Fatal Strongyloidiasis in Patients Receiving Corticosteroids

Cruz, T.; Rebouças, Gilberto; Rocha, Heonir

doi:10.1056/nejm196611172752003

Cited by 174 publications

(70 citation statements)

References 8 publications

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“…Carriage by Strongyloides larvae of enterobacteria from the colon often produces sepsis 2,7 or meningitis. The results of several studies have documented an association of disseminated Strongyloides infection with malignant tumors, severe malnutrition, 8,9 corticosteroid therapy, 10,11 and renal transplantation. 12,13 Some reports have described a significant association between human T cell lymphotropic virus type-1 (HTLV-1) infection and the carriage of S. stercoralis larvae in the stools of both Japanese and Jamaican patients 14,15 This virus is endemic in Peru and has been associated with high risk sexual behavior, 16 Japanese origin, 17 and Quechua ethnicity.…”

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confidence: 99%

Strongyloides stercoralis hyperinfection associated with human T cell lymphotropic virus type-1 infection in Peru.

Gotuzzo¹,

Terashima²,

Alvarez³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

161

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Abstract.A study was conducted in Lima, Peru to determine if patients with Strongyloides hyperinfection had human T cell lymphotropic virus type-1 (HTLV-I) infection. The study included patients with Strongyloides hyperinfection and a control group consisted of sex-and age-matched asymptomatic healthy individuals whose stools were negative for Strongyloides. A third group included patients with intestinal strongyloidiasis. Sera from each study subject were tested for HTLV-1/2I by an ELISA and Western blot. The HLTV-1 infection rates (85.7%, 18 of 21) were significantly (P Ͻ 0.001) associated with Strongyloides hyperinfection compared with the control group (4.7%, 1 of 21). The HTLV-1 rate (10%, 6 of 62) for patients with intestinal strongyloidiasis was significantly (P Ͻ 0.001) lower than patients with Strongyloides hyperinfection, but did not differ significantly (P Ͼ 0.05) from the control group. The association of HTLV-1 infection was observed among 17 of 19 patients more than 20 years of age and one of two younger patients. None had HTLV-2 infection. In conclusion, Strongyloides hyperinfection among Peruvian patients was highly associated with HTLV-1 infection.Strongyloides stercoralis is a soil-transmitted intestinal nematode that has been estimated to infect at least 60 million people, especially in tropical and subtropical regions.1 The parasite is unique among the parasitic nematodes because of its ability to multiply within the human host for many decades, with the potential to cause life-threatening disease in immunocompromised patients. The usual route of transmission is by penetration of the skin by filariform larvae (infectious form), following contact with contaminated soil. After migration through the lung, the larvae crawl over the glottis, and are then swallowed and develop to adults in the small bowel mucosa. The uncomplicated intestinal form of disease produces nonspecific abdominal symptoms with or without mild sporadic diarrhea. Many infected patients are completely asymptomatic. 2 However, an autoinfective cycle may develop in a proportion of untreated cases. In these cases, infectious filariform larvae develop in the intestines from rhabditiform larvae. Penetration of the colon or the anal skin by filariform larvae, and migration through lung allow reinfection of the same host. The autoinfective cycle, which usually results in a low-grade, chronic infection in immunocompetent hosts, is poorly understood 3 . A large number of cases of chronic, asymptomatic Strongyloides infections were reported among World War II in Southeast Asian prisoners of war and in refugees up to 40 years after leaving endemic regions. [4][5][6] In contrast to autoinfection, Strongyloides may produce a disseminated infection in immunocompromised hosts incapable of mounting an immune response against the parasite. Massive dissemination of invasive filariform larvae from the colon to the lung, liver, central nervous system, or kidney frequently results in a fatal outcome. Carriage by Strongyloides larvae of enterobacte...

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confidence: 99%

Strongyloides stercoralis hyperinfection associated with human T cell lymphotropic virus type-1 infection in Peru.

Gotuzzo¹,

Terashima²,

Alvarez³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

161

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“…This pathologic condition results from larvae that become infective within the intestine 14 . Predisposing factors for this overwhelming autoinfection include immunosuppression 11,18 -particularly impaired cell mediated immunity, steroid 5,8 , and other immunosuppressive therapy -severe malnutrition or alcoholism, leukemia, lymphoma 13,19 , and the expanding population of HIV-infected patients 12 . In this condition, filariform larvae invade the intestinal walls and may spread through lymphatic and hematogenic pathways to distant organs such as the liver and biliary tract 9 , pancreas, lungs, and the central nervous system.…”

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confidence: 99%

“…Poor personal hygiene, cutaneous rashes, and eosinophilia are important clues for the diagnosis. However negative stool cultures or eosinopenia do not rule out the diagnosis and under severe conditions may point to the disseminated form of strongyloidiasis 4,8,18 .…”

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Invasive enteritis by Strongyloides stercoralis presenting as acute abdominal distress under corticosteroid therapy

et al. 2001

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Overwhelming helminthiasis is still a problem in endemic areas, especially in immunocompromised patients. We report a case of invasive intestinal strongyloidiasis that was clinically expressed as acute abdominal distress in a 73-year-old man from São Paulo who had been receiving methylprednisone, 20 mg/day, for one year for osteoarthritis. A surgical specimen from the ileum revealed invasive enteritis with severe infestation by Strongyloides stercoralis. The patient died of sepsis 6 days after surgery. The possibility of invasive strongyloidiasis should be considered in the differential diagnosis of acute abdominal distress in patients undergoing immunosuppressive therapy.

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“…A grande m aioria dos casos re latados é constituída por formas clíinicas muito graves da parasitose (1,2,3,5,6,7,9,10,15,16,17,18,19,21,22,23,24,26,27,30,32,33,34).…”

Section: Quanto ã Avaliação Laboratorial Os Indivíduos Normais Excreunclassified

Distúrbios da absorção intestinal na estrongiloidose

Filho¹,

Sobral²,

Arantes³

1974

Rev. Soc. Bras. Med. Trop.

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Fatal Strongyloidiasis in Patients Receiving Corticosteroids

Cited by 174 publications

References 8 publications

Strongyloides stercoralis hyperinfection associated with human T cell lymphotropic virus type-1 infection in Peru.

Strongyloides stercoralis hyperinfection associated with human T cell lymphotropic virus type-1 infection in Peru.

Invasive enteritis by Strongyloides stercoralis presenting as acute abdominal distress under corticosteroid therapy

Distúrbios da absorção intestinal na estrongiloidose

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