Disseminated strongyloidiasis in immunocompromised patients – report of three cases

Galimberti, Ricardo; Pontón, A; Zaputovich, Fátima Agüero; Velasquez, Lorna; Galimberti, Gastón; Torre, Ana Clara; Kowalczuk, Alicia

doi:10.1111/j.1365-4632.2009.04082.x

Cited by 23 publications

(18 citation statements)

References 26 publications

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“…Thus, although larval migration during hyperinfection and disseminated infection was not the subject of the study performed by Schad et al [41], their suggestion that during primary infection, the pulmonary route of migration is only one of many possible routes for the nematode to reach the host duodenum becomes even more relevant in the context of disseminated infection. Particularly with respect to complicated disease, the observation of S. stercoralis larvae, including larva currens [101][102][103], in other organs in the natural host and the isolation of various stages of the parasite from different organs of marmosets and a large amount of larvae from a fragment of skin and surrounding tissues from one specimen in this study support the idea that parasite larvae can migrate randomly, reaching a number of peripheral sites in the host.…”

Section: Discussionsupporting

confidence: 68%

Strongyloides stercoralis infection in marmosets: replication of complicated and uncomplicated human disease and parasite biology

Mati

Raso²,

Melo

2014

Parasites & Vectors

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Both complicated and uncomplicated strongyloidiasis occur in C. penicillata that is described as a susceptible small non-human primate model for S. stercoralis. This host permits the maintenance of a human strain of the parasite in the laboratory and can be useful for experimental investigations of strongyloidiasis. In parallel, we discuss data related to the autoinfective cycle that provides new insights into the biology of S. stercoralis.

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Section: Discussionsupporting

confidence: 68%

Strongyloides stercoralis infection in marmosets: replication of complicated and uncomplicated human disease and parasite biology

Mati

Raso²,

Melo

2014

Parasites & Vectors

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“…Albendazole was used as a single drug even in recent case reports; since 2008 we found patients treated with albendazole only in reports from Pakistan [203], Romania [217], Taiwan [182], Israel [187], Kuwait [184], Argentina [25], Malaysia [207], Greece [133], Thailand [208]. …”

Section: Resultsmentioning

confidence: 99%

Severe strongyloidiasis: a systematic review of case reports

et al. 2013

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BackgroundStrongyloidiasis is commonly a clinically unapparent, chronic infection, but immuno suppressed subjects can develop fatal disease. We carried out a review of literature on hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), in order to describe the most challenging aspects of severe strongyloidiasis.MethodsWe conducted a structured search using PubMed to collect case reports and short case series on HS/DS published from 1991 to 2011. We restricted search to papers in English, Spanish, Italian and French. Case reports were classified as HS/DS according to given definitions.ResultsRecords screened were 821, and 311 were excluded through titles and abstract evaluation. Of 510 full-text articles assessed for eligibility, 213 were included in qualitative analysis. As some of them were short case series, eventually the number of cases analyzed was 244.Steroids represented the main trigger predisposing to HS and DS (67% cases): they were mostly administered to treat underlying conditions (e.g. lymphomas, rheumatic diseases). However, sometimes steroids were empirically prescribed to treat signs and symptoms caused by unsuspected/unrecognized strongyloidiasis. Diagnosis was obtained by microscopy examination in 100% cases, while serology was done in a few cases (6.5%). Only in 3/29 cases of solid organ/bone marrow transplantation there is mention of pre-transplant serological screening. Therapeutic regimens were different in terms of drugs selection and combination, administration route and duration. Similar fatality rate was observed between patients with DS (68.5%) and HS (60%).ConclusionsProper screening (which must include serology) is mandatory in high - risk patients, for instance candidates to immunosuppressive medications, currently or previously living in endemic countries. In some cases, presumptive treatment might be justified. Ivermectin is the gold standard for treatment, although the optimal dosage is not clearly defined in case of HS/DS.

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“…Disseminated strongyloidiasis may not always occur as a fatal outcome of hyperinfection syndrome. Disseminated infection with bloody pericardial effusion has been reported in a nonimmunosuppressed patient without manifestations of hyperinfection syndrome [42]. This clinical finding is relatively common in high-risk populations, which are frequently misdiagnosed with gram-negative septicemia or acute respiratory distress syndrome.…”

Section: Pathophysiology and Life Cyclementioning

confidence: 93%

Strongyloidiasis—An Insight into Its Global Prevalence and Management

et al. 2014

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Background Strongyloides stercoralis, an intestinal parasitic nematode, infects more than 100 million people worldwide. Strongyloides are unique in their ability to exist as a free-living and autoinfective cycle. Strongyloidiasis can occur without any symptoms or as a potentially fatal hyperinfection or disseminated infection. The most common risk factors for these complications are immunosuppression caused by corticosteroids and infection with human T-lymphotropic virus or human immunodeficiency virus. Even though the diagnosis of strongyloidiasis is improved by advanced instrumentation techniques in isolated and complicated cases of hyperinfection or dissemination, efficient guidelines for screening the population in epidemiological surveys are lacking.Methodology and ResultsIn this review, we have discussed various conventional methods for the diagnosis and management of this disease, with an emphasis on recently developed molecular and serological methods that could be implemented to establish guidelines for precise diagnosis of infection in patients and screening in epidemiological surveys. A comprehensive analysis of various cases reported worldwide from different endemic and nonendemic foci of the disease for the last 40 years was evaluated in an effort to delineate the global prevalence of this disease. We also updated the current knowledge of the various clinical spectrum of this parasitic disease, with an emphasis on newer molecular diagnostic methods, treatment, and management of cases in immunosuppressed patients.ConclusionStrongyloidiasis is considered a neglected tropical disease and is probably an underdiagnosed parasitic disease due to its low parasitic load and uncertain clinical symptoms. Increased infectivity rates in many developed countries and nonendemic regions nearing those in the most prevalent endemic regions of this parasite and the increasing transmission potential to immigrants, travelers, and immunosuppressed populations are indications for initiating an integrated approach towards prompt diagnosis and control of this parasitic disease.

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Disseminated strongyloidiasis in immunocompromised patients – report of three cases

Abstract: The risk of disseminated strongyloidiasis in patients with impaired cell-mediated immunity is unknown; however, given the poor prognosis of disseminated strongyloidiasis, consideration should be given to the screening of patients at increased risk of infection.

Cited by 23 publications

References 26 publications

Strongyloides stercoralis infection in marmosets: replication of complicated and uncomplicated human disease and parasite biology

Strongyloides stercoralis infection in marmosets: replication of complicated and uncomplicated human disease and parasite biology

Severe strongyloidiasis: a systematic review of case reports

Strongyloidiasis—An Insight into Its Global Prevalence and Management

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