1
|
Buonfrate D, Bradbury RS, Watts MR, Bisoffi Z. Human strongyloidiasis: complexities and pathways forward. Clin Microbiol Rev 2023; 36:e0003323. [PMID: 37937980 PMCID: PMC10732074 DOI: 10.1128/cmr.00033-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/11/2023] [Indexed: 11/09/2023] Open
Abstract
Strongyloidiasis is a World Health Organization neglected tropical disease usually caused by Strongyloides stercoralis, a parasitic worm with a complex life cycle. Globally, 300-600 million people are infected through contact with fecally contaminated soil. An autoinfective component of the life cycle can lead to chronic infection that may be asymptomatic or cause long-term symptoms, including malnourishment in children. Low larval output can limit the sensitivity of detection in stool, with serology being effective but less sensitive in immunocompromise. Host immunosuppression can trigger catastrophic, fatal hyperinfection/dissemination, where large numbers of larvae pierce the bowel wall and disseminate throughout the organs. Stable disease is effectively treated by single-dose ivermectin, with disease in immunocompromised patients treated with multiple doses. Strategies for management include raising awareness, clarifying zoonotic potential, the development and use of effective diagnostic tests for epidemiological studies and individual diagnosis, and the implementation of treatment programs with research into therapeutic alternatives and medication safety.
Collapse
Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Richard S. Bradbury
- School of Health and Life Sciences, Federation University Australia, Berwick, Victoria, Australia
| | - Matthew R. Watts
- Centre for Infectious Diseases and Microbiology, Institute of Clinical Pathology and Medical Research – New South Wales Health Pathology and Sydney Institute for Infectious Diseases, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Zeno Bisoffi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| |
Collapse
|
2
|
Gryschek RCB, Corral MA, Sitta RB, Gottardi M, Pierrotti LC, Costa SF, Abdala E, Chieffi PP, de Paula FM. Strongyloides infection screening in transplant candidates: What is the best strategy? Transpl Infect Dis 2023; 25:e14153. [PMID: 37750481 DOI: 10.1111/tid.14153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The potential that Strongyloides stercoralis infection has to cause major morbidity and high mortality when the disseminated form occurs in transplant patients is of particular concern. METHODS In this study, the objective was to observe S. stercoralis infection in patients who are candidates for transplantation by using parasitological, serological, and molecular techniques and to propose an algorithm for the detection of that infection in transplant candidates. RESULTS By parasitological techniques, 10% of fecal samples were positive. Anti-Strongyloides antibodies immunoglobulin G were detected in 19.3% and 20.7% of patients by immunofluorescence assay and enzyme-linked immunosorbent assay, respectively. S. stercoralis DNA was observed in 17.3% of samples by conventional polymerase chain reaction and 32.7% of samples by quantitative polymerase chain reaction (qPCR). CONCLUSION The set of results allows us to reinforce that a positive result by parasitological techniques and/or qPCR indicates that the specific treatment should be applied. However, the improvement of diagnostic techniques may suggest changes in the screening for strongyloidiasis in these patients.
Collapse
Affiliation(s)
- Ronaldo Cesar Borges Gryschek
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Marcelo Andreetta Corral
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Renata Barnabé Sitta
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Maiara Gottardi
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Ligia Camera Pierrotti
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Silvia Figueiredo Costa
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Edson Abdala
- Immunosuppressed Infection Group, Divisão de Moléstias Infecciosas e Parasitárias do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Pedro Paulo Chieffi
- Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, Sao Paulo, Brazil
| | - Fabiana Martins de Paula
- Laboratório de Investigação Médica (LIM/06), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Wang Y, Zhang X. Gastroduodenal strongyloidiasis infection causing protein-losing enteropathy: A case report and review of the literature. Heliyon 2023; 9:e18094. [PMID: 37483822 PMCID: PMC10362134 DOI: 10.1016/j.heliyon.2023.e18094] [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: 12/14/2022] [Revised: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
Strongyloides stercoralis is an intestinal nematode in which adult worms in the host small intestine can cause strongyloidiasis. Symptoms in immunocompromised patients might range from diarrhea and bleeding to sepsis and even death. A 56-year-old patient presented with a 2-month history of weight loss, vomiting, and diarrhea. The patient had type 2 diabetes mellitus (T2DM) and was on long-term prednisone for chronic kidney disease. The results of the gastric emptying test and head magnetic resonance (MRI) were normal. A blood test revealed increased IgE levels, eosinophilia, and hypoalbuminemia. Parasitic larvae were not discovered during stool analysis. Gastroscopy revealed chronic nonatrophic gastritis with erosions and dilation of lymphatic vessels of the duodenum. Small-bowel capsule endoscopy suggested dilation of lymphatic vessels of the small intestine. Colonoscopy revealed no abnormalities. Finally, a histopathology examination identified S. stercoralis pervasion in the gastric antrum and duodenum. The patient was treated with albendazole and discharged successfully. In conclusion, we discovered S. stercoralis as a cause of protein-losing enteropathy in a patient with a long-term oral corticosteroid therapy and T2DM. The diagnosis was made through histopathology, once parasitological examination was negative. Therefore, health professionals should stay alert to S. stercoralis infection in immunocompromised patients with vague gastrointestinal symptoms. More sensitive methods should be applied in the diagnosis.
Collapse
Affiliation(s)
| | - Xuequn Zhang
- Corresponding author. Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.
| |
Collapse
|
6
|
Manh TH, Tran KQL, Ho PT, Vo MM, Pham TQ, Vo TD. Rare Complication of Strongyloidiasis in Vietnam: A Case of Venous Thromboembolism and Duodenal Obstruction. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2023; 81:270-275. [PMID: 37350523 DOI: 10.4166/kjg.2023.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/16/2023] [Accepted: 05/21/2023] [Indexed: 06/24/2023]
Abstract
Strongyloidiasis, a chronic helminth infection caused by the parasitic nematode Strongyloides stercoralis, has various clinical manifestations. Although rare, duodenal obstructions and venous thromboembolism are possible complications of strongyloidiasis. This paper presents the case of a 47-year-old Vietnamese male with a history of right lower limb edema, anorexia, nausea, vomiting, diarrhea, and abdominal discomfort lasting for four months. Venous Doppler ultrasound detected a thrombus in the right femoral vein, while an abdominal CT scan revealed a mass lesion suggestive of a lower bile duct tumor. Esophageogastroduodenoscopy showed a friable duodenal cap mucosa with multiple ulcers and edematous mucosa of the second part of the duodenum that caused a partial lumen obstruction. The final histological examination of the biopsy specimen revealed chronic duodenitis with larvae consistent with Strongyloides stercoralis. The patient was treated with Ivermectin for two weeks and anticoagulation therapy for three months. After treatment and a six-month follow-up, the patient's gastrointestinal symptoms and leg swelling resolved completely. This is the first documented case of a patient in Vietnam with strongyloidiasis who presented with venous thromboembolism and duodenal obstruction.
Collapse
Affiliation(s)
- Tien Huynh Manh
- Department of Internal Medicine, Faculty of Medicine University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Khanh Quoc Le Tran
- Department of Internal Medicine, Faculty of Medicine University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Phat Tan Ho
- Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Man Minh Vo
- Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Thong Quang Pham
- Department of Pathology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Thong Duy Vo
- Department of Internal Medicine, Faculty of Medicine University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
- Department of Gastroenterology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| |
Collapse
|
7
|
Tian Y, Monsel G, Paris L, Danis M, Caumes E. Larva Currens: Report of Seven Cases and Literature Review. Am J Trop Med Hyg 2023; 108:340-345. [PMID: 36535252 PMCID: PMC9896332 DOI: 10.4269/ajtmh.21-0135] [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: 02/04/2021] [Accepted: 06/19/2021] [Indexed: 12/23/2022] Open
Abstract
Strongyloidiasis is a frequent and often unrecognized parasitic disease because of the frequently asymptomatic nature and lack of sensitivity of diagnostic tests. Under conditions of immunosuppression (particularly systemic corticosteroid treatment), potentially fatal dissemination may occur. Thus, prevention and early diagnosis are important. Larva currens is a rare and pathognomonic cutaneous sign of strongyloidiasis, but is poorly described because of its unpredictable and fleeting occurrence. We report seven imported cases of larva currens seen in Paris between 1990 and 2020. We illustrate the clinical and biological features of this specific but uncommon sign of strongyloidiasis with clinical pictures. There were three males and four females, aged between 29 and 58 years. There were five migrants from endemic countries, one tourist and one expatriate. Digestive disorders were the main extracutaneous signs. All patients had eosinophilia above 0.5 G/L. All cases were confirmed by stool tests. All were cured with ivermectin. The rapidity and the short duration of the creeping eruption distinguish it from other parasitoses. Ivermectin is a treatment of choice. The key point is to think about preventing disseminated strongyloidiasis before giving corticosteroids not only among migrants but also among expatriates and tourists in endemic countries.
Collapse
Affiliation(s)
- Yuan Tian
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Gentiane Monsel
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Luc Paris
- Laboratoire de Parasitologie-Mycologie, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Martin Danis
- Laboratoire de Parasitologie-Mycologie, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Eric Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
- Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, INSERM, Paris, France
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Vanbrabant P, Damanet B, Maussen C, Van Esbroeck M, Soentjens P. Screening the asymptomatic soldiers after a stay in sub-Saharan Africa. A retrospective observational study. Travel Med Infect Dis 2020; 39:101941. [PMID: 33278608 DOI: 10.1016/j.tmaid.2020.101941] [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: 02/04/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many tropical clinics offer post-travel screening for parasitic infections in asymptomatic travellers. However, literature on attack rates and incidence rates of parasitic infections is scarce. METHOD All military personnel returning from a tropical region during the year 2018 were tested for the presence of antibodies against Strongyloides stercoralis, Schistosoma and Entamoeba histolytica. Test results were compared with previous results if available to distinguish recent and old infection. RESULTS In total, 949 soldiers were included in the study. The median age was years 31 (IQR: 26-41), 96.3% were male. The median duration of stay in the tropics was 35 days (IQR: 14-90). The destination was predominantly central Africa. Serological tests were positive for S. stercoralis in 10 patients (1.1%), Schistosoma in 3 (0.3%), and E. histolytica in 16 (1.7%). The attack rates were 0.84, 0.32 and 1.69 respectively. The incidence rates were 3.99, 1.49 and 7.97 respectively. CONCLUSIONS The risk for parasitic infection in the asymptomatic returning soldiers is low. However, the potentially serious complications of unrecognised parasitic infection can legitimise systematic screening.
Collapse
Affiliation(s)
- Peter Vanbrabant
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium; General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Benjamin Damanet
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium; School of Public Health, Free University of Brussels, Brussels, Belgium
| | - Chris Maussen
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Patrick Soentjens
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
10
|
Lötsch F, Grobusch MP. Seroprevalence of Toxocara spp. antibodies in humans in Africa: A review. ADVANCES IN PARASITOLOGY 2020; 109:483-499. [PMID: 32381214 DOI: 10.1016/bs.apar.2020.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Human toxocariasis occurs worldwide and is caused by nematodes of the species of the genus Toxocara. Infection occurs by the ingestion of eggs and is usually asymptomatic or oligosymptomatic. However, severe manifestations occur. The burden of disease and its public health impact remain ill-defined. The aim of this review was to summarize all available data on the seroprevalence of toxocariasis on the African continent and factors associated with seropositivity. METHODS Twenty-seven original papers published between 1991 and 2017 were identified that provided data suitable for this review. Case-control studies were included and the seroprevalence in the (healthy) control group was used as a surrogate parameter. RESULTS Antibodies against Toxocara spp. were found to be frequent in most populations and regions in Africa with the exception of two publications, one from the Democratic Republic of the Congo and one from Djibouti, where all participants were seronegative. The highest proportion of participants with antibodies was found on the island of La Réunion with 359 out 387 study participants being positive (92.8%). Factors associated with seropositivity were reported across studies, including-among others-older age, contact with soil via geophagia, agricultural activity or playing with soil, contact with animals, especially dogs, and low socio-economic status, defined as absence of water supply or poor housing. Three Egyptian studies found male gender to be associated with toxocariasis, whereas in La Réunion females were at increased risk. CONCLUSIONS Exposure to toxocariasis seems to be very frequent and common in large parts of the African continent. However, no data are available for most countries. The public health impact of human toxocariasis and the frequency of severe manifestations remain unclear.
Collapse
Affiliation(s)
- Felix Lötsch
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Peter Grobusch
- Department of Infectious Diseases, Centre of Tropical Medicine and Travel Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
11
|
Rising Eosinophilia After a Trip to the Caribbean in an HIV-Infected Man. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Overbosch FW, van Gool T, Matser A, Sonder GJB. Low incidence of helminth infections (schistosomiasis, strongyloidiasis, filariasis, toxocariasis) among Dutch long-term travelers: A prospective study, 2008-2011. PLoS One 2018; 13:e0197770. [PMID: 29847574 PMCID: PMC5976197 DOI: 10.1371/journal.pone.0197770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/08/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite the considerable burden of helminth infections in developing countries and increasing international travel, little is known about the risks of infection for travelers. OBJECTIVE We studied the attack and incidence rate of serology confirmed strongyloidiasis, filariasis, and toxocariasis among long-term travelers and associated factors. A second objective was to evaluate eosinophilia as a positive/negative predictive value (PPV/NPV) for a recent helminth infection. METHODS From 2008 to 2011, clients of the Public Health Service travel clinic planning travel to (sub)tropical countries for 12-52 weeks were invited to participate in a prospective study. Participants kept a weekly diary, recording itinerary, symptoms, and physician visits during travel and completed a post-travel questionnaire. Pre- and post-travel blood samples were serologically tested for the presence of IgG antibodies against Schistosoma species, Strongyloides stercoralis, filarial species, and Toxacara species and were used for a blood cell count. Factors associated with recent infection were analyzed using Poisson regression. Differences among groups of travelers were studied using chi square tests. RESULTS For the 604 participants, median age was 25 years (interquartile range [IQR]: 23-29), 36% were male, median travel duration was 20 weeks (IQR: 15-25), and travel purpose was predominantly tourism (62%). Destinations were Asia (45%), Africa (18%), and the Americas (37%). Evidence of previous infection was found in 13/604 participants: antibodies against Schistosoma spp. in 5 (0.8%), against S.stercoralis in 3 (0.5%), against filarial species in 4 (0.7%), and against Toxocara spp. in 1 (0.2%). Ten recent infections were found in 9 participants (3, 1, 6, 0 cases, in the above order), making the attack rates 0.61, 0.17, 1.1 and 0, and the incidence rates per 1000 person-months 1.5, 0.34, 2.6 and 0. The overall PPV and NPV of eosinophila for recent infection were 0 and 98%, respectively. CONCLUSIONS The risk of the helminth infections under study in this cohort of long-term travelers was low. Routine screening for eosinophilia appeared not to be of diagnostic value.
Collapse
Affiliation(s)
- Femke W. Overbosch
- Department of Infectious Diseases, Public Health Service (GGD), Amsterdam, the Netherlands
- National Coordination Centre for Traveller’s health Advice (LCR), Amsterdam, the Netherlands
| | - Tom van Gool
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, the Netherlands
- Department of Medical Microbiology, Parasitology Section, Academic Medical Center, Amsterdam, the Netherlands
| | - Amy Matser
- Department of Infectious Disease Research and Prevention, Public Health Service (GGD), Amsterdam, the Netherlands
| | - Gerard J. B. Sonder
- Department of Infectious Diseases, Public Health Service (GGD), Amsterdam, the Netherlands
- National Coordination Centre for Traveller’s health Advice (LCR), Amsterdam, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
13
|
Ofori E, Ramai D, Khan A, Xiao P, Reddy M, Shahzad G. Hepatobiliary strongyloidiasis presenting as an ampullary lesion on esophagogastroduodenoscopy/endoscopic ultrasound. Gastroenterol Rep (Oxf) 2018; 7:367-370. [PMID: 31687157 PMCID: PMC6821160 DOI: 10.1093/gastro/goy002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/06/2017] [Accepted: 12/22/2017] [Indexed: 01/13/2023] Open
Abstract
Strongyloidiasis is an intestinal infection caused by the parasitic nematodes of the Strongyloides species, most commonly Strongyloides stercoralis. We report a case of a 66-year-old immigrant male from Haiti who presented with complaints of diarrhea and an unintentional 80-lb weight loss over the past 5 years. Stool examination was positive for strongyloidiasis. Following albendazole therapy, esophagogastroduodenoscopy (EGD) showed a unique ampullary lesion. Histopathology of the ampullary lesion showed reactive epithelium with Strongyloides larva. In addition, endoscopic ultrasound (EUS) detected a large pancreatic cyst. Both these findings were absent on EGD 5 years previously, prior to the onset of his symptoms. This paper documents a rare case of an ampullary lesion and pancreatic cyst secondary to hepatobiliary strongyloidiasis in a non-Human Immunodeficiency Virus (HIV) patient. We review the epidemiology, life cycle, clinical presentation and treatment of strongyloidiasis.
Collapse
Affiliation(s)
- Emmanuel Ofori
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA.,St. George's University School of Medicine, True Blue, Grenada, WI
| | - Alisha Khan
- St. George's University School of Medicine, True Blue, Grenada, WI
| | - Philip Xiao
- Department of Pathology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
| | - Madhavi Reddy
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
| | - Ghulamullah Shahzad
- Division of Gastroenterology and Hepatology, The Brooklyn Hospital Center, Academic Affiliate of The Icahn School of Medicine at Mount Sinai, Clinical Affiliate of The Mount Sinai Hospital, Brooklyn, NY, USA
| |
Collapse
|
14
|
Alabi A, Boggild AK, Bitnun A. Acute strongyloidiasis in a child recently returned from vacation in Cuba. CMAJ 2017; 189:E1416-E1420. [PMID: 29158455 DOI: 10.1503/cmaj.170464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ajibola Alabi
- Division of Infectious Diseases (Alabi, Bitnun), The Hospital for Sick Children; Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild), Toronto General Hospital, University Health Network; Department of Medicine (Boggild) and Department of Paediatrics (Bitnun), University of Toronto; Public Health Ontario Laboratories (Boggild), Toronto, Ont
| | - Andrea K Boggild
- Division of Infectious Diseases (Alabi, Bitnun), The Hospital for Sick Children; Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild), Toronto General Hospital, University Health Network; Department of Medicine (Boggild) and Department of Paediatrics (Bitnun), University of Toronto; Public Health Ontario Laboratories (Boggild), Toronto, Ont
| | - Ari Bitnun
- Division of Infectious Diseases (Alabi, Bitnun), The Hospital for Sick Children; Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine (Boggild), Toronto General Hospital, University Health Network; Department of Medicine (Boggild) and Department of Paediatrics (Bitnun), University of Toronto; Public Health Ontario Laboratories (Boggild), Toronto, Ont.
| |
Collapse
|
15
|
Toxocariasis in humans in Africa - A systematic review. Travel Med Infect Dis 2017; 20:15-25. [PMID: 29037977 DOI: 10.1016/j.tmaid.2017.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/26/2017] [Accepted: 10/11/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Toxocariasis is a globally distributed zoonosis. The most important definitive hosts are dogs, whereas humans serve as paratenic hosts. Transmission to humans occurs by accidental ingestion of eggs, e.g. by consumption of contaminated fruits or vegetables. Although exposure to Toxocara is usually considered as relatively benign, it is implicated in a range of neurological, ophthalmologic and other organ-specific conditions, some of them with grave consequences. This review provides an overview on the epidemiology, presentation and risk factors of exposure to Toxocara in Africa. METHODS A systematic search was performed for studies published after January 1st, 1990, in English, French, Portuguese, Spanish, Dutch or German. The review was prepared according to PRISMA guidelines. Studies on toxocariasis in human populations and contamination in human environments were included. RESULTS Sixty-five papers were included. Antibodies against Toxocara spp. in humans were found to be very common across Africa. Severe manifestations have been reported mainly from North Africa. Environmental contamination including soil, vegetables and fruits sold on markets was demonstrated in various locations in Africa. CONCLUSIONS Exposure to Toxocara is prevalent across the African continent. However, the complication frequency, the impact of the condition on the individual and the public health relevance of this zoonosis, and the economic impact have never been systematically evaluated.
Collapse
|
16
|
The changing aetiology of eosinophilia in migrants and returning travellers in the Hospital for Tropical Diseases, London 2002-2015: An observational study. J Infect 2017; 75:301-308. [PMID: 28842188 DOI: 10.1016/j.jinf.2017.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Determining the cause of eosinophilia in patients returning from the tropics continues to present a diagnostic challenge. The history, symptoms and degree of eosinophilia are often poor predictors of eventual diagnosis, but helminths are an important cause. The current British Infection Association recommendations use travel history to guide investigation of eosinophilia. However the global burden of helminth disease and travel patterns have changed over the last 3 decades and guidelines based on previous epidemiology need to be reviewed in the light of current data. METHODS Consecutive patients presenting with, or referred for, investigation of eosinophilia were identified prospectively. Case notes, laboratory results and electronic records were reviewed for demographic and clinical data. Patients with an eosinophil count ≥0.50 × 109/L were included, and grouped based on lifetime history of travel to: West Africa, elsewhere in Africa, and the rest of the world. Results were compared to published data from 1997 to 2002 collected at the same centre. RESULTS Of 410 patients who met the inclusion criteria, 407 had a documented travel history. Average yearly referrals for eosinophilia fell from 58 per year between 1997 and 2002, to 33 per year (2002-2015). The proportion of eosinophilia cases diagnosed with a parasitic cause fell from 64% to 50%, and yields for all parasitological investigations fell, the largest reduction in stool microscopy (20% yield to 9%) and day bloods for microfilariae (14% yield to 3%). Strongyloides stercoralis was the commonest diagnosis overall in our cohort, accounting for 50% of the total parasites diagnosed, and was present in 38% of patients from West Africa, 19% from rest of Africa, and 34% from rest of world; a relative increase compared to previous data. Schistosomiasis is slightly less common in those who had travelled to West Africa than the rest of Africa, and overall point prevalence has fallen from 33% (1997-2002) to 17% (2002-2015). Travellers were significantly less likely than patients who had immigrated to the UK to be diagnosed with any parasite (OR 0.54 95% CI 0.378-0.778 p = 0.0009). DISCUSSION A parasitic cause will still be found in half of people returning from the tropics with an eosinophilia, but we observed a fall in the overall prevalence of parasitic diagnoses when compared with the earlier data. This may, in part, be explained by the impact of control programmes on the prevalence of parasites globally, especially filarial disease. S. stercoralis now represents the majority of parasites diagnosed in our cohort from all continents. We identified significantly higher rates of strongyloidiasis in immigrants than returning travellers. Despite the falling yields of stool microscopy and filarial serology the current guidelines based on travel history remain relevant with adequate yield.
Collapse
|
17
|
Requena-Méndez A, Buonfrate D, Gomez-Junyent J, Zammarchi L, Bisoffi Z, Muñoz J. Evidence-Based Guidelines for Screening and Management of Strongyloidiasis in Non-Endemic Countries. Am J Trop Med Hyg 2017; 97:645-652. [PMID: 28749768 DOI: 10.4269/ajtmh.16-0923] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Strongyloidiasis is an intestinal parasitic infection becoming increasingly important outside endemic areas, not only because of the high prevalence found in migrant populations, but also because immunosuppressed patients may suffer a potentially fatal disseminated disease. The aim of these guidelines is to provide evidence-based guidance for screening and treatment of strongyloidiasis in non-endemic areas. A panel of experts focused on three main clinical questions (who should be screened and how, how to treat), and reviewed pertinent literature available in international databases of medical literature and in documents released by relevant organizations/societies. A consensus of the experts' opinion was sought when specific issues were not covered by evidence. In particular, six systematic reviews were retrieved and constituted the main support for this work. The evidence and consensus gathered led to recommendations addressing various aspects of the main questions. Grading of evidence and strength of recommendation were attributed to assess the quality of supporting evidence. The screening of individuals at risk of the infection should be performed before they develop any clinical complication. Moreover, in immunosuppressed patients, the screening should be mandatory. The screening is based on a simple and widely accessible technology and there is now a universally accepted treatment with a high efficacy rate. Therefore, the screening could be implemented as part of a screening program for migrants although further cost-effectiveness studies are required to better evaluate this strategy from a public health point of view.
Collapse
Affiliation(s)
- Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Dora Buonfrate
- Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar, Verona, Italy
| | - Joan Gomez-Junyent
- Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Lorenzo Zammarchi
- Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Universita Degli Studi di Firenze, Florence, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Sacro Cuore Hospital, Negrar, Verona, Italy
| | - José Muñoz
- Barcelona Institute for Global Health (ISGlobal-CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| |
Collapse
|
18
|
Approach to Eosinophilia in a Traveler from the Tropics. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
19
|
Mohamed R, Hamodat MM, Al-Abbadi MA. Gastric Strongyloidiasis: Report of 2 Cases and Brief Review of the Literature. Lab Med 2016; 48:93-96. [PMID: 27965275 DOI: 10.1093/labmed/lmw041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Strongyloides stercoralis is an intestinal nematode with a complicated lifecycle and auto-infection. In healthy individuals, this parasite usually does not cause any symptoms. But in immunocompromised patients, the symptoms vary from abdominal pain and discomfort to sepsis and death.Gastric infection and involvement by this nematode are rare and uncommon. Here we report 2 cases of Strongyloides stercoralis hyperinfection that were discovered in gastric biopsies in 2 immunocompromised patients. A gastric biopsy was taken for each patient and both showed cross sections of adult worms, eggs, and rhabditiform larvae of S. stercoralis embedded within gastric crypts. This short report describes these 2 immunocompromised patients with disseminated infection by S. strecoralis with gastric involvement with emphasis on recognition of the histological findings in gastric biopsies.
Collapse
Affiliation(s)
- Rawia Mohamed
- Department of Pathology and Laboratory Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Mowafak M Hamodat
- Department of Pathology and Laboratory Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Mousa A Al-Abbadi
- Department of Pathology and Laboratory Medicine, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| |
Collapse
|
20
|
Takaoka K, Gourtsoyannis Y, Hart JD, Armstrong M, Daniel A, Mewse E, Phillips D, Bailey RL. Incidence rate and risk factors for giardiasis and strongyloidiasis in returning UK travellers. J Travel Med 2016; 23:taw050. [PMID: 27432907 DOI: 10.1093/jtm/taw050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few studies have investigated incidence rate and risk factors for giardiasis and strongyloidiasis in returning UK travellers. The clinical presentations of these two diseases are often similar and difficult to distinguish. This study was conducted to investigate the incidence rate and the risk factors for symptomatic giardiasis and strongyloidiasis in returned tropical travellers. METHODS We retrospectively analysed 3306 consecutive attendances presenting to the emergency clinic at the Hospital for Tropical Diseases in London, the UK from September 2008 to May 2010. Odds ratios between the diagnoses and patient variables were analysed by logistic regression. RESULTS Giardiasis was diagnosed in 92/3306 cases (2.8%, proportionate morbidity), and the incidence rate per 1000 person-months was 12.5. Multivariate analysis with logistic regression revealed that Caucasian ethnicity (adjusted odds ratio (aOR): 2.37, 95% confidence interval (CI): 1.12-5.03, P value = 0.025), travel length ≥32 days (aOR: 2.63, 95%CI: 1.43-4.83, P = 0.002), travelling to South or South East Asia (aOR: 4.90, 95%CI: 2.03-11.8, P < 0.001, aOR: 3.36, 95%CI: 1.43-7.93, P = 0.006), afebrile presentation (aOR: 2.14, 95%CI: 1.14-4.03, P = 0.018), and presenting with gastro-intestinal symptoms (aOR: 14.6, 95%CI: 6.08-35.0, P < 0.001) were all associated with giardiasis. In contrast, strongyloidiasis was found only in 0.94% (proportionate morbidity) of the cases (31/3306), and the incidence rate per 1000 person-months was 3.1. Multivariate analysis revealed that male sex (aOR: 3.05, 95%CI: 1.36-6.85, P = 0.007), and non-Caucasian ethnicity (aOR: 2.69, 95%CI: 1.32-5.49, P = 0.007) were associated with strongyloidiasis. CONCLUSIONS The incidence rate and risk factors for both infectious diseases were identified. The results of this study might guide clinicians to make more accurate and timely diagnoses in returned tropical travellers.
Collapse
Affiliation(s)
- Kensuke Takaoka
- Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Yannis Gourtsoyannis
- Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - John D Hart
- Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | | | | | - Emma Mewse
- The Hospital for Tropical Diseases, London, UK
| | | | - Robin L Bailey
- Faculty of Infectious and Tropical Diseases, Department of Clinical Research, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.,The Hospital for Tropical Diseases, London, UK
| |
Collapse
|
21
|
Abstract
In determining the etiology of eosinophilia, it is necessary to consider the type of patient, including previous travel and exposure history, comorbidities, and symptoms. In this review, we discuss the approach to the patient with eosinophilia from an infectious diseases perspective based on symptom complexes.
Collapse
Affiliation(s)
- Elise M O'Connell
- Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Center Drive, Building 4, Room B105, Bethesda, MD 20892, USA.
| | - Thomas B Nutman
- Helminth Immunology Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 4 Center Drive, Building 4, Room B105, Bethesda, MD 20892, USA
| |
Collapse
|
22
|
Weitzel T, Rosas R, Fica A, Dabanch J, Polanco M, Egaña A, Triantafilo V, Pfarr K, Hoerauf A, Reiter-Owona I. Is there a risk of filarial infection during long-term missions in Haiti? Travel Med Infect Dis 2016; 14:137-42. [PMID: 26750186 DOI: 10.1016/j.tmaid.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Haiti has the highest prevalence of lymphatic filariasis (Wuchereria bancrofti) in the Western Hemisphere. Still, the risk of filarial infection for long-term visitors such as humanitarian aid workers or military personnel is uncertain. The presented study analyzed the exposure to W. bancrofti in Chilean participants of the UN Stabilization Mission in Haiti (MINUSTAH) in 2011. METHODS Blood samples collected from 531 participants were screened for antifilarial antibodies by IgG ELISA, and, if positive, analyzed by immunofluorescence assay (IFA), IgG4 ELISA, Real-Time PCR, and circulating filarial antigen (CFA) card test. RESULTS ELISA screening was positive in 10 cases. Seroconversion occurred in only two cases (0.38%) based on ELISA values determined in samples taken before and after deployment. Positive IgG ELISA values could not be confirmed by IFA and IgG4 ELISA. Real-Time PCR and CFA testing did not reveal the presence of filaria. CONCLUSIONS Our data indicate that in the examined cohort of MINUSTAH participants in 2011, the risk of filarial exposure or infection was low.
Collapse
Affiliation(s)
- Thomas Weitzel
- Programa Medicina del Viajero, Clínica Alemana, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile; Laboratorio Clínico, Clínica Alemana, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
| | - Reinaldo Rosas
- Programa de Prevención de la Salud del Personal en Comisión de Servicio en el Extranjero, Comando de Salud del Ejército, Fuerzas Armadas de Chile, Santiago, Chile
| | - Alberto Fica
- Servicio de Infectología, Hospital Militar, Santiago, Chile
| | | | - Myriam Polanco
- Programa de Prevención de la Salud del Personal en Comisión de Servicio en el Extranjero, Comando de Salud del Ejército, Fuerzas Armadas de Chile, Santiago, Chile
| | - Alicia Egaña
- Laboratorio Clínico, Hospital Militar, Santiago, Chile
| | | | - Kenneth Pfarr
- Institute of Medical Microbiology, Immunology and Parasitology, University Clinic Bonn, Bonn, Germany
| | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology, University Clinic Bonn, Bonn, Germany
| | - Ingrid Reiter-Owona
- Institute of Medical Microbiology, Immunology and Parasitology, University Clinic Bonn, Bonn, Germany
| |
Collapse
|
23
|
CATMAT statement on disseminated strongyloidiasis: Prevention, assessment and management guidelines. ACTA ACUST UNITED AC 2016; 42:12-19. [PMID: 29769976 DOI: 10.14745/ccdr.v42i01a03] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background Strongyloides stercoralis is a parasitic nematode found in humans, with a higher prevalence in tropical and sub-tropical regions worldwide. If untreated, the infection can progress to disseminated strongyloidiasis, a critical illness which may be fatal. Objective To provide clinical guidance on the prevention, assessment and management of disseminated strongyloidiasis. Methods A literature review was conducted to evaluate the current evidence and to identify any systematic reviews, case reports, guidelines and peer reviewed and non-peer reviewed medical literature. The Committee to Advise on Tropical Medicine and Travel (CATMAT) assembled a working group to develop this statement, which was then critically reviewed and approved by all CATMAT members. Recommendations CATMAT recommends that screening for strongyloidiasis should be considered for individuals with epidemiologic risk and/or co-morbidities that place them at risk for Strongyloides hyperinfection and dissemination. Those at highest risk of hyperinfection and dissemination are individuals born in a Strongyloides-endemic area who undergo iatrogenic immunosuppression or have intercurrent human T-lymphotropic virus (HTLV-1) infection. Diagnosis of strongyloidiasis is based on serologic testing and/or examination of stools and other clinical specimens for larvae. Referral to a tropical medicine specialist with expertise in the management of strongyloidiasis is recommended for suspected and confirmed cases. A diagnosis and treatment algorithm for strongyloidiasis has been developed as a reference tool. Conclusion Strongyloidiasis is relatively widespread in the global migrant population and screening for the disease should be based on an individual risk assessment. A practical tool for the clinician to use in the prevention, assessment and management of disseminated strongyloidiasis in Canada is now available.
Collapse
|
24
|
Teixeira MCA, Pacheco FTF, Souza JN, Silva MLS, Inês EJ, Soares NM. Strongyloides stercoralis Infection in Alcoholic Patients. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4872473. [PMID: 28105424 PMCID: PMC5220430 DOI: 10.1155/2016/4872473] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/13/2016] [Indexed: 12/28/2022]
Abstract
The course of Strongyloides stercoralis infection is usually asymptomatic with a low discharge of rhabditoid larva in feces. However, the deleterious effects of alcohol consumption seem to enhance the susceptibility to infection, as shown by a fivefold higher strongyloidiasis frequency in alcoholics than in nonalcoholics. Moreover, the association between S. stercoralis infection and alcoholism presents a risk for hyperinfection and severe strongyloidiasis. There are several possible mechanisms for the disruption of the host-parasite equilibrium in ethanol-addicted patients with chronic strongyloidiasis. One explanation is that chronic ethanol intake stimulates the hypothalamic-pituitary-adrenal (HPA) axis to produce excessive levels of endogenous cortisol, which in turn can lead to a deficiency in type 2 T helper cells (Th2) protective response, and also to mimic the parasite hormone ecdysone, which promotes the transformation of rhabditiform larvae to filariform larvae, leading to autoinfection. Therefore, when untreated, alcoholic patients are continuously infected by this autoinfection mechanism. Thus, the early diagnosis of strongyloidiasis and treatment can prevent serious forms of hyperinfection in ethanol abusers.
Collapse
Affiliation(s)
- Marcia C. A. Teixeira
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
- *Marcia C. A. Teixeira:
| | - Flavia T. F. Pacheco
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
| | - Joelma N. Souza
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
| | - Mônica L. S. Silva
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
| | - Elizabete J. Inês
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
| | - Neci M. Soares
- Faculdade de Farmácia, Universidade Federal da Bahia, 40170115 Salvador, BA, Brazil
| |
Collapse
|
25
|
Bolívar-Mejía A, Rodríguez-Morales AJ, Paniz-Mondolfi AE, Delgado O. [Cardiovascular manifestations of human toxocariasis]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 83:120-9. [PMID: 23462238 DOI: 10.1016/j.acmx.2012.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 06/13/2012] [Accepted: 07/03/2012] [Indexed: 11/25/2022] Open
Abstract
Toxocariasis is a parasitic infection produced by helminths that cannot reach their adult stage in humans. For their etiological species (Toxocara canis and Toxocara cati), man is a paratenic host. Infection by such helminths can produce a variety of clinical manifestations, such as: visceral larvae migrans syndrome, ocular larvae migrans syndrome and covert toxocariasis. In the visceral larvae migrans syndrome, the organs that are mainly involved include liver, lungs, skin, nervous system, muscles, kidneys and the heart. Regarding the latter, the importance of cardiovascular manifestations in toxocariasis, as well as its clinical relevance, has increasingly begun to be recognized. The current article is based on a systematic information search, focused mainly on the clinical and pathological aspects of cardiovascular manifestations in toxocariasis, including its pathophysiology, laboratory findings, diagnosis and therapeutical options, with the objective of highlighting its importance as a zoonosis and its relevance to the fields of cardiovascular medicine in adults and children.
Collapse
Affiliation(s)
- Adrián Bolívar-Mejía
- Grupo de Investigación en Electrocardiografía, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia
| | | | | | | |
Collapse
|
26
|
Toxocariasis diagnosed in international travelers at the Institute of Tropical Medicine, Antwerp, Belgium, from 2000 to 2013. PLoS Negl Trop Dis 2015; 9:e0003559. [PMID: 25746418 PMCID: PMC4351981 DOI: 10.1371/journal.pntd.0003559] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/22/2015] [Indexed: 11/19/2022] Open
Abstract
Although infection with Toxocara canis or T. catis (commonly referred as toxocariasis) appears to be highly prevalent in (sub)tropical countries, information on its frequency and presentation in returning travelers and migrants is scarce. In this study, we reviewed all cases of asymptomatic and symptomatic toxocariasis diagnosed during post-travel consultations at the reference travel clinic of the Institute of Tropical Medicine, Antwerp, Belgium. Toxocariasis was considered as highly probable if serum Toxocara-antibodies were detected in combination with symptoms of visceral larva migrans if present, elevated eosinophil count in blood or other relevant fluid and reasonable exclusion of alternative diagnosis, or definitive in case of documented seroconversion. From 2000 to 2013, 190 travelers showed Toxocara-antibodies, of a total of 3436 for whom the test was requested (5.5%). Toxocariasis was diagnosed in 28 cases (23 symptomatic and 5 asymptomatic) including 21 highly probable and 7 definitive. All but one patients were adults. Africa and Asia were the place of acquisition for 10 and 9 cases, respectively. Twelve patients (43%) were short-term travelers (< 1 month). Symptoms, when present, developed during travel or within 8 weeks maximum after return, and included abdominal complaints (11/23 symptomatic patients, 48%), respiratory symptoms and skin abnormalities (10 each, 43%) and fever (9, 39%), often in combination. Two patients were diagnosed with transverse myelitis. At presentation, the median blood eosinophil count was 1720/μL [range: 510-14160] in the 21 symptomatic cases without neurological complication and 2080/μL [range: 1100-2970] in the 5 asymptomatic individuals. All patients recovered either spontaneously or with an anti-helminthic treatment (mostly a 5-day course of albendazole), except both neurological cases who kept sequelae despite repeated treatments and prolonged corticotherapy. Toxocariasis has to be considered in travelers returning from a (sub)tropical stay with varying clinical manifestations or eosinophilia. Prognosis appears favorable with adequate treatment except in case of neurological involvement.
Collapse
|
27
|
Vanhaecke C, Perignon A, Monsel G, Regnier S, Paris L, Caumes E. Aetiologies of creeping eruption: 78 cases. Br J Dermatol 2015; 170:1166-9. [PMID: 24116380 DOI: 10.1111/bjd.12637] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Creeping eruption is a migratory linear cutaneous trail. In addition to hookworm-related cutaneous larva migrans (HrCLM), other diseases can also be revealed by this sign. OBJECTIVES To report the different aetiologies of creeping eruption. METHODS All consecutive patients with creeping eruption presenting to our unit in Pitié Salpêtrière Hospital in Paris between 1 March 2008 and 31 January 2013 were included. The diagnoses were based on microscopic data when available (hookworm folliculitis, strongyloidiasis) or the association of epidemiological, clinical, biological features and good outcome after specific treatment (HrCLM, loiasis, gnathostomiasis). RESULTS Seventy-four patients (95%) presented with HrCLM. All but one had been travelling in a tropical country; seven (9%) also presented with folliculitis. Skin scraping of hookworm folliculitis lesions was performed in five cases and revealed living nematode larvae in three cases. Two patients (3%) with cutaneous gnathostomiasis after returning from Bali and Japan presented with intermittent creeping dermatitis on the foot and thigh, respectively. One patient (1%), native to Cameroon, was diagnosed with loiasis and one patient (1%), with no travel history, presented with 'creeping hair'. CONCLUSION Hookworm-related cutaneous larva migrans explains 95% of the cases of creeping eruption; gnathostomiasis, loiasis and cutaneous pili migrans may also be diagnosed.
Collapse
Affiliation(s)
- C Vanhaecke
- Service de Maladies Infectieuses et Tropicales, Hôpital Pitié Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | | | | | | | | | | |
Collapse
|
28
|
Levenhagen MA, Costa-Cruz JM. Update on immunologic and molecular diagnosis of human strongyloidiasis. Acta Trop 2014; 135:33-43. [PMID: 24686097 DOI: 10.1016/j.actatropica.2014.03.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 03/17/2014] [Accepted: 03/19/2014] [Indexed: 01/31/2023]
Abstract
Human strongyloidiasis is an intestinal parasitosis that may affect 100 million individuals. However, the prevalence rates of this infection may represent smaller values than the actual data, mainly due to difficulties in its diagnosis. The aim of this study was to update the immunological and molecular methods applied to the diagnosis of human strongyloidiasis. There is a great diversity of techniques used in the diagnosis of this parasitosis, such as immunofluorescence antibody test (IFAT), enzyme-linked immunosorbent assay (ELISA), immunoblotting, luciferase immunoprecipitation system (LIPS), dispstick and polymerase chain reaction (PCR), all with advantages and disadvantages, and with unique features for specific purposes. Considering the magnitude of strongyloidiasis and the importance of early diagnosis, due to the possibility of chronicity and hyperinfection, this study analyzes the different methods currently employed, and demonstrates the necessity of developing innovative methodologies, which also maintain diagnostic accuracy, particularly for regions with limited technological resources.
Collapse
|
29
|
McGuinness SL, Leder K. Global Burden of Toxocariasis: A Common Neglected Infection of Poverty. CURRENT TROPICAL MEDICINE REPORTS 2014. [DOI: 10.1007/s40475-013-0012-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
30
|
Ramírez-Olivencia G, Espinosa MÁC, Martín AB, Núñez NI, de Las Parras ER, Núñez ML, Puente SP. Imported strongyloidiasis in Spain. Int J Infect Dis 2013; 18:32-7. [PMID: 24211226 DOI: 10.1016/j.ijid.2013.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 08/30/2013] [Accepted: 09/03/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES The objective of this study was to assess the epidemiological, laboratory, and clinical features of imported strongyloidiasis in a tropical medicine referral unit in Madrid, Spain. METHODS This was a retrospective study based on a review of medical records. A patient was diagnosed with strongyloidiasis when the infection could be detected by conventional stool analysis and/or serology against Strongyloides stercoralis, regardless of the presence of symptoms. RESULTS One hundred and seventy-eight cases of strongyloidiasis were included in the study. Stool tests were performed in all patients, and serology in 160 patients (89.9%). The diagnosis of strongyloidiasis was based on serology only in four patients; 21 patients only had positive stool tests. A third of the total strongyloidiasis cases in this study were travel-related, mainly associated with short trips (<2 months). Only 47.8% of total cases were symptomatic. We found no differences in clinical presentation between immigrants and travelers with strongyloidiasis. CONCLUSIONS Not only should strongyloidiasis be suspected in symptomatic travelers and immigrants, but it should also be ruled out when elevated IgE levels or eosinophilia are present. Strongyloidiasis can be asymptomatic in HIV patients, but it should be diagnosed and treated before a possible hyperinfection develops.
Collapse
Affiliation(s)
| | | | | | | | - Esperanza Rodríguez de Las Parras
- Malaria & Emerging Parasitic Diseases Laboratory, Parasitology Department, National Centre of Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Lago Núñez
- Unit of Tropical Medicine, Infectious Disease Department, Hospital Carlos III, Madrid, Spain
| | - Sabino Puente Puente
- Unit of Tropical Medicine, Infectious Disease Department, Hospital Carlos III, Madrid, Spain
| |
Collapse
|
31
|
|
32
|
Abstract
Schistosomiasis is increasingly encountered among travelers returning from the tropics, mainly from Africa. Schistosoma-infected travelers have served as sentinels for the existence of unknown foci of transmission even outside Africa. Acute schistosomiasis (also termed Katayama syndrome) is the common manifestation among travelers and may follow exposure to any of the Schistosoma species. Neuroschistosomiasis is a rare complication but may result in severe disability. Diagnosis in travelers is hampered by the poor sensitivity of microscopy in urine and stool, especially during acute infections, while seroconversion may be delayed for a period of weeks. During acute schistosomiasis, symptomatic treatment is the only available therapy, while for chronic schistosomiasis, praziquantel is the only drug available, despite reports of emerging resistance to it. Since the potential for exposure to Schistosoma through travel will probably continue to increase, it is clear that new, sensitive diagnostic methods and drugs affecting the parasite in all its stages are needed.
Collapse
|
33
|
Requena-Méndez A, Chiodini P, Bisoffi Z, Buonfrate D, Gotuzzo E, Muñoz J. The laboratory diagnosis and follow up of strongyloidiasis: a systematic review. PLoS Negl Trop Dis 2013; 7:e2002. [PMID: 23350004 PMCID: PMC3547839 DOI: 10.1371/journal.pntd.0002002] [Citation(s) in RCA: 256] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 11/27/2012] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Strongyloidiasis is frequently under diagnosed since many infections remain asymptomatic and conventional diagnostic tests based on parasitological examination are not sufficiently sensitive. Serology is useful but is still only available in reference laboratories. The need for improved diagnostic tests in terms of sensitivity and specificity is clear, particularly in immunocompromised patients or candidates to immunosuppressive treatments. This review aims to evaluate both conventional and novel techniques for the diagnosis of strongyloidiasis as well as available cure markers for this parasitic infection. METHODOLOGY/PRINCIPAL FINDINGS The search strategy was based on the data-base sources MEDLINE, Cochrane Library Register for systematic review, EmBase, Global Health and LILACS and was limited in the search string to articles published from 1960 to August 2012 and to English, Spanish, French, Portuguese and German languages. Case reports, case series and animal studies were excluded. 2003 potentially relevant citations were selected for retrieval, of which 1649 were selected for review of the abstract. 143 were eligible for final inclusion. CONCLUSIONS Sensitivity of microscopic-based techniques is not good enough, particularly in chronic infections. Furthermore, techniques such as Baermann or agar plate culture are cumbersome and time-consuming and several specimens should be collected on different days to improve the detection rate. Serology is a useful tool but it might overestimate the prevalence of disease due to cross-reactivity with other nematode infections and its difficulty distinguishing recent from past (and cured) infections. To evaluate treatment efficacy is still a major concern because direct parasitological methods might overestimate it and the serology has not yet been well evaluated; even if there is a decline in antibody titres after treatment, it is slow and it needs to be done at 6 to 12 months after treatment which can cause a substantial loss to follow-up in a clinical trial.
Collapse
Affiliation(s)
- Ana Requena-Méndez
- Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain.
| | | | | | | | | | | |
Collapse
|
34
|
Sultana Y, Gilbert GL, Ahmed BN, Lee R. Strongyloidiasis in a high risk community of Dhaka, Bangladesh. Trans R Soc Trop Med Hyg 2012; 106:756-62. [PMID: 23084030 DOI: 10.1016/j.trstmh.2012.08.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 08/29/2012] [Accepted: 08/29/2012] [Indexed: 11/28/2022] Open
Abstract
Residents of a slum community of Dhaka city, Bangladesh were tested by serological and faecal examination for evidence of Strongyloides stercoralis infection. In stool specimens from a total of 147 participants Strongyloides larvae were found in 34 (23.1%) by Harada-Mori culture, 15 (10.2%) by agar plate culture (APC) and one (0.7%) by microscopy. Strongyloides IgG, IgG1 and IgG4 antibodies were found in 90 (61.2%), 46 (31.3%) and 53 (36.1%) of participants, respectively. A positive correlation was observed between total IgG levels and the presence of isotypes IgG1 and IgG4 (p<0.001). Six sera (4.0%) reacted to the recombinant filaria antigen Bm 14, three of which were Strongyloides IgG positive. This indicates either there is cross reactivity or some participants are co-infected with lymphatic filariasis. No correlations were found between positive serology and Strongyloides infection in stool, socio- demographic factors or domestic hygienic practices. However, positive stool cultures showed significant associations with irregular nail trimming, walking bare-foot and irregular hand washing after defecation (p<0.05). Other enteric parasites were detected in stools of some participants but their presence showed no correlation with S. stercoralis infection or socio demographic factors. This study confirms that squatters in this slum community in Dhaka have a high prevalence of S. stercoralis infection identified both by serological and coprological methods.
Collapse
Affiliation(s)
- Yasmin Sultana
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, Westmead Hospital, Westmead, NSW, Australia.
| | | | | | | |
Collapse
|
35
|
Buonfrate D, Angheben A, Gobbi F, Muñoz J, Requena-Mendez A, Gotuzzo E, Mena MA, Bisoffi Z. Imported strongyloidiasis: epidemiology, presentations, and treatment. Curr Infect Dis Rep 2012; 14:256-62. [PMID: 22322601 DOI: 10.1007/s11908-012-0248-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Strongyloidiasis is extremely more frequent in immigrants than in travellers. Clinical presentations do not differ significantly between the two groups, and the most frequent picture is a chronic infection characterized by intermittent, mild, non-specific symptoms. Acute presentation is rare but it has been reported in travellers. Screening of asymptomatic subjects is not generally recommended, while a presumptive treatment with ivermectin might be justified for all travellers and immigrant patients presenting unexplained eosinophilia and/or compatible symptoms, even in case of negative test results. In fact, delayed diagnosis and treatment has life-threatening consequences in patients with conditions predisposing to development of hyperinfection and dissemination.
Collapse
Affiliation(s)
- Dora Buonfrate
- Centre for Tropical Diseases (CTD), Sacro Cuore Hospital, Via Sempreboni 5, Negrar, Verona, Italy,
| | | | | | | | | | | | | | | |
Collapse
|
36
|
|
37
|
Mejia R, Nutman TB. Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis. Curr Opin Infect Dis 2012; 25:458-63. [PMID: 22691685 PMCID: PMC3430846 DOI: 10.1097/qco.0b013e3283551dbd] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW This review discusses the latest approaches to the diagnosis and treatment of patients with strongyloidiasis, with an emphasis on infection in the immunocompromised host and the risk for disseminated strongyloidiasis. RECENT FINDINGS The differences in acute, chronic, accelerated autoinfection, and disseminated disease in Strongyloides stercoralis infection are explored with particular emphasis on early diagnosis, treatment, and prevention. The goals of treatment are investigated for the different infection states. Predisposing risks for dissemination are delineated, and the roles played for newer diagnostics in the identification of at-risk individuals are detailed. SUMMARY The use of newer diagnostic tests and broader screening of immunocompromised patients from Strongyloides-endemic areas is of paramount importance, particularly if prevention of life-threatening dissemination is the goal.
Collapse
Affiliation(s)
- Rojelio Mejia
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-0425, USA
| | | |
Collapse
|
38
|
Abstract
SUMMARYHuman strongyloidiasis is a neglected tropical disease with global distribution and this infection is caused by the parasitic nematodeStrongyloides stercoralis. The aim of this study was to determine the prevalence of strongyloidiasis in Dhaka, Bangladesh. Sera from 1004 residents from a slum (group A) and 299 from city dwellers (group B) were tested for total IgG and IgG subclasses toStrongyloidesantigen. There was a significant difference (P < 0·001) in IgG seroprevalence between group A (22%) and group B (5%). Reactive IgG subclasses (IgG1 and IgG4) were also higher in group A (P < 0·05). The seroprevalence of strongyloidiasis in group A increased with age but was unrelated to sex. The presence of reactive IgG toStrongyloidesantigen had no correlation with either socio-economic or personal hygiene factors. However, a history of diarrhoea in a family member, in the past 6 months, but not in the respondents was associated with detection of antibodies toS. stercoralis(P < 0·01). None of the sera from either group had an HTLV-I reaction. This study demonstrates that strongyloidiasis is prevalent in Dhaka, especially among slum dwellers, but concurrent infection with HTLV-I was not found. Future epidemiological studies should identify individual risk factors and other communities at risk so that appropriate interventions can be planned.
Collapse
|
39
|
Visser JT, Narayanan A, Campbell B. Strongyloides, dengue fever, and tuberculosis conversions in New Zealand police deploying overseas. J Travel Med 2012; 19:178-82. [PMID: 22530825 DOI: 10.1111/j.1708-8305.2012.00601.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Members of New Zealand Police (NZP) deploy overseas in a variety of roles. There is limited published data on travel-related morbidity in police as a subgroup of travelers. METHODS An audit of pre- and postdeployment medical files for all NZP personnel deploying overseas during 2004 to 2010 was undertaken. Of all deployments, 58.9% were within Oceania. RESULTS Positive Strongyloides stercoralis serology was returned in 6.07% (95% CI: 3.80%-9.13%) at a rate of 9.00/1,000 person deployment months (pdm) (95% CI: 5.57-13.8). Dengue fever seroconversion was recorded in 4.91% (95% CI: 3.40%-6.83%) at a rate of 8.57/1,000 pdm (95% CI: 5.90-12.0). The relative risk of dengue infection was 7.47 for Timor Leste compared to all other deployment destinations. An association between seroconverting for both dengue fever and Strongyloides was found. Tuberculosis conversion was recorded in 1.76% (95% CI: 0.85%-3.21%) at a rate of 2.92/1,000 pmd (95% CI: 1.48-5.375). A single case of human immunodeficiency virus (HIV) seroconversion was recorded. There were no recorded hepatitis C seroconversions. CONCLUSIONS Police deploying overseas appear to have similar rates of dengue and tuberculosis conversion as other groups of travelers, and they appear to be at low risk of hepatitis C and HIV. Strongyloidiasis appears to be a significant risk; postdeployment prevalence was markedly higher than that reported in a small number of studies.
Collapse
Affiliation(s)
- Jenny T Visser
- Department of Primary Health Care & General Practice, School of Medicine & Health Sciences, University of Otago, Wellington, New Zealand.
| | | | | |
Collapse
|
40
|
Belderok SM, van den Hoek A, Kint JA, Schim van der Loeff MF, Sonder GJ. Incidence, risk factors and treatment of diarrhoea among Dutch travellers: reasons not to routinely prescribe antibiotics. BMC Infect Dis 2011; 11:295. [PMID: 22035314 PMCID: PMC3223148 DOI: 10.1186/1471-2334-11-295] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 10/29/2011] [Indexed: 11/21/2022] Open
Abstract
Background Travellers' diarrhoea (TD) is the most common infectious disease among travellers. In the Netherlands, stand-by or prophylactic antibiotics are not routinely prescribed to travellers. This study prospectively assessed the incidence rate, risk factors, and treatment of TD among immunocompetent travellers. Methods Persons who attended the travel clinic of the Public Health Service Amsterdam in 2006-2007 before short-term travel to tropical and subtropical countries were invited to answer a questionnaire regarding sociodemographics and travel purpose; they were also asked to keep a daily structured travel diary, recording their itinerary, symptoms, and self-medication or consultation with a doctor. Diarrhoea episodes containing blood or mucous were considered severe. Results Of 1202 travellers, the median age was 38 years, and the median travel duration 3 weeks. Of all episodes, 96% were mild. The median duration of TD was 2 days and significantly shorter in subsequent episodes compared to first episodes (p < 0.0005). Of first episodes 38% started in the first travel week. The incidence rate (IR) for first episodes was 2.49 (95% confidence interval [CI], 2.30-2.70) per 100 travel days, with the highest IR among travellers to South-Central and West Asia. The IR for first and subsequent episodes was comparable. Risk factors for first episodes included female sex, a Western country of birth, and tourism as the purpose of travel. The lowest risk was in travellers to South America. An independent risk factor for subsequent episodes was female sex. In total, 5% of travellers used antibiotics; of those, 92% had mild diarrhoea, and 53% received antibiotics over the counter. Conclusions TD is common among travellers, but the overall course is mild, not requiring treatment. The incidence rates for first and second episodes are comparable. Female sex is a risk factor for the first episode, as well as subsequent ones. Prescription antibiotics are not needed in short-term healthy travellers.
Collapse
Affiliation(s)
- Sanne-Meike Belderok
- Department of Infectious Diseases, Public Health Service (GGD), Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|