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Chastain DB, Spradlin M, Ahmad H, Henao-Martínez AF. Unintended Consequences: Risk of Opportunistic Infections Associated With Long-term Glucocorticoid Therapies in Adults. Clin Infect Dis 2024; 78:e37-e56. [PMID: 37669916 DOI: 10.1093/cid/ciad474] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Indexed: 09/07/2023] Open
Abstract
Glucocorticoids are widespread anti-inflammatory medications used in medical practice. The immunosuppressive effects of systemic glucocorticoids and increased susceptibility to infections are widely appreciated. However, the dose-dependent model frequently used may not accurately predict the risk of infection in all patients treated with long-term glucocorticoids. In this review, we examine the risks of opportunistic infections (OIs) in patients requiring glucocorticoid therapy by evaluating the influence of the glucocorticoid dose, duration, and potency, combined with biological and host clinical factors and concomitant immunosuppressive therapy. We propose strategies to prevent OIs, which involve screening, antimicrobial prophylaxis, and immunizations. While this review focuses on patients with autoimmune, inflammatory, or neoplastic diseases, the potential risks and preventative strategies are likely applicable to other populations. Clinicians should actively assess the benefit-harm ratios of systemic glucocorticoids and implement preventive efforts to decrease their associated infections complications.
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Affiliation(s)
- Daniel B Chastain
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Albany, Georgia, USA
| | - Megan Spradlin
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hiba Ahmad
- Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
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2
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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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3
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Hamze H, Tai T, Harris D. Strongyloides hyperinfection syndrome precipitated by immunosuppressive therapy for rheumatoid arthritis and COVID-19 pneumonia. Trop Dis Travel Med Vaccines 2023; 9:15. [PMID: 37794447 PMCID: PMC10552379 DOI: 10.1186/s40794-023-00201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/17/2023] [Indexed: 10/06/2023] Open
Abstract
The COVID-19 pandemic has posed clinical and public health challenges worldwide. The use of corticosteroids has become an evidence-based practice to reduce the hyperinflammatory process involved in severe COVID-19 disease. However, this can result in the reactivation of parasitic infestations, even with a short course. We report the case of a 64-year-old Cuban born patient who passed away from S. stercoralis hyperinfection syndrome following treatment with dexamethasone for severe COVID-19 disease on a background of prolonged immunosuppression for rheumatoid arthritis. Clinicians should be aware of the risk of strongyloidiasis as a complication of the treatment for severe COVID-19 and other immunosuppressive therapies. We recommend empiric Strongyloides treatment for those who are from, or who have accumulated risk by travelling to endemic areas, and are being treated with corticosteroids for severe COVID-19 disease.
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Affiliation(s)
- Hasan Hamze
- Department of Pathology and Laboratory Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC, V6T 1Z7, Canada
| | - Teresa Tai
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - David Harris
- Department of Medicine, Division of Infectious Diseases, BC Centre for Excellence in HIV/AIDS (BC-CfE), St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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4
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Gardini G, Froeschl G, Gurrieri F, De Francesco MA, Cattaneo C, Marchese V, Piccinelli G, Corbellini S, Pagani C, Santagiuliana M, Fumarola B, Gulletta M, Perandin F, Castelli F, Matteelli A. Strongyloides stercoralis infection: an underlying cause of invasive bacterial infections of enteric origin. Results from a prospective cross-sectional study of a northern Italian tertiary hospital. Infection 2023; 51:1541-1548. [PMID: 37462896 PMCID: PMC10545639 DOI: 10.1007/s15010-023-02072-1] [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: 02/03/2022] [Accepted: 06/28/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE OF THE STUDY We assessed the prevalence of S. stercoralis in a cohort of inpatients with invasive bacterial infections of enteric origin to investigate whether the parasite may facilitate these bacterial infections even in the absence of larval hyperproliferation. METHODS We performed a prospective cross-sectional study in a hospital in northern Italy. Subjects admitted due to invasive bacterial infection of enteric origin and potential previous exposure to S. stercoralis were systematically enrolled over a period of 10 months. S. stercoralis infection was investigated with an in-house PCR on a single stool sample and with at least one serological method (in-house IFAT and/or ELISA Bordier). Univariate, bi-variate and logistic regression analyses were performed. RESULTS Strongyloidiasis was diagnosed in 14/57 patients (24.6%; 95% confidence interval 14.1-37.8%) of which 10 were Italians (10/49, 20.4%) and 4 were migrants (4/8, 50.0%). Stool PCR was performed in 43/57 patients (75.4%) and no positive results were obtained. Strongyloidiasis was found to be significantly associated (p ≤ 0.05) with male gender, long international travels to areas at higher endemicity, deep extra-intestinal infectious localization and solid tumors. In the logistic regression model, increased risk remained for the variables deep extra-intestinal infectious localization and oncologic malignancy. CONCLUSIONS Our findings suggest a new role of chronic strongyloidiasis in favoring invasive bacterial infections of enteric origin even in the absence of evident larval dissemination outside the intestinal lumen. Further well-designed studies should be conducted to confirm our results, and possibly establish the underlying mechanisms.
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Affiliation(s)
- Giulia Gardini
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany
| | - Francesca Gurrieri
- Department of Microbiology and Virology, University Hospital of Brescia, Brescia, Italy
| | | | - Chiara Cattaneo
- Division of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Valentina Marchese
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giorgio Piccinelli
- Department of Microbiology and Virology, University Hospital of Brescia, Brescia, Italy
| | - Silvia Corbellini
- Department of Microbiology and Virology, University Hospital of Brescia, Brescia, Italy
| | - Chiara Pagani
- Division of Hematology, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Benedetta Fumarola
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Maurizio Gulletta
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesca Perandin
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Verona, Italy
| | - Francesco Castelli
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Alberto Matteelli
- Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
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5
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Bocanegra C, Álvarez-Martínez MJ, Arsuaga Vicente M, Belhassen-García M, Chamorro Tojeiro S, Camprubí-Ferrer D, Fernández Soto P, García Vázquez E, Herrador Ortiz Z, Martín O, Muro A, Pérez Arellano JL, Reguera Gómez M, Salas-Coronas J, Salvador F, Sotillo Gallego J, Sulleiro E, Torrús Tendero D, Velasco Arribas M, Rodríguez Guardado A. Executive summary consensus statement of imported diseases group (GEPI) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Tropical Medicine and International Health (SETMSI), on the diagnostic and treatment of imported schistosomiasis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:505-512. [PMID: 37230838 DOI: 10.1016/j.eimce.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/08/2023] [Indexed: 05/27/2023]
Abstract
Schistosomiasis is a highly prevalent disease, especially in immigrant populations, and is associated with significant morbidity and diagnostic delays outside endemic areas. For these reasons, the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Tropical Medicine and International Health (SEMTSI) have developed a joint consensus document to serve as a guide for the screening, diagnosis and treatment of this disease outside endemic areas. A panel of experts from both societies identified the main questions to be answered and developed recommendations based on the scientific evidence available at the time. The document was reviewed by the members from both societies for final approval.
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Affiliation(s)
- Cristina Bocanegra
- Unidad de Medicina Tropical y Salud Internacional Vall d'Hebron-Drassanes, PROSICS Barcelona, Servicio de Enfermedades Infecciosas Hospital Universitario Vall d'Hebron, Spain
| | - Miriam J Álvarez-Martínez
- Servicio de Microbiología, Hospital Clínic de Barcelona, Departamento de Fundamentos Clínicos, Facultad de Medicina y Ciencias de la Salud, Universidad de Barcelona, ISGlobal, Spain
| | - Marta Arsuaga Vicente
- Unidad de Patología Importada y Salud Internacional (CSUR), Unidad de Alto Aislamiento, CIBERINFEC, Hospital La Paz-Carlos III, Madrid, Spain
| | - Moncef Belhassen-García
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital Universitario de Salamanca, Centro de Investigación en Enfermedades Tropicales de la Universidad de Salamanca (CIETUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Sandra Chamorro Tojeiro
- Unidad de Referencia Nacional para Enfermedades Tropicales, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, IRYCIS, CIBERINFEC, Spain
| | | | - Pedro Fernández Soto
- Grupo Enfermedades Infecciosas y Tropicales (e-INTRO), Instituto de Investigación Biomédica de Salamanca-Centro de Investigación de Enfermedades Tropicales de la Universidad de Salamanca (IBSAL-CIETUS), Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - Elisa García Vázquez
- Unidad de Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB, Facultad de Medicina, Universidad de Murcia, Spain
| | | | - Oihane Martín
- Servicio de Microbiología y Parasitología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Antonio Muro
- Grupo de Investigación Enfermedades Infecciosas y Tropicales (e-INTRO), IBSAL, CIETUS, Facultad de Farmacia, Universidad de Salamanca, Salamanca, Spain
| | - José Luis Pérez Arellano
- Universidad de las Palmas de Gran Canaria, Unidad de Enfermedades Infecciosas y Medicina Tropical, Hospital Insular de Gran Canaria, Spain
| | - Marta Reguera Gómez
- Departamento de Parasitología, Facultad de Farmacia, Universidad de Valencia, Valencia, Spain
| | - Joaquín Salas-Coronas
- Unidad de Medicina Tropical, Hospital Universitario Poniente El Ejido, Almería, Spain
| | - Fernando Salvador
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, PROSICS Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Sotillo Gallego
- Laboratorio de Referencia e Investigación en Parasitología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Spain
| | - Elena Sulleiro
- Servicio de Microbiología, Hospital Vall d́Hebron, Barcelona, CIBERINFEC, ISCIII, Universitat Autònoma de Barcelona, Spain
| | - Diego Torrús Tendero
- Unidad de Referencia de Enfermedades Importadas y Salud Internacional, Unidad de Enfermedades Infecciosas, Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Área de Parasitología, Universidad Miguel Hernández, Spain
| | - María Velasco Arribas
- Sección Infecciosas y Medicina Tropical, Medicina Interna, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Madrid, Spain
| | - Azucena Rodríguez Guardado
- Área de Gestión Clínica Medicina Interna, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
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6
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Akers AN, Vest A, Schenone CV, Rodriguez A. Strongyloides stercoralis Hyperinfection Syndrome in Pregnancy. Cureus 2023; 15:e43568. [PMID: 37719554 PMCID: PMC10503402 DOI: 10.7759/cureus.43568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/19/2023] Open
Abstract
Strongyloidiasis is a parasitic infection with a high global burden of disease. Hyperinfection syndrome is a life-threatening complication that predominantly affects immunosuppressed individuals, such as those receiving corticosteroid treatment. Despite its worldwide prevalence, little is known about the clinical effects of this condition on the feto-maternal dyad during pregnancy. We present a case of placental abruption leading to preterm delivery in a pregnancy complicated by Strongyloides stercoralis hyperinfection syndrome following antenatal corticosteroid use. Although rare, this condition is associated with high mortality rates and adverse pregnancy outcomes. Therefore, screening at-risk individuals may be warranted in pregnancies where antenatal corticosteroid administration is considered.
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Affiliation(s)
- Allison N Akers
- Obstetrics and Gynecology, University of South Florida, Tampa, USA
| | - Adriana Vest
- Obstetrics and Gynecology, University of South Florida, Tampa, USA
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7
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Rosca EC, Heneghan C, Spencer EA, Plüddemann A, Maltoni S, Gandini S, Onakpoya IJ, Evans D, Conly JM, Jefferson T. Coinfection with Strongyloides and SARS-CoV-2: A Systematic Review. Trop Med Infect Dis 2023; 8:tropicalmed8050248. [PMID: 37235296 DOI: 10.3390/tropicalmed8050248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Treatments for COVID-19, including steroids, might exacerbate Strongyloides disease in patients with coinfection. We aimed to systematically review clinical and laboratory features of SARS-CoV-2 and Strongyloides coinfection, investigate possible interventions, assess outcomes, and identify research gaps requiring further attention. METHODS We searched two electronic databases, LitCOVID and WHO, up to August 2022, including SARS-CoV-2 and Strongyloides coinfection studies. We adapted the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) system for standardized case causality assessment to evaluate if using corticosteroids or other immunosuppressive drugs in COVID-19 patients determined acute manifestations of strongyloidiasis. RESULTS We included 16 studies reporting 25 cases of Strongyloides and SARS-CoV-2 coinfection: 4 with hyperinfection syndrome; 2 with disseminated strongyloidiasis; 3 with cutaneous reactivation of strongyloidiasis; 3 with isolated digestive symptoms; and 2 with solely eosinophilia, without clinical manifestations. Eleven patients were asymptomatic regarding strongyloidiasis. Eosinopenia or normal eosinophil count was reported in 58.3% of patients with Strongyloides reactivation. Steroids were given to 18/21 (85.7%) cases. A total of 4 patients (19.1%) received tocilizumab and/or Anakirna in addition to steroids. Moreover, 2 patients (9.5%) did not receive any COVID-19 treatment. The causal relationship between Strongyloides reactivation and COVID-19 treatments was considered certain (4% of cases), probable (20% of patients), and possible (20% of patients). For 8% of cases, it was considered unlikely that COVID-19 treatment was associated with strongyloidiasis reactivations; the relationship between the Strongyloides infection and administration of COVID-19 treatment was unassessable/unclassifiable in 48% of cases. Of 13 assessable cases, 11 (84.6%) were considered to be causally associated with Strongyloides, ranging from certain to possible. CONCLUSIONS Further research is needed to assess the frequency and risk of Strongyloides reactivation in SARS-CoV-2 infection. Our limited data using causality assessment supports recommendations that clinicians should screen and treat for Strongyloides infection in patients with coinfection who receive immunosuppressive COVID-19 therapies. In addition, the male gender and older age (over 50 years) may be predisposing factors for Strongyloides reactivation. Standardized guidelines should be developed for reporting future research.
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Affiliation(s)
- Elena C Rosca
- Department of Neurology, Victor Babes University of Medicine and Pharmacy, Piata Eftimie Murgu 2, 300041 Timisoara, Romania
| | - Carl Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Elizabeth A Spencer
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Annette Plüddemann
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford OX2 6GG, UK
| | - Susanna Maltoni
- Division of Research and Innovation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Igho J Onakpoya
- Department of Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK
| | - David Evans
- Li Ka Shing Institute of Virology and Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - John M Conly
- Departments of Medicine, Microbiology, Immunology & Infectious Diseases, and Pathology & Laboratory Medicine, Synder Institute for Chronic Diseases and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB T2N 1N4, Canada
| | - Tom Jefferson
- Department of Continuing Education, University of Oxford, Rewley House, 1 Wellington Square, Oxford OX1 2JA, UK
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8
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Strongyloides and COVID-19: Challenges and Opportunities for Future Research. Trop Med Infect Dis 2023; 8:tropicalmed8020127. [PMID: 36828543 PMCID: PMC9967524 DOI: 10.3390/tropicalmed8020127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/12/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Strongyloides stercoralis is a soil transmitted helminth endemic to tropical and subtropical areas that can persist for decades in immunocompetent human hosts as a chronic asymptomatic infection. The use of corticosteroids, a mainstay of treatment for patients hospitalized with severe coronavirus disease (COVID-19), can trigger a life-threatening Strongyloides hyperinfection syndrome and disseminated disease. We identified 22 previously published cases of strongyloidiasis occurring in individuals with COVID-19, with one death reported among the seven patients who had Strongyloides hyperinfection syndrome. A total of seventeen patients had previously received corticosteroids, and of the five with no prior corticosteroid use, one presented with hyperinfection syndrome. We identify the key challenges in the diagnosis and treatment of Strongyloides within the context of COVID-19, including our imprecise knowledge of the global distribution of Strongyloides, the overlapping symptoms and signs of COVID-19 and Strongyloides hyperinfection syndrome, the limited utility of eosinophilia as a clinical marker for strongyloidiasis in this setting, the lack of validated algorithms to screen for Strongyloides prior to corticosteroid use, and the paucity of treatment options for critically ill patients with COVID-19 who cannot take oral ivermectin. Future research should focus on improved diagnostic methods and population prevalence estimates, optimizing the approaches for Strongyloides screening in persons with COVID-19 (including clinical trial participants and strategies for resource-limited settings) and better defining the role of pre-emptive treatment.
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9
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Raheel H, Kopalakrishnan S, Bhasker S, Makhani L, Clarke S, Nicholas MN, Mufti A, Boggild AK. Inflammatory bowel disease later diagnosed as strongyloides colitis in migrants to Canada: a case series. Ther Adv Infect Dis 2023; 10:20499361231162719. [PMID: 37008791 PMCID: PMC10064163 DOI: 10.1177/20499361231162719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 02/21/2023] [Indexed: 03/31/2023] Open
Abstract
Strongyloides colitis is a gastrointestinal manifestation of the parasitic infection, Strongyloides stercoralis, which may be misdiagnosed and treated as ulcerative colitis (UC) in patients presenting in non-endemic regions. Treatment of Strongyloides colitis as UC can lead to a lethal hyperinfection syndrome. Therefore, prior to commencing immunosuppressive treatment of UC, it is essential to use diagnostic markers to differentiate the two etiologies. In this case series, we discuss two migrant patients who were previously diagnosed with UC and treated accordingly who presented to our clinic for further investigation of suspected parasitic infection.
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Affiliation(s)
- Hira Raheel
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | | | - Shveta Bhasker
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Leila Makhani
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Tropical Disease Unit, Division of Infectious Diseases, UHN-Toronto General Hospital, Toronto, ON, Canada
| | - Shareese Clarke
- Lawrence S. Bloomberg Faculty of Nursing, Toronto, ON, Canada
| | - Mathew N. Nicholas
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Asfandyar Mufti
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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10
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Yeung S, Bharwada Y, Bhasker S, Boggild A. Strongyloidiasis: what every gastroenterologist needs to know. Ther Adv Chronic Dis 2022; 13:20406223221137499. [PMID: 36407019 PMCID: PMC9666874 DOI: 10.1177/20406223221137499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/20/2022] [Indexed: 04/28/2024] Open
Abstract
Strongyloidiasis is caused by the intestinal roundworm, Strongyloides stercoralis, which has the potential for fatal outcome. It may present with vague gastrointestinal symptoms and mimic gastrointestinal diseases such as inflammatory bowel disease, and as such, it should be in the purview of the gastroenterologist. While strongyloidiasis is generally asymptomatic or produces mild symptoms in patients with an intact immune system, individuals who are immunocompromised may develop life-threatening disease through hyperinfection syndrome and disseminated disease. The worm has a complex lifecycle and is able to autoinfect its host, thereby allowing indefinite persistence even decades after initial infection. This leads to cases where travelers, and those who lived in endemic countries, may present years after travel. With its features of prolonged infection, relatively high global prevalence, and potential for fatal outcomes, it is imperative for all clinicians to be aware of this disease. Owing to its involvement with the gastrointestinal system, however, we will outline salient points about strongyloidiasis for the gastroenterologist.
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Affiliation(s)
- Sabrina Yeung
- Department of Internal Medicine, McMaster
University, Hamilton, ON, Canada
| | - Yashvi Bharwada
- Department of Internal Medicine, University of
Manitoba, Winnipeg, MB, Canada
| | - Shveta Bhasker
- Institute of Health Policy, Management and
Evaluation, Dalla Lana School of Public Health, University of Toronto,
Toronto, ON, Canada
| | - Andrea Boggild
- Tropical Disease Unit, Division of Infectious
Diseases, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto,
ON M5G 2C4, Canada
- Department of Medicine, University of Toronto,
Toronto, ON, Canada
- Institute of Medical Science, University of
Toronto, Toronto, ON, Canada
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11
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Chronic Strongyloidiasis in the Primary Care Setting. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2022. [DOI: 10.1097/ipc.0000000000001166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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12
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Song P, Li H, Liu T, Liu Y, Ma X, Su L. Disseminated Strongyloidiasis Misdiagnosed as Guillain-Barré Syndrome: The Value of High-Throughput Genetic Sequencing of Pathogenic Microorganisms in Parasitic Infections. Infect Drug Resist 2022; 15:5601-5607. [PMID: 36172625 PMCID: PMC9512064 DOI: 10.2147/idr.s381298] [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: 07/27/2022] [Accepted: 09/12/2022] [Indexed: 12/20/2022] Open
Abstract
Background With the widespread use of steroids and immunosuppressants in mainland China, disseminated strongyloidiasis is becoming a severely underestimated tropical disease due to the lack of disease-specific manifestations and well-established diagnostic methods. Case Presentation Here, we report a 70-year-old woman who was diagnosed with Guillain-Barré syndrome due to autonomic disturbance, symmetrical bulbar palsy, and lower-motor-nerve damage in the extremities; her symptoms continued to worsen after hormone and immunoglobulin therapy. Later, parasitic larvae were found in the patient’s gastric fluid, and metagenomic Next Generation Sequencing (mNGS) detection of bronchoalveolar-lavage fluid also found a large number of Strongyloides roundworms. The patient was diagnosed with disseminated strongyloidiasis. The patient was given albendazole for anthelmintic treatment, but died two days after being transferred to the ICU due to the excessive strongyloidiasis burden. Conclusion This case highlights the combined application of mNGS and traditional testing in the clinical diagnosis of difficult and critical parasitic infections in immunocompromised patients. mNGS is a new, adjunct diagnostic method to rapidly screen for possible parasitic etiologies.
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Affiliation(s)
- Peng Song
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Huaichen Li
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Tingting Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Yao Liu
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Xiaobin Ma
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Lili Su
- Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
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De l’Étoile-Morel S, Naeem F, Alghounaim M, Semret M, Yansouni CP, Libman MD, Barkati S. Evaluation of Strongyloides Awareness and Knowledge among Canadian Physicians Caring for Patients At Risk for Severe Strongyloidiasis: A National Cross-sectional Survey. Am J Trop Med Hyg 2022; 107:359-366. [PMID: 35895404 PMCID: PMC9393448 DOI: 10.4269/ajtmh.22-0109] [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: 02/05/2022] [Accepted: 02/25/2022] [Indexed: 08/03/2023] Open
Abstract
In Canada, a substantial proportion of migrants come from strongyloidiasis-endemic regions. Systematic screening for Strongyloides is not performed in immunocompromised patients in whom this infection could be potentially fatal. We aim to assess the level of Strongyloides awareness and knowledge among Canadian physicians caring for immunocompromised patients and identify factors currently associated with screening. Using an online survey distributed through Canadian medical associations, we collected information on physicians' demographics, practice setting, overall awareness and knowledge of Strongyloides, and current practices. Descriptive analysis and logistic regression models were performed to identify the factors associated with Strongyloides screening. Nineteen national and provincial medical associations agreed to participate. Between November 2020 and August 2021, 368 of 5,194 (7%) physicians that were contacted responded to our survey. Quebec (46%) and Ontario (24%) were the most responsive. Sixty-nine percent of respondents practiced medicine in academic settings. Infectious disease (ID) specialists/medical microbiologists (38%) followed by nephrologists (33%) were the most represented. Most respondents (95%) had heard about Strongyloides. However, 36% of non-ID specialists considered themselves unfamiliar. Forty percent of respondents did not or rarely performed screening for strongyloidiasis in high-risk populations. Screening was associated with younger-aged physicians (odds ratio [OR] 2.35; 95% confidence interval [CI] 1.07-5.18), physicians who frequently served migrants (OR 3.33; 95% CI 1.44-7.66), or those who had training in global health and ID/medical microbiology (OR 3.71; 95% CI 1.21-11.34 and OR 46.42; 95% CI 15.89-135.59, respectively). Our survey suggests a general lack of knowledge of Strongyloides among Canadian physicians that is associated with low rates of screening in high-risk populations.
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Affiliation(s)
- Samuel De l’Étoile-Morel
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
| | - Faheel Naeem
- J. D. MacLean Centre for Tropical Diseases at McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Mohammad Alghounaim
- The Montreal Children’s Hospital, Division of Infectious Diseases, Department of Pediatrics, McGill University Health Centre, Montreal, Canada
| | - Makeda Semret
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
- J. D. MacLean Centre for Tropical Diseases at McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Cedric P. Yansouni
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
- J. D. MacLean Centre for Tropical Diseases at McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Michael D. Libman
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
- J. D. MacLean Centre for Tropical Diseases at McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Sapha Barkati
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada
- J. D. MacLean Centre for Tropical Diseases at McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
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Jenks NP, Driscoll B, Locke T. Strongyloidiasis Hyperinfection Syndrome in COVID-19 Positive Migrants Treated with Corticosteroids. J Immigr Minor Health 2022; 24:1431-1434. [PMID: 35939223 PMCID: PMC9358917 DOI: 10.1007/s10903-022-01386-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2022] [Indexed: 12/15/2022]
Abstract
The aim of this study is to highlight the potentially fatal risk of Strongyloidiasis Hyperinfection Syndrome for hospitalized immigrant patients with moderate to severe COVID-19 disease and undiagnosed Strongyloidiasis. We reviewed electronic medical records of immigrants from 2010 to 2022 and extracted the number of patients with eosinophilia, strongyloidiasis and COVID-19 infection, outpatient and hospitalized. While 885 outpatients were diagnosed with eosinophilia, only 356 (40.2%) were tested for strongyloidiasis and 160 (44.9%) yielded a reactive serology. COVID-19 infection was reported in 6,412 patients. 1135 (17.7%) of these patients sought hospital care. Patients with undiagnosed strongyloidiasis are at risk for a potentially fatal parasitosis if treated with systemic corticosteroids for COVID-19. This supports clinical guidelines in hospital settings for those with severe COVID-19. Strongyloidiasis should be considered by taking a thorough travel or migration history and testing before giving immunosuppressive drugs.
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Affiliation(s)
- Nancy Piper Jenks
- Sun River Health, 1037 Main St, Peekskill, NY, 10566, United States.
| | - Brendan Driscoll
- Sun River Health, 1037 Main St, Peekskill, NY, 10566, United States
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15
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Rodríguez-Guardado A, Álvarez-Martínez MJ, Flores MD, Sulleiro E, Torrús-Tendero D, Velasco M, Membrillo FJ. Screening for strongyloidiasis in Spain in the context of the SARS-CoV-2 pandemic: Results of a survey on diagnosis and treatment. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022:S2529-993X(22)00174-5. [PMID: 35970704 PMCID: PMC9372776 DOI: 10.1016/j.eimce.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/31/2021] [Accepted: 11/06/2021] [Indexed: 12/15/2022]
Abstract
Introduction The generalization of treatment with dexamethasone or other immunosuppressants in patients with SARS-CoV-2 infection may increase the risk of occurrence of severe forms of strongyloidiasis. A nationwide survey was conducted to better understand the diagnostic and therapeutic situation of strongyloidiasis in SARS-CoV-2 co-infected patients in Spain. Materials and methods A survey was designed and sent to all SEIMC members during February and March 2021. Responses were exported for computer processing to Microsoft Excel 2017 and statistically processed with the free software PSPP. Results 189 responses were received, of which 121 (64%) were selected for further processing. Eighty-four centers (69.5%) had no specific strongyloidiasis screening protocol. Forty-two centers (34.7%) had serological techniques available in their laboratories and the rest were sent to a reference laboratory. Only 22 centers (18%) screened for strongyloidiasis in SARS-CoV-2 infected patients. A total of 227 cases of strongyloidiasis were diagnosed in patients with SARS-CoV-2 infection. In four cases patients developed a massive hyperinfestation syndrome leading to the death of one patient. Conclusion COVID-19 has highlighted the need to unify screening and treatment protocols for imported pathologies such as strongyloidiosis. Efforts to disseminate knowledge are needed to ensure that this potentially fatal disease is adequately treated in patients with the highest risk of complications, such as those with COVID-19.
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16
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Barkati S, Naeem F, Hales L, Quan C, Libman M. Strongyloides stercoralis prevalence in solid-organ and haematopoietic stem cell transplant candidates and recipients: a systematic review and meta-analysis protocol. BMJ Open 2022; 12:e057649. [PMID: 35914914 PMCID: PMC9345034 DOI: 10.1136/bmjopen-2021-057649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Strongyloides stercoralis is an intestinal helminth ubiquitous in tropical and subtropical regions worldwide. It persists in the human host for a lifetime as a result of autoinfection and if undetected and untreated, can lead to increased morbidity and high mortality in immunocompromised individuals such as the transplant population. Transplant patients, including solid-organ and haematopoietic stem cell transplants (SOT and HSCT, respectively), are at a high risk of hyperinfection and disseminated strongyloidiasis. Unfortunately screening is often not systematically performed. Prevalence estimates of Strongyloides in this high-risk population is not well studied. Through this systematic review, we aim to summarise the descriptive evidence on Strongyloides prevalence in SOT and HSCT patients, including diagnostic and screening practices alongside the cases of hyperinfection, disseminated strongyloidiasis and the mortality rate in this population. METHODS AND ANALYSES Through the use of various online library databases, we will conduct a systematic review including relevant literature on the prevalence of Strongyloides in SOT and HSCT patients as well as studies assessing hyperinfection and disseminated strongyloidiasis in this patient population. The Population, Intervention, Comparison, Outcome and Study Design strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be used to determine a final subset of studies for analysis. Quality assessment for case series and case reports will be determined by a modified quality assessment tool developed by the National Heart, Lung, and Blood Institute (NIH), and the CARE guidelines, respectively. We will provide a narrative synthesis of the findings pertaining to the primary and secondary outcomes of interest (prevalence of Strongyloides and mortality rate in transplant population, respectively) alongside the associated 95% CI. Estimates from individual studies will be pooled using a random effects model. ETHICS AND DISSEMINATION This systematic review does not require formal ethical approval since no primary data will be collected. Findings will be disseminated through a peer-reviewed publication and relevant conferences. PROSPERO REGISTRATION NUMBER CRD42021269305.
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Affiliation(s)
- Sapha Barkati
- J.D. MacLean Centre for Tropical Diseases at McGill University, Montreal, Québec, Canada
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Faheel Naeem
- J.D. MacLean Centre for Tropical Diseases at McGill University, Montreal, Québec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Lindsay Hales
- Medical Libraries, McGill University Health Centre, Montreal, Québec, Canada
| | - Curtis Quan
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases at McGill University, Montreal, Québec, Canada
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, Québec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
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17
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Atluri K, Aimlin I, Arora S. Current Effective Therapeutics in Management of COVID-19. J Clin Med 2022; 11:jcm11133838. [PMID: 35807123 PMCID: PMC9267414 DOI: 10.3390/jcm11133838] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
The current pandemic due to the SARS-CoV-2 virus has caused irreparable damage globally. High importance is placed on defining current therapeutics for Coronavirus Disease 2019 (COVID-19). In this review, we discuss the evidence from pivotal trials that led to the approval of effective therapeutics in the treatment and prevention of COVID-19. We categorize them as effective outpatient and inpatient management strategies The review also attempts to contextualize the efficacy of therapeutics to the emerging variants. Vaccines, which remain the most effective prevention against hospitalization and deaths is not included in this review.
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Affiliation(s)
- Kavya Atluri
- Department of Bioinformatics, University of California, Los Angeles, CA 90095, USA;
| | - Iris Aimlin
- Department of Internal Medicine, Montefiore Medical Center, New York, NY 10467, USA;
| | - Shitij Arora
- Department of Internal Medicine, Division of Hospital Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10461, USA
- Correspondence: ; Tel.: +1-7189207270
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Corral MA, Gonçalves ALR, Costa IN, Abdala E, Pierrotti LC, Chieffi PP, Costa‐Cruz JM, Gryschek RCB, Martins de Paula F. Immune complexes as a tool for strongyloidiasis immunodiagnosis in kidney and liver transplant candidate. Parasite Immunol 2022; 44:e12920. [DOI: 10.1111/pim.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Marcelo A. Corral
- Laboratório de Investigação Médica (LIM‐06), Hospital das Clínicas da Faculdade de Medicina Universidade de São Paulo São Paulo Brazil
| | - Ana Lucia R. Gonçalves
- Laboratório de Diagnóstico de Parasitoses Universidade Federal de Uberlândia Uberlândia Minas Gerais Brazil
| | - Idessania N. Costa
- Departamento de Ciências Patológicas, Laboratório de Imunoparasitologia das Doenças Negligenciadas e Câncer Universidade Estadual de Londrina Paraná Brazil
| | - Edson Abdala
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | - Ligia C. Pierrotti
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo São Paulo Brazil
| | | | - Julia Maria Costa‐Cruz
- Laboratório de Diagnóstico de Parasitoses Universidade Federal de Uberlândia Uberlândia Minas Gerais Brazil
| | - Ronaldo Cesar B. Gryschek
- Laboratório de Investigação Médica (LIM‐06), Hospital das Clínicas da Faculdade de Medicina Universidade de São Paulo São Paulo Brazil
- Instituto de Medicina Tropical de São Paulo Universidade de São Paulo São Paulo Brazil
| | - Fabiana Martins de Paula
- Laboratório de Investigação Médica (LIM‐06), Hospital das Clínicas da Faculdade de Medicina Universidade de São Paulo São Paulo Brazil
- Instituto de Medicina Tropical de São Paulo Universidade de São Paulo São Paulo Brazil
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19
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Mah J, Lieu A, Holmes E, Vaughan S. A case of disseminated strongyloidiasis after multiple courses of immunosuppression. CMAJ 2022; 194:E89-E92. [PMID: 35074835 PMCID: PMC8900751 DOI: 10.1503/cmaj.211056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jordan Mah
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta.
| | - Anthony Lieu
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta
| | - Emma Holmes
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta
| | - Stephen Vaughan
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta
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20
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Barkati S, Greenaway C, Libman MD. Strongyloidiasis in immunocompromised migrants to non-endemic countries in the era of COVID-19: what is the role for presumptive ivermectin? J Travel Med 2022; 29:6374820. [PMID: 34581413 PMCID: PMC8500134 DOI: 10.1093/jtm/taab155] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/22/2022]
Abstract
The COVID-19 pandemic has led to widespread use of dexamethasone. Corticosteroid therapy is an important risk factor for Strongyloides hyperinfection. Challenges associated with the performance of Strongyloides tests, and the poor availability of high quality and timely diagnostic testing, makes the use of presumptive ivermectin reasonable in selected situations.
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Affiliation(s)
- Sapha Barkati
- To whom correspondence should be addressed. Sapha Barkati, J.D. MacLean Centre for Tropical Diseases at McGill University, 1001 Boulevard Decarie, Montreal, Quebec, Canada, H4A 3J1. Tel: 514-934-1934 ext. 42812; Fax: 514-843-1582;
| | - Christina Greenaway
- J.D. MacLean Centre for Tropical Diseases at McGill University, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases, SBMD Jewish General Hospital, Montreal, Quebec, Canada
- Center for Clinical Epidemiology, Lady Davis Research Institute, Montreal, Quebec, Canada
| | - Michael D Libman
- J.D. MacLean Centre for Tropical Diseases at McGill University, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, Division of Infectious Diseases, McGill University Health Centre, Montreal, Quebec, Canada
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21
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Comelli A, Mangioni D, Scaramella L, Maraschini A, Gaudino C, Folli C, Ceriotti F, Triulzi F, Canetta C, Gori A, Bandera A. Strongyloides stercoralis central nervous system dissemination in a migrant misdiagnosed with eosinophilic granulomatosis with polyangiitis. J Travel Med 2022; 29:6414508. [PMID: 34718667 DOI: 10.1093/jtm/taab177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/12/2022]
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22
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Sanyang AM, Joof E, Sey AP, Sambou S, Mohamed Z, Sanneh B. Prevalence and risk factors of strongyloidiasis among schoolchildren in Sabach Sanjal and Upper Badibou districts in the North Bank East Region of The Gambia. Parasite Epidemiol Control 2022; 15:e00228. [PMID: 35005262 PMCID: PMC8716566 DOI: 10.1016/j.parepi.2021.e00228] [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: 11/25/2020] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
Background Strongyloidiasis is a parasitic disease that mainly affects humans and is caused by a roundworm called Strongyloides stercoralis. It is endemic in humid tropical regions that include Africa, Latin America and Southern Asia. Among the public health important soil-transmitted helminths (STHs) classified as neglected tropical diseases, S. stercoralis is the most neglected. A study of schistosomiasis and STHs mapping was conducted and S. stercoralis larvae were detected using the utilized diagnostic method; thus, this current study described the prevalence and risk factors of S. stercoralis infection in districts of Sabach Sanjal and Upper Badibou in The Gambia. Methods The cross-sectional study enrolled 851 schoolchildren, ages 7 to 14 years old. The participants were enrolled from 17 schools in Sabach Sanjal and Upper Badibou Districts. The WHO random sampling technique n/50 (25 boys and 25 girls) was used. Stool samples were collected from each participant and Kato-Katz smear method was used to screen for S. stercoralis infection. Results Out of the total 851 pupils, 76 pupils (8.9%) were positive for S. stercoralis infection. The mean age of infected persons was 10.1 years (±2.2). The prevalence of infection was higher among females (9.2%) than males (8.7%). Rates of infection for age categories 7–10 years and 11–14 years were 12.4% and 4.2%, respectively. Rates of infection by districts were 12.3% for Sabach Sanjal and 7.1% for Upper Badibou. Schoolchildren from Sabach Sanjal were 1.6 times more likely to have strongyloidiasis compared to those from Upper Badibou (aOR = 1.64, p-value = 0.058). Schoolchildren aged 7–10 years were 3.2 times more likely to have strongyloidiasis infection compared to the 11–14-year-olds (aOR = 3.20, p-value <0.001). Schoolchildren who ‘sometimes’ have water or tissue after defaecation have more infection rate compared to those who ‘always’ have water or tissue after defaecation. However, this difference was not statistically significant (aOR = 1.36, p-value = 0.308). Conclusion The study revealed the prevalence of strongyloidiasis in Sabach Sanjal and Upper Badibou districts of The Gambia. Kato-Katz technique might be inadequate for detecting S. stercoralis; thus, more studies are needed to determine the true prevalence of the disease in these two districts through the combined use of highly sensitive techniques such as Baermann, Koga Agar Culture and polymerase chain reaction.
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Affiliation(s)
- Abdoulie M Sanyang
- National Public Health Laboratories, Ministry of Health, Bertil Herding High way, Kotu, the Gambia
| | - Ebrima Joof
- National Public Health Laboratories, Ministry of Health, Bertil Herding High way, Kotu, the Gambia.,School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Alhagie Papa Sey
- National Public Health Laboratories, Ministry of Health, Bertil Herding High way, Kotu, the Gambia
| | - Sana Sambou
- Epidemiology and Disease Control Unit, Ministry of Health, Bertil Herding Highway, Kotu, the Gambia
| | - Zeehaida Mohamed
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Bakary Sanneh
- National Public Health Laboratories, Ministry of Health, Bertil Herding High way, Kotu, the Gambia
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23
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Niaki NZ, Désy D, Rashed S, Bougrine A. Strongyloides stercoralis infection causing reversible chronic urticaria with histologic findings of leukocytoclastic vasculitis. JAAD Case Rep 2022; 21:189-191. [PMID: 35252520 PMCID: PMC8888897 DOI: 10.1016/j.jdcr.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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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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[Screening for strongyloidiasis in Spain in the context of the SARS-CoV-2 pandemic: results of a survey on diagnosis and treatment]. Enferm Infecc Microbiol Clin 2021:S0213-005X(21)00386-4. [PMID: 34931102 PMCID: PMC8673747 DOI: 10.1016/j.eimc.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/06/2021] [Indexed: 12/15/2022]
Abstract
Introducción La generalización del tratamiento con dexametasona u otros inmunosupresores en pacientes con infección por SARS-CoV-2 puede aumentar el riesgo de aparición de formas graves de estrongiloidiosis. Se realizó una encuesta a nivel nacional para conocer mejor de la situación diagnóstica y terapéutica de la estrongiloidiosis en España en pacientes coinfectados por SARS-CoV-2. Materiales y métodos Se diseñó una encuesta que fue enviada a todos los miembros de SEIMC durante los meses de febrero y marzo de 2021. Las respuestas se exportaron para su procesamiento informático al programa Microsoft Excel 2017 y se procesaron estadísticamente con el software libre PSPP. Resultados Se recibieron 189 respuestas, de las cuales se seleccionaron 121 (64%) para su procesamiento posterior. En 84 centros (69,5%) no existía ningún protocolo de cribado específico de estrongiloidiosis. Cuarenta y dos centros (34,7%) disponían de técnicas serológicas en sus laboratorios y en el resto se enviaban a un laboratorio de referencia. Solo 22 centros (18%) realizaron cribado de estrongiloidiosis en pacientes infectados por SARS-CoV-2. Se diagnosticaron 227 casos de estrongiloidiosis en pacientes con infección por el SARS-CoV-2. En cuatro casos los pacientes desarrollaron un síndrome de hiperinfestación masiva que condujo al fallecimiento de uno. Conclusión La COVID-19 ha puesto de manifiesto la necesidad de unificar protocolos de cribado y tratamiento de patologías importadas como la estrongiloidiosis. Es necesario realizar un esfuerzo de difusión del conocimiento para que esta patología potencialmente mortal sea tratada adecuadamente en los pacientes con mayor riesgo de complicaciones, como son aquellos con COVID-19.
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A Practical Approach to Screening for Strongyloides stercoralis. Trop Med Infect Dis 2021; 6:tropicalmed6040203. [PMID: 34941659 PMCID: PMC8704417 DOI: 10.3390/tropicalmed6040203] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 11/29/2022] Open
Abstract
Strongyloides stercoralis, causative agent of a neglected tropical disease, is a soil-transmitted helminth which may cause lifelong persisting infection due to continuous autoinfection. In the case of immunosuppression, life-threatening hyperinfection and disseminated strongyloidiasis can develop. We propose a pragmatic screening algorithm for latent strongyloidiasis based on epidemiologic exposure and immunosuppression status that can be applied for any kind of immunosuppressive therapy. The algorithm allows the diagnosis of latent strongyloidiasis with optimal accuracy in a well-equipped setting, while for endemic settings where the complete testing array is unavailable, an empiric treatment is generally recommended. Accurate diagnosis and extensive empiric treatment will both contribute to decreasing the current neglect of strongyloidiasis.
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Berto CG, Coyle CM, Friedman L, Walker PF. Where was my patient born? The Intersection of tropical medicine and migrant health. Curr Opin Infect Dis 2021; 34:447-454. [PMID: 34267044 DOI: 10.1097/qco.0000000000000773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is unprecedented movement of people across international borders and parasitic infections, previously restricted to endemic regions, are now encountered in nonendemic areas of the world. RECENT FINDINGS Migrants may import parasitic infections acquired in their countries of origin. Increasingly, clinicians in nonendemic regions are faced with patients with neglected diseases such as Chagas disease, malaria and strongyloidiasis. There are gaps in knowledge among physicians in nonendemic regions, which lead to missed opportunities for preventive strategies and early treatment. Both primary care and infectious disease physicians should have a broad knowledge of common parasitic infections to improve health outcomes and decrease healthcare disparities through early identification and treatment of disease encountered in migrants. SUMMARY Migrant health is still a young field in medicine; clinicians should be aware of diseases seen in migrants, and access both educational and clinical resources, including experts in tropical medicine, in order to reduce health disparities among migrants. Collaboration between primary care and infectious disease/tropical medicine experts should be strengthened.
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Affiliation(s)
- Cesar G Berto
- Department of Medicine, NYC Health and Hospitals/Jacobi, Albert Einstein College of Medicine
| | - Christina M Coyle
- Department of Medicine, NYC Health and Hospitals/Jacobi, Albert Einstein College of Medicine
- Division of Infectious Disease, Albert Einstein College of Medicine, Bronx, New York
| | | | - Patricia F Walker
- Department of Medicine, Global Medicine, University of Minnesota, Minneapolis
- Health Partners Institute, Bloomington
- HealthPartners Travel and Tropical Medicine Center, St Paul, Minnesota, USA
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Cai DH, Wang J, Fang XL. A case of triple infection including strongyloides stercoralis in a microscopic polyangiitis patient. Respir Med Case Rep 2021; 34:101479. [PMID: 34401314 PMCID: PMC8350363 DOI: 10.1016/j.rmcr.2021.101479] [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: 04/03/2021] [Revised: 07/07/2021] [Accepted: 07/22/2021] [Indexed: 11/28/2022] Open
Abstract
We present the case of a microscopic polyangiitis (MPA) patient who developed strongyloidiasis, nocardia and citrobacter freundii (CF) infection after corticosteroides and immunosuppressant therapy. When digestive, respiratory or other system symptoms consecutively occur in a immunocompromised host who lives in tropical or temperate zone and have close contact with soil, we should take strongyloidiasis into consideration despite absence of eosinophilia. Mixed infection with nocardia cannot be easily excluded. It is essential to search for the etiology proof with multiple approaches positively and repeatedly.
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Affiliation(s)
- De-Han Cai
- Nephrology Department in Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jun Wang
- Department II of Respiratory and Critical Care in Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Xiao-Lin Fang
- Department II of Respiratory and Critical Care in Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, 330006, Jiangxi, China
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Ivermectin treatment for Strongyloides infection in patients with COVID-19. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2021; 47:316-321. [PMID: 34667442 DOI: 10.14745/ccdr.v47i78a04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ivermectin, an antiparasitic agent, is not recommended for prophylaxis or treatment of coronavirus disease 2019 (COVID-19). Inappropriate use of ivermectin for treatment of COVID-19 may make it less available for patients with serious parasitic infections who could benefit from its use and worsen the current shortage of ivermectin in Canada. However, patients with COVID-19 who are candidates to receive immunomodulatory therapies (e.g. corticosteroids and interleukin-6 inhibitors) may be at risk of hyperinfection syndrome and disseminated disease from Strongyloides stercoralis. These complications can be severe and even fatal. It is important to recognize and screen patients who may be at risk of strongyloidiasis, as these patients may require treatment with ivermectin to avoid the potential for a hyperinfection syndrome and disseminated disease, which is frequently deadly. Clinicians should follow evidence-based recommendations to screen and treat for Strongyloides infection in patients with COVID-19 who are under consideration to receive specific COVID-19 therapies that alter immune response and may lead to hyperinfection syndrome or disseminated disease.
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Páramo-Zunzunegui J, Rubio-López L, Benito-Barbero S, Muñoz-Fernández Á. Eosinophilic appendicitis due to Strongyloides stercoralis: a challenging differential diagnosis for clinicians. BMJ Case Rep 2021; 14:14/6/e239685. [PMID: 34078621 DOI: 10.1136/bcr-2020-239685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A 45-year-old man presents with 48-hour status of high temperature, cough and dyspnoea. In the context of pandemic, the patient is initially diagnosed with COVID-19 syndrome. Later, the laboratory and ultrasound study supported acute appendicitis diagnosis. Appendicectomy was performed. The histopathology study confirmed eosinophilic appendicitis and that a parasitic infection was suspected. The stool sample was positive for Strongyloides stercoralis The diagnosis of a S stercoralis is a rare finding in Spain. S. stercoralis simulates clinical findings of inflammatory bowel disease or eosinophilic gastroenteritis, which may lead to the wrong therapeutic choice. Since in inflammatory diseases corticosteroid treatments are considered the initial choice in many cases, in the case of S. stercoralis infection, the administration of this therapy can be fatal. In Spain, the number of diagnoses is much lower than in the past decade, although it is highly probable that the infection has been underdiagnosed due to low clinical awareness among Spanish population.
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Affiliation(s)
- Javier Páramo-Zunzunegui
- Department of General and Digestive Surgery, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain .,Department of Surgery, Rey Juan Carlos University, Madrid, Spain
| | - Laura Rubio-López
- Department of General and Digestive Surgery, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | - Silvia Benito-Barbero
- Department of General and Digestive Surgery, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
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Hameed T, Bashir EA, Khan AQ, Ahmad M. Safety culture implications on safe work practices and work place exposure incidents in Operation Theater. Pak J Med Sci 2021; 37:379-383. [PMID: 33679917 PMCID: PMC7931327 DOI: 10.12669/pjms.37.2.2946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/30/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND & OBJECTIVES The study was undertaken to estimate the prevalence of body and blood fluid exposure incidents such as needle stick injuries, direct contact, splashes, and cuts among health care personnel (HCP) in operation theaters (OTs). The study objective was to investigate perception of safety culture and potential challenges faced by HCP in Pakistani context. METHODS An analytical cross-sectional survey was conducted in four tertiary care hospitals of Rawalpindi and Islamabad that were Akbar Niazi Teaching Hospital (ANTH), Fauji Foundation Hospital (FFH), Benazir Bhutto Hospital (BBH) and Holy Family Hospital (HFH) during March, 2019 to June, 2019. The data of the current study was collected from surgical staff in OTs at four tertiary care teaching hospitals including nurses, house officers, post graduate trainees, registrars, consultants, and technicians in the twin cities i.e., Rawalpindi and Islamabad. RESULTS In our findings (N=367) there was a high prevalence of exposure incidents in past six months, 45% had had got a needle injury, 36% have got a splash, 28.8% had direct contact and 35.6% had a cut once respectively in past six months, the occurrence of exposure incidents twice, thrice and more is also enormous. CONCLUSION The study reflected a dire need of trainings at hospitals so that very strategically the importance of safety being a priority and value of HCP is inculcated on daily basis.
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Affiliation(s)
- Tahira Hameed
- Dr. Tahira Hameed, MBBS, MRCS. Registrar, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Eitezaz Ahmed Bashir
- Brig. Dr. Eitezaz Ahmed Bashir, FCPS (Surg), Professor and Head General Surgery, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | | | - Murtaza Ahmad
- Dr. Murtaza Ahmad, MBBS, Resident Surgery, Sir Ganga Ram Hospital, Lahore, Pakistan
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Gautam D, Gupta A, Meher A, Siddiqui F, Singhai A. Corticosteroids in Covid-19 pandemic have the potential to unearth hidden burden of strongyloidiasis. IDCases 2021; 25:e01192. [PMID: 34150517 PMCID: PMC8197611 DOI: 10.1016/j.idcr.2021.e01192] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/12/2021] [Accepted: 06/12/2021] [Indexed: 11/21/2022] Open
Abstract
COVID-19 pandemic has posed formidable public health and clinical challenges to the entire humanity. A significant proportion of the COVID-19 patients have been provided immunosuppressive agents, particularly corticosteroids, as a part of management of moderate to severe COVID-19 disease. This has the drawback of development of strongyloides hyperinfection to disseminated infection in latent strongyloides infection patients. We are reporting the case of strongyloidiasis hyperinfection in a COVID-19 patient from a developing country, who initially received corticosteroid therapy for management of COVID-19, but later presented to hospital with non-specific, strongyloides related symptoms.
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Affiliation(s)
- Disha Gautam
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
| | - Ayush Gupta
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
- Corresponding author at: Department of Microbiology, All India Institute of Medical Sciences, Bhopal, 462020, India.
| | - Adarsh Meher
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
| | - Farha Siddiqui
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
| | - Abhishek Singhai
- Department of General Medicine, All India Institute of Medical Sciences, Bhopal, India
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Stauffer WM, Alpern JD, Walker PF. COVID-19 and Dexamethasone: A Potential Strategy to Avoid Steroid-Related Strongyloides Hyperinfection. JAMA 2020; 324:623-624. [PMID: 32761166 DOI: 10.1001/jama.2020.13170] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- William M Stauffer
- Center for Global Health and Social Responsibility, University of Minnesota, Minneapolis
- Department of Medicine, Global Medicine, University of Minnesota, Minneapolis
| | - Jonathan D Alpern
- HealthPartners Institute, Bloomington, Minnesota
- HealthPartners Travel and Tropical Medicine Center, St Paul, Minnesota
| | - Patricia F Walker
- Department of Medicine, Global Medicine, University of Minnesota, Minneapolis
- HealthPartners Institute, Bloomington, Minnesota
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Zammarchi L, Tilli M, Botta A, Buonfrate D, Bartoloni A, Boccalini S. Strategies for management of strongyloidiasis in migrants from Sub-Saharan Africa recently arrived in Italy: A cost-effectiveness analysis. Travel Med Infect Dis 2020; 36:101561. [PMID: 31982632 DOI: 10.1016/j.tmaid.2020.101561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/18/2020] [Accepted: 01/20/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Italian and the European Centre for Disease Control and Prevention guidelines both recommend a systematic serological screening for strongyloidiasis in sub-Saharan migrants (SSA), however, studies on clinical and economic impact of this strategy in the Italian and European settings are lacking. METHODS A population of 100,000 migrants from SSA to Italy was considered and a Markov decision tree model was developed to assess the clinical and economic impact of two interventions for strongyloidiasis compared with the current practice (passive diagnosis of symptomatic cases): a) universal serological screening and treatment with ivermectin in case of positive test b) universal presumptive treatment with ivermectin. One and 10-year time horizon in the health-care perspective were considered. RESULTS In the one and 10-year time horizon respectively the costs for passive diagnosis was €1,164,169 and €9,735,908, those for screening option was € 2,856,011 and € 4,959,638 and those for presumptive treatment was €3,538,474 and € 4,883,272. Considering the cost per cured subject in the one-year time horizon, screening appears more favorable (€209.53), than the other two options (€232.55 per presumptive treatment and €10,197.29 per current strategy). Incremental cost-effectiveness ratio (ICERs) of screening strategy and presumptive treatment were respectively 265.27 and 333.19. The sensitivity analysis identified strongyloidiasis' prevalence as the main driver of ICER. CONCLUSIONS Compared to the current practice (passive diagnosis) both screening and presumptive treatment strategies are more favorable from a cost-effectiveness point of view, with a slight advantage of the screening strategy in a one-year time horizon.
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Affiliation(s)
- Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
| | - Marta Tilli
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Annarita Botta
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - Dora Buonfrate
- Department of Infectious-Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Sara Boccalini
- Department of Health Sciences, University of Florence, Italy
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Elder K, Turner KA, Cosgrove L, Lexchin J, Shnier A, Moore A, Straus S, Thombs BD. Reporting of financial conflicts of interest by Canadian clinical practice guideline producers: a descriptive study. CMAJ 2020; 192:E617-E625. [PMID: 32538799 PMCID: PMC7867217 DOI: 10.1503/cmaj.191737] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The producers of clinical practice guidelines (CPGs) may not disclose industry funding in their CPGs. We reviewed Canadian national CPGs to examine the existence and disclosure of industry-related organizational funding in the CPGs, financial conflicts of interest of committee members and organizational procedures for managing financial conflicts of interest. METHODS For this descriptive study, we searched the asset map of the Strategy for Patient-Oriented Research Evidence Alliance and the CPG Infobase for CPGs published between Jan. 1, 2016, and Nov. 30, 2018. Eligible guidelines had to have a national focus and either a first-line drug recommendation or a screening recommendation leading to drug treatment. One investigator reviewed all CPG titles to exclude those that were clearly ineligible. Two reviewers independently reviewed all remaining guidelines and extracted data. We analyzed the data descriptively. RESULTS We included 21 CPGs: 3 from government-sponsored organizations, 9 from disease or condition interest groups and 9 from medical professional societies. None of the 3 government-sponsored organizations reported industry funding, and none of their committee members disclosed financial conflicts of interest. Among the 18 disease or condition interest groups and medical professional societies, 14 (93%) of the 15 that disclosed funding sources on websites (3 did not disclose) reported organizational funding from industry, but none disclosed this information in the CPGs; 12 (86%) of the 14 with conflict-of-interest disclosure statements in the CPG (4 did not include disclosures) had at least 1 committee member with a financial conflict (mean proportion of committee members with a conflict 56%); and for all 8 CPGs with identifiable chairs or cochairs (chairs or cochairs not reported for 10) at least 1 of these people had a financial conflict of interest. None of the guidelines described a plan to manage organizational financial conflicts of interest. INTERPRETATION Canadian CPGs are vulnerable to industry influence through funding of producers of guidelines and through the financial conflicts of interest of committee members. The CPG producers that receive industry funding should disclose organizational financial conflicts in the CPGs, should engage independent oversight committees and should restrict voting on recommendations to guideline panelists who have no financial conflicts.
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Affiliation(s)
- Katharine Elder
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Kimberly A Turner
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Lisa Cosgrove
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Joel Lexchin
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Adrienne Shnier
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Ainsley Moore
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Sharon Straus
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - Brett D Thombs
- Lady Davis Institute for Medical Research (Elder, Turner, Thombs), Jewish General Hospital and McGill University, Montréal, Que.; Department of Counselling and School of Psychology (Cosgrove), University of Massachusetts, Boston, Mass.; School of Health Policy and Management (Lexchin, Shnier), York University, Toronto, Ont.; Department of Family Medicine (Moore), McMaster University, Hamilton, Ont.; Knowledge Translation Program (Straus), Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont.
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Asundi A, Beliavsky A, Liu XJ, Akaberi A, Schwarzer G, Bisoffi Z, Requena-Méndez A, Shrier I, Greenaway C. Prevalence of strongyloidiasis and schistosomiasis among migrants: a systematic review and meta-analysis. LANCET GLOBAL HEALTH 2020; 7:e236-e248. [PMID: 30683241 DOI: 10.1016/s2214-109x(18)30490-x] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/25/2018] [Accepted: 10/25/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Global migration from regions where strongyloidiasis and schistosomiasis are endemic to non-endemic countries has increased the potential individual and public health effect of these parasitic diseases. We aimed to estimate the prevalence of these infections among migrants to establish which groups are at highest risk and who could benefit from screening. METHODS We did a systematic review and meta-analysis of strongyloidiasis and schistosomiasis prevalence among migrants born in endemic countries. Original studies that included data for the prevalence of Strongyloides or Schistosoma antibodies in serum or the prevalence of larvae or eggs in stool or urine samples among migrants originating from countries endemic for these parasites and arriving or living in host countries with low endemicity-specifically the USA, Canada, Australia, New Zealand, Israel, and 23 western European countries-were eligible for inclusion. Pooled estimates of the prevalence of strongyloidiasis and schistosomiasis by stool or urine microscopy for larvae or eggs or serum antibodies were calculated with a random-effects model. Heterogeneity was explored by stratification by age, region of origin, migrant class, period of study, and type of serological antigen used. FINDINGS 88 studies were included. Pooled strongyloidiasis seroprevalence was 12·2% (95% CI 9·0-15·9%; I2 96%) and stool-based prevalence was 1·8% (1·2-2·6%; 98%). Migrants from east Asia and the Pacific (17·3% [95% CI 4·1-37·0]), sub-Saharan Africa (14·6% [7·1-24·2]), and Latin America and the Caribbean (11·4% [7·8-15·7]) had the highest seroprevalence. Pooled schistosomiasis seroprevalence was 18·4% (95% CI 13·1-24·5; I2 97%) and stool-based prevalence was 0·9% (0·2-1·9; 99%). Sub-Saharan African migrants had the highest seroprevalence (24·1·% [95% CI 16·4-32·7]). INTERPRETATION Strongyloidiasis affects migrants from all global regions, whereas schistosomiasis is focused in specific regions and most common among sub-Saharan African migrants. Serological prevalence estimates were several times higher than stool estimates for both parasites. These data can be used to inform screening decisions for migrants and support the use of serological screening, which is more sensitive and easier than stool testing. FUNDING None.
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Affiliation(s)
- Archana Asundi
- Division of Infectious Diseases, Boston Medical Center, Boston, USA
| | - Alina Beliavsky
- Department of Internal Medicine, McGill University, Montreal, QC, Canada
| | - Xing Jian Liu
- Department of Internal Medicine, McGill University, Montreal, QC, Canada
| | - Arash Akaberi
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Zeno Bisoffi
- Centre for Tropical Diseases, IRCCS Sacro Cuore Don Calabria Hospital, Negrar, Verona, Italy; Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health, Universitat de Barcelona-Hospital Clinic, Barcelona, Spain
| | - Ian Shrier
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | - Christina Greenaway
- Centre for Clinical Epidemiology of the Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada; Division of Infectious Diseases and Clinical Epidemiology, SMBD Jewish General Hospital, McGill University, Montreal, QC, Canada.
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Rothe K, Katchanov J, Schneider J, Spinner CD, Phillip V, Busch DH, Tappe D, Braren R, Schmid RM, Slotta-Huspenina J. Strongyloides stercoralis hyperinfection syndrome presenting as mechanical ileus after short-course oral steroids for chronic obstructive pulmonary disease (COPD) exacerbation. Parasitol Int 2020; 76:102087. [PMID: 32087332 DOI: 10.1016/j.parint.2020.102087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 12/14/2022]
Abstract
We report a case of a fatal Strongyloides stercoralis hyperinfection syndrome (SHS) in a migrant from Kenya, who had been living in Germany for three decades. A short-course oral steroid treatment for Chronic Obstructive Pulmonary Disease (COPD) exacerbation had been administered four weeks prior to the presentation. The initial clinical and radiological findings suggested a mechanical small bowel obstruction as a cause of ileus. Our case highlights the importance of maintaining a high index of suspicion for strongyloidiasis in patients from endemic areas even years after they left the country of origin. It demonstrates that even a five-day course of prednisolone is able to trigger SHS in patients with underlying strongyloidiasis. History of frequent previous administration of oral prednisolone for COPD exacerbations in our case raises the question why and how the last steroid regimen provoked SHS. SHS can present with multiple gastrointestinal symptoms including ileus and the absence of eosinophilia during the whole course of the disease should not lower the level of suspicion in the appropriate clinical setting.
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Affiliation(s)
- Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany.
| | - Juri Katchanov
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Jochen Schneider
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Christoph D Spinner
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Veit Phillip
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Dirk H Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University Munich, Munich, Germany; German Centre for Infection Research (DZIF), partner site Munich, Munich, Germany
| | - Dennis Tappe
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Rickmer Braren
- Department of Radiology, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, University Hospital Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
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Waters M, Krajden S, Kim C, Elsobky R, Lychacz B, Cheung M, Crowther M, Keystone J. Case Report: Two Cases of Strongyloidiasis Presenting with Thrombotic Events. Am J Trop Med Hyg 2020; 101:418-421. [PMID: 31218995 DOI: 10.4269/ajtmh.19-0347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We report two unusual cases of clinical strongyloidiasis that present as extensive thrombosis: a case of hyperinfection with concurrent eosinophilia and a case of disseminated infection as a complication of immunosuppression. We discuss risk factors for the development of Strongyloides stercoralis infection and thromboembolism, and the recommended management.
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Affiliation(s)
- Mara Waters
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Sigmund Krajden
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,St. Joseph's Health Centre, Toronto, Canada
| | | | | | | | - Matthew Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Jay Keystone
- Tropical Disease Unit, Toronto General Hospital, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
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39
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McLellan J, Gill MJ, Vaughan S, Meatherall B. Schistosoma and Strongyloides screening in migrants initiating HIV Care in Canada: a cross sectional study. BMC Infect Dis 2020; 20:76. [PMID: 31992216 PMCID: PMC6986152 DOI: 10.1186/s12879-020-4779-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Following migration from Schistosoma and Strongyloides endemic to non-endemic regions, people remain at high risk for adverse sequelae from these chronic infections. HIV co-infected persons are particularly vulnerable to the serious and potentially fatal consequences of untreated helminth infection. While general screening guidelines exist for parasitic infection screening in immigrant populations, they remain silent on HIV positive populations. This study assessed the seroprevalence, epidemiology and laboratory characteristics of these two parasitic infections in a non-endemic setting in an immigrant/refugee HIV positive community. METHODS Between February 2015 and 2018 individuals born outside of Canada receiving care at the centralized HIV clinic serving southern Alberta, Canada were screened by serology and direct stool analysis for schistosomiasis and strongyloidiasis. Canadian born persons with travel-based exposure risk factors were also screened. Epidemiologic and laboratory values were analyzed using bivariate logistic regression. We assessed the screening utility of serology, direct stool analysis, eosinophilia and hematuria. RESULTS 253 HIV positive participants were screened. The prevalence of positive serology for Schistosoma and Strongyloides was 19.9 and 4.4%, respectively. Age between 40 and 50 years (OR 2.50, 95% CI 1.13-5.50), refugee status (3.55, 1.72-7.33), country of origin within Africa (6.15, 2.44-18.60), eosinophilia (3.56, 1.25-10.16) and CD4 count < 200 cells/mm3 (2.46, 1.02-5.92) were associated with positive Schistosoma serology. Eosinophilia (11.31, 2.03-58.94) was associated with positive Strongyloides serology. No Schistosoma or Strongyloides parasites were identified by direct stool microscopy. Eosinophilia had poor sensitivity for identification of positive serology. Hematuria was not associated with positive Schistosoma serology. CONCLUSION Positive Schistosoma and Strongyloides serology was common in this migrant HIV positive population receiving HIV care in Southern Alberta. This supports the value of routine parasitic screening as part of standard HIV care in non-endemic areas. Given the high morbidity and mortality in this relatively immunosuppressed population, especially for Strongyloides infection, screening should include both serologic and direct parasitological tests. Eosinophilia and hematuria should not be used for Schistosoma and Strongyloides serologic screening in HIV positive migrants in non-endemic settings.
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Affiliation(s)
- Jessica McLellan
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada.
| | - M John Gill
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada
- Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada
| | - Stephen Vaughan
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada
- Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada
| | - Bonnie Meatherall
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada
- Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada
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40
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Heydarian P, Mobedi I, Mohaghegh MA, Hosseini A, Chegini FG, Esboei BR. A case of fatal disseminated strongyloidiasis accompanied with intestinal obstruction. Oxf Med Case Reports 2019; 2019:omz087. [PMID: 31772736 PMCID: PMC6792121 DOI: 10.1093/omcr/omz087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/24/2019] [Accepted: 07/28/2019] [Indexed: 11/29/2022] Open
Abstract
Strongyloides stercoralis is an endemic parasite in some regions including the tropical and subtropical areas with high humidity. Most infections are asymptomatic with nonspecific signs and symptoms, making the final diagnosis complicated. Here, we report a patient referred to our hospital with signs consistent with sepsis, intestine obstruction, which finally died with the diagnosis of strongyloidiasis. The patient was from northern parts of Iran which are considered as endemic areas for S. stercoralis. In conclusion, there is an important message in this history, i.e. physicians should be aware of specific and non-specific signs of strongyloidiasis especially in people living in endemic areas to make an accurate final diagnosis by proper clinical and paraclinical examinations.
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Affiliation(s)
- Peyman Heydarian
- Department of Medical Parasitology and Mycology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.,Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Iraj Mobedi
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Ali Mohaghegh
- Department of Laboratory Sciences, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Abozar Hosseini
- Laboratory of Hazrat Fatemeh Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Goudarzvand Chegini
- Department of Medical Parasitology and Mycology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.,Student Research Committee, School of Medicine, Qazvin University Of Medical Sciences, Qazvin, Iran
| | - Bahman Rahimi Esboei
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Casado L, Rodriguez-Guardado A, Boga J, Fernández-Suarez J, Martínez-Camblor P, Rodríguez-Perez M, García-Pérez A, Vazquez F, Gascon J. Use of serology in a systematic screening programme for strongyloidiasis in an immigrant population. Int J Infect Dis 2019; 88:60-64. [DOI: 10.1016/j.ijid.2019.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/28/2019] [Accepted: 09/02/2019] [Indexed: 11/28/2022] Open
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Tam J, Schwartz KL, Keystone J, Dimitrakoudis D, Downing M, Krajden S. Case Report: Central Nervous System Strongyloidiasis: Two Cases Diagnosed Antemortem. Am J Trop Med Hyg 2019; 100:130-134. [PMID: 30457095 DOI: 10.4269/ajtmh.18-0813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Central nervous system (CNS) strongyloidiasis is a known but rare form of disseminated infection. The diagnosis is often made postmortem, with only five published cases of an antemortem diagnosis. We report two fatal cases of CNS strongyloidiasis diagnosed antemortem, with Strongyloides stercoralis larvae visualized in the CNS sample in one case. Risk factors for disseminated strongyloidiasis common to both cases included origination from the Caribbean, underlying human T-lymphotropic virus-1 infection, and recent prednisone use. Both cases occurred in Canada, where the occurrence of Strongyloides is uncommon, and serve as a reminder to maintain a high index of suspicion in patients with epidemiologic or clinical risk factors for dissemination.
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Affiliation(s)
- Jennifer Tam
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Kevin L Schwartz
- Division of Infectious Diseases, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jay Keystone
- Tropical Disease Unit, Division of Infectious Diseases, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Dimitri Dimitrakoudis
- Division of Neurology, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada
| | - Mark Downing
- Division of Infectious Diseases, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada
| | - Sigmund Krajden
- Division of Infectious Diseases, Department of Medicine, St. Joseph's Health Centre, Toronto, Canada
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43
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Weiskerger CJ, Brandão J, Ahmed W, Aslan A, Avolio L, Badgley BD, Boehm AB, Edge TA, Fleisher JM, Heaney CD, Jordao L, Kinzelman JL, Klaus JS, Kleinheinz GT, Meriläinen P, Nshimyimana JP, Phanikumar MS, Piggot AM, Pitkänen T, Robinson C, Sadowsky MJ, Staley C, Staley ZR, Symonds EM, Vogel LJ, Yamahara KM, Whitman RL, Solo-Gabriele HM, Harwood VJ. Impacts of a changing earth on microbial dynamics and human health risks in the continuum between beach water and sand. WATER RESEARCH 2019; 162:456-470. [PMID: 31301475 DOI: 10.1016/j.watres.2019.07.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 05/16/2023]
Abstract
Although infectious disease risk from recreational exposure to waterborne pathogens has been an active area of research for decades, beach sand is a relatively unexplored habitat for the persistence of pathogens and fecal indicator bacteria (FIB). Beach sand, biofilms, and water all present unique advantages and challenges to pathogen introduction, growth, and persistence. These dynamics are further complicated by continuous exchange between sand and water habitats. Models of FIB and pathogen fate and transport at beaches can help predict the risk of infectious disease from beach use, but knowledge gaps with respect to decay and growth rates of pathogens in beach habitats impede robust modeling. Climatic variability adds further complexity to predictive modeling because extreme weather events, warming water, and sea level change may increase human exposure to waterborne pathogens and alter relationships between FIB and pathogens. In addition, population growth and urbanization will exacerbate contamination events and increase the potential for human exposure. The cumulative effects of anthropogenic changes will alter microbial population dynamics in beach habitats and the assumptions and relationships used in quantitative microbial risk assessment (QMRA) and process-based models. Here, we review our current understanding of microbial populations and transport dynamics across the sand-water continuum at beaches, how these dynamics can be modeled, and how global change factors (e.g., climate and land use) should be integrated into more accurate beachscape-based models.
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Affiliation(s)
- Chelsea J Weiskerger
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, USA
| | - João Brandão
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisboa, Portugal; Centre for Environmental and Marine Studies (CESAM) - Department of Animal Biology, University of Lisboa, Lisboa, Portugal.
| | - Warish Ahmed
- Commonwealth Scientific and Industrial Research Organisation (CSIRO), Land and Water, Ecosciences Precinct, 41 Boogo Road, Dutton Park, Old, 4102, Australia
| | - Asli Aslan
- Department of Environmental Health Sciences, Georgia Southern University, Statesboro, GA, USA
| | - Lindsay Avolio
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Brian D Badgley
- School of Plant and Environmental Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Alexandria B Boehm
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA, USA
| | - Thomas A Edge
- Department of Biology, McMaster University, Ontario, Canada
| | - Jay M Fleisher
- College of Medicine, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Christopher D Heaney
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Luisa Jordao
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisboa, Portugal
| | | | - James S Klaus
- Department of Marine Geosciences, University of Miami, Miami, FL, USA
| | | | - Päivi Meriläinen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | | | - Mantha S Phanikumar
- Department of Civil and Environmental Engineering, Michigan State University, East Lansing, MI, USA
| | - Alan M Piggot
- Department of Earth and Environment, Florida International University, Miami, FL, USA
| | - Tarja Pitkänen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Clare Robinson
- Department of Civil and Environmental Engineering, Western University, London, Ontario, Canada
| | - Michael J Sadowsky
- BioTechnology Institute and Departments of Soil, Water, & Climate, and Plant and Microbial Biology, University of Minnesota, St. Paul, MN, USA
| | | | | | - Erin M Symonds
- College of Marine Science, University of South Florida, St. Petersburg, FL, USA
| | - Laura J Vogel
- Department of Civil and Environmental Engineering, Western University, London, Ontario, Canada
| | - Kevan M Yamahara
- Monterrey Bay Aquarium Research Institute, Moss Landing, CA, USA
| | - Richard L Whitman
- Great Lakes Science Center, United States Geological Survey, Chesterton, IN, USA
| | - Helena M Solo-Gabriele
- Department of Civil, Architectural, and Environmental Engineering, University of Miami, Coral Gables, FL, USA
| | - Valerie J Harwood
- Department of Integrative Biology, University of South Florida, Tampa, FL, USA
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Richards C, Penner J, Colmegna I, Loewen H, Melaku Z, Melkie A, Meltzer M, Scuccimarri R, Mengistu Y, Hitchon CA. Methotrexate exposure and risk of strongyloidiasis. Trop Med Int Health 2019; 24:1032-1041. [PMID: 31302948 DOI: 10.1111/tmi.13288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Rheumatologic disease patients receiving immunomodulating drugs such as methotrexate (MTX) have increased infection rates. Strongyloides, a global endemic intestinal parasite, can cause significant or fatal disease in immunocompromised patients. The risk of serious Strongyloides infection with MTX dosed for rheumatologic disease is unknown. METHODS We performed a systematic literature review searching EMBASE, Medline and Web of Science databases. All studies reporting humans exposed to MTX and tested for Strongyloides were reviewed. Exclusion criteria were bone marrow transplantation, intrathecal route and MTX exposure completed >1 year prior to clinically apparent Strongyloides disease. RESULTS After excluding duplicates, 294 articles were reviewed. Of these, 29 cases were described in 27 papers. Twenty cases (69%) had an underlying rheumatologic or dermatologic disease, the rest had a haematologic disease. Hyperinfection or dissemination was found in 59% of cases (52% low-dose MTX; 75% high-dose MTX). Death occurred in 34% of cases (19% low-dose MTX; 75% high-dose MTX, P < 0.01). All eight patients on high-dose MTX received other immunosuppressants. Corticosteroids were taken in 18/21 patients on low-dose MTX. One of the three patients on MTX monotherapy had hyperinfection syndrome. None had disseminated Strongyloides. CONCLUSIONS Serious Strongyloides infection can occur with low-dose MTX particularly when given with other immunosuppression. Global travel and greater awareness of rheumatologic conditions in low- to middle-income countries will increase the exposure of individuals prescribed MTX (with or without corticosteroids) to Strongyloides. Strongyloides screening and treatment should be considered for individuals receiving low-dose MTX therapy, particularly if combined with additional immunosuppression.
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Affiliation(s)
- Ceri Richards
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Justin Penner
- Department of Paediatrics, University of British Columbia, Trail, BC, Canada.,Department of Paediatric Infectious Diseases, Imperial College London, London, UK
| | - Ines Colmegna
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Hal Loewen
- Neil John Mclean Library, University of Manitoba, Winnipeg, MB, Canada
| | - Zenebe Melaku
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA.,Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Addisu Melkie
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | | | - Carol A Hitchon
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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Bosqui LR, Marques PD, de Melo GB, Gonçalves-Pires MDRF, Malta FM, Pavanelli WR, Conchon-Costa I, Costa-Cruz JM, Paula FM, Costa IN. Molecular and Immnune Diagnosis: Further Testing for Human Strongyloidiasis. Mol Diagn Ther 2019; 22:485-491. [PMID: 29934882 DOI: 10.1007/s40291-018-0340-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Detection of Strongyloides stercoralis larvae is particularly challenging because only a small number of larvae are released into the feces, regardless of infection stage. OBJECTIVE Our objective was to apply conventional polymerase chain reaction (PCR) to the detection of S. stercoralis DNA in feces samples to evaluate its performance in samples of patients with strongyloidiasis and compare results with those of immunodiagnosis. METHODS Stool, serum, and saliva samples were collected from each individual (n = 48) at the clinic hospital of the State University of Londrina, Brazil, for parasitological, immunological, and molecular tests. Stool samples were processed via parasitological methods. Serum samples were used for immunoglobulin G (IgG) detection and saliva samples for IgA detection by ELISA. RESULTS For amplification by conventional PCR, two different primers were used: species specific (101 bp) and genus specific (392 bp). The results showed that 34 (97.1%) of the 35 copro-positive individuals for S. stercoralis were positive for serum IgG and 19 (54.3%) were positive for salivary IgA. Regarding molecular analysis, both primers (species and genus specific) demonstrated positivity in 100% of the samples, which was confirmed by sequencing the positive samples. CONCLUSION Complementary examinations of the parasitological method demonstrated excellent results in the context of the diagnosis of strongyloidiasis, especially in asymptomatic patients with irregular larval release in the feces.
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Affiliation(s)
- Larissa R Bosqui
- Departamento de Ciências Patológicas, CCB, Laboratório de Parasitologia Experimental, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid Campus Universitário, Londrina, PR, CEP 86051-990, Brazil.
| | - Priscilla D Marques
- Departamento de Moléstias Infecciosas e Parasitárias - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, CEP 01246903, Brazil
| | - Gessica B de Melo
- Departamento de Moléstias Infecciosas e Parasitárias - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, CEP 01246903, Brazil
| | - Maria do Rosário F Gonçalves-Pires
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Pará 1720, Uberlândia, MG, CEP 38400-902, Brazil
| | - Fernanda M Malta
- Departamento de Moléstias Infecciosas e Parasitárias - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, CEP 01246903, Brazil
| | - Wander R Pavanelli
- Departamento de Ciências Patológicas, CCB, Laboratório de Parasitologia Experimental, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid Campus Universitário, Londrina, PR, CEP 86051-990, Brazil
| | - Ivete Conchon-Costa
- Departamento de Ciências Patológicas, CCB, Laboratório de Parasitologia Experimental, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid Campus Universitário, Londrina, PR, CEP 86051-990, Brazil
| | - Julia M Costa-Cruz
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Av. Pará 1720, Uberlândia, MG, CEP 38400-902, Brazil
| | - Fabiana M Paula
- Departamento de Moléstias Infecciosas e Parasitárias - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, CEP 01246903, Brazil
| | - Idessania N Costa
- Departamento de Ciências Patológicas, CCB, Laboratório de Parasitologia Experimental, Universidade Estadual de Londrina, Rodovia Celso Garcia Cid Campus Universitário, Londrina, PR, CEP 86051-990, Brazil
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Makhani L, Khatib A, Corbeil A, Kariyawasam R, Raheel H, Clarke S, Challa P, Hagopian E, Chakrabarti S, Schwartz KL, Boggild AK. 2018 in review: five hot topics in tropical medicine. Trop Dis Travel Med Vaccines 2019; 5:5. [PMID: 31016025 PMCID: PMC6466725 DOI: 10.1186/s40794-019-0082-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/28/2019] [Indexed: 02/07/2023] Open
Abstract
The year 2018 heralded many new developments in the field of tropical medicine, including licensure of novel drugs for novel indications, licensure of existing drugs for existing indications but in novel settings, and globalized outbreaks of both vector-borne and zoonotic diseases. We herein describe five top stories in tropical medicine that occurred during 2018, and illuminate the practice-changing development within each story.
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Affiliation(s)
- Leila Makhani
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4 Canada
| | - Aisha Khatib
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4 Canada
| | - Antoine Corbeil
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | | | - Hira Raheel
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Shareese Clarke
- Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4 Canada
| | - Priyanka Challa
- Department of Life Science, University of Toronto, Toronto, Canada
| | - Emma Hagopian
- Department of Arts and Science, University of Toronto, Toronto, Canada
| | - Sumontra Chakrabarti
- Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4 Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of Infectious Diseases, Trillium Health Partners, Mississauga, Canada
| | - Kevin L. Schwartz
- Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4 Canada
- Division of Infectious Diseases, St. Joseph’s Health Centre, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
| | - Andrea K. Boggild
- Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street, 13EN-218, Toronto, ON M5G 2C4 Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
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Yeung SHM, Mourad O, Klowak M, Showler AJ, Klowak S, Boggild AK. Implementation and evaluation of a quality and safety tool for ambulatory strongyloidiasis patients at high risk of adverse outcome. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2019; 5:3. [PMID: 30988956 PMCID: PMC6448213 DOI: 10.1186/s40794-019-0080-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/26/2019] [Indexed: 01/20/2023]
Abstract
Background Strongyloidiasis is a common infection in Canadian migrants that can cause life-threatening hyperinfection in immunosuppressed hosts. We designed and implemented a safety tool to guide management of patients with Strongyloides in order to prevent adverse outcomes. Methods: Patients treated at our centre for strongyloidiasis from January 1, 2013 to December 31, 2015 were identified through our ivermectin access log. Patients were categorized into pre-implementation and post-implementation groups. A retrospective chart review for predefined variables was conducted. Results Of 37 patients with strongyloidiasis, 26 were in the pre-implementation group and 11 were in the post-implementation group. Documented seroreversion (positive to negative) occurred in 42.1% of patients pre-implementation and 62.5% of patients post-implementation (p = 0.420). Documented stool clearance occurred in 80.0% of patients pre-implementation and 100.0% of patients post-implementation (p = 1.000). More patients were screened for HTLV-1 coinfection post-implementation (80.0%) versus pre-implementation (30.8%) (p = 0.011). Loss to follow-up after treatment occurred in 23.1% of patients pre-implementation and 20.0% of patients post-implementation (p = 1.000). Conclusions The safety tool may be useful in the treatment of patients with strongyloidiasis to improve documentation of patient outcomes and standardize care. Future research should include a powered prospective study. Electronic supplementary material The online version of this article (10.1186/s40794-019-0080-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabrina H M Yeung
- 1University of Toronto, 27 King's College Circle, Toronto, Ontario M5S1A1 Canada
| | - Omar Mourad
- 2Western University, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Michael Klowak
- 3McMaster University, 1280 Main Street West, Hamilton, Ontario L8S4L8 Canada
| | - Adrienne J Showler
- 4Georgetown University, 3800 Reservoir Rd NW, Washington, DC 20007 USA.,5Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street 13EN-218, Toronto, Ontario M5G2C4 Canada
| | - Stefanie Klowak
- 5Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street 13EN-218, Toronto, Ontario M5G2C4 Canada
| | - Andrea K Boggild
- 1University of Toronto, 27 King's College Circle, Toronto, Ontario M5S1A1 Canada.,5Tropical Disease Unit, Toronto General Hospital, 200 Elizabeth Street 13EN-218, Toronto, Ontario M5G2C4 Canada.,6Public Health Ontario Laboratory, 661 University Avenue, Toronto, Ontario M5G1M1 Canada.,7Department of Medicine, University of Toronto, Toronto, Canada
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Alsager K, Waqar S, Furrukh H, Alattas N. Donor-derived strongyloidiasis in a Saudi pediatric kidney transplant recipient: A case report and mini-review. Pediatr Transplant 2019; 23:e13315. [PMID: 30578622 DOI: 10.1111/petr.13315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 09/15/2018] [Accepted: 09/18/2018] [Indexed: 11/27/2022]
Abstract
S. stercoralis infection has been identified as a donor-derived infection in cases of solid organ transplant among recipients with no prior risk factor for parasitic exposure. Worldwide and regional reports from the adult kidney transplant population highlight this indirect method of infection and caution about delayed diagnosis, severe complications, and death related to donor-derived S. stercoralis infection. We report a deceased-donor-derived S. stercoralis infection in a 12-year-old Saudi girl who underwent kidney transplantation. This is the first pediatric case reported outside the United States of America. Although she presented with mild bouts of gastrointestinal symptoms, the need for additional immune suppression put her at risk of serious complications. A literature review highlights the importance of awareness about S. stercoralis infections and complications in kidney transplant recipients, pretransplant screening of donors based on risk assessment, and the challenges with treatment availability and duration in this vulnerable population.
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Affiliation(s)
- Khaled Alsager
- Division of Pediatric Infectious Diseases, King Abdullah Specialized Children's Hospital (KASCH), National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Saadia Waqar
- Division of Pediatric Infectious Diseases, King Abdullah Specialized Children's Hospital (KASCH), National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hina Furrukh
- Division of Pediatric Infectious Diseases, King Abdullah Specialized Children's Hospital (KASCH), National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Nadia Alattas
- Division of Pediatric Infectious Diseases, King Abdullah Specialized Children's Hospital (KASCH), National Guard Health Affairs, Riyadh, Saudi Arabia.,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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50
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Boggild AK, Geduld J, Libman M, Yansouni CP, McCarthy AE, Hajek J, Ghesquiere W, Mirzanejad Y, Vincelette J, Kuhn S, Plourde PJ, Chakrabarti S, Greenaway C, Hamer DH, Kain KC. Spectrum of illness in migrants to Canada: sentinel surveillance through CanTravNet. J Travel Med 2019; 26:5159662. [PMID: 30395252 DOI: 10.1093/jtm/tay117] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Due to ongoing political instability and conflict in many parts of the world, migrants are increasingly seeking asylum and refuge in Canada. METHODS We examined demographic and travel correlates of illnesses among migrants to Canada to establish a detailed epidemiologic framework of this population for Canadian practitioners. Data on ill-returned Canadian travellers presenting to a CanTravNet site between 1 January 2015 and 31 December 2015 were analyzed. RESULTS During the study period, 2415 ill travellers and migrants presented to a CanTravNet site, and of those, 519 (21.5%) travelled for the purpose of migration. Sub-Saharan Africa (n = 160, 30.8%), southeast Asia (n = 84, 16.2%) and south central Asia (n = 75, 14.5%) were the most common source regions for migrants, while the top specific source countries, of 98 represented, were the Philippines (n = 45, 8.7%), China (n = 36, 6.9%) and Vietnam (n = 31, 6.0%). Compared with non-migrant travellers, migrants were more likely to have a pre-existing immunocompromising medical condition, such as HIV or diabetes mellitus (P < 0.0001), and to require inpatient management of their illness (P < 0.0001). Diagnoses such as tuberculosis (n = 263, 50.7%), hepatitis B and C (n = 78, 15%) and HIV (n = 11, 2.1%) were over-represented in the migrant population compared with non-migrant travellers (P < 0.0001). Most cases of tuberculosis in the migrant population (n = 263) were latent (82% [n = 216]); only 18% (n = 47) were active. CONCLUSIONS Compared with non-migrant travellers, migrants were more likely to present with a communicable infectious disease, such as tuberculosis, potentially complicated by an underlying immunosuppressing condition such as HIV. These differences highlight the divergent healthcare needs in the migrant population, and underscore the importance of surveillance programmes to understand their burden of illness. Intake programming should be adequately resourced to accommodate the medical needs of this vulnerable population of new Canadians.
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Affiliation(s)
- Andrea K Boggild
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University Health Network and the University of Toronto, Toronto ON, Canada.,Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON, Canada
| | - Jennifer Geduld
- Office of Border and Travel Health, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Michael Libman
- The J.D. MacLean Centre for Tropical Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Cedric P Yansouni
- The J.D. MacLean Centre for Tropical Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anne E McCarthy
- Tropical Medicine and International Health Clinic, Division of Infectious Diseases, Ottawa Hospital and the University of Ottawa, Ottawa ON, Canada
| | - Jan Hajek
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver British Columbia, Canada
| | - Wayne Ghesquiere
- Infectious Diseases, Vancouver Island Health Authority, Department of Medicine, University of British Columbia, Victoria, British Columbia, Canada
| | - Yazdan Mirzanejad
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver British Columbia, Canada.,Fraser Health, Surrey, British Columbia, Canada
| | - Jean Vincelette
- Hôpital Saint-Luc du CHUM, Université de Montréal, Montréal, Quebec, Canada
| | - Susan Kuhn
- Section of Pediatric Infectious Diseases, Departments of Pediatrics and Medicine, Alberta Children's Hospital and the University of Calgary, Calgary, Alberta, Canada
| | - Pierre J Plourde
- Travel Health and Tropical Medicine Services, Population and Public Health Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | - Sumontra Chakrabarti
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University Health Network and the University of Toronto, Toronto ON, Canada.,Trillium Health Partners, Mississauga, ON, Canada
| | - Christina Greenaway
- The J.D. MacLean Centre for Tropical Diseases, Department of Medicine, McGill University, Montreal, Quebec, Canada.,Division of Infectious Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, USA
| | - Kevin C Kain
- Tropical Disease Unit, Division of Infectious Diseases, Department of Medicine, University Health Network and the University of Toronto, Toronto ON, Canada.,SAR Laboratories, Sandra Rotman Centre for Global Health, Toronto, ON Canada
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