Severe Strongyloidiasis Associated With Subclinical Human T-cell Leukemia/Lymphoma Virus-1 Infection

Bush, Larry M.; Almeida, Kleper N.F. de; Pérez, María T.

doi:10.1097/ipc.0b013e31818ec25b

Cited by 2 publications

(3 citation statements)

References 39 publications

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“…In immuno-compromised states such as with the use of corticosteroids, cytotoxic agents, tumor factor inhibitors, or the presence of hematological malignancies, as well as the coinfection with HTLV1, severe symptomatic strongyloidiasis can occur. The exact mechanism that leads to this severity is not known, but events that inhibit Th2-directed immune responses can release eosinophil-mediated control of the parasites [ 6 – 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…Bush et al [ 6 ] described a paradoxical effect of being infected with the human immunodeficiency virus (HIV) or having the acquired immunodeficiency syndrome (AIDS), as it does not seem to be an independent risk factor for aggressive Strongyloides infection. At the same time, although strongyloidiasis was once considered an AIDS-defining illness, there is no evidence that a low CD4 will increase the risk of dissemination or decrease the chance of clearing an infection [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Severe Strongyloidiasis with Negative Serology after Corticosteroid Treatment

2015

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Patient: Male, 77Final Diagnosis: Deere strongyloidiasisSymptoms: Abdominal pain • apetite loss • diarrheaMedication: PrednisolonClinical Procedure: Upper endoscopySpecialty: Gastroenterology and HepatologyObjective:Unusual clinical courseBackground:Strongyloidiasis usually presents as a chronic and limited disease, but in some immunocompromised patients it may become a life-threatening disease.Case Report:A 77-year-old Haitian male, with history of temporal arteritis on 40 mg of oral prednisone presented complaining of decreased oral intake, epigastric pain, and non-bloody diarrhea. He had bi-temporal wasting and a distended abdomen but without guarding or tenderness.Laboratory examination included mild leukocytosis, anemia, negative HIV antibody, negative parasite stool exam, and negative serology for Giardia and Strongyloides. CT of the abdomen showed multiple distended loops, without obstruction.During the admission he had a 4 g hemoglobin drop and a positive occult blood test, requiring blood transfusions, IV pantoprazole, and upper endoscopy. Findings included severe duodenitis, blunted villi, and intramucosal and luminal helminthic worms and eggs. Pathology showed Strongyloides stercoralis infection, confirmed by subsequent PCR.He was given 1 day of 15 mg oral ivermectin, diarrhea resolved, and was discharged with a percutaneous endoscopic gastrostomy tube because of the persistent lack of appetite.Conclusions:Given the persistent nature of strongyloidiasis and its high susceptibility to ivermectin, it potentially would be worth consider treating high-risk patients in the appropriate clinical and epidemiological setting, irrespective of screening test results, in order to avoid false-negative result consequences.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Severe Strongyloidiasis with Negative Serology after Corticosteroid Treatment

2015

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“…In immunocompromised states such as with the use of corticosteroids, cytotoxic agents, tumor factor inhibitors, or the presence of hematological malignancies, as well as the coinfection with HTLV1, severe symptomatic strongyloidiasis can occur. The exact mechanism that leads to this severity is not known, but events that inhibit Th2-directed immune responses can release eosinophil-mediated control of the parasites [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

Severe Strongyloidiasis With Negative Serology After Corticosteroid Treatment

Rodríguez¹,

Abraham²,

Williams³

2014

American Journal of Gastroenterology

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Unusual clinical course Background: Strongyloidiasis usually presents as a chronic and limited disease, but in some immunocompromised patients it may become a life-threatening disease. Case Report: A 77-year-old Haitian male, with history of temporal arteritis on 40 mg of oral prednisone presented complaining of decreased oral intake, epigastric pain, and non-bloody diarrhea. He had bi-temporal wasting and a distended abdomen but without guarding or tenderness. Laboratory examination included mild leukocytosis, anemia, negative HIV antibody, negative parasite stool exam, and negative serology for Giardia and Strongyloides. CT of the abdomen showed multiple distended loops, without obstruction. During the admission he had a 4 g hemoglobin drop and a positive occult blood test, requiring blood transfusions, IV pantoprazole, and upper endoscopy. Findings included severe duodenitis, blunted villi, and intramucosal and luminal helminthic worms and eggs. Pathology showed Strongyloides stercoralis infection, confirmed by subsequent PCR. He was given 1 day of 15 mg oral ivermectin, diarrhea resolved, and was discharged with a percutaneous endoscopic gastrostomy tube because of the persistent lack of appetite. Conclusions: Given the persistent nature of strongyloidiasis and its high susceptibility to ivermectin, it potentially would be worth consider treating high-risk patients in the appropriate clinical and epidemiological setting, irrespective of screening test results, in order to avoid false-negative result consequences.

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Severe Strongyloidiasis Associated With Subclinical Human T-cell Leukemia/Lymphoma Virus-1 Infection

Cited by 2 publications

References 39 publications

Severe Strongyloidiasis with Negative Serology after Corticosteroid Treatment

Severe Strongyloidiasis with Negative Serology after Corticosteroid Treatment

Severe Strongyloidiasis With Negative Serology After Corticosteroid Treatment

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