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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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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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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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Smith CJ, Gaballah AH, Bowers K, Baxter C, Caruso CR. Atypical pulmonary presentation of Strongyloides stercoralis hyperinfection in a patient with philadelphia chromosome-positive acute lymphoblastic leukemia: Case report. IDCases 2022; 29:e01530. [PMID: 35712053 PMCID: PMC9193837 DOI: 10.1016/j.idcr.2022.e01530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/04/2022] [Indexed: 11/28/2022] Open
Abstract
Strongyloides stercoralis is a soil-transmitted helminth endemic to tropical and subtropical regions and can be acquired due to parasite penetration through the skin. It can remain dormant in the gastrointestinal system for decades after the primary infection. In immunocompromised patients, this parasite can cause autoinfection with progression to hyperinfection syndrome. Here we report a unique case of pulmonary strongyloidiasis in a 32-year-old female, originally from Guatemala, with a significant clinical history of Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia diagnosed in 2019. The patient is status post chemotherapy with tyrosine kinase inhibitor plus hyper-CVAD regimen (Cyclophosphamide, Vincristine sulfate, Doxorubicin hydrochloride (Adriamycin), and Dexamethasone). History of drug-induced hyperglycemia and obesity was also noted. Her current chief complaint included dyspnea, tachycardia, and chest pain. Chest computerized tomography (CT) scan showed diffuse interstitial pulmonary edema with septal thickening, scattered ground-glass opacities, and small pericardial effusion. Due to normal ejection fraction, the differential diagnosis included non-cardiogenic pulmonary edema, pneumonitis secondary to chemotoxicity, and infection. She rapidly progressed to acute hypoxic respiratory failure, and a bronchoalveolar lavage study revealed numerous larvae consistent with Strongyloides hyperinfection. Further workup revealed eosinophilia with negative Strongyloides IgG antibody. Given the rarity of this infection in the United States and the patient's place of birth, acquired latent Strongyloides infection is favored as the initial source of infection. The reactivation of the infection process was most likely secondary to her chemotherapy treatment. Strongyloides hyperinfection diagnosis can be challenging to establish and entails a high level of suspicion. Cytology evaluation is an essential factor for diagnosis.
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Affiliation(s)
- Caitlyn J. Smith
- University of Missouri, Department of Pathology and Anatomical Sciences, Columbia, MO, USA
- Correspondence to: Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO 65212, USA.
| | | | - Kelly Bowers
- University of Missouri, Department of Pathology and Anatomical Sciences, Columbia, MO, USA
| | - Chase Baxter
- University of Missouri, Division of Pulmonary, Critical Care and Environmental Medicine, Columbia, MO, USA
| | - Carla R. Caruso
- University of Missouri, Department of Pathology and Anatomical Sciences, Columbia, MO, USA
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5
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Strongyloidiasis – diagnostic and therapeutic dilemmas in hyperinfection patients: a case series. J Helminthol 2022; 96:e76. [DOI: 10.1017/s0022149x22000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
The helminth infection caused by Strongyloides stercoralis is widespread in tropical regions, but rare in European countries. Unfamiliarity with the disease and diagnostic obstacles could contribute to its lethal outcome. Frequent use of corticosteroids during the COVID-19 pandemic could increase its significance. The aim of this retrospective descriptive study was to explore disease patterns and discuss clinical dilemmas in patients with S. stercoralis hyperinfection treated at the University Hospital for Infectious Diseases ‘Dr. Fran Mihaljević’ in Zagreb, Croatia, between 2010 and 2021. Five out of 22 (22.7%) immunosuppressed patients treated due to strongyloidiasis developed hyperinfection. All patients were male, median 64 years; four were immunosuppressed by corticosteroids (although ileum resection could have been the trigger in one) and one by rituximab. The diagnosis was established after a median of 1.5 months of symptom duration, accidentally in all patients, by visualizing the parasite in the gastric/duodenal mucosa in four cases, and bronchial aspirate in one. All patients were cachectic, four out of five had severe hypoalbuminemia and all suffered secondary bacterial/fungal infection. Despite combined antibiotic, antifungal and antihelmintic therapy, three out of five of the patients died, after failing to clear living parasites from stool samples. We can conclude that significant delays in diagnosis and lack of clinical suspicion were observed among our patients with the most severe clinical presentations of strongyloidiasis. Although being beyond diagnostic recommendations for strongyloidiasis, an early upper gastrointestinal endoscopy with mucosal sample analysis could expedite diagnosis in severe, immunosuppressed patients. The persistence of viable parasites in the stool despite antihelmintic therapy should be further investigated.
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Gordon CA, Shield JM, Bradbury RS, Muhi S, Page W, Judd JA, Lee R, Biggs BA, Ross K, Kurscheid J, Gray DJ, McManus DP. HTLV-I and Strongyloides in Australia: The worm lurking beneath. ADVANCES IN PARASITOLOGY 2021; 111:119-201. [PMID: 33482974 DOI: 10.1016/bs.apar.2020.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Strongyloidiasis and HTLV-I (human T-lymphotropic virus-1) are important infections that are endemic in many countries around the world with an estimated 370 million infected with Strongyloides stercoralis alone, and 5-10 million with HTVL-I. Co-infections with these pathogens are associated with significant morbidity and can be fatal. HTLV-I infects T-cells thus causing dysregulation of the immune system which has been linked to dissemination and hyperinfection of S. stercoralis leading to bacterial sepsis which can result in death. Both of these pathogens are endemic in Australia primarily in remote communities in Queensland, the Northern Territory, and Western Australia. Other cases in Australia have occurred in immigrants and refugees, returned travellers, and Australian Defence Force personnel. HTLV-I infection is lifelong with no known cure. Strongyloidiasis is a long-term chronic disease that can remain latent for decades, as shown by infections diagnosed in prisoners of war from World War II and the Vietnam War testing positive decades after they returned from these conflicts. This review aims to shed light on concomitant infections of HTLV-I with S. stercoralis primarily in Australia but in the global context as well.
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Affiliation(s)
- Catherine A Gordon
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Jennifer M Shield
- Department of Pharmacy and Biomedical Sciences, La Trobe University, Bendigo, VIC, Australia; Department of Medicine, The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Richard S Bradbury
- School of Health and Life Sciences, Federation University, Berwick, VIC, Australia
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Page
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Jenni A Judd
- School of Health Medical and Applied Sciences, Central Queensland University, Bundaberg, QLD, Australia; Centre for Indigenous Health Equity Research, Central Queensland University, Bundaberg, QLD, Australia
| | - Rogan Lee
- Westmead Clinical School, The University of Sydney, Westmead, NSW, Australia
| | - Beverley-Ann Biggs
- Department of Medicine, The Peter Doherty Institute for Infection and Immunity, University of Melbourne and the Royal Melbourne Hospital, Melbourne, VIC, Australia; Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kirstin Ross
- College of Science and Engineering, Flinders University, Adelaide, South Australia, Australia
| | - Johanna Kurscheid
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Darren J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - Donald P McManus
- Infectious Diseases Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
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Lier AJ, Tuan JJ, Davis MW, Paulson N, McManus D, Campbell S, Peaper DR, Topal JE. Case Report: Disseminated Strongyloidiasis in a Patient with COVID-19. Am J Trop Med Hyg 2020; 103:1590-1592. [PMID: 32830642 PMCID: PMC7543803 DOI: 10.4269/ajtmh.20-0699] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The SARS-CoV-2 virus has emerged and rapidly evolved into a current global pandemic. Although bacterial and fungal coinfections have been associated with COVID-19, little is known about parasitic infection. We report a case of a COVID-19 patient who developed disseminated strongyloidiasis following treatment with high-dose corticosteroids and tocilizumab. Screening for Strongyloides infection should be pursued in individuals with COVID-19 who originate from endemic regions before initiating immunosuppressive therapy.
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Affiliation(s)
- Audun J Lier
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jessica J Tuan
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Matthew W Davis
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut
| | - Nathan Paulson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Dayna McManus
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut
| | - Sheldon Campbell
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - David R Peaper
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey E Topal
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, Connecticut.,Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Rodrigues JP, Vasconcelos Azevedo FVP, Zoia MAP, Maia LP, Correia LIV, Costa-Cruz JM, de Melo Rodrigues V, Goulart LR. The Anthelmintic Effect on Strongyloides venezuelensis Induced by BnSP- 6, a Lys49-phospholipase A2 Homologue from Bothrops pauloensis Venom. Curr Top Med Chem 2019; 19:2032-2040. [DOI: 10.2174/1568026619666190723152520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/20/2019] [Accepted: 07/01/2019] [Indexed: 12/13/2022]
Abstract
Background:
Phospholipases A2 (PLA2) from snake venoms have a broad potential as
pharmacological tools on medicine. In this context, strongyloidiasis is a neglected parasitic disease
caused by helminths of the genus Strongyloides. Currently, ivermectin is the drug of choice for treatment,
however, besides its notable toxicity, therapeutic failures and cases of drug resistance have been
reported. BnSP-6, from Bothorps pauloensis snake venom, is a PLA2 with depth biochemical characterization,
reporting effects against tumor cells and bacteria.
Objective:
The aim of this study is to demonstrate for the first time the action of the PLA2 on Strongyloides
venezuelensis.
Methods:
After 72 hours of treatment with BnSP-6 mortality of the infective larvae was assessed by motility
assay. Cell and parasite viability was evaluated by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl
tetrazolium bromide (MTT) assay. Furthermore, autophagic vacuoles were labeled with Monodansylcadaverine
(MDC) and nuclei of apoptotic cells were labeled with Propidium Iodide (PI). Tissue degeneration
of the parasite was highlighted by Transmission Electron Microscopy (TEM).
Results:
The mortality index demonstrated that BnSP-6 abolishes the motility of the parasite. In addition,
the MTT assay attested the cytotoxicity of BnSP-6 at lower concentrations when compared with
ivermectin, while autophagic and apoptosis processes were confirmed. Moreover, the anthelmintic effect
was demonstrated by tissue degeneration observed by TEM. Furthermore, we report that BnSP-6
showed low cytotoxicity on human intestinal cells (Caco-2).
Conclusion:
Altogether, our results shed light on the potential of BNSP-6 as an anthelmintic agent,
which can lead to further investigations as a tool for pharmaceutical discoveries.
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Affiliation(s)
- Jéssica Peixoto Rodrigues
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Fernanda Van Petten Vasconcelos Azevedo
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-227, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Mariana Alves Pereira Zoia
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Larissa Prado Maia
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Lucas Ian Veloso Correia
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-227, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Julia Maria Costa-Cruz
- Laboratory of Parasitological Diagnostics, Institute of Biomedical Sciences, Federal University of Uberlandia, Campus Umuarama BL-4C, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Veridiana de Melo Rodrigues
- Laboratory of Biochemistry and Animal Toxins, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-227, Uberlândia, Minas Gerais, 38400-902, Brazil
| | - Luiz Ricardo Goulart
- Laboratory of Nanobiotechnology, Institute of Biotechnology, Federal University of Uberlandia, Av. Amazonas s/n, Campus Umuarama BL-2E, SL-248, Uberlândia, Minas Gerais, 38400-902, Brazil
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Abstract
Gastrointestinal mucosal biopsies in the hematopoietic stem cell transplantation setting are challenging because histologic features of graft-versus-host disease (GVHD), which is treated by increasing immunosuppression, overlap with those of other conditions, such as infection, which can get worse with GVHD treatment. More than one condition can occur at the same time. It is important to understand the histologic features of GVHD, drug toxicity, infection, and clinical factors surrounding patients, including timing of biopsy in relation to transplantation, medication history, and laboratory data. Rendering a correct diagnosis and generating a pathology report with standard language that can direct clinical management ensure proper management.
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Strongyloidiasis Current Status with Emphasis in Diagnosis and Drug Research. J Parasitol Res 2017; 2017:5056314. [PMID: 28210503 PMCID: PMC5292188 DOI: 10.1155/2017/5056314] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/08/2016] [Indexed: 12/27/2022] Open
Abstract
Strongyloidiasis is a parasitic neglected disease caused by the nematode Strongyloides stercoralis affecting 30 to 100 million people worldwide. Complications, strongly associated with alcoholism, organ transplants, and HTLV-1 virus, often arise due to late diagnosis, frequently leading to patient death. Lack of preemptive diagnosis is not the only difficulty when dealing with this parasite, since there are no gold standard diagnostic techniques, and the ones used have problems associated with sensitivity, resulting in false negatives. Treatment is also an issue as ivermectin and benzimidazoles administration leads to inconsistent cure rates and several side effects. Researching new anti-Strongyloides drugs is a difficult task since S. stercoralis does not develop until the adult stages in Mus musculus (with the exception of SCID mice), the main experimental host model. Fortunately, alternative parasite models can be used, namely, Strongyloides ratti and S. venezuelensis. However, even with these models, there are other complications in finding new drugs, which are associated with specific in vitro assay protocol steps, such as larvae decontamination. In this review, we highlight the challenges associated with new drug search, the compounds tested, and a list of published in vitro assay methodologies. We also point out advances being made in strongyloidiasis diagnosis so far.
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Buonfrate D, Gobbi F, Beltrame A, Bisoffi Z. Severe Anemia and Lung Nodule in an Immunocompetent Adopted Girl with Strongyloides stercoralis Infection. Am J Trop Med Hyg 2016; 95:1051-1053. [PMID: 27601521 DOI: 10.4269/ajtmh.16-0504] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/27/2016] [Indexed: 11/07/2022] Open
Abstract
Strongyloides stercoralis is a soil-transmitted helminth widely diffused in tropical areas. Chronic infection is usually characterized by absent or mild symptoms, but immunocompromised subjects are at risk of developing a severe syndrome that can be fatal if not promptly treated. We report a case of S. stercoralis infection causing severe anemia (hemoglobin 4.9 g/dL) and a lung nodule in a 14-year-old girl of Ethiopian origin adopted by an Italian couple. Severe anemia due to strongyloidiasis has been rarely reported, and mostly in severely ill patients, whereas our patient was immunocompetent and in good general conditions. Also, lung nodules have been only occasionally described in absence of respiratory symptoms. We discuss the management of patients with these findings, and we suggest to update the screening of immigrants from countries endemic for strongyloidiasis, including serology.
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Affiliation(s)
- Dora Buonfrate
- Centre for Tropical Diseases, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy.
| | - Federico Gobbi
- Centre for Tropical Diseases, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Anna Beltrame
- Centre for Tropical Diseases, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
| | - Zeno Bisoffi
- Centre for Tropical Diseases, Ospedale Sacro Cuore Don Calabria, Negrar, Verona, Italy
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12
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Buonfrate D, Gobbi F, Bisoffi Z. Comment on: Subcutaneous ivermectin use in the treatment of severeStrongyloides stercoralisinfection: two case reports and a discussion of the literature. J Antimicrob Chemother 2016; 71:1130-1. [DOI: 10.1093/jac/dkv450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Alsharif A, Sodhi A, Murillo LC, Headley AS, Kadaria D. Wait!!! No Steroids for this Asthma…. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:398-400. [PMID: 26114594 PMCID: PMC4484613 DOI: 10.12659/ajcr.893729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patient: Female, 31 Final Diagnosis: Hyperinfection syndrome due to Strongyloides stercoralis Symptoms: Abdominal pain • shortness of breath Medication: Prednisone Clinical Procedure: Bronchoscopy with BAL Specialty: Pulmonology
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Affiliation(s)
- Abdelhamid Alsharif
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, College of Medicine at Memphis, Memphis, TN, USA
| | - Amik Sodhi
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, College of Medicine at Memphis, Memphis, TN, USA
| | - Luis C Murillo
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, College of Medicine at Memphis, Memphis, TN, USA
| | - Arthur S Headley
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, College of Medicine at Memphis, Memphis, TN, USA
| | - Dipen Kadaria
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, College of Medicine at Memphis, Memphis, TN, USA
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