244 Inclusion of Strongyloides stercoralis Infection in the Differential Diagnoses of Nonspecific Gastrointestinal Symptoms and Hypereosinophilia Among Immunocompromised Patients With a History of Outside Travel

Background:Strongyloidiasis is self-limited by the complete immune system, it may be complicated and causes hyperinfection in immunocompromised patients. Objective: Here, we report a case of an immunocompromised patient with duodenal involvement ofStrongyloides stercoralis.Case Report:A 65-year-old man presented with severe pain in central abdomen and periumbilical regions. He had no history of alcohol consumption, smoking and surgery but the history of RA (Rheumatoid Arthritis) and hypothyroidism taking immunosuppressive medications. The patient underwent endoscopy and colonoscopy which pathological analysis of the biopsies revealed remarkable findings in favor of Strongyloidiasis. After two consecutive day’s consumption of ivermectin 200µg/kg, the symptoms were completely removed. Also, the stool examination was negative forS.stercoralislarvae two weeks after end of the treatment.Conclusions:It seems that in immunocompromised patients with gastrointestinal symptoms assumption of parasite-like infections such as Strongyloidiasis should be considered as one of the diagnosis options. Due to the physiological and gut microbial alternations, these patients are more susceptible to infectious diseases.

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The Importance of Screening Strongyloides stercoralis Infection in Solid Organ Transplant Donors and Recipients

Archives of Clinical Infectious Diseases ◽

10.5812/archcid.118047 ◽

2021 ◽

Vol 16 (4) ◽

Author(s):

Sara Abolghasemi ◽

Farnaz Zolfaghari ◽

Shahnaz Sali ◽

Abdollah Ghaffari ◽

Mehran Noori

Keyword(s):

Organ Transplant ◽

Gastrointestinal Symptoms ◽

Strongyloides Stercoralis ◽

Solid Organ Transplant ◽

Solid Organ ◽

Kidney Transplant Recipients ◽

Place Of Residence ◽

Birth Place ◽

Immunosuppressed Patients ◽

History Of

Background: Strongyloides stercoralis is an intestinal nematode with worldwide distribution which is endemic in tropical and subtropical areas. It is unique in its ability to complete its entire life cycle and reinfect its human host via a phenomenon called autoinfection. The majority of infections are clinically asymptomatic or can manifest with gastrointestinal symptoms, such as heartburn, bloating, diarrhea, abdominal discomfort, gastroesophageal reflux disease (GERD), or symptoms related to the penetration of larvae through skin, including dermatitis and eosinophilia. Immunosuppressed patients, such as solid organ transplant patients with untreated strongyloidiasis are at great risk of hyperinfection, dissemination syndromes, and often fatal conditions associated with strongyloidiasis. Methods: In this retrospective single-center cross-sectional study, we evaluated 157 cases (131 heart, lung, and kidney transplant recipients and 26 kidney donors) in Tehran, Iran, from March 2020 to April 2021. Demographic information including age, gender, place of birth, place of residence, underlying disease, being the donor or recipient, history of previous transplant and type of transplant, travel history to endemic regions, and seropositivity for S. stercoralis were evaluated. Results: Among 157 cases with a mean age of 38.9 years, 40 (25.5%) cases tested positive for S. stercoralis antibodies. Out of 26 donors, eight cases were seropositive, and among 131 recipients, 32 cases were seropositive. There was no significant correlation between birth place and place of residence in endemic areas and seropositivity for S. stercoralis. None of the cases showed hypereosinophilia, hyperinfection, or disseminated syndrome. Also, we found no significant correlation between the type and time of transplant, history of previous transplants, and S. stercoralis infection. Conclusions: Universal screening for S. stercoralis latent infection is important in immunosuppressed patients, especially in solid organ transplants because of the high risk of hyperinfection and disseminated syndrome, which may culminate in death. Furthermore, screening for latent strongyloides infection in donors seems to be necessary because of the possibility of strongyloides infection being transmitted from donors to recipients.

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Staphylococcus warneri meningitis in a patient with Strongyloides stercoralis hyperinfection and lymphoma: first report of a case

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652010000300011 ◽

2010 ◽

Vol 52 (3) ◽

pp. 169-170 ◽

Cited By ~ 12

Author(s):

Renzo Nino Incani ◽

Marcos Hernández ◽

Jackeline Cortez ◽

María Elena González ◽

Yaimir Dorel Salazar

Keyword(s):

Cell Lymphoma ◽

Gastrointestinal Symptoms ◽

Strongyloides Stercoralis ◽

Staphylococcus Warneri ◽

Hyperinfection Syndrome ◽

History Of ◽

Cerebrospinal Fluid Culture ◽

Mantel Cell Lymphoma ◽

First Time ◽

Fluid Culture

A case of meningitis due to Staphylococcus warneri in a patient with a hyperinfection with Strongyloides stercoralis possibly associated with rituximab treatment for mantel cell lymphoma is reported for the first time in the literature. The patient was a 59-year-old woman, with a 3-year history of an apparently well controlled lymphoma after treatment with chemotherapy-immunotherapy and then immunotherapy alone, and diagnosis of strongyloidiasis. Meningitis was diagnosed by cerebrospinal fluid culture and tested with an automated plate system. The patient was successfully treated with vancomycin; although fever and productive cough persisted. Severe gastrointestinal symptoms and pneumonia developed three weeks later. Hyperinfection syndrome by S. stercoralis was diagnosed, with abundant larvae in feces and expectoration.

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E. coliMeningitis Presenting in a Patient with DisseminatedStrongyloides stercoralis

Case Reports in Infectious Diseases ◽

10.1155/2013/424362 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Juliana B. Gomez ◽

Yvan Maque ◽

Manuel A. Moquillaza ◽

William E. Anicama

Keyword(s):

Gastrointestinal Symptoms ◽

Abdominal Distension ◽

Strongyloides Stercoralis ◽

The Body ◽

Case Presentation ◽

E Coli ◽

History Of ◽

Disseminated Strongyloidiasis ◽

Proper Diagnosis ◽

Cerebrospinal Fluid Culture

Introduction. SpontaneousEscherichia colimeningitis is an infrequent condition in adults and is associated with some predisposing factors, including severeStrongyloides stercoralis(SS) infections.Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell’s palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrumβ-lactamase producingE. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multipleStrongyloideslarvae throughout the body.Conclusion.Strongyloides stercoralisinfection should be excluded in adults with spontaneousE. colimeningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis.

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Voltage-gated potassium channel limbic encephalitis presenting as functional cognitive impairment

BMJ Case Reports ◽

10.1136/bcr-2019-233179 ◽

2020 ◽

Vol 13 (12) ◽

pp. e233179

Author(s):

Eric Garrels ◽

Fawziya Huq ◽

Gavin McKay

Keyword(s):

Cognitive Impairment ◽

Case Report ◽

Potassium Channel ◽

Limbic Encephalitis ◽

Psychiatric Symptoms ◽

Differential Diagnoses ◽

Visual Hallucinations ◽

Voltage Gated ◽

History Of ◽

Impaired Cognition

Limbic encephalitis is often reported to present as seizures and impaired cognition with little focus on psychiatric presentations. In this case report, we present a 49-year-old man who initially presented to the Psychiatric Liaison Service with a several month history of confusion with the additional emergence of visual hallucinations and delusions. Due to the inconsistent nature of the symptoms in the context of a major financial stressor, a provisional functional cognitive impairment diagnosis was made. Investigations later revealed a positive titre of voltage-gated potassium channel (VGKC) antibodies, subtype leucine-rich glioma inactivated 1 accounting for his symptoms which dramatically resolved with steroids and immunoglobulins. This case highlighted the need for maintaining broad differential diagnoses in a patient presenting with unusual psychiatric symptoms.

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Asymptomatic Eosinophilic Infiltration with Endoscopic and Histological Findings Consistent with Eosinophilic Gastritis

Case Reports in Gastroenterology ◽

10.1159/000516688 ◽

2021 ◽

pp. 652-656

Author(s):

Kazuki Yamamoto ◽

Takeshi Okamoto ◽

Katsuyuki Fukuda

Keyword(s):

Asymptomatic Patient ◽

Gastrointestinal Symptoms ◽

The Body ◽

Eosinophilic Infiltration ◽

Histological Findings ◽

High Power Field ◽

Medical Checkup ◽

Endoscopic Findings ◽

Eosinophilic Gastritis ◽

History Of

Eosinophilic gastritis often presents with gastrointestinal symptoms in the absence of abnormal endoscopic findings. On the other hand, endoscopic changes due to eosinophilic infiltration in an asymptomatic patient are rare. A 29-year-old woman with a history of asthma on steroid inhalers presented for an annual medical checkup. Esophagogastroduodenoscopy revealed diffuse white granular patches in the body of the stomach, suggestive of eosinophilic gastritis. Histology showed over 100 eosinophils per high-power field, also consistent with eosinophilic gastritis. As the absence of symptoms precluded the diagnosis of eosinophilic gastritis, the patient was diagnosed with asymptomatic eosinophilic infiltration of the stomach.

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Carnobacterium inhibens isolated in blood culture of an immunocompromised, metastatic cancer patient: a case report and literature review

BMC Infectious Diseases ◽

10.1186/s12879-021-06095-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Carson Ka-Lok Lo ◽

Prameet M. Sheth

Keyword(s):

Metastatic Cancer ◽

Immunocompromised Patients ◽

Case Presentation ◽

Gram Positive Bacteria ◽

Disease Spectrum ◽

The Us ◽

History Of ◽

Amoxicillin Clavulanic Acid ◽

Live Bacteria ◽

Health Canada

Abstract Background Carnobacterium species are lactic acid-producing Gram-positive bacteria that have been approved by the US Food and Drug Administration and Health Canada for use as a food bio-preservative. The use of live bacteria as a food additive and its potential risk of infections in immunocompromised patients are not well understood. Case presentation An 81-year-old male with a history of metastatic prostate cancer on androgen deprivation therapy and chronic steroids presented to our hospital with a 2-week history of productive cough, dyspnea, altered mentation, and fever. Extensive computed tomography imaging revealed multifocal pneumonia without other foci of infection. He was diagnosed with pneumonia and empirically treated with ceftriaxone and vancomycin. Blood cultures from admission later returned positive for Carnobacterium inhibens. He achieved clinical recovery with step-down to oral amoxicillin/clavulanic acid for a total 7-day course of antibiotics. Conclusions This is the fourth reported case of bacteremia with Carnobacterium spp. isolated from humans. This case highlights the need to better understand the pathogenicity and disease spectrum of bacteria used in the food industry for bio-preservation, especially in immunocompromised patients.

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Metastatic Melanoma Presenting as Intussusception in an 80-Year-Old Man: A Case Report

Case Reports in Pathology ◽

10.1155/2013/672816 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Sarah Alghamdi ◽

Yumna Omarzai

Keyword(s):

Differential Diagnosis ◽

Small Intestine ◽

Gastrointestinal Tract ◽

Metastatic Melanoma ◽

Clinical Presentation ◽

Gastrointestinal Symptoms ◽

Common Site ◽

Neoplastic Process ◽

History Of ◽

Uncommon Neoplasm

Malignant melanoma of the gastrointestinal tract is an uncommon neoplasm that could be primary or metastatic. Small intestine represents the most common site for the metastatic melanoma; however, it could be found anywhere in the gastrointestinal tract. Intussusception is a rare cause of intestinal obstruction in adults compared to children. In 90% of the cases, the underlying cause can be found, and in 65% of the cases, intussusception is caused by the neoplastic process. The majority of the neoplasms are benign, and about 15% are malignant. Metastatic melanoma is one of the most common metastatic malignancies to the gastrointestinal tract; however, the premortem diagnosis is rarely made. Here, we report an uncommon clinical presentation of metastatic melanoma causing intussusception in an 80-year-old man. This diagnosis should be considered in a differential diagnosis in any patient who presents with gastrointestinal symptoms and a history of melanoma.

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Acute Iodine Toxicity from a Suspected Oral Methamphetamine Ingestion

Clinical Medicine Insights Case Reports ◽

10.4137/ccrep.s20086 ◽

2014 ◽

Vol 7 ◽

pp. CCRep.S20086 ◽

Cited By ~ 3

Author(s):

Marilyn N. Bulloch

Keyword(s):

Case Report ◽

Gastrointestinal Symptoms ◽

Liver Function Tests ◽

Oral Ingestion ◽

Methamphetamine Abuse ◽

Normal Limits ◽

Naturally Occurring ◽

History Of ◽

Systemic Symptoms ◽

Iodine Toxicity

Background Iodine is a naturally occurring element commercially available alone or in a multitude of products. Iodine crystals and iodine tincture are used in the production of methamphetamine. Although rarely fatal, iodine toxicity from oral ingestion can produce distressing gastrointestinal symptoms and systemic symptoms, such as hypotension and tachycardia, from subsequent hypovolemia. Objective The objective of this case report is to describe a case of iodine toxicity from suspected oral methamphetamine ingestion. Case Report A male in his early 20′s presented with gastrointestinal symptoms, chills, fever, tachycardia, and tachypnea after orally ingesting a substance suspected to be methamphetamine. The patient had elevated levels of serum creatinine, liver function tests, and bands on arrival, which returned to within normal limits by day 4 of admission. Based on the patient's narrow anion gap, halogen levels were ordered on day 3 and indicated iodine toxicity. This is thought to be the first documented case of iodine toxicity secondary to suspected oral methamphetamine abuse. Conclusion Considering that the incidence of methamphetamine abuse is expected to continue to rise, clinicians should be aware of potential iodine toxicity in a patient with a history of methamphetamine abuse.

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Histopathology of Gastric and Duodenal Strongyloides stercoralis Locations in Fifteen Immunocompromised Subjects

Archives of Pathology & Laboratory Medicine ◽

10.5858/2006-130-1792-hogads ◽

2006 ◽

Vol 130 (12) ◽

pp. 1792-1798 ◽

Cited By ~ 39

Author(s):

Francesco Rivasi ◽

Silvio Pampiglione ◽

Renzo Boldorini ◽

Loredana Cardinale

Keyword(s):

Colorectal Adenocarcinoma ◽

Parasitic Infection ◽

Strongyloides Stercoralis ◽

Duodenal Mucosa ◽

Gastric Ulcers ◽

Immunocompromised Patients ◽

Histologic Diagnosis ◽

Immunodeficiency Virus ◽

Gastric Biopsies ◽

Duodenal Biopsies

Abstract Context.—Strongyloidiasis is a worldwide parasitic infection affecting approximately 75 million people. In Italy, it was more prevalent in the past among rural populations of irrigated areas. Objective.—To determine the histopathologic alterations of the gastric and duodenal mucosa associated with the presence of Strongyloides stercoralis parasites. Design.—Fifteen cases of strongyloidiasis were observed in immunocompromised patients during a recent 6-year period in Italy. S stercoralis was found histologically in gastric biopsies (10 cases), in a gastrectomy (1 case), and in duodenal biopsies (9 cases). In 5 cases the parasite was present both in gastric and duodenal biopsies. Four patients were affected by lymphoma, 2 by multiple myeloma, 2 by gastric carcinoma, 1 by chronic myeloid leukemia, 1 by sideroblastic anemia, 1 by colorectal adenocarcinoma, 1 by chronic idiopathic myelofibrosis, 1 by chronic gastritis, 1 by gastric ulcers, and 1 by rheumatoid arthritis in corticosteroid therapy. No patient was affected by human immunodeficiency virus infection. Strongyloidiasis was not clinically diagnosed. Results.—Histologic examination revealed several sections of S stercoralis larvae, many eggs, and some adult forms. All the parasites were located in the gastric and/or the duodenal crypts. Eosinophils infiltrating into the lamina propria were found in all cases; their intensity was correlated with the intensity of the infection. Conclusions.—Histologic diagnosis of strongyloidiasis must be taken into consideration when examining both gastric and duodenal biopsies in immunocompromised patients, to avoid the development of an overwhelming infection of the parasite, which is dangerous for the life of the patient.

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