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Cutfield T, Motuhifonua SK, Blakiston M, Bhally H, Duffy E, Lane R, Otte E, Swager T, Taylor AM, Playle V. Strongyloidiasis in Auckland: A ten-year retrospective study of diagnosis, treatment and outcomes of a predominantly Polynesian and Fijian migrant cohort. PLoS Negl Trop Dis 2024; 18:e0012045. [PMID: 38547314 PMCID: PMC11003684 DOI: 10.1371/journal.pntd.0012045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 04/09/2024] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Strongyloides stercoralis is not endemic in Aotearoa New Zealand (AoNZ). However, approximately one third of Auckland residents are born in endemic countries. This study aimed to describe the epidemiology and management of strongyloidiasis in Auckland, with a focus on migrants from Pacific Island Countries and Territories. METHODS This study retrospectively reviewed clinical, laboratory and pharmacy records data for all people diagnosed with strongyloidiasis in the Auckland region between July 2012 and June 2022. People with negative Strongyloides serology were included to estimate seropositivity rate by country of birth. FINDINGS Over ten years, 691 people were diagnosed with strongyloidiasis. Most diagnoses were made by serology alone (622, 90%). The median age was 63 years (range 15-92), 500 (72%) were male, and the majority were born in Polynesia (350, 51%), Fiji (130, 19%) or were of Pasifika ethnicity (an additional 7%). Twelve participants (1.7%) had severe strongyloidiasis at diagnosis. The total proportion treated with ivermectin was only 70% (484/691), with no differences between immunocompromised and immunocompetent participants, nor by ethnicity. The outcome of treatment (based on a combination of serology and/or eosinophilia and/or stool microscopy) could only be determined in 50% of the treated cohort. One participant failed treatment with ivermectin, experiencing recurrent strongyloidiasis, and another participant died in association with severe strongyloidiasis. The rate of 'positive' Strongyloides serology was highest among participants born in Samoa (48%), Fiji (39%), and Southeast Asian countries (34%). INTERPRETATION Strongyloidiasis was common and under-treated in Auckland during the study period. Clinicians should have a low threshold for considering strongyloidiasis in migrants from endemic countries, including Polynesia and Fiji.
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Affiliation(s)
- Tim Cutfield
- Department of Infectious Diseases, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Soana Karuna Motuhifonua
- Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Grafton, Auckland, New Zealand
| | - Matthew Blakiston
- Department of Microbiology, Labtests Auckland, Mount Wellington, Auckland, New Zealand
| | - Hasan Bhally
- Department of Infectious Diseases, Te Whatu Ora Waitematā, Takapuna, Auckland, New Zealand
| | - Eamon Duffy
- Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Grafton, Auckland, New Zealand
- Department of Infectious Diseases, Te Whatu Ora Te Toka Tumai Auckland, Grafton, Auckland, New Zealand
| | - Rebekah Lane
- Department of Infectious Diseases, Te Whatu Ora Te Toka Tumai Auckland, Grafton, Auckland, New Zealand
| | - Erik Otte
- Department of Microbiology, Canterbury Health Laboratories, Hagley Avenue, Christchurch Central City, Christchurch, New Zealand
| | - Terri Swager
- LabPLUS Auckland, Auckland City Hospital, Grafton, Auckland
| | - Amanda Maree Taylor
- Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Grafton, Auckland, New Zealand
| | - Veronica Playle
- Department of Infectious Diseases, Te Whatu Ora Counties Manukau, Auckland, New Zealand
- Faculty of Medical and Health Sciences, The University of Auckland, Park Road, Grafton, Auckland, New Zealand
- LabPLUS Auckland, Auckland City Hospital, Grafton, Auckland
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Gordon CA, Utzinger J, Muhi S, Becker SL, Keiser J, Khieu V, Gray DJ. Strongyloidiasis. Nat Rev Dis Primers 2024; 10:6. [PMID: 38272922 DOI: 10.1038/s41572-023-00490-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Strongyloidiasis is a neglected tropical disease caused primarily by the roundworm Strongyloides stercoralis. Strongyloidiasis is most prevalent in Southeast Asia and the Western Pacific. Although cases have been documented worldwide, global prevalence is largely unknown due to limited surveillance. Infection of the definitive human host occurs via direct skin penetration of the infective filariform larvae. Parasitic females reside in the small intestine and reproduce via parthenogenesis, where eggs hatch inside the host before rhabditiform larvae are excreted in faeces to begin the single generation free-living life cycle. Rhabditiform larvae can also develop directly into infectious filariform larvae in the gut and cause autoinfection. Although many are asymptomatic, infected individuals may report a range of non-specific gastrointestinal, respiratory or skin symptoms. Autoinfection may cause hyperinfection and disseminated strongyloidiasis in immunocompromised individuals, which is often fatal. Diagnosis requires direct examination of larvae in clinical specimens, positive serology or nucleic acid detection. However, there is a lack of standardization of techniques for all diagnostic types. Ivermectin is the treatment of choice. Control and elimination of strongyloidiasis will require a multifaceted, integrated approach, including highly sensitive and standardized diagnostics, active surveillance, health information, education and communication strategies, improved water, sanitation and hygiene, access to efficacious treatment, vaccine development and better integration and acknowledgement in current helminth control programmes.
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Affiliation(s)
- Catherine A Gordon
- Infection and Inflammation Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia.
- Faculty of Medicine, University of Queensland, St Lucia, Brisbane, Queensland, Australia.
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Stephen Muhi
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- The University of Melbourne, Department of Microbiology and Immunology, Parkville, Victoria, Australia
| | - Sören L Becker
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg/Saar, Germany
| | - Jennifer Keiser
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Darren J Gray
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia
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Dumas G, Arabi YM, Bartz R, Ranzani O, Scheibe F, Darmon M, Helms J. Diagnosis and management of autoimmune diseases in the ICU. Intensive Care Med 2024; 50:17-35. [PMID: 38112769 DOI: 10.1007/s00134-023-07266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/01/2023] [Indexed: 12/21/2023]
Abstract
Autoimmune diseases encompass a broad spectrum of disorders characterized by disturbed immunoregulation leading to the development of specific autoantibodies, resulting in inflammation and multiple organ involvement. A distinction should be made between connective tissue diseases (mainly systemic lupus erythematosus, systemic scleroderma, inflammatory muscle diseases, and rheumatoid arthritis) and vasculitides (mainly small-vessel vasculitis such as antineutrophil cytoplasmic antibody-associated vasculitis and immune-complex mediated vasculitis). Admission of patients with autoimmune diseases to the intensive care unit (ICU) is often triggered by disease flare-ups, infections, and organ failure and is associated with high mortality rates. Management of these patients is complex, including prompt disease identification, immunosuppressive treatment initiation, and life-sustaining therapies, and requires multi-disciplinary involvement. Data about autoimmune diseases in the ICU are limited and there is a need for multicenter, international collaboration to improve patients' diagnosis, management, and outcomes. The objective of this narrative review is to summarize the epidemiology, clinical features, and selected management of severe systemic autoimmune diseases.
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Affiliation(s)
- Guillaume Dumas
- Medical Intensive Care Unit, Service de Médecine Intensive-Réanimation, CHU Grenoble-Alpes, Université Grenoble-Alpes, INSERM, U1042-HP2, Grenoble, France.
| | - Yaseen M Arabi
- Intensive Care Department, Ministry of the National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences Riyadh, Riyadh, Kingdom of Saudi Arabia
| | - Raquel Bartz
- Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Otavio Ranzani
- Barcelona Institute for Global Health, ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Pulmonary Division, Faculdade de Medicina, Heart Institute, InCor, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Franziska Scheibe
- Department of Neurology and Experimental Neurology, Charité- Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Michaël Darmon
- Medical Intensive Care Unit, APHP, Hôpital Saint-Louis, Famirea Study Group, ECSTRA Team, and Clinical EpidemiologyUMR 1153, Center of Epidemiology and Biostatistics, Sorbonne Paris Cité, CRESS, INSERM, Université Paris Cité, Paris, France
| | - Julie Helms
- Faculté de Médecine, Service de Médecine Intensive-Réanimation, Université de Strasbourg (UNISTRA), Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, 1 Place de L'Hôpital, Strasbourg, France
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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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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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Montreuil N, Sternberg CA, Abaribe O, Ayoade FO. Disseminated Strongyloides stercoralis infection in the setting of Escherichia coli meningitis and bacteraemia in a patient living with HIV on high-dose corticosteroid therapy. BMJ Case Rep 2023; 16:e256105. [PMID: 37643819 PMCID: PMC10465900 DOI: 10.1136/bcr-2023-256105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
Strongyloidiasis, a helminth infection caused by Strongyloides stercoralis, can be complicated by hyperinfection, especially in the setting of immunosuppression; however, many patients go undiagnosed. One clue to diagnosis is unexplained gram-negative bacteraemia or meningitis in patients who are immunosuppressed. Serology can be helpful but may be negative in these patients who are immunocompromised.We present the case of a white cisgender man from Central America in his 40s, living with HIV, with a CD4 count of 77 cells/µL. He was diagnosed with Strongyloides hyperinfection after an increase in his steroid dose. He also had Escherichia coli meningitis and bacteraemia. Strongyloidiasis was diagnosed by stool microscopy despite a negative serology test.This case highlights the challenges in diagnosing strongyloidiasis in the setting of immunosuppression. A high index of clinical suspicion is warranted for patients living with HIV on high-dose corticosteroids. Up to three stool microscopy studies for Strongyloides should be sent in addition to serology.
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Affiliation(s)
- Nadine Montreuil
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Candice A Sternberg
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Obinna Abaribe
- Department of Medicine, Infectious Disease Doctors Medical Group APC, Plano, Texas, USA
| | - Folusakin O Ayoade
- Division of Infectious Diseases/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Pérez-Jacoiste Asín MA, De Castro M, De Dios B, Pérez-Ayala A, Lalueza A, García-Reyne A, Losada I, Herrero-Martínez JM, Jiménez PH, Lumbreras C, Lizasoain M, López Medrano F. Enhancing screening adherence for strongyloides infection in latinx inpatients with COVID-19: a local protocol implementation study. Pathog Glob Health 2023:1-9. [PMID: 37525476 DOI: 10.1080/20477724.2023.2240088] [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: 08/02/2023] Open
Abstract
Strongyloides stercoralis hyperinfection syndrome has been observed in immunosuppressed coronavirus disease 2019 (COVID-19) patients. Detecting and treating asymptomatic Strongyloides infection in individuals from endemic areas can effectively prevent hyperinfection. Unfortunately, many clinicians are unaware of this neglected infection. Therefore, we aimed to evaluate whether including Strongyloides screening in COVID-19 management protocols would encourage this practice. To accomplish this, we conducted a retrospective single-center study at 'Hospital Universitario 12 de Octubre' in Madrid, Spain, comparing two consecutive cohorts. The first cohort comprised all Latinx patients over 18 years old who were admitted for COVID-19 between March 1st and April 30th, 2020. The second cohort consisted of Latinx patients admitted between July 1st and December 31st, 2020, following an amendment to the COVID-19 management protocol that recommended screening for strongyloidiasis in at-risk patients. We identified 559 and 795 patients in the first and second periods, respectively. The percentage of individuals screened increased significantly from 8.8% to 51.6% after the screening recommendation was included in the protocol (odds ratio [OR] 11.08, 95% confidence interval [CI] 8.01-15.33). In both periods, the screening rate was significantly higher among those receiving immunosuppression than those who did not receive steroids and/or tocilizumab. No other factors influenced the screening rate. In conclusion, including strongyloidiasis screening recommendations in COVID-19 management protocols led to its increased implementation. However, the overall screening rate remained low, emphasizing the need for further efforts to enhance screening practices.
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Affiliation(s)
- María Asunción Pérez-Jacoiste Asín
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Marta De Castro
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Begoña De Dios
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Pérez-Ayala
- Department of Microbiology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Antonio Lalueza
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana García-Reyne
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Irene Losada
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
- Barcelona Institute for Global Health, ISGlobal-Hospital Clinic, Universitat de Barcelona, Barcelona, Spain
| | - Juan María Herrero-Martínez
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | | | - Carlos Lumbreras
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Manuel Lizasoain
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Francisco López Medrano
- School of Medicine, Universidad Complutense, Madrid, Spain
- Centro de Investigación Biomédica En Red de Enfermedades Infecciosas (CIBERINFEC; CB21/13/00009), Instituto de Salud Carlos III, Madrid, Spain
- Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Madrid, Spain
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Wang Y, Zhang X. Gastroduodenal strongyloidiasis infection causing protein-losing enteropathy: A case report and review of the literature. Heliyon 2023; 9:e18094. [PMID: 37483822 PMCID: PMC10362134 DOI: 10.1016/j.heliyon.2023.e18094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023] Open
Abstract
Strongyloides stercoralis is an intestinal nematode in which adult worms in the host small intestine can cause strongyloidiasis. Symptoms in immunocompromised patients might range from diarrhea and bleeding to sepsis and even death. A 56-year-old patient presented with a 2-month history of weight loss, vomiting, and diarrhea. The patient had type 2 diabetes mellitus (T2DM) and was on long-term prednisone for chronic kidney disease. The results of the gastric emptying test and head magnetic resonance (MRI) were normal. A blood test revealed increased IgE levels, eosinophilia, and hypoalbuminemia. Parasitic larvae were not discovered during stool analysis. Gastroscopy revealed chronic nonatrophic gastritis with erosions and dilation of lymphatic vessels of the duodenum. Small-bowel capsule endoscopy suggested dilation of lymphatic vessels of the small intestine. Colonoscopy revealed no abnormalities. Finally, a histopathology examination identified S. stercoralis pervasion in the gastric antrum and duodenum. The patient was treated with albendazole and discharged successfully. In conclusion, we discovered S. stercoralis as a cause of protein-losing enteropathy in a patient with a long-term oral corticosteroid therapy and T2DM. The diagnosis was made through histopathology, once parasitological examination was negative. Therefore, health professionals should stay alert to S. stercoralis infection in immunocompromised patients with vague gastrointestinal symptoms. More sensitive methods should be applied in the diagnosis.
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Affiliation(s)
| | - Xuequn Zhang
- Corresponding author. Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, China.
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9
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Yongbantom A, Sribenjalux W, Manomaiwong N, Meesing A. Efficacy of Oral Ivermectin as Empirical Prophylaxis for Strongyloidiasis in Patients Treated with High-Dose Corticosteroids: A Retrospective Cohort Study. Am J Trop Med Hyg 2023; 108:1183-1187. [PMID: 37127266 PMCID: PMC10540102 DOI: 10.4269/ajtmh.22-0712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/20/2023] [Indexed: 05/03/2023] Open
Abstract
People living in areas endemic for strongyloidiasis are at risk of latent Strongyloides stercoralis infection. Corticosteroid therapy is a well-established risk factor for life-threatening hyperinfection syndrome and disseminated disease owing to suppression of the immune system. There are limited data available on the efficacy and cost of providing oral ivermectin prophylaxis to all patients receiving high-dose corticosteroids for strongyloidiasis in endemic areas. We thus conducted this retrospective cohort study at Khon Kaen University's Srinagarind Hospital from 2015 to 2019. Inclusion criteria were as follows: age ≥ 18 years, having received ≥ 0.5 mg/kg/day of prednisolone or equivalent for at least 14 days, and hospitalization during the study period. A total of 250 patients were included in the study: 125 in the empirical prophylaxis group (prescribed ivermectin even if fecal examination results were negative or nonexistent) and the remaining patients in the definite therapy group (prescribed ivermectin only if S. stercoralis was detected by fecal examination). The prevalence of strongyloidiasis at enrollment estimated by fecal examination was 5.5%. Ivermectin was given to 125 patients (100%) in the prophylaxis group compared with 12 (9.6%) in the definite therapy group (P value < 0.001). During the 12-month follow-up period, S. stercoralis was detected in three patients, two in the prophylaxis group and one in the definite therapy group (P value = 1.000). No cases of hyperinfection syndrome or disseminated disease were found. The empirical prophylaxis strategy had a significantly higher cost than the definite therapy strategy (563 versus 254, P value < 0.001) and did not demonstrate superior efficacy in strongyloidiasis prevention.
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Affiliation(s)
- Akedanai Yongbantom
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wantin Sribenjalux
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen, Thailand
| | - Natapong Manomaiwong
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Atibordee Meesing
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
- Research and Diagnostic Center for Emerging Infectious Diseases, Khon Kaen University, Khon Kaen, Thailand
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10
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Jarrah J, Alsaadi A, Putman EM, Williams J. Polymicrobial bacteremia in a heart transplant recipient: More than what meets the eye. Am J Transplant 2023; 23:854-856. [PMID: 37271567 DOI: 10.1016/j.ajt.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 12/01/2022] [Accepted: 12/10/2022] [Indexed: 06/06/2023]
Affiliation(s)
- Joud Jarrah
- Infectious Diseases Division, Henry Ford Hospital, Detroit, Michigan, USA.
| | - Ayman Alsaadi
- Internal medicine department, Henry Ford Hospital, Detroit, Michigan, USA
| | - Elieen M Putman
- Pathology department, Henry Ford Hospital, Detroit, Michigan, USA
| | - Jonathan Williams
- Infectious Diseases Division, Henry Ford Hospital, Detroit, Michigan, USA
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11
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Kim JY, Oh S, Yoon M, Yong TS. Importance of Balanced Attention Toward Coronavirus Disease 2019 and Neglected Tropical Diseases. Yonsei Med J 2023; 64:351-358. [PMID: 37226561 DOI: 10.3349/ymj.2022.0656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/26/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has been spreading since 2019, causing a worldwide pandemic. Amid the COVID-19 pandemic, tuberculosis, AIDS, and malaria have adversely affected the quality of life of patients and killed millions of people. In addition, COVID-19 continues to impede the delivery of health services, including those for the control of neglected tropical diseases (NTDs). Furthermore, NTDs have been reported as possible co-pathogens among patients infected with COVID-19. However, studies regarding parasitic co-infection among these patients have been limited. This review aimed to explore and describe the cases and reports of parasitic infections in the backdrop of COVID-19 to provide comprehensive knowledge regarding this aspect. We reviewed seven cases of patients who had parasitic co-infection and tested positive for COVID-19, and summarized the literature on the importance of controlling parasitic diseases. In addition, we identified recommendations for the control of parasitic diseases under possible difficulties, such as declining funding for parasitic diseases in 2020. This review highlights the growing burden of NTDs under COVID-19 that may be caused by the deficiency of healthcare infrastructure and human resources as the main reasons. Clinicians should remain vigilant for possible co-infections with parasites in COVID-19 patients, while policymakers are urged to reinforce a balanced and long-term health strategy that addresses both NTDs and COVID-19.
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Affiliation(s)
- Ju Yeong Kim
- Department of Tropical Medicine, Institute of Tropical Medicine, Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul, Korea
| | - Singeun Oh
- Department of Tropical Medicine, Institute of Tropical Medicine, Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul, Korea
| | - Moonsoo Yoon
- Department of Tropical Medicine, Institute of Tropical Medicine, Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul, Korea
| | - Tai-Soon Yong
- Department of Tropical Medicine, Institute of Tropical Medicine, Arthropods of Medical Importance Resource Bank, Yonsei University College of Medicine, Seoul, Korea.
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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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Costache C, Colosi IA, Neculicioiu VS, Florian DI, Petrushev B, Vasvari A, Seicean A. A Rare Case of Strongyloides stercoralis Hyperinfection in a Diabetic Patient from Romania—Case Report and Review of the Literature. Pathogens 2023; 12:pathogens12040530. [PMID: 37111416 PMCID: PMC10146644 DOI: 10.3390/pathogens12040530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
Severe cases of strongyloidiasis are most often associated with multiple causes of immune suppression, such as corticoid treatment and HTLV (human T-lymphotropic virus) coinfection. Diabetes is not traditionally considered a risk factor for the development of severe strongyloidiasis. We report a rare case of autochthonous severe strongyloidiasis in Romania, a European country with a temperate climate. A 71-year-old patient with no prior travel history was admitted with multiple gastrointestinal complaints and recent weight loss. CT (computed tomography) scans indicated duodenal wall thickening, and duodenal endoscopy evidenced mucosal inflammation, ulcerations and partial duodenal obstruction at D4. Microscopic examination of stool samples and biopsy specimens from the gastric and duodenal mucosa revealed an increased larval burden characteristic of Strongyloides stercoralis hyperinfection. Sequential treatment with albendazole and ivermectin achieved parasitological cure and complete recovery. The novelty of our case stems from the scarcity of severe strongyloidiasis cases reported in Europe and especially in Romania, the absence of other risk factors in our patient aside from diabetes, the involvement of the gastric mucosa and the rare presentation as partial duodenal obstruction. This case highlights the importance of considering strongyloidiasis as a differential diagnosis, even in temperate climates where cases are sporadic, in cases in which immune suppression is not evident and in the absence of eosinophilia. The case is presented in the context of the first literature review examining the relationship between severe strongyloidiasis and diabetes, emphasizing diabetes as a possible risk factor for severe strongyloidiasis.
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Affiliation(s)
- Carmen Costache
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioana Alina Colosi
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Vlad Sever Neculicioiu
- Department of Microbiology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence:
| | - Diana Ioana Florian
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Bobe Petrushev
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Alexandra Vasvari
- Department of Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Andrada Seicean
- Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
- Department of Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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Screening of Schistosomiasis, Strongyloidiasis and Sexually Transmitted Infections in Nigerian Female Sex Workers Living in Rome. Pathogens 2023; 12:pathogens12020274. [PMID: 36839546 PMCID: PMC9961054 DOI: 10.3390/pathogens12020274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Female Sex Workers (FSWs) are at high risk for acquisition and transmission of sexually transmission infections (STIs). Although several studies investigated the diffusion of STIs in this population, none of them investigated the occurrence of helminth infections in FSW coming from endemic regions. This study aims to assess the prevalence of STIs and helminth infections in a cohort of FSWs. METHOD authors conducted a prevalent, observational, and descriptive study on 97 Nigerian FSWs aged 17 to 52 years from January to December 2020. RESULTS a total of 97 FSWs were recruited. Of these, only 82 had completed screening for hepatitis B, C, syphilis, and HIV, while all 97 were screened for schistosomiasis and strongyloidiasis. The prevalence of STIs among FSWs in Rome was lower than in other European countries. The overall prevalence of HIV and HBsAg were 1.2%, (1/82) and 2.4% (2/82), respectively, while no case of hepatitis C and syphilis was found. Regarding parasitological screening, the overall prevalence of schistosoma species was 4.1% (4/97) while 5.15% (5/97) were positive for strongyloidiasis. CONCLUSIONS our study shows a low prevalence of STIs in Nigerian FSWs except for Hepatitis B and a higher prevalence of schistosomiasis and strongyloidiasis. The permanent monitoring of STI and parasitic infections in sex workers coming from Africa is strongly warranted, especially for hepatitis B, schistosomiasis and strongyloidiasis, to allow a timely diagnosis and treatment, and to plan preventive strategies.
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15
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Tian Y, Monsel G, Paris L, Danis M, Caumes E. Larva Currens: Report of Seven Cases and Literature Review. Am J Trop Med Hyg 2023; 108:340-345. [PMID: 36535252 PMCID: PMC9896332 DOI: 10.4269/ajtmh.21-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/19/2021] [Indexed: 12/23/2022] Open
Abstract
Strongyloidiasis is a frequent and often unrecognized parasitic disease because of the frequently asymptomatic nature and lack of sensitivity of diagnostic tests. Under conditions of immunosuppression (particularly systemic corticosteroid treatment), potentially fatal dissemination may occur. Thus, prevention and early diagnosis are important. Larva currens is a rare and pathognomonic cutaneous sign of strongyloidiasis, but is poorly described because of its unpredictable and fleeting occurrence. We report seven imported cases of larva currens seen in Paris between 1990 and 2020. We illustrate the clinical and biological features of this specific but uncommon sign of strongyloidiasis with clinical pictures. There were three males and four females, aged between 29 and 58 years. There were five migrants from endemic countries, one tourist and one expatriate. Digestive disorders were the main extracutaneous signs. All patients had eosinophilia above 0.5 G/L. All cases were confirmed by stool tests. All were cured with ivermectin. The rapidity and the short duration of the creeping eruption distinguish it from other parasitoses. Ivermectin is a treatment of choice. The key point is to think about preventing disseminated strongyloidiasis before giving corticosteroids not only among migrants but also among expatriates and tourists in endemic countries.
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Affiliation(s)
- Yuan Tian
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Gentiane Monsel
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Luc Paris
- Laboratoire de Parasitologie-Mycologie, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Martin Danis
- Laboratoire de Parasitologie-Mycologie, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
| | - Eric Caumes
- Service de Maladies Infectieuses et Tropicales, Hôpital Universitaire de la Pitié-Salpêtrière, Paris, France
- Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), Sorbonne Université, INSERM, Paris, France
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16
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Oshima R, Matsuhisa T, Kondo T, Sato M, Sato J, Yamamura M. Strongyloidiasis presenting during treatment of low-dose glucocorticoid plus rituximab for anti-signal recognition particle antibody-positive polymyositis: A case report. Mod Rheumatol Case Rep 2023; 7:113-116. [PMID: 36264196 DOI: 10.1093/mrcr/rxac083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 11/13/2022]
Abstract
Strongyloidiasis, an intestinal parasitic infection caused by Strongyloides stercoralis, rarely occurs in Japan. When treated with immunosuppressive drugs, two potentially lethal conditions, hyperinfection and dissemination, may develop in asymptomatic carriers of this parasite. We report the development of strongyloidiasis during treatment of polymyositis with glucocorticoids plus rituximab (RTX). A 44-year-old woman had been diagnosed with anti-signal recognition particle antibody-positive polymyositis with interstitial pneumonia 6 years previously, for which she had recently been receiving prednisolone at 5 mg/day and RTX at 375 mg/m2 twice every 3 months. Her condition appeared to be well controlled. She was admitted to our hospital with a 1-month history of chronic diarrhoea and epigastric pain. Standard microscopic examination of a sample of faeces revealed the presence of S. stercoralis; however, serologic testing for parasites was negative. Treatment with ivermectin alleviated her inflammatory diarrhoea and eradicated the faecal parasites. We believe that our patient had an exacerbation of S. stercoralis infection (hyperinfection syndrome) that was exacerbated by low-dose glucocorticoids plus RTX. Strongyloidiasis should be considered in immunocompromised individuals with unexplained diarrhoea, even in non-endemic areas.
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Affiliation(s)
- Ryo Oshima
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takaharu Matsuhisa
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Takeshi Kondo
- Center for Postgraduate Clinical Training and Career Development, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Motoki Sato
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Juichi Sato
- Department of Infectious Diseases, Gifu Prefectural General Medical Center, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masahiro Yamamura
- Department of Rheumatology and Collagen Disease Centre, Okayama Saiseikai General Hospital, Okayama, Japan
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17
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Ramprasad A, Kodan P, Jonnalagadda K, Bir R, Verma N, Sahni K, Vikram NK, Soneja M, Mirdha BR, Wig N. Seroprevalence of Strongyloides infection among steroid recipients in a tertiary care centre in North India. LE INFEZIONI IN MEDICINA 2022; 30:593-601. [PMID: 36482946 PMCID: PMC9715000 DOI: 10.53854/liim-3004-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/10/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Strongyloides stercoralis (S. stercoralis), a unique parasite, can cause mortal disease even years after the exposure. Iatrogenic use of steroids can complicate asymptomatic infections to a life-threatening hyperinfection and/or disseminated infection. Data regarding seroprevalence of strongyloidiasis remains scarce and this knowledge gap needs due attention in many endemic countries including India. AIM The present study is aimed at assessing the seroprevalence of Strongyloides infection and the need for routine screening among individuals receiving steroid therapy. METHODOLOGY Eighty patients receiving steroid therapy and thirty healthy volunteers who had not received any immunosuppressive drugs and/or anthelminthic therapy in last six months were enrolled as cases and controls respectively and they were screened by Strongyloides IgG ELISA. RESULTS Among the 80 patients on steroids, the mean cumulative prednisolone equivalent dose received was 8.2 g (±11.2 g) for a mean duration of 184 days, 16 patients (20%, 95% CI 11.9-30) had a positive Strongyloides IgG serology. Only 4 controls (4/30, 13.3%, CI 3.8-30.7) tested positive (p=0.4). CONCLUSIONS Our study demonstrated a Strongyloides seroprevalence of 20% in the study population emphasizing the need for screening for Strongyloides infection prior to immunosuppressive therapy in order to prevent hyperinfection or possible dissemination.
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Affiliation(s)
- Aishwarya Ramprasad
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Parul Kodan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Kirtana Jonnalagadda
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Raunak Bir
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi,
India
| | - Nishant Verma
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi,
India
| | - Kanika Sahni
- Department of Dermatology, All India Institute of Medical Sciences, New Delhi,
India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
| | - Bijay Ranjan Mirdha
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi,
India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi,
India
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18
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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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19
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Buonfrate D, Tamarozzi F, Paradies P, Watts MR, Bradbury RS, Bisoffi Z. The diagnosis of human and companion animal Strongyloides stercoralis infection: Challenges and solutions. A scoping review. ADVANCES IN PARASITOLOGY 2022; 118:1-84. [PMID: 36088083 DOI: 10.1016/bs.apar.2022.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Strongyloidiasis is the infection caused by soil-transmitted nematodes of Strongyloides species, infecting humans and some animals. Strongyloides stercoralis is the species with most clinical and epidemiological relevance in humans and dogs, due to its high prevalence and its capacity of inducing a life-threatening hyperinfection. Diagnosis of strongyloidiasis is challenging, due to the absence of a single reference standard test with high sensitivity and specificity, which also hampers the estimation of the accuracy of other diagnostic tests. In this chapter, we review the deployment and performance of the parasitological, immunological, molecular tests for the diagnosis of strongyloidiasis in humans and in dogs. Further, we comment the available evidence from genotyping studies that have addressed the zoonotic potential of S. stercoralis. Finally, we discuss the use of different diagnostic methods in relation to the purpose (i.e., screening, individual diagnosis, inclusion in a clinical trial) and the setting (endemic/non-endemic areas) and report the accuracy figures reported by systematic reviews on either parasitological, serological or molecular techniques published in literature.
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Affiliation(s)
- Dora Buonfrate
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy.
| | - Francesca Tamarozzi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Paola Paradies
- Department of Emergency and Organs Transplantation, Veterinary Section, Campus of Veterinary Medicine, University of Bari, Bari, Italy
| | - 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
| | - Richard S Bradbury
- School of Health and Life Sciences, Federation University Australia, Berwick, VC, Australia
| | - Zeno Bisoffi
- Department of Infectious Tropical diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy; Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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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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Wikman-Jorgensen P, Requena-Méndez A, Navarro M, Llenas-García J. Comments to the document GEPI-SEIMC screening recommendations for patients with suspected strongyloidosis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:411-412. [PMID: 35624067 PMCID: PMC9574943 DOI: 10.1016/j.eimce.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
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22
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Singh S, Singh US. Coinfection with Strongyloides and Ascaris in a COVID-19-positive male presenting with acute abdomen: a case report. Future Microbiol 2022; 17:1099-1105. [PMID: 35899471 PMCID: PMC9332911 DOI: 10.2217/fmb-2022-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Ascaris lumbricoides and Strongyloides stercoralis are soil-transmitted helminthic infections usually seen in people with poor socioeconomic conditions, hygiene and fecal sanitation living in endemic countries. Here, we present a case of coinfection in a COVID-positive older adult male presenting to our facility with symptoms of acute abdomen. Investigative workup guided timely diagnosis of the case. Prompt initiation of antihelminthic drugs together with antibiotics/antivirals for COVID symptoms resulted in favorable outcome in the case. A high index of suspicion on the part of the treating and diagnosing doctor is required in the COVID era. This will help not only in diagnosis but will also give an understanding to the exact pathogenesis for better patient outcome.
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Affiliation(s)
- Sweta Singh
- Department of Microbiology, Autonomous State Medical College, Mirzapur UP, India
| | - Uday S Singh
- Department of Radiodiagnosis, Advance Diagnostic Centre, Lucknow, UP, India
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Osman E, Amin NA, Noon TPM, Lahat SNH, Rosli MS, Sham SF, Periyasamy PR, Ghazali N, Manap SNAA, Noordin R. Comparison of Two Serological Assays in Detecting Strongyloides Infection in Immunocompromised Patients. Am J Trop Med Hyg 2022; 107:tpmd220076. [PMID: 35895335 PMCID: PMC9490643 DOI: 10.4269/ajtmh.22-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/02/2022] [Indexed: 11/07/2022] Open
Abstract
Strongyloides infection may develop into fatal hyperinfection and dissemination syndrome in immunocompromised hosts. Despite suboptimal specificity issues, the detection of IgG antibodies by ELISA has been central in the serodiagnosis of Strongyloides infection. Recently, an IgG4-based lateral-flow test (SsRapid) using recombinant NIE (rNIE) protein with good diagnostic performance has been reported. This study assessed the result concordance between a commercial IgG-ELISA and the SsRapid. Additionally, we determined the Strongyloides seroprevalence and its association with clinical manifestations. Immunocompromised patients (N = 200) were from Hospital Canselor Tuanku Muhriz, Kuala Lumpur, Malaysia, and were diagnosed with HIV/AIDS, hematological malignancy, and solid organ cancers. Their plasma samples were tested using a commercial IgG-ELISA and SsRapid. A fair concordance (κ = 0.27-0.33; P < 0.05) among the tests was demonstrated. The SsRapid exhibited a significantly higher (P < 0.05) seroprevalence (10.5% [21/200]) compared with IgG-ELISA (7.5% [15/200]). After adsorption with rNIE, all SsRapid-positive samples tested negative with the rapid test, thus showing binding specificity. There was no significant association with clinical manifestations. This study revealed that SsRapid is a useful diagnostic tool for Strongyloides infection, and there is a notable seroprevalence among the immunocompromised patients.
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Affiliation(s)
- Emelia Osman
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nur Azma Amin
- Universiti Kuala Lumpur Institute of Medical Science Technology Selangor, Malaysia
| | - Thieeraporn Phraseart Ma Noon
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Siti Nuratiqah Hanani Lahat
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohamad Syairazi Rosli
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Shazia Farhana Sham
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Nuraffini Ghazali
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Siti Nor Azreen Abd Manap
- Department of Parasitology and Medical Entomology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rahmah Noordin
- Institute for Research in Molecular Medicine, Universiti Sains Malaysia (USM), Penang, Malaysia
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Domínguez VR, Pérez-López C, Sánchez CV, Contreras CU, Guerrero AI, Abenza Abildúa MJ. Strongyloides hyperinfection syndrome due to corticosteroid therapy after resection of meningioma: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 4:CASE21667. [PMID: 35855010 PMCID: PMC9274291 DOI: 10.3171/case21667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/04/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Strongyloidiasis is an underdiagnosed and preventable life-threatening disease caused by infection with the helminth Strongyloides stercoralis. Chronic asymptomatic infection can be sustained for decades, and immunosuppression can lead to disseminated infection, with a mortality rate of 70%–100%. In the neurosurgical population, corticosteroids are the most consistent cause of hyperinfection. OBSERVATIONS The authors present the case of a 33-year-old woman of Paraguayan origin who was diagnosed with sphenoid planum meningioma and treated with a high dose of corticosteroids on the basis of the diagnosis. She underwent surgery, and pathological anatomy reflected grade I meningioma. After the surgery, she started with a history of dyspnea, productive cough, fever, and urticarial rash. Later, she presented with intestinal pseudo-obstruction and bacterial meningitis with hydrocephalus. Serology was positive for Strongyloides (enzyme-linked immunosorbent assay), and she was diagnosed with hyperinfection syndrome. Ivermectin 200 µg/kg daily was established. LESSONS It may be of interest to rule out a chronic Strongyloides infection in patients from risk areas (immigrants or those returning from recent trips) before starting treatment with corticosteroids.
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Affiliation(s)
| | - Carlos Pérez-López
- Departments of Neurosurgery and
- Neuroradiology, Hospital Universitario la Paz, Madrid, Spain
| | | | | | | | - María José Abenza Abildúa
- Neuroradiology, Hospital Universitario la Paz, Madrid, Spain
- Department of Neurology, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
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25
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Wikman-Jorgensen P, Requena-Méndez A, Navarro M, Llenas-García J. [Comments to the document GEPI-SEIMC screening recommendations for patients with suspected strongyloidosis]. Enferm Infecc Microbiol Clin 2022; 40:411-412. [PMID: 35469335 PMCID: PMC9020610 DOI: 10.1016/j.eimc.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Philip Wikman-Jorgensen
- Servicio de Medicina Interna, Hospital Universitario San Juan de Alicante-FISABIO, San Juan de Alicante, España
| | - Ana Requena-Méndez
- Instituto de Salud Global de Barcelona (ISGlobal, Hospital Clinic-University of Barcelona), Barcelona, España.,Department of Medicine Solna, Karolinska Institutet, Solna, Suecia
| | - Miriam Navarro
- Unidad de Epidemiología, Centro de Salud Pública de Elche, Alicante, España.,Departamento de Salud Pública, Historia de la Ciencia y Ginecología; Universidad Miguel Hernández de Elche, Alicante, España
| | - Jara Llenas-García
- Servicio de Medicina Interna/infecciosas, Hospital Vega Baja-FISABIO, Alicante, España.,Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche, San Juan de Alicante, España
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26
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Rodari P, Tamarozzi F, Tais S, Degani M, Perandin F, Buonfrate D, Nicastri E, Lepore L, Giancola ML, Carrara S, Tavelli A, Cozzi-Lepri A, D'Arminio Monforte A, Silva R, Angheben A. Prevalence of Chagas disease and strongyloidiasis among HIV-infected Latin American immigrants in Italy – The CHILI study. Travel Med Infect Dis 2022; 48:102324. [DOI: 10.1016/j.tmaid.2022.102324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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27
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Müller F, Chandra S, Bogoch II, Rashid M, Redditt V. Intestinal parasites in stool testing among refugees at a primary care clinic in Toronto, Canada. BMC Infect Dis 2022; 22:249. [PMID: 35282824 PMCID: PMC8918311 DOI: 10.1186/s12879-022-07226-4] [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: 11/24/2021] [Accepted: 02/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Enteric parasites are endemic in many of the countries from which refugees originate. Clinical guidelines vary in approaches to screening for and treating intestinal parasites in refugee receiving countries. This study aims to investigate the prevalence and species of intestinal parasites identified in stool ova and parasite (O&P) specimens in a sample of newly arrived refugees in Toronto, Canada. Methods We conducted a retrospective chart review of 1042 refugee patients rostered at a specialized primary care clinic in Toronto from December 2011 to September 2016. Patients who completed recommended stool O&P analyses were included. Basic sociodemographic and clinical variables and results of stool O&P were examined. Results 419 patients (40.2%) had a stool O&P positive for any protozoan or helminth species. Sixty-nine patients (6.6%) had clinically significant parasite species (excluding B hominis, D fragilis, and E dispar, given their lower risk for causing symptoms/complications): 2.3% had clinically significant protozoans and 4.2% had helminths on stool analysis. Conclusion Given the relatively low prevalence of clinically significant parasites identified, our findings do not support universal screening for enteric parasites with stool O&P among refugee claimants/asylum seekers. However, stool analysis should be considered in certain clinical situations, as part of a more tailored approach.
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28
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Talukder MR, Pham H, Woodman R, Wilson K, Taylor K, Kaldor J, Einsiedel L. The Association between Diabetes and Human T-Cell Leukaemia Virus Type-1 (HTLV-1) with Strongyloides stercoralis: Results of a Community-Based, Cross-Sectional Survey in Central Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042084. [PMID: 35206272 PMCID: PMC8872355 DOI: 10.3390/ijerph19042084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
In central Australia, an area that is endemic for the human T-cell leukaemia virus type-1 (HTLV-1), the prevalence of Strongyloides stercoralis and its association with other health conditions are unknown. A cross-sectional community-based survey was conducted in seven remote Aboriginal communities in central Australia, from 2014 to 2018. All residents aged ≥10 years were invited to complete a health survey and to provide blood for Strongyloides serology, HTLV-1 serology and HTLV-1 proviral load (PVL). Risk factors for Strongyloides seropositivity and associations with specific health conditions including diabetes and HTLV-1 were determined using logistic regression. Overall Strongyloides seroprevalence was 27% (156/576) (children, 22% (9/40); adults (≥15 years), 27% (147/536), varied widely between communities (5–42%) and was not associated with an increased risk of gastrointestinal, respiratory or dermatological symptoms. Increasing age, lower HTLV-1 PVL (<1000 copies per 105 peripheral blood leucocytes) compared to the HTLV-1 uninfected group and community of residence were significant risk factors for Strongyloides seropositivity in an adjusted model. A modest reduction in the odds of diabetes among Strongyloides seropositive participants was found (aOR 0.58, 95% CI 0.35, 1.00; p = 0.049); however, this was lost when body mass index was included in the adjusted model (aOR 0.48, 95% CI 0.48, 1.47; p = 0.542). Strongyloides seropositivity had no relationship with anaemia. Exploring social and environmental practices in communities with low Strongyloides seroprevalence may provide useful lessons for similar settings.
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Affiliation(s)
- Mohammad Radwanur Talukder
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
| | - Hai Pham
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA 5001, Australia;
| | - Kim Wilson
- National Serology Reference Laboratory, Melbourne, VIC 3065, Australia;
| | - Kerry Taylor
- Poche Centre for Indigenous Health and Wellbeing, Alice Springs, NT 0870, Australia;
| | - John Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Lloyd Einsiedel
- Baker Heart and Diabetes Institute, Alice Springs Hospital, Alice Springs, NT 0870, Australia; (M.R.T.); (H.P.)
- Alice Springs Hospital, Alice Springs, NT 0870, Australia
- Correspondence:
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29
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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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30
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Aslam A, Barlas U, Yassan LJ, Lodhi M. An unusual case of gastric outlet obstruction and melena. Clin J Gastroenterol 2022; 15:374-380. [DOI: 10.1007/s12328-021-01584-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 12/24/2021] [Indexed: 11/28/2022]
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31
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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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32
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Autier B, Boukthir S, Degeilh B, Belaz S, Dupuis A, Chevrier S, Gangneux JP, Robert-Gangneux F. Clinical value of serology for the diagnosis of strongyloidiasis in travelers and migrants: A 4-year retrospective study using the Bordier IVD ® Strongyloides ratti ELISA assay. Parasite 2021; 28:79. [PMID: 34870590 PMCID: PMC8647686 DOI: 10.1051/parasite/2021075] [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: 08/03/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022] Open
Abstract
Strongyloides stercoralis serology is a sensitive method for strongyloidiasis diagnosis, but it is prone to cross-reactions with other helminthiases. This four-year retrospective study aimed at estimating the performance of the Bordier IVD®Strongyloides ratti ELISA assay in a non-endemic country (France). The study included all patients tested for strongyloidiasis in our center between 2015 and 2019, by both serology and stool examination. Cases were defined using an algorithm considering serological results, microscopic examination of stools, and other biological, clinical or epidemiological data. The study included 805 stools from 341 patients (70% migrants, 20% travelers, 10% without travel to a highly endemic area). Thirty patients (8.8%) had positive serology, 9 had microscopically proven strongyloidiasis, and 11 and 10 were classified as probable and possible strongyloidiasis, respectively. Performances of microscopy and serology were compared, considering proven and probable strongyloidiasis as true infections. The sensitivity, specificity, positive predictive value and negative predictive value of serology were 100%, 97%, 67% and 100%, respectively, and those of microscopic examination of stools were 45% (p < 0.01), 100% (p < 0.01), 100% (p = 0.079) and 96% (p < 0.001), respectively. Eosinophilia did not help in discriminating true-positive from false-positive results. Overall, these results underline the high value of the S. stercoralis serologic assay, compared to stool examination. The systematic use of this technique for screening purposes in travelers or migrants, or before onset of immunosuppressive therapy, could help to improve patient management and epidemiological knowledge.
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Affiliation(s)
- Brice Autier
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), UMR_S 1085, 35000 Rennes, France - CHU Rennes, Laboratoire de parasitologie-mycologie, 35000 Rennes, France
| | - Sarrah Boukthir
- Univ Rennes, CHU Rennes, Inserm, CIC-1414, 35000 Rennes, France - CHU Rennes, Laboratoire de bactériologie-hygiène hospitalière, 35000 Rennes, France
| | - Brigitte Degeilh
- CHU Rennes, Laboratoire de parasitologie-mycologie, 35000 Rennes, France
| | - Sorya Belaz
- CHU Rennes, Laboratoire de parasitologie-mycologie, 35000 Rennes, France
| | - Anne Dupuis
- CHU Rennes, Laboratoire de parasitologie-mycologie, 35000 Rennes, France
| | - Sylviane Chevrier
- CHU Rennes, Laboratoire de parasitologie-mycologie, 35000 Rennes, France
| | - Jean-Pierre Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), UMR_S 1085, 35000 Rennes, France - CHU Rennes, Laboratoire de parasitologie-mycologie, 35000 Rennes, France
| | - Florence Robert-Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé Environnement Travail), UMR_S 1085, 35000 Rennes, France - CHU Rennes, Laboratoire de parasitologie-mycologie, 35000 Rennes, France
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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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34
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Carda JP, Santos L, Mariz JM, Monteiro P, Gonçalves HM, Raposo J, Gomes da Silva M. Management of ibrutinib treatment in patients with B-cell malignancies: clinical practice in Portugal and multidisciplinary recommendations. ACTA ACUST UNITED AC 2021; 26:785-798. [PMID: 34605364 DOI: 10.1080/16078454.2021.1980690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Ibrutinib, a potent inhibitor of the Bruton tyrosine kinase, has revolutionized the treatment of many B-cell malignancies. Ibrutinib has an established favorable toxicity profile with up to 8 years of experience in clinical trials; however, despite ibrutinib's favorable toxicity profile, dose reductions and treatment discontinuations are becoming more evident in clinical practice, particularly in the setting of specific clinical contexts and patient characteristics. This manuscript is set to provide practical recommendations on the management of patients treated with this agent in daily practice. METHODS A group of multidisciplinary experts from Portugal met to discuss and highlight practical recommendations, supported on both literature and clinical insights, for the management of the treatment with ibrutinib. RESULTS/DISCUSSION Handling of both toxicities and drug-drug interactions during ibrutinib treatment poses several challenges to healthcare providers and can benefit from a multidisciplinary approach. The involvement of specialties, such as cardiology, infectiology and pharmacology, can bring an added value to patient care, not only in anticipating/managing safety issues and dose adjustments but also in enhancing adherence to treatment, ultimately improving the risk/benefit balance. CONCLUSION By involving a multidisciplinary group of experts, this work provides a set of key recommendations to optimize care and outcomes for ibrutinib-treated patients. Despite not being a fully comprehensive review on the topic, it is intended as a framework to hematologists and other healthcare professionals who manage these patients in their daily clinical practice.
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Affiliation(s)
- José Pedro Carda
- Serviço de Hematologia Clínica, Faculdade de Medicina da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
| | - Lurdes Santos
- Centro Hospitalar Universitário de São João, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Nephrology and Infectious Diseases R&D, I3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - José Mário Mariz
- Onco-Haematology Clinic, Instituto Português de Oncologia do Porto, EPE/IPOFG - CRO, Porto, Portugal
| | - Pedro Monteiro
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Humberto Miguel Gonçalves
- Serviço Farmacêutico, Instituto Português de Oncologia de Lisboa, Francisco Gentil, Lisboa, Portugal
| | - João Raposo
- Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Maria Gomes da Silva
- Instituto Português de Oncologia de Lisboa, Francisco Gentil, EPE, Lisbon, Portugal
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Vellere I, Graziani L, Tilli M, Mantella A, Campolmi I, Mencarini J, Borchi B, Spinicci M, Antonelli A, Rossolini GM, Bartoloni A, Zammarchi L. Strongyloidiasis in the COVID era: a warning for an implementation of the screening protocol. Infection 2021; 49:1065-1067. [PMID: 33970429 PMCID: PMC8107200 DOI: 10.1007/s15010-021-01621-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 04/27/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Iacopo Vellere
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lucia Graziani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marta Tilli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonia Mantella
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Irene Campolmi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Jessica Mencarini
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Michele Spinicci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Antonelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.
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Wikman-Jorgensen P, Requena-Méndez A, Llenas-García J. A Review on Strongyloidiasis in Pregnant Women. Res Rep Trop Med 2021; 12:219-225. [PMID: 34584485 PMCID: PMC8464358 DOI: 10.2147/rrtm.s282268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/07/2021] [Indexed: 12/21/2022] Open
Abstract
Strongyloidiasis is a parasitic infection distributed worldwide, with an estimated 614 million people infected. Strongyloidiasis usually presents asymptomatically or with aspecific and mild clinical symptoms, mainly cutaneous, respiratory, or gastrointestinal. Disseminated disease and hyperinfection syndrome are the most serious complications, have a high mortality rate, usually occur in immunosuppressed patients, and are particularly associated with the use of corticosteroids. Strongyloidiasis is the most neglected of the neglected diseases, and its occurrence in pregnancy has been neglected and understudied. In this review, we focus on the effects of strongyloidiasis during pregnancy and highlight the knowledge shortage and the need for more research on the subject. There are few studies addressing strongyloidiasis prevalence during pregnancy and hyperinfection incidence during pregnancy is practically unknown, with only isolated case reports published. Although data are scarce, the infection has been associated with developmental disabilities and anemia during pregnancy, while hyperinfection may cause both maternal and neonatal death. Data on the best screening and diagnostic strategies during pregnancy are lacking. There is insufficient evidence on ivermectin safety in pregnancy, complicating treatment recommendations.
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Affiliation(s)
- Philip Wikman-Jorgensen
- Internal Medicine Department, Hospital Universitario San Juan de Alicante-FISABIO, San Juan de Alicante, Alicante, Spain
| | - Ana Requena-Méndez
- Barcelona Institute for Global Health (ISGlobal, Hospital Clinic-Universitat de Barcelona), Barcelona, Spain.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jara Llenas-García
- Internal Medicine and Infectious Diseases Department, Hospital Vega Baja-FISABIO, Alicante, Spain.,Clinical Medicine Department, Universidad Miguel Hernández de Elche, Elche, Spain
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COVID-19-Associated Eosinopenia in a Patient With Chronic Eosinophilia Due to Chronic Strongyloidiasis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021; 29:e305-e306. [PMID: 34539164 PMCID: PMC8436813 DOI: 10.1097/ipc.0000000000000991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Eosinopenia was frequently encountered in patients with coronavirus disease 2019 (COVID-19). We describe a case of a 59-year-old man who was treated with high-dose corticosteroids and anti-interleukin 1 receptor antagonist therapy because of severe acute respiratory distress syndrome due to a so-called cytokine storm in COVID-19. He had chronic eosinophilia for many years due to an unknown Strongyloides stercoralis infection, proven by serology and a positive polymerase chain reaction test on a stool sample. COVID-19 led to a complete resolution of eosinophilia, even before immunosuppressive treatment was started. Eosinophilia returned after recovery from COVID-19 and started to decline under treatment with ivermectin. Our case confirms previous reports of eosinopenia in COVID-19, as it appears even in patients with chronic eosinophilia. Presence of eosinophilia should prompt screening for strongyloidiasis in all patients eligible for immunosuppressive therapy because of the risk of Strongyloides hyperinfection syndrome, especially if this treatment is empirical.
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Carnino L, Schwob JM, Neofytos D, Lazo-Porras M, Chappuis F, Eperon G. Screening for Parasitic Infection and Tuberculosis in Immunosuppressed and Pre-Immunosuppressed Patients: An Observational Study. Trop Med Infect Dis 2021; 6:tropicalmed6030170. [PMID: 34564554 PMCID: PMC8482080 DOI: 10.3390/tropicalmed6030170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
Reactivation of latent tuberculosis infection (LTBI) or latent parasitic infection (LPI) during drug-induced immunosuppression can have serious consequences. The Division of tropical and humanitarian medicine of the Geneva University Hospitals runs a specific consultation for parasitic screening of immunosuppressed or pre-immunosuppressed patients. We sought to determine the seroprevalence of LTBI and LPI in such patients and explore its relationship with country of origin or previous travel in a retrospective, single-centre observational study from 2016 to 2019. Demographic data, travel history, ongoing treatments and results of the parasitological (Strongyloides stercoralis, Trypanosoma cruzi, Echinococcus multilocularis, Entamoeba histolytica and Leishmania spp.) and TB screening were collected to calculate LPI or LTBI prevalence. Risk factors for LTBI and strongyloidiasis were analysed using Poisson regression with robust variance. Among 406 eligible patients, 24/353 (6.8%) had LTBI, 8/368 (2.2%) were positive for Strongyloides stercoralis infection, 1/32 (3.1%) was positive for Entamoeba histolytica and 1/299 (0.3%) was positive for Leishmaniasis. No cases of Trypanosoma cruzi (0/274) or Echinococcus multilocularis (0/56) infection were detected. Previous travel to or originating from high-prevalence countries was a risk factor for LTBI (PR = 3.4, CI 95%: 1.4–8.2 and 4.0, CI 95%: 1.8–8.9, respectively). The prevalence of serological Strongyloidiasis in immunosuppressed patients is lower in comparison to those without immunosuppression (PR = 0.1, CI 95%: 0.01–0.8). In conclusion, screening before immunosuppression needs to be individualized, and LTBI and LPI need to be ruled out in patients who originate from or have travelled to high-prevalence countries. The sensitivity of strongyloidiasis serology is reduced following immunosuppression, so an algorithm combining different tests or presumptive treatment should be considered.
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Affiliation(s)
- Luisa Carnino
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1205 Geneva, Switzerland
- Correspondence: ; Tel.: +41-(0)223729611; Fax: +41-(0)223729626
| | - Jean-Marc Schwob
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
| | - Dionysios Neofytos
- Division of Infectious Diseases, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland;
| | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1205 Geneva, Switzerland
| | - Gilles Eperon
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, 1205 Geneva, Switzerland; (J.-M.S.); (M.L.-P.); (F.C.); (G.E.)
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1205 Geneva, Switzerland
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39
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Autier B, Chesnay A, Mayence C, Houcke S, Guégan H, Demar M, Blanchet D. From strongyloidiasis to disseminated mucormycosis: the story of an HTLV-1-infected migrant. J Travel Med 2021; 28:6028726. [PMID: 33295601 DOI: 10.1093/jtm/taaa229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/14/2022]
Abstract
Strongyloidiasis manifestations range from asymptomatic cases to the life-threatening disseminated strongyloidiasis in case of immune deficiency: larvae migrate throughout the body, disseminating germs from the digestive flora to various organs. Here, we described a case of disseminated mucormycosis consecutive to Strongyloides stercoralis hyperinfestation in a Surinamese migrant infected with HTLV-1.
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Affiliation(s)
- Brice Autier
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, Guyane Française.,Univ Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Adélaïde Chesnay
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, Guyane Française.,CEPR - INSERM U1100 /Équipe 3, Faculté de Médecine, Université de Tours, Tours, France
| | - Claire Mayence
- Service de Réanimation médico-chirurgicale, Centre Hospitalier Andrée Rosemon, Cayenne, Guyane Française
| | - Stéphanie Houcke
- Service de Réanimation médico-chirurgicale, Centre Hospitalier Andrée Rosemon, Cayenne, Guyane Française
| | - Hélène Guégan
- Univ Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Magalie Demar
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, Guyane Française.,Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), EA 3593, Université de Guyane, Cayenne, Guyane Française
| | - Denis Blanchet
- Laboratoire Hospitalo-Universitaire de Parasitologie-Mycologie, Centre Hospitalier Andrée Rosemon, Cayenne, Guyane Française.,Ecosystèmes Amazoniens et Pathologie Tropicale (EPaT), EA 3593, Université de Guyane, Cayenne, Guyane Française
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40
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Kalantari N, Chehrazi M, Ghaffari S, Gorgani-Firouzjaee T. Serological assays for the diagnosis of Strongyloides stercoralis infection: a systematic review and meta-analysis of diagnostic test accuracy. Trans R Soc Trop Med Hyg 2021; 114:459-469. [PMID: 32052848 DOI: 10.1093/trstmh/trz135] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/04/2019] [Accepted: 12/03/2019] [Indexed: 12/18/2022] Open
Abstract
The standard method for the diagnosis of Strongyloides stercoralis, stool examinations, is inconvenient and, therefore, serological methods have been proposed. This study aimed to evaluate the accuracy of serological assays for the diagnosis of strongyloidiasis using a systematic review and meta-analysis model. Four electronic databases were reviewed. We used a random effects model and 95% CIs to determine the overall sensitivity, specificity and diagnostic odds ratio (DOR). Heterogeneity was intended with Cochran Q χ2 test and I2 statistic. The accuracy of serological assays resulted in a sensitivity of 71.7% (95% CI: 56.07 to 83.4%), a specificity of 89.9% (95% CI: 80.8 to 94.9%) and a DOR of 22.5 (95% CI: 10.8 to 46.9). The forest plot showed high heterogeneity regarding sensitivity (I2=90.4%, 95% CI: 87.4 to 93.3%; Q=228.1, p=0.000) and specificity (I2=98.9%, 95% CI: 98.8 to 99.1%; Q=2066.4, p=0.000). Fagan's nomogram showed that the probability of someone having the infection and with a positive test result was 49%. Deeks' funnel plots showed no evidence of potential publication bias for the studies (p=0.26). The current review suggests that serological techniques have acceptable sensitivity and specificity and therefore can be recommended for the screening of S. stercoralis infection.
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Affiliation(s)
- Narges Kalantari
- Cellular and Molecular Biology Research Center, Health Research Institute, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I. R. Iran
- Department of Laboratory Sciences, Faculty of Paramedical Sciences, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Medicine, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I. R. Iran
| | - Salman Ghaffari
- Department of Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
| | - Tahmineh Gorgani-Firouzjaee
- Department of Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Ganj Afrooz Ave., Babol 47176-47745, I.R. Iran
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41
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Silva JT, Fernández-Ruiz M, Grossi PA, Hernández-Jimenez P, López-Medrano F, Mularoni A, Prista-Leão B, Santos L, Aguado JM. Reactivation of latent infections in solid organ transplant recipients from sub-Saharan Africa: What should be remembered? Transplant Rev (Orlando) 2021; 35:100632. [PMID: 34130253 DOI: 10.1016/j.trre.2021.100632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/07/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
International migration from Sub-Saharan African countries to the European Union and the United States has significantly increased over the past decades. Although the vast majority of these immigrants are young and healthy people, a minority can be affected by chronic conditions eventually leading to solid organ transplantation (SOT). Importantly, these candidates can bear geographically restricted fungal and parasitic latent infections that can reactivate after the procedure. An appropriate evaluation before transplantation followed by treatment, whenever necessary, is essential to minimize such risk, as covered in the present review. In short, infection due to helminths (Schistosoma spp. and Strongyloides stercoralis) and intestinal protozoa (Entamoeba histolytica, Giardia lamblia or Cyclospora cayetanensis) can be diagnosed by multiple direct stool examination, serological assays and stool antigen testing. Leishmaniasis can be assessed by means of serology, followed by nucleic acid amplification testing (NAAT) if the former test is positive. Submicroscopic malaria should be ruled out by NAAT. Screening for Histoplasma spp. or Cryptococcus spp. is not routinely indicated. Consultation with an Infectious Diseases specialist is recommended in order to adjust preemptive treatment among Sub-Saharan African SOT candidates and recipients.
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Affiliation(s)
- Jose Tiago Silva
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain.
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Paolo Antonio Grossi
- Department of Medicine and Surgery, University of Insubria and ASST Sette Laghi, Ospedale di Circolo of Varese, Varese, Italy
| | - Pilar Hernández-Jimenez
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain
| | - Francisco López-Medrano
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain
| | - Alessandra Mularoni
- Department of Infectious Diseases, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Palermo, Italy
| | - Beatriz Prista-Leão
- Department of Infectious Diseases, University Hospital Center "São João", School of Medicine, University of Porto, Porto, Portugal
| | - Lurdes Santos
- Department of Infectious Diseases, University Hospital Center "São João", School of Medicine, University of Porto, Porto, Portugal
| | - José María Aguado
- Unit of Infectious Diseases, University Hospital "12 de Octubre", Research Institute Hospital "12 de Octubre" (imas12), Madrid, Spain; Department of Medicine, Universidad Complutense, Madrid, Spain
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42
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Olivera MJ. Dexamethasone and COVID-19: Strategies in Low- and Middle-Income Countries to Tackle Steroid-Related Strongyloides Hyperinfection. Am J Trop Med Hyg 2021; 104:1611-1612. [PMID: 33720844 PMCID: PMC8103443 DOI: 10.4269/ajtmh.20-1085] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/01/2021] [Indexed: 12/15/2022] Open
Abstract
COVID-19 can trigger a systemic inflammatory response that in some cases leads to severe lung involvement, multisystem dysfunction, and death. Dexamethasone therapy, because of its potent anti-inflammatory effects, has been proposed for the management of hospitalized patients with severe COVID-19. The subject of this article is to discuss potential strategies to tackle Strongyloides hyperinfection in hospitalized patients with COVID-19 receiving dexamethasone therapy in low- and middle-income countries. In this context, dexamethasone treatment has been found to be generally safe. However, its use in people coinfected with undetected Strongyloides stercoralis increases the risk for Strongyloides hyperinfection/dissemination a potentially fatal complication. Infection caused by S. stercoralis may remain asymptomatic or with mild symptoms in humans for several years. Early detection and specific treatment prevent a fatal evolution of this complication, but the challenge is to screen before corticosteroid therapy. In some cases, presumptive treatment may be justified. Ivermectin is the gold standard for treatment.
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Affiliation(s)
- Mario J. Olivera
- Address correspondence to Mario J Olivera, Grupo de Parasitología, Instituto Nacional de Salud, Ave. Calle 26 51-20, Bogotá DC, Colombia 111321. E-mail:
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43
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Alibrahim F, AlAlwan A, Al Thiab K, Alawaji A, Alwan B, Taher L, Bosaeed M. Strongyloides and hookworms co-infection in a liver transplant patient. IDCases 2021; 24:e01060. [PMID: 33763328 PMCID: PMC7973314 DOI: 10.1016/j.idcr.2021.e01060] [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: 01/02/2021] [Accepted: 03/09/2021] [Indexed: 10/25/2022] Open
Abstract
We here present a female patient who is a recipient of liver transplantation from a cadaveric donor. She developed abdominal pain, nausea, vomiting, and diarrhea for two weeks of duration, after four months of the transplant. Upper gastrointestinal (GI) endoscopy and stool analysis for ova and parasite showed Necator americanus / Ancylostoma duodenale (Hookworm) ova /larvae and Strongyloides stercoralis Larvae. She had a dramatic clinical response to Ivermectin and Albendazole combination, which was given until the clearance of her stool exam. She was discharged from the hospital in good condition, and her infection is considered as a donor-derived transmission of these parasites. To the best of our knowledge, this is the first case report of Strongyloides stercoralis and hookworm co-infection in a liver transplant patient. Parasitic infection should be considered in the differential diagnosis of diarrheal illness of cadaveric transplant patients, even if it is not prevalent in the region.
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Affiliation(s)
- Fatimah Alibrahim
- Infectious Disease Division, Department of Internal Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abduljaleel AlAlwan
- Department of Hepatobiliary Sciences and Organ Transplant Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center's (KAIMRC), Riyadh, Saudi Arabia
| | - Khalefa Al Thiab
- Pharmaceutical Care Services, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahmad Alawaji
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Bassam Alwan
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Leena Taher
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammad Bosaeed
- Infectious Disease Division, Department of Internal Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center's (KAIMRC), Riyadh, Saudi Arabia
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44
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Eslahi AV, Badri M, Nahavandi KH, Houshmand E, Dalvand S, Riahi SM, Johkool MG, Asadi N, Hoseini Ahangari SA, Taghipour A, Zibaei M, Khademvatan S. Prevalence of strongyloidiasis in the general population of the world: a systematic review and meta-analysis. Pathog Glob Health 2021; 115:7-20. [PMID: 33433291 DOI: 10.1080/20477724.2020.1851922] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Strongyloides stercoralis is a neglected soil-transmitted helminth affects approximately 100-370 million people globally. The life cycle is unusual as only larvae can be found in stool specimens. Thecurrent review and meta-analysis represented the distribution of strongyloidiasis in general population of the world based on published papers. Five English databases (Science Direct, Scopus, PubMed, Web of Science, and Google Scholar(were explored for literature published before October 2019.Altogether 235 studies (862243 participants) was eligible. Regarding diagnostic method, the overall prevalence for studies performed microscopic, culture, immunological and molecular method was 1.47% (95% CI = 1.56%), 10.08% (95% CI = 8.99% - 11.16%), 23.88% (95% CI = 20.82% - 26.94%) and 9.3% (95% CI = 7.2% - 11.3%), respectively. Based on microscopic methods, the highest prevalence was related to the Western Pacific region [9.47% (95% CI = 8.55% - 10.39%)]. According to the culture method, Western Pacific region [21.36% (95% CI = 16.32% - 26.39%)] had the highest estimated pooled prevalence. In immunological studies, Eastern Mediterranean Region [40.72% (95% CI = 36.74% - 44.70%)] had the highest seroprevalence.Also in molecular surveys, the highest prevalence was related to the African region [19.72% (95% CI = 16.71% - 22.73%)]. The current study indicated that strongyloidiasis is still considered a health problem in many parts of the world. Thus a comprehensive control program and improvement of public health sectors are required.
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Affiliation(s)
- Aida Vafae Eslahi
- Student Research Committee, Urmia University of Medical Sciences , Urmia, Iran
| | - Milad Badri
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences , Qazvin, Iran
| | | | - Elham Houshmand
- Department of Parasitology, Faculty of veterinary medicine, Rasht Branch, Islamic Azad university , Guilan, Iran
| | - Sahar Dalvand
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - Seyed Mohammad Riahi
- Social Determinants of Health Research Centre, Department of Epidemiology and Biostatistics, School of Health, Birjand University of Medical Sciences , Birjand, Iran
| | - Morteza Ghanbari Johkool
- Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences , Qazvin, Iran
| | - Negar Asadi
- Student Research Committee, Urmia University of Medical Sciences , Urmia, Iran.,Cellular and Molecular Research Center & Department of Medical Parasitology and Mycology, Urmia University of Medical Sciences , Urmia, Iran
| | | | - Ali Taghipour
- Department of Parasitology, Faculty of medical sciences, Tarbiat Modares University , Tehran, Iran
| | - Mohammad Zibaei
- Department of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences , Karaj, Iran.,Evidence-based Phytotherapy and Complementary Medicine Research Center, Alborz University of Medical Sciences , Karaj, Iran
| | - Shahram Khademvatan
- Student Research Committee, Urmia University of Medical Sciences , Urmia, Iran.,Cellular and Molecular Research Center & Department of Medical Parasitology and Mycology, Urmia University of Medical Sciences , Urmia, Iran
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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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Vanbrabant P, Damanet B, Maussen C, Van Esbroeck M, Soentjens P. Screening the asymptomatic soldiers after a stay in sub-Saharan Africa. A retrospective observational study. Travel Med Infect Dis 2020; 39:101941. [PMID: 33278608 DOI: 10.1016/j.tmaid.2020.101941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 11/18/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Many tropical clinics offer post-travel screening for parasitic infections in asymptomatic travellers. However, literature on attack rates and incidence rates of parasitic infections is scarce. METHOD All military personnel returning from a tropical region during the year 2018 were tested for the presence of antibodies against Strongyloides stercoralis, Schistosoma and Entamoeba histolytica. Test results were compared with previous results if available to distinguish recent and old infection. RESULTS In total, 949 soldiers were included in the study. The median age was years 31 (IQR: 26-41), 96.3% were male. The median duration of stay in the tropics was 35 days (IQR: 14-90). The destination was predominantly central Africa. Serological tests were positive for S. stercoralis in 10 patients (1.1%), Schistosoma in 3 (0.3%), and E. histolytica in 16 (1.7%). The attack rates were 0.84, 0.32 and 1.69 respectively. The incidence rates were 3.99, 1.49 and 7.97 respectively. CONCLUSIONS The risk for parasitic infection in the asymptomatic returning soldiers is low. However, the potentially serious complications of unrecognised parasitic infection can legitimise systematic screening.
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Affiliation(s)
- Peter Vanbrabant
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium; General Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Benjamin Damanet
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium; School of Public Health, Free University of Brussels, Brussels, Belgium
| | - Chris Maussen
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Patrick Soentjens
- Centre for Infectious Diseases, Polyclinic Department. Queen Astrid, Military Hospital, Brussels, Belgium; Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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47
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Inglis DM, Bailey MS. Unusual presentations of cutaneous larva migrans in British military personnel. BMJ Mil Health 2020; 169:e78-e81. [PMID: 33243768 DOI: 10.1136/bmjmilitary-2020-001677] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/11/2020] [Accepted: 11/15/2020] [Indexed: 11/03/2022]
Abstract
Cutaneous larva migrans (CLM) is one of numerous skin diseases that occur in British military personnel on deployments to the tropics and sub-tropics. It is typically managed by military primary healthcare services, but diagnostic uncertainty or unavailability of anti-helminthic medication may prompt referral to UK Role 4 healthcare services. Cases of CLM seen at the UK Role 4 Military Infectious Diseases & Tropical Medicine Service from 2005 to 2020 were identified and their case notes were reviewed to identify learning and discussion points. There were 12 cases identified, of which five came from Brunei and three were from Belize. Causes for referral were due to diagnostic uncertainty (58%) and the unavailability of anti-helminthic medication (42%). Several cases had CLM in an unusual distribution due to specific military activities performed in endemic areas. Telemedicine was very useful in making some of the diagnoses in theatre and avoiding the need for medical evacuation. Military personnel may have unusual presentations of CLM due their unique military activities. In areas that are endemic for CLM, clinicians should maintain high clinical suspicion for CLM, carry appropriate anti-helminthic medications and consider screening cases of CLM and their colleagues for other infections with similar aetiology (eg, human hookworm infection and strongyloidiasis).
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Affiliation(s)
- David Michael Inglis
- Institute of Naval Medicine, Gosport, UK .,Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK
| | - M S Bailey
- Department of Infection & Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK.,Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, UK
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48
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Camprubí D, Almuedo-Riera A, Martí-Soler H, Soriano A, Hurtado JC, Subirà C, Grau-Pujol B, Krolewiecki A, Muñoz J. Lack of efficacy of standard doses of ivermectin in severe COVID-19 patients. PLoS One 2020; 15:e0242184. [PMID: 33175880 PMCID: PMC7657540 DOI: 10.1371/journal.pone.0242184] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
Ivermectin has recently shown efficacy against SARS-CoV-2 in-vitro. We retrospectively reviewed severe COVID-19 patients receiving standard doses of ivermectin and we compared clinical and microbiological outcomes with a similar group of patients not receiving ivermectin. No differences were found between groups. We recommend the evaluation of high-doses of ivermectin in randomized trials against SARS-CoV-2.
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Affiliation(s)
- Daniel Camprubí
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Alex Almuedo-Riera
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Helena Martí-Soler
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Juan Carlos Hurtado
- Microbiology Department, Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Carme Subirà
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Berta Grau-Pujol
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
| | - Alejandro Krolewiecki
- Instituto de Investigaciones de Enfermedades Tropicales, Universidad Nacional de Salta/CONICET, Orán, Argentina
| | - Jose Muñoz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic—Universitat de Barcelona, Barcelona, Spain
- * E-mail:
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49
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Strongyloides infection manifested during immunosuppressive therapy for SARS-CoV-2 pneumonia. Infection 2020; 49:539-542. [PMID: 32910321 PMCID: PMC7481762 DOI: 10.1007/s15010-020-01522-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
Background SARS-CoV-2 pandemic has posed formidable public health and clinical challenges. The use of immunosuppressive agents, such as high dose corticosteroids and cytokine inhibitors (e.g., Tocilizumab) has been suggested to contrast the hyperinflammatory process involved in the pathogenesis of the severe disease, with conflicting evidence. Among the drawbacks of immunosuppressive therapy, the risk of reactivation of latent infections, including parasitic infestations, is to be considered. Case presentation We report a case of a 59-year-old Italian patient treated with high dose intravenous dexamethasone and two intravenous doses of Tocilizumab for interstitial bilateral pneumonia associated with SARS-CoV-2 infection who developed itching, abdominal pain, and an increased eosinophil count. Stool examination confirmed the presence of S. stercoralis larvae. The patient was treated with a 4-day course of Ivermectin with full recovery. Discussion We report the first case of S. stercoralis infection following an 11-day treatment with high-dose steroids and Tocilizumab for severe COVID-19. Clinicians should be aware of the risk of strongyloidiasis as a complication of the treatment for severe COVID-19.
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50
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Hermanns V, Flick H, Lingscheid T. Seltene parasitäre Infektionen der Lunge. DER PNEUMOLOGE 2020; 17:330-337. [PMID: 32837495 PMCID: PMC7374075 DOI: 10.1007/s10405-020-00336-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Pulmonale parasitäre Infektionen kommen weltweit vor, werden jedoch aufgrund der Seltenheit in Deutschland in den wenigsten Fällen differenzialdiagnostisch in Betracht gezogen. Parasitäre Lungenerkrankungen können unterschiedlichste pulmonale Manifestationen hervorrufen und sollten bei unklaren Befunden oder fehlendem Therapieansprechen differenzialdiagnostisch mit bedacht werden, um diese heilbaren Erkrankungen so früh wie möglich zu erkennen.
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