Clinical and laboratory features of Strongyloides stercoralis infection at diagnosis and after treatment: a systematic review and meta-analysis

Buonfrate, Dora; Fittipaldo, Veronica Andrea; Vlieghe, Erika; Bottieau, Emmanuel

doi:10.1016/j.cmi.2021.07.016

Cited by 19 publications

(14 citation statements)

References 29 publications

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“…Focusing on military populations, one study of 270 Hispanic veterans diagnosed with Strongyloides reported a rate of eosinophilia of 87%, moderately higher than our findings [ 22 ]. However, another meta-analysis considering 10 studies that reported rates of eosinophilia in patients with strongyloidiasis arrived at a pooled prevalence of eosinophilia at 69.3% (95% CI, 66.4–72.1), which is more in line with our results [ 23 ]. More importantly, 10% of patients in our study were asymptomatic and did not have eosinophilia, so diagnosis would have to rely on identification of risk factors and appropriate screening alone.…”

Section: Discussionsupporting

confidence: 89%

Strongyloides stercoralisin the US Military Health System

Taheri

Kuo

Hockenbury

et al. 2023

Open Forum Infectious Diseases

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Background Strongyloides stercoralis is an intestinal nematode most commonly found in subtropical and tropical locations. Military service members are believed to be at increased risk of exposure due to their unique occupational exposures in endemic regions. Methods Burden, clinical course, and risk factors associated with all Strongyloides infections within the U.S. Military Health System (MHS) from fiscal years 2012-2019 were assessed by manual chart review of records with ICD-9/10 codes for Strongyloides infection. Infection risk in demographic subgroups based on region of birth, military occupation, and age was quantified with univariate analysis and multivariate logistic regression. Results We reviewed 243 charts based on diagnosis coding, yielding 210 confirmed diagnoses (86.4%). Immigrant patients born in Latin America/Caribbean, Sub-Saharan Africa, and East Asia/Pacific regions had statistically significant increased risk ratios of infection at 34.4, 32.0, and 22.4, respectively, when compared to patients born in Europe and North America. In univariate analysis, active duty members in the healthcare occupational category had a statistically significant increased risk ratio of infection at 2.31 compared to those outside this occupation. Multivariate logistic regression analysis demonstrated that occupational categories of healthcare, admininstrative/support, warfighter/combat specialist, and engineering/repair/maintenance occupations, being an immigrant patient, and age >= 65 were all associated with statistically significant increased odds ratios for infection. Conclusions In the Military Health System, occupational exposures, region of birth, and age serve as risk factors for Strongyloides infection. As infections may be chronic, the impact of targeted screening programs to complement routine medical care should be considered.

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Section: Discussionsupporting

confidence: 89%

Strongyloides stercoralisin the US Military Health System

Taheri

Kuo

Hockenbury

et al. 2023

Open Forum Infectious Diseases

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“…Previous hospitals detected the presence of parasites but focused instead on the neurological manifestations. We confirmed the presence of S. stercoralis larvae in the patient’s stool and sputum[ 10 ]. Second, the patient presented with choking and hoarseness at the time of diagnosis.…”

Section: Discussionsupporting

confidence: 59%

Disseminated strongyloidiasis in a patient with rheumatoid arthritis: A case report

Zheng¹,

Xue²

2022

WJCC

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BACKGROUND Strongyloidiasis is usually a chronic infection but it can develop into a fatal disease in immunosuppressed patients. CASE SUMMARY A 68-year-old male with rheumatoid arthritis was treated with a variety of immunosuppressants for the past 3 years. Recently, the patient presented with a partial small-bowel obstruction, petechia, coughing and peripheral neuropathy. The diagnosis was difficult to clarify in other hospitals. Our hospital found Strongyloides stercoralis larvae with active movement in the routine stool and sputum smears. The diagnosis of disseminated strongyloidiasis was established. Ivermectin combined with albendazole was used for treatment. The patient responded to therapy and was discharged. CONCLUSION This case underscores the importance of comprehensive differential diagnosis in immunocompromised patients.

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“…The presence of eosinophilia is generally considered a useful indicator of chronic Strongyloides infection, and it may be present in up to 80% of patients at the time of diagnosis [ 71 ]. However, during Strongyloides hyperinfection, eosinophilia is often absent, with a prevalence of 34% in a single, large retrospective study [ 1 , 2 , 71 ]. The absence of eosinophilia in cases of Strongyloides hyperinfection may be at least in part due to corticosteroid therapy [ 72 ].…”

Section: Diagnosismentioning

confidence: 99%

Strongyloides and COVID-19: Challenges and Opportunities for Future Research

et al. 2023

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Strongyloides stercoralis is a soil transmitted helminth endemic to tropical and subtropical areas that can persist for decades in immunocompetent human hosts as a chronic asymptomatic infection. The use of corticosteroids, a mainstay of treatment for patients hospitalized with severe coronavirus disease (COVID-19), can trigger a life-threatening Strongyloides hyperinfection syndrome and disseminated disease. We identified 22 previously published cases of strongyloidiasis occurring in individuals with COVID-19, with one death reported among the seven patients who had Strongyloides hyperinfection syndrome. A total of seventeen patients had previously received corticosteroids, and of the five with no prior corticosteroid use, one presented with hyperinfection syndrome. We identify the key challenges in the diagnosis and treatment of Strongyloides within the context of COVID-19, including our imprecise knowledge of the global distribution of Strongyloides, the overlapping symptoms and signs of COVID-19 and Strongyloides hyperinfection syndrome, the limited utility of eosinophilia as a clinical marker for strongyloidiasis in this setting, the lack of validated algorithms to screen for Strongyloides prior to corticosteroid use, and the paucity of treatment options for critically ill patients with COVID-19 who cannot take oral ivermectin. Future research should focus on improved diagnostic methods and population prevalence estimates, optimizing the approaches for Strongyloides screening in persons with COVID-19 (including clinical trial participants and strategies for resource-limited settings) and better defining the role of pre-emptive treatment.

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Clinical and laboratory features of Strongyloides stercoralis infection at diagnosis and after treatment: a systematic review and meta-analysis

Cited by 19 publications

References 29 publications

Strongyloides stercoralisin the US Military Health System

Strongyloides stercoralisin the US Military Health System

Disseminated strongyloidiasis in a patient with rheumatoid arthritis: A case report

Strongyloides and COVID-19: Challenges and Opportunities for Future Research

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