Serology and eosinophil count in the diagnosis and management of strongyloidiasis in a non-endemic area.

Abstract

Abstract. Strongyloidiasis is a chronic infection that may result in significant morbidity; however, diagnosis and management remain problematic. The objective of this study was to 1) evaluate the demographic, clinical, and laboratory features of 76 consecutive individuals who had Strongyloides stercoralis larvae identified in their fecal specimens; 2) determine the sensitivity of the Centers for Disease Control and Prevention (CDC) enzyme immunoassay (EIA) for detecting antibodies to Strongyloides in those with confirmed infection; and 3) assess the serologic responses and changes in eosinophil counts following treatment. Most (96%) cases occurred in immigrants, but some patients had immigrated as long as 40 years earlier. The CDC Strongyloides EIA had a sensitivity of 94.6% (95% confidence interval ‫ס‬ 92.0-97.2%) in this patient population with proven infection. Serologic and eosinophil counts decreased after therapy, suggesting that they may be useful markers of treatment success.

High Rate of Strongyloidosis Infection, Out of Endemic Area, in Patients with Eosinophilia and without Risk of Exogenous Reinfections

“…However, this sign is considered a warning by different authors. 18,22,23 In this study the eosinophil counts diminished significantly immediately after ivermectin therapy. As the screening was performed among patients living out of endemic areas, eosinophil values proved to be useful, to include strongyloidosis among the possible differential diagnosis for those patients at risk for this parasitic infection.…”

“…This result reinforces the proposal that eosinophilia may be a good predictive marker of parasite reactivation. 22,23 To summarize, our results indicate the need to include strongyloidosis as a presumptive diagnosis in patients with past risk of infection and especially if they develop eosinophilia out of endemic areas. A suitable diagnosis should include a test with high sensitivity such agar culture, Baerman's, or serology test depending on the laboratory facilities.…”

“…Loutfy and others had reported for the Centers for Disease Control and Prevention (CDC) the Strongyloides EIA 94.6% sensitivity. 17,22 Van Doorn and others 16 reported for EIA a specificity ranging from 95% to 97.7% and a sensitivity of 83-93% depending on the EIA test used. These authors pointed out that serology are less time-consuming and does not require fresh stool samples, which they consider difficult to obtain in routine practices.…”

Maltreatment of Strongyloides Infection: Case Series and Worldwide Physicians-in-Training Survey

“…17,18 Even though this feared iatrogenic complication from corticosteroid therapy does occur, strongyloidiasis generally presents with diffuse, nonspecific gastrointestinal, dermatologic, or respiratory symptoms. 10,19,20 Most chronically infected are asymptomatic. 1,21,22 Minimal data exists regarding strongyloides in non-endemic settings.…”

Intestinal parasitic infections and eosinophilia in an human immunedeficiency virus positive population in Honduras

“…In many cases, the magnitude of these distortions has been found to be largely proportional to the worm burden (Beaver et al 1985, Nokes et al 1992. On the other hand the influence of HIV-1 infection characterized by a Th1 type immune response may decrease interleukine-5 and IgE responses in patients with strongyloidiasis, which usually produces asymptomatic or mild infections, and develop into severe disseminated strongyloidiasis (Porto et al 2001, Loufty et al 2002. The emergence of HIV/ AIDS has furthermore heightened the spectrum of opportunistic parasites by enabling more aggressive and disseminated parasitic infections in human such as cryptosporidiasis, isosporiasis, toxoplasmosis and strongyloidiasis (Vomer et al 1987, Heyworth 1996.…”