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Santarém VA, Pinto GLB, Ferreira IB, Ribeiro J, Filho RTDS, Meisel DMC, Gryschek RCB, Lescano SAZ, Giuffrida R, Kmetiuk LB, de Paula FM, Biondo AW. A silent threat behind bars: Serosurvey and associated risk factors for strongyloidiasis in female inmates and correctional officers. Acta Trop 2024; 257:107301. [PMID: 38955318 DOI: 10.1016/j.actatropica.2024.107301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/04/2024] [Accepted: 06/21/2024] [Indexed: 07/04/2024]
Abstract
Strongyloidiasis has been a neglected parasitic infection caused by Strongyloides genus parasites. Despite assessment of S. stercoralis exposure in different vulnerable populations, seroprevalence in inmates worldwide remains to be fully established. Due to poor sanitation and lack of personal hygienic practices, incarcerated individuals have been considered prone to spread infectious illnesses. Accordingly, the present study has assessed exposure and associated risk factors for strongyloidiasis in women inmates and correctional officers at the Women's State Penitentiary of Parana, part of the third largest incarceration complex in Brazil at the time. Blood samplings were performed in 2020 and 2021from a total of 503 women inmates and 92 correctional officers. Participants voluntarily responded to an epidemiological questionnaire to assess associated risk factors to strongyloidiasis. Serological analysis was performed by ELISA for anti-S. stercoralis IgG detection. Statistical analysis was performed using R software, adopting a 5% level of significance. The data were submitted to univariate analysis by chi-square or Fisher´s Exact test for assessing the association among seropositivity and the variables. The variables with p-value < 0.2 in the univariate analysis were considered fit to be included in the logistic regression. In overall, 356/503 (70.8%; 95% CI: 66.7-74.6) inmates were seropositive for anti-S. stercoralis antibodies, with no statistically associated risk factor to seropositivity. A total of 57/92 (62.0%; 95% CI: 51.8-71.2) correctional officers were seropositive, and logistic regression revealed that individuals older than 50 years were more likely seropositive. In conclusion, the high endemicity observed herein has indicated a history of previous exposure to S. stercoralis and warned for a systematic strongyloidiasis screening for inmates, to prevent long term morbidity and disseminated infection during incarceration.
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Affiliation(s)
- Vamilton Alvares Santarém
- Graduate College in Animal Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP 19050-920, Brazil
| | - Gabriel Luís Brucinski Pinto
- Graduate College of Cell and Molecular Biology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários, 1540, Juvevê, Curitiba, PR 80035-050, Brazil
| | - Isabella Braghin Ferreira
- Graduate College in Animal Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP 19050-920, Brazil
| | - Juliano Ribeiro
- Graduate College of Cell and Molecular Biology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários, 1540, Juvevê, Curitiba, PR 80035-050, Brazil
| | | | - Dirce Mary Correa Meisel
- Laboratory of Medical Investigation (LIM/06), Clinical Hospital of the University of São Paulo, SP, Brazil
| | | | | | - Rogério Giuffrida
- Graduate College in Animal Sciences, University of Western São Paulo (UNOESTE), Presidente Prudente, SP 19050-920, Brazil
| | - Louise Bach Kmetiuk
- Zoonoses Surveillance Unit, Municipal Secretary of Health, Curitiba, PR, Brazil
| | - Fabiana Martins de Paula
- Laboratory of Medical Investigation (LIM/06), Clinical Hospital of the University of São Paulo, SP, Brazil
| | - Alexander Welker Biondo
- Graduate College of Cell and Molecular Biology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários, 1540, Juvevê, Curitiba, PR 80035-050, Brazil.
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Rajamanickam A, Dasan B, Munisankar S, Nott S, Menon PA, Ahamed Shaik F, Chinnaiyan P, Nutman TB, Babu S. Impact of Strongyloides stercoralis infection on complement activation in Type 2 diabetes mellitus: Insights from a clinical and anthelmintic intervention study. PLoS Negl Trop Dis 2024; 18:e0012048. [PMID: 38564496 PMCID: PMC10986927 DOI: 10.1371/journal.pntd.0012048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Numerous studies indicate a potential protective role of helminths in diabetes mellitus (DM) progression. The complement system, vital for host defense, plays a crucial role in tissue homeostasis and immune surveillance. Dysregulated complement activation is implicated in diabetic complications. We aimed to investigate the influence of the helminth, Strongyloides stercoralis (Ss) on complement activation in individuals with type 2 DM (T2D). METHODOLOGY We assessed circulating levels of complement proteins (C1q, C2, C3, C4, C4b, C5, C5a, and MBL (Lectin)) and their regulatory components (Factor B, Factor D, Factor H, and Factor I) in individuals with T2D with (n = 60) or without concomitant Ss infection (n = 58). Additionally, we evaluated the impact of anthelmintic therapy on these parameters after 6 months in Ss-infected individuals (n = 60). RESULTS Ss+DM+ individuals demonstrated reduced levels of complement proteins (C1q, C4b, MBL (Lectin), C3, C5a, and C3b/iC3b) and complement regulatory proteins (Factor B and Factor D) compared to Ss-DM+ individuals. Following anthelmintic therapy, there was a partial reversal of these levels in Ss+DM+ individuals. CONCLUSION Our findings indicate that Ss infection reduces complement activation, potentially mitigating inflammatory processes in individuals with T2D. The study underscores the complex interplay between helminth infections, complement regulation, and diabetes mellitus, offering insights into potential therapeutic avenues.
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Affiliation(s)
| | - Bindu Dasan
- NIH-NIAID-International Center for Excellence in Research, Chennai, India
| | | | - Sujatha Nott
- Infectious Diseases, Dignity Health, Chandler, Arizona, United States of America
| | | | - Fayaz Ahamed Shaik
- NIH-NIAID-International Center for Excellence in Research, Chennai, India
| | | | - Thomas B. Nutman
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Subash Babu
- NIH-NIAID-International Center for Excellence in Research, Chennai, India
- Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America
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Wongphutorn P, Noordin R, Anuar NS, Worasith C, Kopolrat KY, Homwong C, Tippayawat P, Techasen A, Pitaksakurat O, Sithithaworn J, Eamudomkarn C, Sithithaworn P. Examination of Diagnostic Performance of New IgG4 Rapid Test Compared with IgG- and IgG4-ELISAs to Investigate Epidemiology of Strongyloidiasis in Northeast Thailand. Am J Trop Med Hyg 2024; 110:254-262. [PMID: 38190756 PMCID: PMC10859814 DOI: 10.4269/ajtmh.23-0518] [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: 08/06/2023] [Accepted: 10/16/2023] [Indexed: 01/10/2024] Open
Abstract
Strongyloidiasis, caused by Strongyloides stercoralis, is a neglected tropical disease with a global distribution. The infection can be fatal in immunocompromised individuals, and accurate diagnosis leading to timely treatment can save lives. Serodiagnosis is a sensitive method for diagnosis and is recommended for screening high-risk individuals. A point-of-care rapid test will facilitate the screening activities, especially in low-resource settings. This study aims to apply a new IgG4 immunochromatographic test using S. stercoralis recombinant antigen (SsRapid® cassette test) and to compare it with in-house IgG and IgG4 enzyme-linked immunosorbent assays (IgG- and IgG4-ELISAs) using native Strongyloides ratti antigen to investigate the epidemiology of strongyloidiasis in northeast Thailand. A total of 300 people participated, with 136 males and 164 females of a similar mean age. The reference tests were fecal examinations using the formalin-ethyl acetate concentration technique and an agar plate culture technique. The prevalence of S. stercoralis determined by SsRapid (81.7%) was significantly higher than that by fecal examinations (43.3%) or by antibody detection by IgG-ELISA (53.0%) or IgG4-ELISA (44.0%). The diagnostic sensitivities of SsRapid, IgG-ELISA, and IgG4-ELISA were found to be 93.9%, 77.7%, and 63.1%, respectively. The rate of positive tests by the SsRapid was significantly correlated to the levels of Strongyloides-specific IgG4 and IgG antibodies. By all diagnostic methods, male participants had a significantly higher prevalence of strongyloidiasis than females. Age was significantly associated with the concentration of specific serum IgG but not with the SsRapid grading score. In conclusion, SsRapid was shown to be a sensitive and valuable diagnostic test for the epidemiology study of strongyloidiasis.
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Affiliation(s)
| | - Rahmah Noordin
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang, Malaysia
| | - Nor Suhada Anuar
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia, Penang, Malaysia
| | - Chanika Worasith
- Department of Adult Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Kulthida Y. Kopolrat
- Faculty of Public Health, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon, Thailand
| | - Chutima Homwong
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
| | | | - Anchalee Techasen
- Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, Thailand
| | - Opal Pitaksakurat
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Chatanun Eamudomkarn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Paiboon Sithithaworn
- Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Beiromvand M, Ashiri A, de Ree V, Harbecke D, Rödelsperger C, Streit A, Rafiei A. Strongyloides stercoralis genotyping in a human population in southwestern Iran. Parasit Vectors 2024; 17:21. [PMID: 38229164 DOI: 10.1186/s13071-023-06103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Strongyloidiasis is a neglected tropical disease (NTD) that is caused mainly by Strongyloides stercoralis, with an estimated 600 million people infected worldwide, and in fewer cases by Strongyloides fuelleborni fuelleborni and Strongyloides fuelleborni kellyi. A number of studies have been conducted on the genetic diversity of S. stercoralis in East and Southeast Asia; however, there is very limited corresponding information from West Asian countries, including Iran. METHODS For Strongyloides worms collected from patients in southwestern Iran, the hypervariable regions I (HVR-I) and IV (HVR-IV) of the nuclear 18S ribosomal DNA (rDNA) locus (SSU) and a fragment of the subunit 1 mitochondrial cytochrome c oxidase gene (cox-1) were sequenced. For a subset of the worms, whole-genome sequencing data were generated. RESULTS The cox-1 sequences of 136 worms isolated from 23 patients indicated that all isolates were S. stercoralis. Among the cox-1 sequences, 33 polymorphic sites and 13 haplotypes were found. The phylogenetic analysis demonstrated that some sequences clustered fairly closely with sequences from humans and dogs from other parts of the world, while others formed a separate, Iran-specific group. Among 64 S. stercoralis analyzed, we found three of the previously described SSU HVR-I haplotypes, with haplotype II being the most frequent haplotype. In contrast to Southeast Asia, where S. stercoralis heterozygous for different haplotypes at the HVR-I locus are rare, we found 20 worms to be heterozygous for two different HVR-I haplotypes, 18 of which fell into the Iran-specific cox-1 cluster. SSU-heterozygous worms also showed elevated heterozygosity at the whole-genome level. CONCLUSIONS We conclude that the S. stercoralis population from the Khuzestan province shares much of the genetic diversity with the population in Southeast Asia, but there is an indication of additional genetic input. There appears to be some population structure with different subpopulations, which however do interbreed at least occasionally.
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Affiliation(s)
- Molouk Beiromvand
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
- Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Alireza Ashiri
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Veroni de Ree
- Department of Integrative Evolutionary Biology, Max Planck Institute for Biology Tübingen, Tübingen, Baden‑Württemberg, Germany
| | - Dorothee Harbecke
- Department of Integrative Evolutionary Biology, Max Planck Institute for Biology Tübingen, Tübingen, Baden‑Württemberg, Germany
| | - Christian Rödelsperger
- Department of Integrative Evolutionary Biology, Max Planck Institute for Biology Tübingen, Tübingen, Baden‑Württemberg, Germany
| | - Adrian Streit
- Department of Integrative Evolutionary Biology, Max Planck Institute for Biology Tübingen, Tübingen, Baden‑Württemberg, Germany.
| | - Abdollah Rafiei
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Buonfrate D, Montresor A, Bisoffi Z, Tamarozzi F, Bisanzio D. Progress towards the implementation of control programmes for strongyloidiasis in endemic areas: estimation of number of adults in need of ivermectin for strongyloidiasis. Philos Trans R Soc Lond B Biol Sci 2024; 379:20220433. [PMID: 38008113 PMCID: PMC10676811 DOI: 10.1098/rstb.2022.0433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 10/13/2023] [Indexed: 11/28/2023] Open
Abstract
The World Health Organization has started a process to issue guidelines for the control of strongyloidiasis. The guidelines might recommend to implement preventive chemotherapy (PC) at community level (i.e. to all individuals above 5 years of age), over a defined prevalence threshold. We previously estimated the number of school-age children (SAC) who would need PC. Here we estimate the number of people above 15 years of age who might be included in PC for strongyloidiasis. Based on previous Strongyloides prevalence estimates and on countries' age distribution, we retrieved the number of adults in need of PC. We then subtracted the number of people already involved in ivermectin mass distribution for the elimination of onchocerciasis and lymphatic filariasis and people living in countries where Loa loa is endemic. The number of adults to be involved in PC was estimated at 905.4 (95% confidence interval (CI): 520.6-1177.2), 660.2 (95% CI: 512.7-1214.9), and 512.1 (95% CI: 276-719.4) million people, when the strongyloidiasis prevalence threshold for implementing PC was set to 10%, 15% and 20%, respectively. Estimates at country level are also provided.These estimates might help endemic countries wishing to implement PC for strongyloidiasis to allocate resources to include adults in addition to SAC in control programmes. This article is part of the Theo Murphy meeting issue 'Strongyloides: omics to worm-free populations'.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore don Calabria Hospital, 370242, Negrar, Verona, Italy
| | - Antonio Montresor
- Department of Control of Neglected Tropical Diseases, World Health Organization, 12024, Geneva, Switzerland
| | - Zeno Bisoffi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore don Calabria Hospital, 370242, Negrar, Verona, Italy
| | - Francesca Tamarozzi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore don Calabria Hospital, 370242, Negrar, Verona, Italy
| | - Donal Bisanzio
- Research Triangle Institute International, Washington, DC 20005-3967, USA
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, NG5 1PB, UK
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Zhu L, Zhang H, Fang J, Xiao S, Xiong F, Deng C, Yang Q, Fu C, Pan Q, Zhao H. Massive Airway Bleeding Caused by Pulmonary Strongyloidiasis in a Patient with a Transplanted Kidney. Int Med Case Rep J 2024; 17:1-7. [PMID: 38196944 PMCID: PMC10772052 DOI: 10.2147/imcrj.s442535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/26/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction We report a fatal case of massive airway bleeding caused by pulmonary strongyloidiasis in a patient with a transplanted kidney. Case Presentation A 47-year-old male, regularly taking immunosuppressants post-kidney transplant, visited our hospital with symptoms of abdominal bloating, nausea, and emesis persisting for three days. After hospitalization, he developed a cough, hemoptysis, and respiratory failure. Sputum analysis confirmed an infestation with Strongyloides stercoralis. Despite receiving albendazole therapy and bronchoscopic management for bronchial hemorrhage, the patient ultimately died due to acute respiratory and circulatory collapse triggered by severe airway bleeding. Conclusion Patients undergoing immunosuppressive therapy following kidney transplantation are at increased risk for disseminated strongyloidiasis. Consequently, infectious disease screening prior to transplantation, along with essential preventive pharmacotherapy, is of paramount importance.
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Affiliation(s)
- Longyin Zhu
- Department of Nephrology, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China
| | - Huhai Zhang
- Department of Nephrology, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China
| | - Jia Fang
- Department of Nephrology, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China
| | - Shuang Xiao
- Department of Infectious Disease, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China
| | - Fu Xiong
- Department of Respiratory and Critical Care Medicine, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China
| | - Caixia Deng
- Department of Respiratory and Critical Care Medicine, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China
| | - Qin Yang
- Department of Nephrology, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China
| | - Chunxiao Fu
- Department of Nephrology, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China
| | - Qianguang Pan
- Department of Nephrology, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China
| | - Hongwen Zhao
- Department of Nephrology, the First Hospital Affiliated to Army Military Medical University (Southwest Hospital), Chongqing, 400038, People’s Republic of China
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Barnikel M, Grabmaier U, Mertsch P, Ceelen F, Janke C, Behr J, Kneidinger N, Milger K. Domestic Parasitic Infections in Patients with Asthma and Eosinophilia in Germany - Three Cases with Learnings in the Era of Anti- IL5 Treatments. J Asthma Allergy 2023; 16:1229-1232. [PMID: 37965273 PMCID: PMC10642391 DOI: 10.2147/jaa.s428607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
Eosinophilic inflammation is a hallmark of asthma, and blood eosinophilia has been established as a biomarker for phenotyping asthma and predicting the response to anti-IL5 treatments. Although parasitic infections are rare in European adults, they remain an important differential diagnosis for blood eosinophilia. We present three patients with both domestic parasitic infections and asthma to raise awareness of the potential challenge of eosinophilia and to provide experience in the management of parasitic infections in the setting of planned or ongoing anti-IL5 treatment. One, a patient from Croatia with moderate asthma but severe blood eosinophilia had an underlying Strongyloides stercoralis infection, with positive stool cultures. Second, a patient with severe allergic asthma and gastrointestinal symptoms had a positive S. stercoralis titer in serology with a clinical response to treatment with ivermectin. Third, a patient with severe nonallergic eosinophilic asthma and eosinophilic granulomatosis with polyangiitis (EGPA) showed an increasing hepatic tumour under anti-IL5-receptor therapy. Positive serology confirmed the diagnosis of Echinococcus multilocularis, and albendazole therapy was initiated. Anti-IL5 therapies were safely started (Patient 2) or resumed (Patient 3) after the initiation of antiparasitic treatment. Screening for parasitic infections is useful in cases of hypereosinophilia, extrapulmonary symptoms or stay in endemic regions.
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Affiliation(s)
- Michaela Barnikel
- Department of Medicine V, LMU University Hospital, Munich, Germany
- Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Ulrich Grabmaier
- Department of Medicine I, LMU University Hospital, Munich, Germany
| | - Pontus Mertsch
- Department of Medicine V, LMU University Hospital, Munich, Germany
- Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Felix Ceelen
- Department of Pneumology, Asklepios-Fachkliniken Munich-Gauting, Gauting, Germany
| | - Christian Janke
- Department of Infectious Diseases and Tropical Medicine, LMU University Hospital, Munich, Germany
| | - Jürgen Behr
- Department of Medicine V, LMU University Hospital, Munich, Germany
- Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Nikolaus Kneidinger
- Department of Medicine V, LMU University Hospital, Munich, Germany
- Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katrin Milger
- Department of Medicine V, LMU University Hospital, Munich, Germany
- Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
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Costache C, Colosi IA, Neculicioiu VS, Florian DI, Petrushev B, Vasvari A, Seicean A. A Rare Case of Strongyloides stercoralis Hyperinfection in a Diabetic Patient from Romania—Case Report and Review of the Literature. Pathogens 2023; 12:pathogens12040530. [PMID: 37111416 PMCID: PMC10146644 DOI: 10.3390/pathogens12040530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
Severe cases of strongyloidiasis are most often associated with multiple causes of immune suppression, such as corticoid treatment and HTLV (human T-lymphotropic virus) coinfection. Diabetes is not traditionally considered a risk factor for the development of severe strongyloidiasis. We report a rare case of autochthonous severe strongyloidiasis in Romania, a European country with a temperate climate. A 71-year-old patient with no prior travel history was admitted with multiple gastrointestinal complaints and recent weight loss. CT (computed tomography) scans indicated duodenal wall thickening, and duodenal endoscopy evidenced mucosal inflammation, ulcerations and partial duodenal obstruction at D4. Microscopic examination of stool samples and biopsy specimens from the gastric and duodenal mucosa revealed an increased larval burden characteristic of Strongyloides stercoralis hyperinfection. Sequential treatment with albendazole and ivermectin achieved parasitological cure and complete recovery. The novelty of our case stems from the scarcity of severe strongyloidiasis cases reported in Europe and especially in Romania, the absence of other risk factors in our patient aside from diabetes, the involvement of the gastric mucosa and the rare presentation as partial duodenal obstruction. This case highlights the importance of considering strongyloidiasis as a differential diagnosis, even in temperate climates where cases are sporadic, in cases in which immune suppression is not evident and in the absence of eosinophilia. The case is presented in the context of the first literature review examining the relationship between severe strongyloidiasis and diabetes, emphasizing diabetes as a possible risk factor for severe strongyloidiasis.
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Affiliation(s)
- Carmen Costache
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioana Alina Colosi
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Vlad Sever Neculicioiu
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence:
| | - Diana Ioana Florian
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Bobe Petrushev
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Alexandra Vasvari
- Department of Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
- Department of Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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