Intestinal strongyloidiasis and hyperinfection syndrome

Vadlamudi, Raja; David, S.; Krishnaswamy, Guha

doi:10.1186/1476-7961-4-8

Cited by 220 publications

(192 citation statements)

References 95 publications

(150 reference statements)

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“…stercoralis can be divided into the following two types: the infectious filarial type and the noninfectious rhabditiform type [14]. Filarial S. stercoralis invades the human body percutaneously via feces-contaminated soil, converts into the rhabditiform type, and lays eggs in the duodenum.…”

Section: Discussionmentioning

confidence: 99%

Minimal change nephrotic syndrome in a patient with strongyloidiasis

et al. 2010

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Strongyloidiasis, a chronic infection caused by the intestinal parasite Strongyloides stercoralis, is prevalent in the Nansei Islands of Japan. Here, we report our findings on a case of strongyloidiasis complicated with steroid-resistant minimal change nephrotic syndrome in a 69-year-old male resident of Fukuoka Prefecture who had lived in Yakushima, one of the Nansei Islands, until age 15. In October 2006, he developed proteinuria and edema, and was diagnosed with minimal change nephrotic syndrome on the basis of the renal biopsy findings. Following treatment with prednisolone, the level of proteinuria decreased to 0.29 g/day by day 35. However, 5 days later (day 40), the patient developed persistent watery diarrhea and vomiting, leading to dehydration and malnutrition. Pneumonia and bacterial meningitis subsequently developed (day 146); filarial (infectious-type) and rhabditiform (noninfectious-type) S. stercoralis larvae were detected for the first time in the patient's sputum, gastric juice, feces, and urine. Although treatment with ivermectin was started immediately and the parasitosis responded to the treatment, the patient died of sepsis. Consequently, although strongyloidiasis is a rare infection except in endemic regions, it is essential to consider the possibility of this disease and begin treatment early for patients who have lived in endemic areas and who complain of unexplained diarrhea during steroid-induced or other immunosuppression.

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Section: Discussionmentioning

confidence: 99%

Minimal change nephrotic syndrome in a patient with strongyloidiasis

et al. 2010

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“…Infected individuals may be asymptomatic or present severe and fatal forms of the disease in situations of parasite dissemination consequent to compromised host immunity. This has been seen, for example, as a result of glucocorticoid treatment (Vadlamudi et al 2006;Olsen et al 2009). …”

Section: Introductionmentioning

confidence: 92%

Callithrix penicillata as a nonhuman primate model for strongyloidiasis

2012

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In order to better understand experimental strongyloidiasis in small New World primates, and to evaluate aspects of reinfection and immunosuppression induced by glucocorticoids, nine specimens of Callithrix penicillata (Primates: Cebidae) were administered (by subcutaneous injection, sc) 3000 infective larvae of a strain of Strongyloides venezuelensis (Rhabditida: Strongyloididae) that had been maintained in successive passages through AKR/J mice since 1987. The mean prepatent period was 5.6 ± 0.7 days post-infection (DPI). The mean patent period of infection among the untreated animals (marmosets 1-7) was 123.4 ± 61.4 DPI. Two animals (marmosets 8 and 9) received dexamethasone (2.5 mg/kg, sc) for five consecutive days starting on the 20th day after infection, but this treatment did not alter the course of the infection, and the patent period for these animals was 100.5 ± 58.7 DPI (59 and 142, respectively). Stool examination showed that the highest quantities of parasite eggs were expelled between the 8th and 19th days after inoculation of the larvae. Thereafter, there was a gradual reduction in the number of parasite eggs in feces of all marmosets. During the chronic phase of the infection, before completely negative parasitological findings were obtained, the parasitological examinations were intermittently positive. Reinfection of three of these animals did not result in new positive examinations. However, given the receptiveness of these animals to initial infection with S. venezuelensis and their similarities to human beings, it is proposed that C. penicillata could be used as a nonhuman primate model for experimental strongyloidiasis.

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“…16 The effect of these drugs could also be similar to ecdysteroid (the hormone that triggers the process of moulting), triggering the dreaded outcome of severe infections. 14,16,17 Gram-negative bacteria and other bowel flora may gain access to the bloodstream through ulcers in the bowel or by transport on the surface of migrating larvae. 21,28,29 The severe and potentially fatal infections caused by S. stercoralis are known as hyperinfection syndrome and disseminated strongyloidiasis, 14 rarely observed in immunocompetent individuals.…”

Section: Discussionmentioning

confidence: 99%

“…14,16,17 Gram-negative bacteria and other bowel flora may gain access to the bloodstream through ulcers in the bowel or by transport on the surface of migrating larvae. 21,28,29 The severe and potentially fatal infections caused by S. stercoralis are known as hyperinfection syndrome and disseminated strongyloidiasis, 14 rarely observed in immunocompetent individuals. The hyperinfection syndrome is characterized by an acceleration of life cycle and hyperinfection, and by an increased parasite burden within the sites of the nematode cycle.…”

Section: Discussionmentioning

confidence: 99%

“…rheumatoid arthritis and systemic lupus erythematous), sarcoidosis, postsurgical state, are more likely to develop severe forms of the disease. [14][15][16][17][18][19][20] sometimes septic shock, disseminated intravascular coagulation, renal and respiratory failure. 30,31 Disseminated infection refers to the migration of larvae to organs beyond the range of pulmonary auto infective cycle, but does not imply a greater severity of disease.…”

Section: Discussionmentioning

confidence: 99%

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Strongyloides stercoralis hyperinfection - a dreaded but still missed diagnosis

Crenitte¹,

Campos²,

Felipe-Silva³

2012

ACR

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Strongyloides stercoralis (S. stercoralis), an intestinal nematode, is endemic in tropical and subtropical regions, being less prevalent in temperate climates. The number of infected persons worldwide ranges between 10 million and 100 million people. In Brazil the reported prevalence is 13%. Chronic infection may be asymptomatic or accompanied by gastrointestinal and respiratory symptoms. Under immunosuppressive conditions, the infection assumes serious proportions frequently accompanied by septic shock, disseminated intravascular coagulopathy and respiratory distress syndrome. The authors report a case of a 50-year-old female patient who was a chronic user of glucocorticoids and had been seeking medical attention for two months because of continuous gastrointestinal symptoms. She was admitted to the emergency room with clinical signs of septic shock and died after four days despite an adequate antibiotic regimen, vasopressor drugs, and ventilatory support. The autopsy revealed the unsuspected finding of S. stercoralis hyperinfection and septicemia.

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Intestinal strongyloidiasis and hyperinfection syndrome

Cited by 220 publications

References 95 publications

Minimal change nephrotic syndrome in a patient with strongyloidiasis

Minimal change nephrotic syndrome in a patient with strongyloidiasis

Callithrix penicillata as a nonhuman primate model for strongyloidiasis

Strongyloides stercoralis hyperinfection - a dreaded but still missed diagnosis

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