Cutaneous Strongyloides stercoralis infection: an unusual presentation

Ly, Micki N; Bethel, Shauna L; Usmani, Arif S.; Lambert, David

doi:10.1067/mjd.2003.338

Cited by 71 publications

(45 citation statements)

References 24 publications

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“…Therefore, clinical suspicion is essential for early diagnosis and improvement in survival. Cutaneous manifestations in disseminated strongyloidiasis are infrequent, but they may be a valuable diagnostic sign [3][4][5][6][7]. We report six immunosuppressed cancer patients with proven diagnosis of disseminated strongyloidiasis presenting with periumbilical purpura and septic shock.…”

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confidence: 99%

Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?

Salluh¹,

Bozza²,

Pinto³

et al. 2005

Braz J Infect Dis

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Cutaneous manifestations in disseminated strongyloidiasis are infrequent but should raise the suspicion for its diagnosis. We retrospectively evaluated the charts of six patients with cancer and a proven diagnosis of disseminated strongyloidiasis. All patients had received prophylaxis with albendazole before starting antineoplastic therapy, which included high-dose steroids. They presented with septic shock, acute respiratory failure and characteristic purpuric periumbilical skin lesions. Strongyloides larvae were identified in tracheal aspirates (n=5), gastric aspirates (n=4), lung (n=2) and skin biopsies (n=2). All patients died despite antihelminthic therapy and intensive care support.

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confidence: 99%

Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?

Salluh¹,

Bozza²,

Pinto³

et al. 2005

Braz J Infect Dis

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“…A manifestação cutânea mais comum na estrongiloidíase é a larva currens, isto é, lesão urticariforme, linear, pruriginosa, normalmente única e ocasionalmente múltipla, decorrente da penetração ativa da larva na pele da borda anal do indivíduo 8 . As lesões de pele na forma disseminada resultam da disseminação hematogênica do parasita, conforme já descrito em lesões do parênquima cerebral, com características isquêmicas, conseqüentes à embolização do nematódeo 6 .…”

Section: Figura 1 -Lesões Purpúricas Abdominais Apresentadas Pelo Pacunclassified

Púrpura em paciente com estrongiloidíase disseminada

Ribeiro

Rodrigues

Silva

et al. 2005

Rev. Soc. Bras. Med. Trop.

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RESUMOO Strongyloides stercoralis possui dois tipos de ciclo evolutivo: o direto ou homogônico e o indireto ou heterogônico, sendo que no homem ocorre ainda a auto-infecção, que pode ser de forma interna ou externa. Em situações especiais, o ciclo de auto-infecção pode acelerar-se, levando à rápida elevação do número de vermes nos órgãos normalmente envolvidos no ciclo biológico, fenômeno conhecido como hiperinfecção. Pode evoluir para estrongiloidíase disseminada, que se estabelece quando ocorre uma aceleração do curso normal do ciclo biológico do parasita e invasão, pelas larvas filariformes, de órgãos como pele, sistema nervoso central, rins, fígado, com alta mortalidade 6 . Esta complicação ocorre com maior freqüência em indivíduos com depressão da imunidade celular por neoplasias (linfomas, leucemias), transplantados renais, alcoólatras e infecção pelo vírus da imunodeficiência adquirida humana (HIV) 10 .No presente trabalho, é descrito um caso de estrongiloidíase disseminada, com acometimento cutâneo em forma de púrpura, que se desenvolveu em um paciente timectomizado e usuário crônico de corticosteróide devido à miastenia gravis.

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“…The parasite has the ability to reproduce indefinitely within the host 8 if not treated with antihelminthics.…”

Section: Strongyloides' Life Cyclementioning

confidence: 99%

“…Larvae pass through the digestive system until they reach the small intestine, where they submerge themselves in the intestinal mucosa. 8 Embedded worms undergo further development into predominantly adult females, which are capable of parthenogenic (asexual) reproduction. 9 Adult females drive an autoinfective life cycle, whereby eggs are laid in the gut.…”

Section: Strongyloides' Life Cyclementioning

confidence: 99%

Human strongyloidiasis: identifying knowledge gaps, with emphasis on environmental control

Taylor

Garrard

O’Donahoo

et al. 2014

RRTM

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Strongyloides is a human parasitic nematode that is poorly understood outside a clinical context. This article identifies gaps within the literature, with particular emphasis on gaps that are hindering environmental control of Strongyloides. The prevalence and distribution of Strongyloides is unclear. An estimate of 100-370 million people infected worldwide has been proposed; however, inaccuracy of diagnosis, unreliability of prevalence mapping, and the fact that strongyloidiasis remains a neglected disease suggest that the higher figure of more than 300 million cases is likely to be a more accurate estimate. The complexity of Strongyloides life cycle means that laboratory cultures cannot be maintained outside of a host. This currently limits the range of laboratory-based research, which is vital to controlling Strongyloides through environmental alteration or treatment. Successful clinical treatment with antihelminthic drugs has meant that controlling Strongyloides through environmental control, rather than clinical intervention, has been largely overlooked. These control measures may encompass alteration of the soil environment through physical means, such as desiccation or removal of nutrients, or through chemical or biological agents. Repeated antihelminthic treatment of individuals with recurrent strongyloidiasis has not been observed to result in the selection of resistant strains; however, this has not been explicitly demonstrated, and relying on such assumptions in the longterm may prove to be shortsighted. It is ultimately naive to assume that continued administration of antihelminthics will be without any negative long-term effects. In Australia, strongyloidiasis primarily affects Indigenous communities, including communities from arid central Australia. This suggests that the range of Strongyloides extends beyond the reported tropical/subtropical boundary. Localized conditions that might result in this extended boundary include accumulation of moisture within housing because of malfunctioning health hardware inside and outside the house and the presence of dog fecal matter inside or outside housing areas.

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Cutaneous Strongyloides stercoralis infection: an unusual presentation

Cited by 71 publications

References 24 publications

Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?

Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?

Púrpura em paciente com estrongiloidíase disseminada

Human strongyloidiasis: identifying knowledge gaps, with emphasis on environmental control

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