Comparative Diagnosis of Strongyloidiasis in Immunocompromised Patients

Abstract

Abstract. Strongyloides hyperinfection syndrome and disseminated strongyloidiasis frequently occur in immunocompromised persons and can lead to high complication and mortality rates. Thus, detection of Strongyloides stercolaris in those patients is crucial. The present study aimed to determine the prevalence of strongyloidiasis and compare the detection rates of different strongyloidiasis detection methods. We conducted a cross-sectional study of 135 adults with various immunocompromising conditions (corticosteroid usage, chemotherapy, hematologic malignancies, organ transplants, use of immunosuppressive agents, and symptomatic human immunodeficiency virus infection) in Phramongkutklao Hospital, Bangkok, Thailand. All patients were asked to undergo serology testing for Strongyloides IgG by indirect enzyme-linked immunosorbent assay (ELISA), and 3 days of stool collection for use in a simple smear along with formalin-ether concentration and agar plate techniques. Prevalence rates of strongyloidiasis were 5% by stool concentration technique, 5.4% by IgG-ELISA, and 6.7% by agar plate culture. Three of the eight strongyloidiasis cases in this study had hyperinfection syndrome. The tested risk factors of age, sex, occupation, and immunocompromising condition were not associated with Strongyloides infestation. Serology was only 42.9% sensitive (positive predictive value), but it was 96.3% specific (negative predictive value). In conclusion, prevalence rates of strongyloidiasis in this study were 5-7%. Although agar plate culture was the most sensitive technique, the other diagnostic methods might be alternatively used.

High Prevalence of Strongyloidiasis in Spain: A Hospital-Based Study

“…In our study, the prevalence in HIV-infected individuals and patient from transplant units, but not necessarily immunosuppressed individuals, was much lower compared with other general out /in-patient unit services of the hospitals. One possible explanation that could have contributed to the lower prevalence found in potentially immunosuppressed patients is that the serology had a lower sensitivity in immunosuppressed patients, as has been reported in other studies [18]. The sensitivity of the serology in immunosuppressed patients deserves a further evaluation to examine its accuracy, since only a few studies have evaluated it, showing a lower sensitivity compared to parasitological techniques [18], and no studies have evaluated, its accuracy at different levels of immunosuppression.…”

“…Despite having cross-reactions with other helminthic infections, this is less likely to occur in migrant populations since the possibility of co-infections is lower [16] and it is thus now the current recommended screening technique for these populations [17]. The sensitivity of the serological tests in immunosuppressed individuals seems to be lower [18], but only limited data are available and further prospective studies should better evaluate the accuracy of serological tests in immunosuppressed patients.…”

High Prevalence of Strongyloidiasis in Spain: A Hospital-Based Study

“…In our study, prevalence in HIV-infected individuals and transplant units was much lower compared with other general out/in-patients units services of the hospitals. One possible explanation that could have contributed to the lower prevalence found in potentially immunosuppressed patients, is that the serology has a lower sensitivity in immunosuppressed patients as it has been reported in other studies [18].The sensitivity of the serology in immunosuppressed patients deserves further evaluation of its accuracy, since only few studies have evaluated it, showing a lower sensitivity compared to parasitological techniques [18] This is a hospital-based study and results should be interpreted in the context of a hospital-based population. Generalizing our prevalence results to the general (or wider) population should be done with caution since the positive selection bias should be taken into account.…”

“…Despite having cross-reactions with other helminthic infections, this fact is less likely to occur in migrant populations since the possibility of co-infections is lower [16] and therefore it is nowadays the current recommended screening technique in these populations [17]. The sensitivity of the serological tests in immunosuppressed individuals seems to be lower [18]; but these are limited data and further prospective studies should better evaluate the accuracy of the serological tests in immunosuppressed patients.…”

Imunoproteômica aplicada ao aprimoramento do diagnóstico sorológico da estrongiloidíase humana

“…Bahia, em pacientes com lupus eritematoso sistêmico a positividade do ELISA foi de 16%; em Minas Gerais,Paula et al (2000) realizaram imunofluorescência indireta e ELISA em crianças imunodeprimidas e a positividade foi de 8,4% e 12,1% nas respectivas técnicas; no Rio de Janeiro,Schaffel et al (2001) investigaram pacientes com doenças oncohematológicas e a sorologia foi positiva em 23,3%. Globalmente, na Tailândia,Luvira et al (2016) identificaram 5,4% de positividade no ELISA em pacientes em tratamento com corticoides, com doenças oncohematológicas, transplantados e portadores do vírus HIV. Na Turquia, Erdem-Kivrak et al (2017) realizaram triagem de pacientes com doença renal crônica ou transplantados de rim e encontraram apenas 0,92% de positividade no ELISA e na PCR em tempo real.…”