralis (S. stercoralis). Corticosteroids, frequently administered to patients with severe COVID-19, can transform chronic asymptomatic strongyloidiasis into the above-mentioned fatal diseases. This study aimed to investigate the prevalence of strongyloidiasis in COVID-19 patients receiving corticosteroids in a hypoendemic region. METHODS The present cross-sectional study enrolled 308 COVID-19 patients admitted to two hospitals in Ahvaz and Abadan in the southwest of Iran between 2020 and 2022. A real-time reverse transcription polymerase chain reaction (RT-PCR) test and chest computed tomography (CT) scan were employed to detect and monitor the disease's severity in the patients, respectively. All patients were evaluated for IgG/IgM against S. stercoralis using Enzyme-linked immunosorbent assay (ELISA) test. Subsequently, individuals with a positive ELISA test were confirmed using parasitological methods, including direct smear and agar plate culture (APC). RESULTS The patients were between 15 and 94 years old, with a mean age of 57.99 ± 17.4 years. Of the 308 patients, 12 (3.9%) had a positive ELISA test, while 296 (96.1%) had negative results. Three of the 12 patients with a positive ELISA result died, and three failed to provide a stool sample. To this end, only six cases were examined parasitologically, in which S. stercoralis larvae were observed in five patients. Significant differences were found between S. stercoralis infection with sex (p = 0.037) and age (p = 0.027). Binary regression analysis revealed that strongyloidiasis was positively associated with sex (odds ratio [OR]: 5.137; 95% confidence interval [CI]: 1.107-23.847), age (OR: 5.647; 95% CI 1.216-26.218), and location (OR: 3.254; 95% CI: 0.864-12.257). CONCLUSIONS Our findings suggest that screening for latent strongyloidiasis in COVID-19 patients in endemic areas using high-sensitivity diagnostic methods, particularly ELISA, before receiving suppressive drugs should be given more consideration.
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Affiliation(s)
- Alireza Ashiri
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Molouk Beiromvand
- Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Abdollah Rafiei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Reza Heidari
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ameneh Takesh
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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24
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Akers AN, Vest A, Schenone CV, Rodriguez A. Strongyloides stercoralis Hyperinfection Syndrome in Pregnancy. Cureus 2023; 15:e43568. [PMID: 37719554 PMCID: PMC10503402 DOI: 10.7759/cureus.43568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Strongyloidiasis is a parasitic infection with a high global burden of disease. Hyperinfection syndrome is a life-threatening complication that predominantly affects immunosuppressed individuals, such as those receiving corticosteroid treatment. Despite its worldwide prevalence, little is known about the clinical effects of this condition on the feto-maternal dyad during pregnancy. We present a case of placental abruption leading to preterm delivery in a pregnancy complicated by Strongyloides stercoralis hyperinfection syndrome following antenatal corticosteroid use. Although rare, this condition is associated with high mortality rates and adverse pregnancy outcomes. Therefore, screening at-risk individuals may be warranted in pregnancies where antenatal corticosteroid administration is considered.
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Affiliation(s)
- Allison N Akers
- Obstetrics and Gynecology, University of South Florida, Tampa, USA
| | - Adriana Vest
- Obstetrics and Gynecology, University of South Florida, Tampa, USA
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25
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Lupia T, Crisà E, Gaviraghi A, Rizzello B, Di Vincenzo A, Carnevale-Schianca F, Caravelli D, Fizzotti M, Tolomeo F, Vitolo U, De Benedetto I, Shbaklo N, Cerutti A, Fenu P, Gregorc V, Corcione S, Ghisetti V, De Rosa FG. Overlapping Infection by Strongyloides spp. and Cytomegalovirus in the Immunocompromised Host: A Comprehensive Review of the Literature. Trop Med Infect Dis 2023; 8:358. [PMID: 37505654 PMCID: PMC10385408 DOI: 10.3390/tropicalmed8070358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
Strongyloides and cytomegalovirus co-infections are rarely reported, even though they are distinguished by high morbidity and mortality, especially in immunocompromised hosts. We narratively reviewed the literature on reported cases of Strongyloides and CMV co-infections in immunosuppressed patients. Most cases occurred in males with a median age of 47 (IQR, 37-59). Strongyloides/CMV co-infections occurred among immunocompromised hosts, especially in solid organ transplants and hematological or rheumatological diseases. Most of the patients underwent a course of steroid treatment before the diagnosis of co-infections. Other common immunomodulatory agents were tacrolimus and mycophenolate. The first clinical manifestations of co-infections were mainly gastrointestinal, followed by respiratory symptoms. CMV was, in most patients, co-infected with an isolated reactivation, although Strongyloides manifested especially as hyperinfection syndrome. Ganciclovir and ivermectin are the mainstays of CMV and Strongyloides treatment. However, the treatment mortality reported in this narrative review is around 52.4%. Interestingly secondary bacterial infections are common in CMV/Strongyloides-infected patients.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
| | - Elena Crisà
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Alberto Gaviraghi
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Barbara Rizzello
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | - Fabrizio Carnevale-Schianca
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Daniela Caravelli
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Marco Fizzotti
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Francesco Tolomeo
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Umberto Vitolo
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | - Piero Fenu
- Healthcare Management, IRCCS Candiolo, 10100 Candiolo, Italy
| | - Vanesa Gregorc
- Unit of Oncology and Haematology, Candiolo Cancer Institute (FPO-IRCCS), Strada Provinciale 142, Km 3,95, 10060 Candiolo, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Valeria Ghisetti
- Microbiology Unit, Amedeo di Savoia Hospital, 10100 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
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26
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Lupia T, Crisà E, Gaviraghi A, Rizzello B, Di Vincenzo A, Carnevale-Schianca F, Caravelli D, Fizzotti M, Tolomeo F, Vitolo U, De Benedetto I, Shbaklo N, Cerutti A, Fenu P, Gregorc V, Corcione S, Ghisetti V, De Rosa FG. Strongyloides spp. and Cytomegalovirus Co-Infection in Patient Affected by Non-Hodgkin Lymphoma. Trop Med Infect Dis 2023; 8:331. [PMID: 37368749 DOI: 10.3390/tropicalmed8060331] [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: 05/23/2023] [Revised: 06/15/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
To our knowledge, we have described the first case of Strongyloides/Cytomegalovirus (CMV) concomitant infection that occurred in a European country. The patient was a 76-year-old woman affected by relapsed non-Hodgkin lymphoma who presented interstitial pneumonia with a rapidly progressive worsening of respiratory insufficiency, leading to cardiac dysfunction and consequent death. CMV reactivation is a common complication in immunocompromised patients, while hyperinfection/disseminated strongyloidiasis (HS/DS) is rare in low endemic regions, but has been widely described in Southeast Asia and American countries. HS and DS are two consequences of the failure of infection control by the immune system: HS is the uncontrolled replication of the parasite within the host and DS the spreading of the L3 larvae in organs other than the usual replication sites. Only a few cases of HS/CMV infection have been reported in the literature, and only in one patient with lymphoma as an underlying disease. The clinical manifestations of these two infections overlap, usually leading to a delayed diagnosis and a consequent poor outcome.
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Affiliation(s)
- Tommaso Lupia
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
| | - Elena Crisà
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Alberto Gaviraghi
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Barbara Rizzello
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | | | - Daniela Caravelli
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Marco Fizzotti
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Francesco Tolomeo
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Umberto Vitolo
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | | | - Piero Fenu
- Healthcare Management, IRCCS Candiolo, 10100 Candiolo, Italy
| | - Vanesa Gregorc
- Unit of Oncology and Haematology, Candiolo Cancer Institute, 10060 Candiolo, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- School of Medicine, Tufts University, Boston, MA 02111, USA
| | - Valeria Ghisetti
- Microbiology Unit, Amedeo di Savoia Hospital, 10100 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Unit of Infectious Diseases, Cardinal Massaia, 14100 Asti, Italy
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
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27
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Yongbantom A, Sribenjalux W, Manomaiwong N, Meesing A. Efficacy of Oral Ivermectin as Empirical Prophylaxis for Strongyloidiasis in Patients Treated with High-Dose Corticosteroids: A Retrospective Cohort Study. Am J Trop Med Hyg 2023; 108:1183-1187. [PMID: 37127266 PMCID: PMC10540102 DOI: 10.4269/ajtmh.22-0712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/20/2023] [Indexed: 05/03/2023] Open
Abstract
People living in areas endemic for strongyloidiasis are at risk of latent Strongyloides stercoralis infection. Corticosteroid therapy is a well-established risk factor for life-threatening hyperinfection syndrome and disseminated disease owing to suppression of the immune system. There are limited data available on the efficacy and cost of providing oral ivermectin prophylaxis to all patients receiving high-dose corticosteroids for strongyloidiasis in endemic areas. We thus conducted this retrospective cohort study at Khon Kaen University's Srinagarind Hospital from 2015 to 2019. Inclusion criteria were as follows: age ≥ 18 years, having received ≥ 0.5 mg/kg/day of prednisolone or equivalent for at least 14 days, and hospitalization during the study period. A total of 250 patients were included in the study: 125 in the empirical prophylaxis group (prescribed ivermectin even if fecal examination results were negative or nonexistent) and the remaining patients in the definite therapy group (prescribed ivermectin only if S. stercoralis was detected by fecal examination). The prevalence of strongyloidiasis at enrollment estimated by fecal examination was 5.5%. Ivermectin was given to 125 patients (100%) in the prophylaxis group compared with 12 (9.6%) in the definite therapy group (P value < 0.001). During the 12-month follow-up period, S. stercoralis was detected in three patients, two in the prophylaxis group and one in the definite therapy group (P value = 1.000). No cases of hyperinfection syndrome or disseminated disease were found. The empirical prophylaxis strategy had a significantly higher cost than the definite therapy strategy (563 versus 254, P value < 0.001) and did not demonstrate superior efficacy in strongyloidiasis prevention.
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Affiliation(s)
- Akedanai Yongbantom
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wantin Sribenjalux
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Natapong Manomaiwong
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Atibordee Meesing
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen, Thailand
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28
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Rosca EC, Heneghan C, Spencer EA, Plüddemann A, Maltoni S, Gandini S, Onakpoya IJ, Evans D, Conly JM, Jefferson T. Coinfection with Strongyloides and SARS-CoV-2: A Systematic Review. Trop Med Infect Dis 2023; 8:tropicalmed8050248. [PMID: 37235296 DOI: 10.3390/tropicalmed8050248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Treatments for COVID-19, including steroids, might exacerbate Strongyloides disease in patients with coinfection. We aimed to systematically review clinical and laboratory features of SARS-CoV-2 and Strongyloides coinfection, investigate possible interventions, assess outcomes, and identify research gaps requiring further attention. METHODS We searched two electronic databases, LitCOVID and WHO, up to August 2022, including SARS-CoV-2 and Strongyloides coinfection studies. We adapted the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system for standardized case causality assessment to evaluate if using corticosteroids or other immunosuppressive drugs in COVID-19 patients determined acute manifestations of strongyloidiasis. RESULTS We included 16 studies reporting 25 cases of Strongyloides and SARS-CoV-2 coinfection: 4 with hyperinfection syndrome; 2 with disseminated strongyloidiasis; 3 with cutaneous reactivation of strongyloidiasis; 3 with isolated digestive symptoms; and 2 with solely eosinophilia, without clinical manifestations. Eleven patients were asymptomatic regarding strongyloidiasis. Eosinopenia or normal eosinophil count was reported in 58.3% of patients with Strongyloides reactivation. Steroids were given to 18/21 (85.7%) cases. A total of 4 patients (19.1%) received tocilizumab and/or Anakirna in addition to steroids. Moreover, 2 patients (9.5%) did not receive any COVID-19 treatment. The causal relationship between Strongyloides reactivation and COVID-19 treatments was considered certain (4% of cases), probable (20% of patients), and possible (20% of patients). For 8% of cases, it was considered unlikely that COVID-19 treatment was associated with strongyloidiasis reactivations; the relationship between the Strongyloides infection and administration of COVID-19 treatment was unassessable/unclassifiable in 48% of cases. Of 13 assessable cases, 11 (84.6%) were considered to be causally associated with Strongyloides, ranging from certain to possible. CONCLUSIONS Further research is needed to assess the frequency and risk of Strongyloides reactivation in SARS-CoV-2 infection. Our limited data using causality assessment supports recommendations that clinicians should screen and treat for Strongyloides infection in patients with coinfection who receive immunosuppressive COVID-19 therapies. In addition, the male gender and older age (over 50 years) may be predisposing factors for Strongyloides reactivation. Standardized guidelines should be developed for reporting future research.
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Affiliation(s)
- Elena C Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu 2, 300041 Timisoara, Romania
| | - Carl Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Elizabeth A Spencer
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Annette Plüddemann
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Susanna Maltoni
- Division of Research and Innovation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Igho J Onakpoya
- Department of Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK
| | - David Evans
- Li Ka Shing Institute of Virology and Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - John M Conly
- Departments of Medicine, Microbiology, Immunology & Infectious Diseases, and Pathology & Laboratory Medicine, Synder Institute for Chronic Diseases and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 1N4, Canada
| | - Tom Jefferson
- Department of Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK
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29
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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.
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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
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Carranza-Rodríguez C, López-Delgado L, Granados-Magan Á, Pérez-Arellano JL. Seroprevalence of Strongyloides stercolaris in Patients about to Receive Immunosuppressive Treatment in Gran Canaria (Spain). Trop Med Infect Dis 2023; 8:tropicalmed8030181. [PMID: 36977182 PMCID: PMC10057594 DOI: 10.3390/tropicalmed8030181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/17/2023] [Accepted: 03/18/2023] [Indexed: 03/22/2023] Open
Abstract
Strongyloides stercoralis infection is generally asymptomatic or mildly symptomatic, but in the immunosuppressed host, it is associated with more severe and complicated forms with a worse prognosis. S. stercoralis seroprevalence was studied in 256 patients before receiving immunosuppressive treatment (before kidney transplantation or starting biological treatments). As a control group, serum bank data of 642 individuals representative of the population of the Canary Islands were retrospectively analyzed. To avoid false positives due to cross-reactivity with other similar helminth antigens present in the study area, IgG antibodies to Toxocara spp. and Echinococcus spp. were evaluated in cases positive for Strongyloides. The data show this is a prevalent infection: 1.1% of the Canarian population, 2.38% of Canarian individuals awaiting organ transplants and 4.8% of individuals about to start biological agents. On the other hand, strongyloidiasis can remain asymptomatic (as observed in our study population). There are no indirect data, such as country of origin or eosinophilia, to help raise suspicion of the disease. In summary, our study suggests that screening for S. stercoralis infection should be performed in patients who receive immunosuppressive treatment for solid organ transplantation or biological agents, in line with previous publications.
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Affiliation(s)
- Cristina Carranza-Rodríguez
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Correspondence: ; Tel.: +34-928451213; Fax: +34-928441413
| | - Laura López-Delgado
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - Álvaro Granados-Magan
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
| | - José-Luis Pérez-Arellano
- Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
- Departamento de Ciencias Médicas y Quirúrgicas, Universidad de Las Palmas de Gran Canaria, 35016 Las Palmas de Gran Canaria, Spain
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Mewara A, Gudisa R, Sharma N, Kanaujia R. A fatal case of Strongyloides hyperinfection with obscure risk factors. Eur J Clin Microbiol Infect Dis 2023; 42:661-663. [PMID: 36930391 DOI: 10.1007/s10096-023-04588-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Abhishek Mewara
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Rajendra Gudisa
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nikita Sharma
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rimjhim Kanaujia
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Strongyloides and COVID-19: Challenges and Opportunities for Future Research. Trop Med Infect Dis 2023; 8:tropicalmed8020127. [PMID: 36828543 PMCID: PMC9967524 DOI: 10.3390/tropicalmed8020127] [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: 01/11/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Strongyloides stercoralis is a soil transmitted helminth endemic to tropical and subtropical areas that can persist for decades in immunocompetent human hosts as a chronic asymptomatic infection. The use of corticosteroids, a mainstay of treatment for patients hospitalized with severe coronavirus disease (COVID-19), can trigger a life-threatening Strongyloides hyperinfection syndrome and disseminated disease. We identified 22 previously published cases of strongyloidiasis occurring in individuals with COVID-19, with one death reported among the seven patients who had Strongyloides hyperinfection syndrome. A total of seventeen patients had previously received corticosteroids, and of the five with no prior corticosteroid use, one presented with hyperinfection syndrome. We identify the key challenges in the diagnosis and treatment of Strongyloides within the context of COVID-19, including our imprecise knowledge of the global distribution of Strongyloides, the overlapping symptoms and signs of COVID-19 and Strongyloides hyperinfection syndrome, the limited utility of eosinophilia as a clinical marker for strongyloidiasis in this setting, the lack of validated algorithms to screen for Strongyloides prior to corticosteroid use, and the paucity of treatment options for critically ill patients with COVID-19 who cannot take oral ivermectin. Future research should focus on improved diagnostic methods and population prevalence estimates, optimizing the approaches for Strongyloides screening in persons with COVID-19 (including clinical trial participants and strategies for resource-limited settings) and better defining the role of pre-emptive treatment.
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Tebib N, Tebib N, Paredes M, Castro R, Baggio S, Torrico MV, Leon AAF, Zamorano MH, Chappuis F, Getaz L. Prevalence and risk factors of Strongyloides stercoralis in haemodialysis in Cochabamba, Bolivia: a cross-sectional study. BMC Nephrol 2023; 24:27. [PMID: 36750775 PMCID: PMC9903486 DOI: 10.1186/s12882-023-03074-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Strongyloidiasis is an infectious disease that can be fatal in immunocompromised patients. Patients with end-stage renal failure who are on dialysis have a considerably weakened immune system, and organ transplantation is a major risk factor for severe strongyloidiasis. Knowledge of the local epidemiology in tropical and subtropical areas is an essential prerequisite for designing an appropriate strategy to prevent this potentially lethal complication. In this study, we aimed to estimate the prevalence and associated risk factors of S. stercoralis infection in patients on dialysis in Cochabamba, Bolivia. METHODS A cross-sectional study was carried out among patients undergoing haemodialysis in Cochabamba (elevation 2,500 m, temperate climate), collecting information on socio-demographic, lifestyle, and clinical variables, and using one coproparasitological technique (the modified Baermann technique) and one serological (ELISA) test for S.stercoralis diagnosis. RESULTS In total, 149 patients participated in the study (mean age = 51.4 years, 48.3% male). End-stage renal disease was predominantly (59%) of hypertensive and/or diabetic origin. The positive serological prevalence was 18.8% (95% CI: 13.3%-25.9%). Based on the sensitivity and specificity of the ELISA test, the estimate of the actual prevalence was 15.1% (95% CI: 9.4%-20.7%). Stool samples of 105 patients (70.5%) showed a coproparasitological prevalence of 1.9% (95% CI: 0.52%-6.68%). No potential risk factors were significantly associated with S. stercoralis infection. CONCLUSIONS We found a high seroprevalence of S. stercoralis in Bolivian patients undergoing haemodialysis in Cochabamba. We recommend presumptive antiparasitic treatment at regular intervals to avoid the potentially fatal complications of severe strongyloidiasis.
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Affiliation(s)
- Nicolas Tebib
- grid.492936.30000 0001 0144 5368Intensive Care Unit, Centre Hospitalier de Bienne, Bienne, Switzerland
| | - Nathalie Tebib
- grid.492936.30000 0001 0144 5368Division of Internal Medicine, Centre Hospitalier de Bienne, Bienne, Switzerland
| | - Mauricio Paredes
- Centro de Hemodiálisis de La Media Luna Roja de Irán, Cochabamba, Bolivia
| | - Rosario Castro
- Division of Infectious Diseases, Hospital Clınico VIEDMA, Cochabamba, Bolivia
| | - Stéphanie Baggio
- grid.150338.c0000 0001 0721 9812Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland ,grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | | | | | - Francois Chappuis
- grid.150338.c0000 0001 0721 9812Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Laurent Getaz
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland. .,Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
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Scott J, Emeto TI, Melrose W, Warner J, Rush C. Seroepidemiology of Strongyloides spp. Infection in Balimo, Western Province, Papua New Guinea. Am J Trop Med Hyg 2023; 108:346-352. [PMID: 36572010 PMCID: PMC9896327 DOI: 10.4269/ajtmh.22-0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/12/2022] [Indexed: 12/27/2022] Open
Abstract
Strongyloidiasis in Papua New Guinea (PNG) is poorly understood. There have been limited surveys describing the levels of endemicity in some regions of PNG, but in the Western Province, its occurrence and level of burden are unknown. This study aimed to determine the seroepidemiology of Strongyloides spp. seropositivity within a community located in the Balimo region of the Western Province. Plasma samples were collected from 120 adult participants and were subjected to anti-IgG Strongyloides spp. serological testing. Logistical regression analyses were performed to identify relationships between strongyloidiasis and attributes of sociodemography. In this cross-sectional cohort study, 22.5% (27/120; 95% CI: 15.9-30.8%) of participants were seropositive for strongyloidiasis. Participants with higher body mass indices were less likely to be seropositive for Strongyloides spp. infection (odds ratio [OR] = 0.85, P value = 0.008), and in the multivariable analysis, increasing units of age (adjusted OR [aOR] = 0.93, P value = 0.048) and participants ≤ 40 years old were associated with a decreased likelihood of Strongyloides spp. seropositivity (aOR = 0.07, P value = 0.034). The results from this study indicate that the occurrence of strongyloidiasis is high in the Western Province, PNG, and age is a determining factor of seroreactivity. This study provides evidence of endemic strongyloidiasis in this community and raises questions as to the impact of this neglected disease and other intestinal parasites on disease burden and comorbidities.
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Affiliation(s)
- Jessica Scott
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Theophilus I. Emeto
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
- World Health Organization Collaborating Centre for Vector-Borne and Neglected Tropical Diseases, James Cook University, Townsville, Australia
| | - Wayne Melrose
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Jeffrey Warner
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
| | - Catherine Rush
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
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Oshima R, Matsuhisa T, Kondo T, Sato M, Sato J, Yamamura M. Strongyloidiasis presenting during treatment of low-dose glucocorticoid plus rituximab for anti-signal recognition particle antibody-positive polymyositis: A case report. Mod Rheumatol Case Rep 2023; 7:113-116. [PMID: 36264196 DOI: 10.1093/mrcr/rxac083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
Strongyloidiasis, an intestinal parasitic infection caused by Strongyloides stercoralis, rarely occurs in Japan. When treated with immunosuppressive drugs, two potentially lethal conditions, hyperinfection and dissemination, may develop in asymptomatic carriers of this parasite. We report the development of strongyloidiasis during treatment of polymyositis with glucocorticoids plus rituximab (RTX). A 44-year-old woman had been diagnosed with anti-signal recognition particle antibody-positive polymyositis with interstitial pneumonia 6 years previously, for which she had recently been receiving prednisolone at 5 mg/day and RTX at 375 mg/m2 twice every 3 months. Her condition appeared to be well controlled. She was admitted to our hospital with a 1-month history of chronic diarrhoea and epigastric pain. Standard microscopic examination of a sample of faeces revealed the presence of S. stercoralis; however, serologic testing for parasites was negative. Treatment with ivermectin alleviated her inflammatory diarrhoea and eradicated the faecal parasites. We believe that our patient had an exacerbation of S. stercoralis infection (hyperinfection syndrome) that was exacerbated by low-dose glucocorticoids plus RTX. Strongyloidiasis should be considered in immunocompromised individuals with unexplained diarrhoea, even in non-endemic areas.
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Affiliation(s)
- Ryo Oshima
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takaharu Matsuhisa
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takeshi Kondo
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Motoki Sato
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Juichi Sato
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiro Yamamura
- Department of Rheumatology and Collagen Disease Centre, Okayama Saiseikai General Hospital, Okayama, Japan
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Sangwalee W, Norkaew J, Inthachak S, Janwan P, Rodpai R, Sanpool O, Sadaow L, Boonroumkaew P, Intapan PM, Maleewong W, Thanchomnang T. Prevalence of intestinal parasitic infections and genetic differentiation of Strongyloides stercoralis among migrant workers from Myanmar, Lao PDR and Cambodia in northeastern Thailand. PLoS One 2022; 17:e0279754. [PMID: 36584196 PMCID: PMC9803317 DOI: 10.1371/journal.pone.0279754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/13/2022] [Indexed: 01/01/2023] Open
Abstract
Intestinal parasitic infections (IPIs) remain a public-health problem worldwide, including in countries of the Lower Mekong subregion. Increases in human migration from neighboring countries might cause reemerging parasitic infections, leading to spread of parasites in the landscape. Here, we conducted a cross-sectional study to identify the prevalence of IPIs in migrant workers from Myanmar, Lao PDR, and Cambodia who were dwelling in Nakhon Ratchasima Province, northeastern Thailand. The identification of Strongyloides species and genetic differentiation of worms from migrant workers with different countries of origin was also assessed. Fresh stool samples were collected from 338 migrant workers and examined for evidence of IPIs using agar plate culture (APC) and the formalin-ethyl acetate concentration technique (FECT). Among those nine samples positive for nematodes by APC, the Strongyloides or hookworm species present was confirmed using the polymerase chain reaction (PCR) followed by DNA sequencing. This revealed eight cases of Strongyloides stercoralis infection and one of Necator americanus. Fifty-one out of 338 individuals (15.09%) were positive for IPIs using FECT and APC. Eggs of Opisthorchis-like flukes were the most common parasite (11.83% of samples), followed by S. stercoralis (2.37%), Entamoeba coli (1.50%), hookworm (0.89%), Taenia sp. (0.60%) and Hymenolepis nana (0.30%). The genetic differentiation of S. stercoralis recovered from migrant workers with different countries of origin was analyzed. Specimens of S. stercoralis isolated from workers from Lao PDR, Cambodia and Myanmar were genetically similar to those sequenced from Thailand. However, there were population-genetic differences between S. stercoralis from these Southeast Asian countries and other regions of the world. This study demonstrated that IPIs were prevalent in migrant workers in the northeastern region of Thailand. Our findings provided molecular confirmation of the presence of S. stercoralis and explored the genetic differentiation of S. stercoralis from those infected migrant workers. An effective anti-parasitic drug should be provided for migrant workers and its administration enforced.
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Affiliation(s)
- Wararat Sangwalee
- Faculty of Public Health, Vongchavalitkul University, Nakhon Ratchasima, Thailand
| | - Jun Norkaew
- Faculty of Public Health, Vongchavalitkul University, Nakhon Ratchasima, Thailand
| | - Sengchoy Inthachak
- Faculty of Education, Vongchavalitkul University, Nakhon Ratchasima, Thailand
| | - Penchom Janwan
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat, Thailand
| | - Rutchanee Rodpai
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Oranuch Sanpool
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Lakkhana Sadaow
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Patcharaporn Boonroumkaew
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Pewpan M. Intapan
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | - Wanchai Maleewong
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand,Mekong Health Science Research Institute, Khon Kaen University, Khon Kaen, Thailand
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Morel R, Maddumabandara K, Amarasinghe N, Amarangani S, Amarasinghe A, Gunathilaka M, Wathsala G, Bandara L, Wijesundara S, Gunaratne N, Waduge R, Medagama A. Strongyloidiasis infection in a borderline lepromatous leprosy patient with adrenocorticoid insufficiency undergoing corticosteroid treatment: a case report. J Med Case Rep 2022; 16:458. [PMID: 36482424 PMCID: PMC9733215 DOI: 10.1186/s13256-022-03673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Strongyloidiasis is a soil-transmitted helminthiasis mainly caused by Strongyloides stercoralis. It is endemic to the tropics and subtropics. Sri Lanka has a 0-1.6% prevalence rate. S. stercoralis infection was identified in a 33-year-old Sri Lankan male patient treated with corticosteroids for borderline lepromatous leprosy with adrenocortical dysfunction. CASE PRESENTATION In March 2020, a 33-year-old Sri Lankan (Sinhalese) male patient presented with watery diarrhea, lower abdominal pain, and post-prandial abdominal fullness. Previously, he was diagnosed with borderline lepromatous leprosy and was treated with rifampicin, clofazimine, and prednisolone 60 mg daily since July 2019. After developing gastrointestinal symptoms, he had defaulted leprosy treatment including the prednisolone for 3 months. Duodenal biopsy revealed numerous intraepithelial nematodes within the lumina of glands in the duodenum whose appearance favored Strongyloides. Fecal wet smear revealed numerous Strongyloidis stercoralis L1 rhabditiform larvae. Larval tracks were seen in the agar plate culture. L3 filariform larvae of Strongyloidis stercoralis were seen in the Harada-Mori culture. In addition, the short synacthen test revealed adrenocortical insufficiency, and oral hydrocortisone and fludrocortisone were started with albendazole treatment against strongyloidiasis. Fecal wet smear and culture repeated after treatment with albendazole were negative for Strongyloidis stercoralis. The patient was discharged in July 2020 on oral hydrocortisone. One month later his condition was reviewed and the repeated fecal wet smear and agar plate culture was normal. He is being followed up every 3 months. CONCLUSION This is the first case of strongyloidiasis diagnosed in a patient with borderline lepromatous leprosy from Sri Lanka. The patient manifested symptoms of strongyloidiasis while on high-dose steroid therapy for his lepromatous reaction. Subsequently, the patient not only discontinued his steroid therapy, but also developed adrenocortical insufficiency as a complication of leprosy. Therefore, although diagnosis of strongyloidiasis was delayed, his subsequent low steroid levels probably protected him from disseminated disease. This is an interesting case where symptomatic strongyloidiasis was diagnosed in a patient who was initially treated with high-dose steroids but subsequently developed adrenocortical insufficiency. We emphasize the need to screen all patients prior to the commencement of immunosuppressive therapy.
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Affiliation(s)
- Rumala Morel
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Kusala Maddumabandara
- grid.11139.3b0000 0000 9816 8637Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Nisansala Amarasinghe
- grid.11139.3b0000 0000 9816 8637Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Sujeewa Amarangani
- grid.11139.3b0000 0000 9816 8637Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Anjalie Amarasinghe
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Mihiri Gunathilaka
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Gayani Wathsala
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Lakmalee Bandara
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Sunil Wijesundara
- grid.11139.3b0000 0000 9816 8637Department of Parasitology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Nilupuli Gunaratne
- grid.11139.3b0000 0000 9816 8637Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Roshitha Waduge
- grid.11139.3b0000 0000 9816 8637Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
| | - Arjuna Medagama
- grid.11139.3b0000 0000 9816 8637Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Kandy, Sri Lanka
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Ramprasad A, Kodan P, Jonnalagadda K, Bir R, Verma N, Sahni K, Vikram NK, Soneja M, Mirdha BR, Wig N. Seroprevalence of Strongyloides infection among steroid recipients in a tertiary care centre in North India. LE INFEZIONI IN MEDICINA 2022; 30:593-601. [PMID: 36482946 PMCID: PMC9715000 DOI: 10.53854/liim-3004-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/10/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Strongyloides stercoralis (S. stercoralis), a unique parasite, can cause mortal disease even years after the exposure. Iatrogenic use of steroids can complicate asymptomatic infections to a life-threatening hyperinfection and/or disseminated infection. Data regarding seroprevalence of strongyloidiasis remains scarce and this knowledge gap needs due attention in many endemic countries including India. AIM The present study is aimed at assessing the seroprevalence of Strongyloides infection and the need for routine screening among individuals receiving steroid therapy. METHODOLOGY Eighty patients receiving steroid therapy and thirty healthy volunteers who had not received any immunosuppressive drugs and/or anthelminthic therapy in last six months were enrolled as cases and controls respectively and they were screened by Strongyloides IgG ELISA. RESULTS Among the 80 patients on steroids, the mean cumulative prednisolone equivalent dose received was 8.2 g (±11.2 g) for a mean duration of 184 days, 16 patients (20%, 95% CI 11.9-30) had a positive Strongyloides IgG serology. Only 4 controls (4/30, 13.3%, CI 3.8-30.7) tested positive (p=0.4). CONCLUSIONS Our study demonstrated a Strongyloides seroprevalence of 20% in the study population emphasizing the need for screening for Strongyloides infection prior to immunosuppressive therapy in order to prevent hyperinfection or possible dissemination.
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Affiliation(s)
- Aishwarya Ramprasad
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Parul Kodan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Kirtana Jonnalagadda
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Raunak Bir
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi,
India
| | - Nishant Verma
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi,
India
| | - Kanika Sahni
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi,
India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Bijay Ranjan Mirdha
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi,
India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
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Saqib SU, Sood S, Wong L, Patel A. Strongyloides colitis, a rare but important mimic of Crohn's disease, resulting in coma and multi-organ failure: a case report. Surg Case Rep 2022; 8:211. [PMID: 36447071 PMCID: PMC9708997 DOI: 10.1186/s40792-022-01568-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/14/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Strongyloides colitis is a severe form of strongyloidiasis that carries a high mortality rate if untreated. There is an overlapping clinical presentation between Strongyloides colitis and Crohn's disease. Here, we present a case of a patient who was diagnosed with Crohn's disease and was treated with immunosuppressant therapy which resulted in a poor outcome. CASE PRESENTATION A middle-aged, native African male presented with diarrhea, abdominal pain, and weight loss. Colonoscopy showed some patchy inflammation in the caecum, which on biopsy was suggestive of Crohn's disease. He had a short course of steroids before being admitted to an emergency with abdominal pain, diarrhea, malnutrition, and severe weight loss. Initial conservative treatment failed, and he became acutely unwell and septic with peritonitis. Laparotomy was carried out, which showed mild inflammation in the terminal ileum, which was not resected. Postoperatively, the patient became comatose and went into multi-organ dysfunction. He failed to progress, and a further laparotomy and subtotal colectomy were performed on the 12th postoperative day. His multi-organ failure progressed, and he succumbed to death 4 days later. DISCUSSION Strongyloides stercoralis is a parasite causing an enteric infection in animals and humans. Strongyloidiasis in immunocompetent individuals is usually an indolent disease. However, in immunocompromised individuals, it can cause hyperinfective syndrome. Patients with strongyloid colitis should undergo colonoscopy and biopsy where acute inflammation with eosinophilic infiltrates indicates parasitic infiltration of the colonic wall. Surgery is generally not indicated, and any surgical intervention with misdiagnosis of a flare-up of IBD can be very detrimental to the patient. CONCLUSION Strongyloid colitis can very harmfully mimic Crohn's colitis, and the use of steroids and immunosuppressants can disseminate parasitic infection. Hyperinfection syndrome can lead to sepsis, organ dysfunction, and comma. Disseminated infection carries a high mortality.
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Affiliation(s)
- Sabah Uddin Saqib
- grid.412570.50000 0004 0400 5079University Hospital Coventry and Warwickshire Trust, Coventry, UK
| | - Sumit Sood
- grid.412570.50000 0004 0400 5079University Hospital Coventry and Warwickshire Trust, Coventry, UK
| | - Ling Wong
- grid.412570.50000 0004 0400 5079University Hospital Coventry and Warwickshire Trust, Coventry, UK
| | - Abhilasha Patel
- grid.412570.50000 0004 0400 5079University Hospital Coventry and Warwickshire Trust, Coventry, UK
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40
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Fatal Case of Autochthonous Strongyloides stercoralis Hyperinfection in an Immunosuppressed Calabrian Patient. REPORTS 2022. [DOI: 10.3390/reports5040047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Strongyloides stercoralis is an intestinal nematode that can induce disseminated infection in immunocompromised patients. It is most commonly acquired in tropical and subtropical countries; however, foci of the infection have also been reported in temperate geographic areas. In non-endemic areas, the diagnosis of an S. stercoralis infection is challenging due to the variety of clinical symptoms. Herein, we report the case of a patient, born and raised in the Calabria region of Southern Italy, who presented with melanoma and S. stercoralis hyperinfection, which is characterized by dyspnea, productive cough, inappetence, marked asthenia, weight loss, and Klebsiella pneumoniae bacteremia. He worked as a farmer and never traveled to another country known to be endemic for S. stercoralis. Despite the prompt identification of the parasite with sputum microscopy and the initiation of therapy with ivermectin and piperacillin–tazobactam, the patient later died. This case underscores the continued risk for S. stercoralis infection even in geographic areas that were previously considered non-endemic for the nematode and indicates that the geographic distribution of S. stercoralis may be expanding in Italy.
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Abad CLR, Bhaimia E, Schuetz AN, Razonable RR. A comprehensive review of Strongyloides stercoralis infection after solid organ and hematopoietic stem cell transplantation. Clin Transplant 2022; 36:e14795. [PMID: 35987856 PMCID: PMC10078215 DOI: 10.1111/ctr.14795] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND We reviewed the scientific literature to gain insight on the epidemiology and outcome of Strongyloides stercoralis infections after transplantation. METHODS CINAHL, PUBMED, and OVID/MEDLINE were reviewed from inception through March 31, 2022 using key words Strongyloides and transplantation. RESULTS Our review identified 108 episodes of Strongyloides infection among 91 solid organ transplant (SOT) and 15 hematopoietic cell transplant (HCT) recipients. Median time to infection was 10.8 (range, .14-417) and 8.8 (range, 0-208) weeks after SOT and HCT, respectively. Gastrointestinal symptoms were frequent (86/108 [79.6%]), while skin rash (22/108 [20.3%]) and fever (31/103 [30%]) were less common. Peripheral eosinophilia was observed in half of patients (41/77 [53.2%]). Bacteremia (31/59 [52.5%]) was frequently due to Gram-negative organisms (24/31 [77.4%]). Abnormal chest radiologic findings were reported in half (56/108 [51.9%]). The majority had hyperinfection syndrome (97/108 [89.8%]) while disseminated strongyloidiasis was less common (11/108 [10.2%]). Thirty-two cases were categorized as donor-derived infection (DDI), with donors (23/24 [95.8%]) who had traveled to or lived in endemic areas. Median time to DDI was 8 weeks (range .5-34.3 weeks) after transplantation. Treatment consisted of ivermectin (n = 26), a benzimidazole (n = 27), or both drugs (n = 28). There was high all-cause mortality (48/107, 44.9%) and a high Strongyloides-attributable mortality (32/49, 65.3%). CONCLUSIONS Strongyloidiasis should be strongly considered among recipients with epidemiologic risk factors for infection, even in the absence of eosinophilia or rash. A policy that provides guidance on pro-active screening is needed, to ensure preventive measures are provided to recipients at increased risk.
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Affiliation(s)
- Cybele Lara R Abad
- Department of Medicine, Division of Infectious Diseases, University of the Philippines-Manila, Philippine General Hospital, Manila, Philippines
| | - Eric Bhaimia
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, and The William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine and Sciences, Rochester, Minnesota, USA
| | - Audrey N Schuetz
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Sciences, Rochester, Minnesota, USA
| | - Raymund R Razonable
- Department of Medicine, Division of Public Health, Infectious Diseases and Occupational Medicine, and The William J Von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine and Sciences, Rochester, Minnesota, USA
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Controversies in neuroimmunology: multiple sclerosis, vaccination, SARS-CoV-2 and other dilemas. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:78-99. [PMID: 36322548 PMCID: PMC9714524 DOI: 10.7705/biomedica.6366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Indexed: 12/04/2022]
Abstract
Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.
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Tan JT, Tseng CW. Strongyloides stercoralis hyperinfection presenting with shock and intermittent eosinophilia: A case report. Medicine (Baltimore) 2022; 101:e30490. [PMID: 36107578 PMCID: PMC9439756 DOI: 10.1097/md.0000000000030490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis. The clinical presentation varies according to the stage of infection. Diagnosing strongyloidiasis is a challenge in clinical practice due to the inconsistency of eosinophilia and the low sensitivity of standard microscopic stool examination. Strongyloides infection presenting with shock is rare. PATIENT CONCERNS In this case, the condition of a 77-year-old immunocompromised patient with intermittent diarrhea progressed to shock and hypoalbuminemia. Reviewing her medical records, we learned that she had experienced intermittent peripheral eosinophilia during the past 10 months. Although a series of examinations were done, the disease progressed and the diagnosis remained uncertain. DIAGNOSIS Using standard microscopic stool examination and gastroduodenscopy with biopsy, a diagnosis of strongyloidiasis was made. INTERVENTIONS After the diagnosis of strongyloidiasis was made, 2 courses of ivermectin were administered. OUTCOMES The patient recovered uneventfully after treatment and there is no recurrence of eosinophilia in 1 year follow-up. LESSONS This report provides a brief review of the current modalities used for diagnosing strongyloidiasis. It emphasizes the low sensitivity of microscopic examination, and highlights the role of gastroduodenoscopy in the diagnosis of strongyloidiasis. This report also assures that patients with strongyloidiasis have a good prognosis when they are treated timely and appropriately.
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Affiliation(s)
- Jih Tze Tan
- School of Medicine, Tzu Chi University, Hualien, Taiwan (R.O.C.)
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan (R.O.C.)
| | - Chih-Wei Tseng
- School of Medicine, Tzu Chi University, Hualien, Taiwan (R.O.C.)
- Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan (R.O.C.)
- *Correspondence: Chih-Wei Tseng, Division of Gastroenterology, Department of Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Road, Dalin Township, Chiayi County 622, Taiwan (R.O.C.) (e-mail: )
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Buonfrate D, Rodari P, Barda B, Page W, Einsiedel L, Watts M. Current pharmacotherapeutic strategies for Strongyloidiasis and the complications in its treatment. Expert Opin Pharmacother 2022; 23:1617-1628. [PMID: 35983698 DOI: 10.1080/14656566.2022.2114829] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Strongyloidiasis, an infection caused by the soil-transmitted helminth Strongyloides stercoralis, can lead immunocompromised people to a life-threatening syndrome. We highlight here current and emerging pharmacotherapeutic strategies for strongyloidiasis and discuss treatment protocols according to patient cohort. We searched PubMed and Embase for papers published on this topic between 1990 and May 2022. AREAS COVERED Ivermectin is the first-line drug, with an estimated efficacy of about 86% and excellent tolerability. Albendazole has a lower efficacy, with usage advised when ivermectin is not available or not recommended. Moxidectin might be a valid alternative to ivermectin, with the advantage of being a dose-independent formulation. EXPERT OPINION The standard dose of ivermectin is 200 µg/kg single dose orally, but multiple doses might be needed in immunosuppressed patients. In the case of hyperinfection, repeated doses are recommended up to 2 weeks after clearance of larvae from biological fluids, with close monitoring and further dosing based on review. Subcutaneous ivermectin is used where there is impaired intestinal absorption/paralytic ileus. In pregnant or lactating women, studies have not identified increased risk with ivermectin use. However, with limited available data, a risk-benefit assessment should be considered for each case.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria hospital, via Sempreboni 5, 37024 Negrar, Verona, Italy
| | - Paola Rodari
- Department of Infectious, Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria hospital, via Sempreboni 5, 37024 Negrar, Verona, Italy
| | - Beatrice Barda
- Ospedale La Carità, Ospedale regionale di Locarno, Locarno 6600, Switzerland
| | - Wendy Page
- Miwatj Health Aboriginal Corporation, 1424 Arnhem Rd, Nhulunbuy NT 0880, Australia
| | - Lloyd Einsiedel
- Peter Doherty Institute, University of Melbourne, 792 Elizabeth St, Melbourne VIC 3000, Australia
| | - Matthew 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
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Swan C, Phan T, McKew G. Clinical Performance of Real-Time Polymerase Chain Reaction for Strongyloides stercoralis Compared with Serology in a Nonendemic Setting. Am J Trop Med Hyg 2022; 107:355-358. [PMID: 35895584 PMCID: PMC9393460 DOI: 10.4269/ajtmh.21-1289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/04/2022] [Indexed: 08/03/2023] Open
Abstract
Strongyloides stercoralis is a nematode endemic to subtropical and tropical regions that may cause asymptomatic carriage, peripheral eosinophilia, cutaneous, gastrointestinal, and pulmonary disease, or hyperinfection syndrome. Conventional diagnostic methods for strongyloidiasis include feces microscopy and culture, with low sensitivity in chronic infection due to the low helminth burden, and serology, which may be prone to false-negative results with immunocompromise and false-positive results with other infections and immunological disorders. We evaluated a laboratory-developed real-time polymerase chain reaction (RT-PCR), detecting the 18S SSU ribosomal RNA gene, compared with conventional diagnostic methods, using serology via ELISA as the gold-standard. The population studied included tertiary hospital inpatients and outpatients residing in a nonendemic area. Seven hundred fifty unfixed stool specimens submitted sequentially between 2014 and 2018 were tested for S. stercoralis via microscopy and RT-PCR. Agar plate culture (APC), Harada-Mori culture (HMC), and ELISA were performed in conjunction with 141, 135, and 177 of the specimens, respectively. RT-PCR yielded 13 positive and 730 negative results, with inhibition in seven specimens. ELISA yielded 53 positive, 18 equivocal, and 106 negative results. Results for direct diagnostic methods obtained after treatment with ivermectin were excluded from the performance analysis. Compared with ELISA, RT-PCR, microscopy, APC, and HMC exhibited sensitivities of 38%, 6%, 3%, and 0%, respectively, and specificities of 100%. Given the low sensitivities commensurate with testing a population with remote infection and thus low parasite burden, we recommend a combination of serological and molecular diagnostic testing to achieve the best balance of sensitivity and specificity.
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Affiliation(s)
- Christopher Swan
- NSW Health Pathology, Department of Microbiology and Infectious Diseases, Concord Repatriation and General Hospital, Concord, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Thuy Phan
- NSW Health Pathology, Department of Microbiology and Infectious Diseases, Concord Repatriation and General Hospital, Concord, Australia
- School of Molecular and Biosciences, The University of Sydney, Sydney, Australia
| | - Genevieve McKew
- NSW Health Pathology, Department of Microbiology and Infectious Diseases, Concord Repatriation and General Hospital, Concord, Australia
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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46
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Singh S, Singh US. Coinfection with Strongyloides and Ascaris in a COVID-19-positive male presenting with acute abdomen: a case report. Future Microbiol 2022; 17:1099-1105. [PMID: 35899471 PMCID: PMC9332911 DOI: 10.2217/fmb-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Ascaris lumbricoides and Strongyloides stercoralis are soil-transmitted helminthic infections usually seen in people with poor socioeconomic conditions, hygiene and fecal sanitation living in endemic countries. Here, we present a case of coinfection in a COVID-positive older adult male presenting to our facility with symptoms of acute abdomen. Investigative workup guided timely diagnosis of the case. Prompt initiation of antihelminthic drugs together with antibiotics/antivirals for COVID symptoms resulted in favorable outcome in the case. A high index of suspicion on the part of the treating and diagnosing doctor is required in the COVID era. This will help not only in diagnosis but will also give an understanding to the exact pathogenesis for better patient outcome.
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Affiliation(s)
- Sweta Singh
- Department of Microbiology, Autonomous State Medical College, Mirzapur UP, India
| | - Uday S Singh
- Department of Radiodiagnosis, Advance Diagnostic Centre, Lucknow, UP, India
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47
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Munisankar S, Rajamanickam A, Balasubramanian S, Muthusamy S, Dolla CK, Menon PA, Chinnayan P, Whalen C, Gumne P, Kaur I, Nadimpalli V, Deverakonda A, Chen Z, David Otto J, Habitegiyorgis T, Kandaswamy H, Nutman TB, Babu S. Seroprevalence of Strongyloides stercoralis infection in a South Indian adult population. PLoS Negl Trop Dis 2022; 16:e0010561. [PMID: 35857754 PMCID: PMC9299326 DOI: 10.1371/journal.pntd.0010561] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The prevalence of Strongyloides stercoralis infection is estimated to be 30–100 million worldwide, although this an underestimate. Most cases remain undiagnosed due to the asymptomatic nature of the infection. We wanted to estimate the seroprevalence of S. stercoralis infection in a South Indian adult population.
Methods
To this end, we performed community-based screening of 2351 individuals (aged 18–65) in Kanchipuram District of Tamil Nadu between 2013 and 2020. Serological testing for S. stercoralis was performed using the NIE ELISA.
Results
Our data shows a seroprevalence of 33% (768/2351) for S. stercoralis infection which had a higher prevalence among males 36% (386/1069) than among females 29.8% (382/1282). Adults aged ≥55 (aOR = 1.65, 95% CI: 1.25–2.18) showed higher adjusted odds of association compared with other age groups. Eosinophil levels (39%) (aOR = 1.43, 95% CI: 1.19–1.74) and hemoglobin levels (24%) (aOR = 1.25, 95% CI: 1.11–1.53) were significantly associated with S. stercoralis infection. In contrast, low BMI (aOR = 1.15, 95% CI: 0.82–1.61) or the presence of diabetes mellitus (OR = 1.18, 95% CI: 0.83–1.69) was not associated with S. stercoralis seropositivity.
Conclusions
Our study provides evidence for a very high baseline prevalence of S. stercoralis infection in South Indian communities and this information could provide realistic and concrete planning of control measures.
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Affiliation(s)
- Saravanan Munisankar
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
- * E-mail:
| | - Anuradha Rajamanickam
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | - Suganthi Balasubramanian
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | - Satishwaran Muthusamy
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
| | | | | | | | - Christopher Whalen
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Paschaline Gumne
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Inderdeep Kaur
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Varma Nadimpalli
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Akshay Deverakonda
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Zhenhao Chen
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - John David Otto
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Tesfalidet Habitegiyorgis
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Harish Kandaswamy
- Office of Cyber Infrastructure and Computational Biology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States of America
| | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Subash Babu
- National Institutes of Health-National Institute for Research in Tuberculosis-International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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48
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Praveena R. Diagnosing parasitic infestation in a patient with tuberculosis. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i3.1221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This report describes a case of diarrhea, abdominal pain, and strongyloidiasis in a 33-year-old woman. She had co-existing abdominal tuberculosis. The role of repeated stool microscopy in patients with a compromised immune system with a high index of clinical suspicion for the parasite is important. Strongyloidiasis was not clinically suspected in this patient and was diagnosed as part of evaluation for diarrhoea. But the case raises the importance not only of testing for strongyloidiasis in tuberculosis patients with symptoms suspicious of strongyloidiasis but also therapy for the parasite in such instances. Treatment with steroids for tuberculosis may also worsen the symptoms of strongyloidiasis.
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De Liberato C, Iatta R, Scarito MA, Grifoni G, Dante G, Otranto D. Strongyloides stercoralis in a dog litter: Evidence suggesting a transmammary transmission. Acta Trop 2022; 231:106465. [PMID: 35427536 DOI: 10.1016/j.actatropica.2022.106465] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/29/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Strongyloides stercoralis is a soil-transmitted helminth with an unusual life cycle, causing canine and human strongyloidiasis, mainly endemic in tropical and subtropical areas. Following percutaneous or oral transmission of infective third-stage larvae in the vertebrate host, the parasite can cause autoinfection, leading to life-long infection. At present, the transmammary transmission was only assessed in experimentally infested dogs. Here, we provide observational evidence of S. stercoralis transmammary transmission in puppies suckling from a truffle dog from Central Italy, from where its presence was neglected.
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Affiliation(s)
- Claudio De Liberato
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy.
| | - Roberta Iatta
- Dipartimento Interdisciplinare di Medicina, Università di Bari, Piazza Giulio Cesare 11, Bari 70124, Italy
| | - Maria Alessia Scarito
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy
| | - Goffredo Grifoni
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy
| | - Giampiero Dante
- Istituto Zooprofilattico Sperimentale del Lazio e della Toscana "M. Aleandri", Via Appia Nuova 1411,Rome 00178 , Italy
| | - Domenico Otranto
- Dipartimento di Medicina Veterinaria, Università di Bari, Str. prov. per Casamassima km 3, Valenzano 70010, Italy
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Mendez P, Walsh B, Hallem EA. Using newly optimized genetic tools to probe Strongyloides sensory behaviors. Mol Biochem Parasitol 2022; 250:111491. [PMID: 35697205 PMCID: PMC9339661 DOI: 10.1016/j.molbiopara.2022.111491] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/25/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022]
Abstract
The oft-neglected human-parasitic threadworm, Strongyloides stercoralis, infects roughly eight percent of the global population, placing disproportionate medical and economic burden upon marginalized communities. While current chemotherapies treat strongyloidiasis, disease recrudescence and the looming threat of anthelminthic resistance necessitate novel strategies for nematode control. Throughout its life cycle, S. stercoralis relies upon sensory cues to aid in environmental navigation and coordinate developmental progression. Odorants, tastants, gases, and temperature have been shown to shape parasite behaviors that drive host seeking and infectivity; however, many of these sensory behaviors remain poorly understood, and their underlying molecular and neural mechanisms are largely uncharacterized. Disruption of sensory circuits essential to parasitism presents a promising strategy for future interventions. In this review, we describe our current understanding of sensory behaviors - namely olfactory, gustatory, gas sensing, and thermosensory behaviors - in Strongyloides spp. We also highlight the ever-growing cache of genetic tools optimized for use in Strongyloides that have facilitated these findings, including transgenesis, CRISPR/Cas9-mediated mutagenesis, RNAi, chemogenetic neuronal silencing, and the use of fluorescent biosensors to measure neuronal activity. Bolstered by these tools, we are poised to enter an era of rapid discovery in Strongyloides sensory neurobiology, which has the potential to shape pioneering advances in the prevention and treatment of strongyloidiasis.
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Affiliation(s)
- Patricia Mendez
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, USA; Molecular Biology Interdepartmental PhD Program, University of California Los Angeles, Los Angeles, CA, USA.
| | - Breanna Walsh
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, USA; Molecular Biology Interdepartmental PhD Program, University of California Los Angeles, Los Angeles, CA, USA; Medical Scientist Training Program, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Elissa A Hallem
- Department of Microbiology, Immunology, and Molecular Genetics, University of California, Los Angeles, Los Angeles, CA, USA; Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA, USA.
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