Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Abstract

AIM:To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis (S. stercoralis ) hyperinfection. METHODS:Over a period of 23 years , we investigated 25 patients with S. stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis. The clinical and endoscopic findings were analyzed retrospectively. R E S U LT S :Tw e n t y -f o u r ( 9 6 % ) o f t h e p a t i e n t s investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1 (HTLV-1) infection. The abnormal endoscopic findings, mainly edematous mucosa, white villi and erythematous mucosa, were observed in 23 (92%) patients. The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy. The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative (Endoscopic severity score: 4.86 ± 2.47 vs 2.71 ± 1.38, P < 0.05). CONCLUSION:Our study clearly demonstrates that, in addition to stool analysis, endoscopic observation and biopsies are very important. We also emphasize that S. stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.

Clinical, endoscopic and histopathological profiles of parasitic duodenitis cases diagnosed by upper digestive endoscopy

“…Kisimoto et al (5) also observed that 68% of 25 subjects studied had larvae of S. stercoralis in stool examination. Indeed, in 11 cases of HUPES, 80% of patients had stool sample examination positive for the agent found in biopsy, showing that intestinal parasitosis are a common neglected differential diagnosis.…”

“…Kishimoto et al (5) , after investigation of 25 patients infected with S. stercoralis, also presented, as predominant symptoms, the presence of vomiting, diarrhea, weight loss and abdominal pain. Moreover, Kishimoto found the presence of sepsis in 12% of cases.…”

“…In S. stercoralis infection, it was also observed presence of protein-losing enteropathy (2,4,8) . Histopathological findings showed edema and infiltration of the lamina propria by lymphocites and plasmocites, shortened or absent villus, cryptitis and crypt hyperplasia, epithelial layer infiltration by numerous intra-epithelial lymphocites and antigen-presenting cells and the presence of lymphagectasia (2,4,5,8) . This paper aims to set a profile of the parasitic duodenitis diagnosed by upper digestive endoscopy among patients of "Complexo Hospitalar Professor Edgar Santos" (HUPES), a general teaching Hospital in the state of Bahia, Northeast Brazil, establishing the characteristics of affected patients, the main signs and symptoms and histological findings.…”

“…Some studies mention the appearance of intestinal blockage, fever and evolution to sepsis (2,4,5,8,9) .…”

Estrongiloidosis como causa de hemorragia digestiva baja

“…Sin embargo, se han descrito casos en que los hallazgos endoscópicos e histopatológicos no son métodos confiables para confirmar esta patología 9 . Los exámenes coproparasitológicos tienen poca sensibilidad en el diagnóstico de esta helmintiasis.…”