Strongyloides stercoralis pancolitis in an immunocompetent patient

Sridhara, Srividya; Simon, Norman; Raghuraman, U.V.; Crowson, Neil; Aggarwal, Vishal

doi:10.1016/j.gie.2007.11.020

Cited by 9 publications

(14 citation statements)

References 16 publications

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“…Thirty-seven articles were found, of which 2 were reports of strongyloides hyperinfection in immunocompetent patients. 3,4 The references of these 2 reports were reviewed for further publications but none were found.…”

Section: Literature Reviewmentioning

confidence: 99%

Strongyloides as a Cause of Fever of Unknown Origin

Neumann¹,

Ritter²,

Mounsey

2012

The Journal of the American Board of Family Medicine

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Strongyloides is endemic in parts of the United States. Most often it is asymptomatic but it has a wide range of clinical presentations. Because of the unusual capacity of strongyloides for autoinfection, it can cause hyperinfection, when it effects the pulmonary and gastrointestinal systems, or disseminated infection, when other organs are involved. Both hyperinfection and disseminated strongyloides usually occur in immunosuppressed patients. We report a case of hyperinfection with strongyloides in a man presenting with fever of unknown origin who was not immunosuppressed. ( A 36-year-old Hispanic man presented with 4 weeks of fever up to 38.8°C, a nonproductive cough, generalized abdominal pain, and a 12-lb weight loss. He had no history of tick exposure, contact with sickness, or recent travel. He had been treated previously with antiviral medication for influenza and with ciprofloxacin for presumptive prostatitis with no improvement in his symptoms. He had no significant medical history and was not taking any chronic medications. He worked as a brick layer and lived with his wife and children in rural North Carolina; he denied alcohol use. Review of systems was negative for diarrhea, vomiting, rash, night sweats, and dysuria. It was positive for headache, malaise, myalgias, arthralgias, and decreased appetite.Physical examination revealed a well-nourished, well-developed man who appeared flushed but was otherwise in no acute distress. He had a temperature of 38.6°C, pulse of 95 beats per minute, respiratory rate of 22 breaths per minute, and blood pressure of 146/83 mm Hg. Physical examination was otherwise normal. Laboratory examination revealed a white blood cell count of 11.2 ϫ 10

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Section: Literature Reviewmentioning

confidence: 99%

Strongyloides as a Cause of Fever of Unknown Origin

Neumann¹,

Ritter²,

Mounsey

2012

The Journal of the American Board of Family Medicine

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“…In immunocompromised individuals, autoinfection may give rise to potentially fatal hyperinfection with disseminated strongyloidiasis. Severe strongyloidiasis has a mortality rate of approximately 60% [6]. In the present study, not all patients had accompanying hyperinfection or disseminated strongyloidiasis.…”

Section: Discussionmentioning

confidence: 47%

“…Up to 30% infected individuals are asymptomatic [6]. In immunocompromised individuals, autoinfection may give rise to potentially fatal hyperinfection with disseminated strongyloidiasis.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopic Findings and Pathologic Characteristics of Strongyloides Colitis: A Case Series

Matsui¹,

Hokama

Makishi³

et al. 2011

Digestion

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Background/Aims: Strongyloidiasis, which is caused by Strongyloides stercoralis, is one of the prevalent infections in the tropical and subtropical regions worldwide. The larvae mainly infect the small intestine and cause serious disseminated strongyloidiasis. Although upper gastrointestinal features in strongyloidiasis are well known, colonoscopic evaluation has not been established yet. The aim of this study is to clarify the characteristic findings on colonic lesions in strongyloidiasis. Method: From January 2005 to December 2009, 10 cases with strongyloidiasis underwent colonoscopy at a single center on an endemic island of Japan. The clinical and colonoscopic findings were analyzed retrospectively. Results: Six (60%) cases had an immunocompromised condition, including human T lymphotropic virus type 1 infection, corticosteroids, and chemotherapy. Hyperinfection or disseminated strongyloidiasis was not presented. Endoscopic features included yellowish-white nodules, erythema, and loss of vascular pattern, which were mainly observed in the right colon. Pathological examination revealed the filariform Strongyloides larvae and the eosinophilic infiltration of the lamina propria. Conclusion: This study demonstrates that colonoscopic observation and biopsies are very useful to diagnose strongyloidiasis. Asymptomatic cases with strongyloidiasis can have colonic involvement. Yellowish-white nodules may be a characteristic finding of colonic lesions in strongyloidiasis and can be a cautious marker to prevent fatal disseminated strongyloidiasis in endemic regions.

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“…Strongyloides stercoralis infections are acquired at a young age when infective filariform larvae in fecally contaminated soil penetrate the skin, travel to the lungs, and migrate to the duodenum and upper jejunum to mature, 2–4,7 where adult female larvae lay eggs 4,6–8 . Hatched non‐infective rhabditiform larvae are passed in the stool, or transform into filariform larvae, initiating an autoinfection cycle by penetrating the colonic mucosa or perianal skin 1,2,5–8 .…”

Section: Discussionmentioning

confidence: 99%

“…Most patients with S. stercoralis hyperinfection are immunocompromised, most commonly from corticosteroids or HTLV‐1 infection 2,5 . Oral administration of ivermectin, albendazole, or thiabendazole results in a high cure rate 1–8 …”

Section: Discussionmentioning

confidence: 99%

Diagnostic Yield of Double‐balloon Enteroscopy With Intestinal Juice Analysis for Intestinal Strongyloidiasis

Nakamura

Matsushita

Tahashi

et al. 2010

Digestive Endoscopy

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Strongyloidiasis is relatively common in tropical and subtropical areas. Most patients with Strongyloides stercoralis hyperinfection are immunocompromised, most commonly from corticosteroids or human T-cell lymphoma virus type 1 (HTLV-1) infection. We encountered a patient with HTLV-1 infection accompanied by paralytic ileus, in whom strongyloidiasis in the duodenum and jejunum was disclosed by esophagogastroduodenoscopy (EGD) and double-balloon enteroscopy (DBE). Until the age of 7 years, he lived on Amami-Oshima Island, Japan, where both S. stercoralis and HTLV-1 are endemic. EGD and peroral DBE disclosed white villi, edematous mucosa, and the disappearance of folds in the duodenum and jejunum. Biopsy specimens from the white villi in the duodenum and jejunum revealed S. stercoralis larvae. In both duodenal and jejunal juice, the rhabditiform larvae moved around. Because the larvae invade the lymph vessels, resulting in lymphangiectasia in edematous enteritis, the appearance of white villi may reflect villous atrophy/destruction and mucosal edema. Although our patient revealed no eosinophilia and negative stool specimens for parasites or ova, EGD and DBE with multiple biopsies and intestinal juice analysis are valuable diagnostic tools for strongyloidiasis.

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Strongyloides stercoralis pancolitis in an immunocompetent patient

Cited by 9 publications

References 16 publications

Strongyloides as a Cause of Fever of Unknown Origin

Strongyloides as a Cause of Fever of Unknown Origin

Colonoscopic Findings and Pathologic Characteristics of Strongyloides Colitis: A Case Series

Diagnostic Yield of Double‐balloon Enteroscopy With Intestinal Juice Analysis for Intestinal Strongyloidiasis

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