Strongyloidiasis: challenges in diagnosis and management in non-endemic Kuwait

Abstract

Among immunocompromised individuals, hyper-infection with Strongyloides stercoralis may occur and lead to fatal strongyloidiasis. To clinicians and laboratory diagnosticians in non-endemic countries such as Kuwait, this severe infection poses a particular problem. The clinical histories and signs and symptoms of four Kuwaiti cases of S. stercoralis hyper-infection were reviewed. Each of the four was found not only to have lived in an area where S. stercoralis was endemic but also to have been treated with immunosuppressive steroids (for medical problems unrelated to the nematode infection). When they presented with undiagnosed hyper-infections their clinical features were confusing. Three of the cases, all with low eosinophil counts, died but the other, who was treated with thiabendazole, survived. In the light of these observations, healthy medical examinees who had recently moved from endemic zones were checked for asymptomatic S. stercoralis infection, both by stool examination and ELISA-based serology. Of 381 stool samples investigated over a 3-month period, 183 (48%) were found positive for helminths, 7% for S. stercoralis. Of 198 individuals from endemic zones who were screened after another medical examination, 71 (35.8%) were found positive for intestinal helminth parasites, including one (1.45%) infected with S. stercoralis. Although ELISA appear reliable in making a presumptive diagnosis of strongylodiasis, the results of such assays are not very specific and are best interpreted in conjunction with the patient's clinical status. The concurrent administration of anthelminthics to patients prescribed steroids who, because they live or have lived in an area where S. stercoralis is endemic, are at risk of infection with the nematode, should be considered.

Severe strongyloidiasis: a systematic review of case reports

“…In these areas of low/no endemicity, half of the patients were immigrants (70/146, 48%), while a few subjects were veterans (5/146, 3%) who presumably acquired the infection during military service in an endemic country. Other areas of low endemicity where cases have been reported are in Eastern Asia (21 cases, mostly from Japan ( [170-177]) and Taiwan ( [178-182])), the Arabian peninsula (nine cases, mostly from Kuwait ( [183,184]) and Qatar ( [185,186])) and Israel ( [187,188]) (three cases). Countries such as Iran ( [189]), Turkey ( [190]) and Venezuela ( [191]) that might be presumed at medium to high prevalence, account for only one case each.…”

IgG avidity in differential serodiagnosis of human strongyloidiasis active infection

“…Furthermore, immunodiagnostic tests are not able to distinguish cases with positive coproparasitological tests from those with negative stool examination for S. stercoralis larvae but with positive serology. For that reason there is no established ideal screening strategy [26,27].…”

Hookworm and Threadworm Infections and Their Association With Hemoglobin and Eosinophil Concentrations in Residents of Salvador-Bahia, Brazil

“…Controversially, the S. stercoralis-infected groups were not significantly different from the control group, except the adult male group. The development of anemia in S. stercoralis-infected individuals is correlated with alcoholism, malnutrition, the breakdown of local immune responses, and/or alterations in intestinal barriers 24,39,52 . Our population is characterized by a high socioeconomic status with access to basic sanitation and a good nutritional status.…”