scholarly journals Strongyloides stercoralis in the Immunocompromised Population

2004 ◽  
Vol 17 (1) ◽  
pp. 208-217 ◽  
Author(s):  
Paul B. Keiser ◽  
Thomas B. Nutman
Keyword(s):  
Hematologic Malignancy ◽  
Clinical Manifestations ◽  
Parasite Burden ◽  
Strongyloides Stercoralis ◽  
Glucocorticoid Treatment ◽  
T Lymphotropic Virus ◽  
Intestinal Nematode ◽  
Increased Risk ◽  
Hyperinfection Syndrome ◽  
And Migration

SUMMARY Strongyloides stercoralis is an intestinal nematode of humans that infects tens of millions of people worldwide. S. stercoralis is unique among intestinal nematodes in its ability to complete its life cycle within the host through an asexual autoinfective cycle, allowing the infection to persist in the host indefinitely. Under some conditions associated with immunocompromise, this autoinfective cycle can become amplified into a potentially fatal hyperinfection syndrome, characterized by increased numbers of infective filariform larvae in stool and sputum and clinical manifestations of the increased parasite burden and migration, such as gastrointestinal bleeding and respiratory distress. S. stercoralis hyperinfection is often accompanied by sepsis or meningitis with enteric organisms. Glucocorticoid treatment and human T-lymphotropic virus type 1 infection are the two conditions most specifically associated with triggering hyperinfection, but cases have been reported in association with hematologic malignancy, malnutrition, and AIDS. Anthelmintic agents such as ivermectin have been used successfully in treating the hyperinfection syndrome as well as for primary and secondary prevention of hyperinfection in patients whose exposure history and underlying condition put them at increased risk.

scholarly journals Human infection withStrongyloides stercoralisand other related Strongyloides species

Parasitology ◽  
2016 ◽  
Vol 144 (3) ◽  
pp. 263-273 ◽  
Author(s):  
THOMAS B. NUTMAN
Keyword(s):  
Immune Responses ◽  
Immune Status ◽  
Treatment Options ◽  
Strongyloides Stercoralis ◽  
Human Infection ◽  
Molecular Tests ◽  
Intestinal Nematode ◽  
Hyperinfection Syndrome ◽  
Asymptomatic Infections ◽  
And Control

SUMMARYThe majority of the 30–100 million people infected withStrongyloides stercoralis, a soil transmitted intestinal nematode, have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding because of the autoinfective process associated with its unique life cycle. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. Corticosteroid use and HTLV-1 infection are most commonly associated with the hyperinfection syndrome.Strongyloidesadult parasites reside in the small intestine and induce immune responses both local and systemic that remain poorly characterized. Definitive diagnosis ofS. stercoralisinfection is based on stool examinations for larvae, but newer diagnostics – including new immunoassays and molecular tests – will assume primacy in the next few years. Although good treatment options exist for infection and control of this infection might be possible,S. stercoralisremains largely neglected.

scholarly journals Strongyloides stercoralis hyperinfection: an unusual cause of gastrointestinal bleeding

2015 ◽  
Vol 61 (4) ◽  
pp. 311-312 ◽  
Author(s):  
Juliana Trazzi Rios ◽  
Matheus Cavalcante Franco ◽  
Bruno da Costa Martins ◽  
Elisa Ryoka Baba ◽  
Adriana Vaz Safatle-Ribeiro ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Strongyloides Stercoralis ◽  
Pulmonary Involvement ◽  
Parasitic Disease ◽  
Diagnostic Challenge ◽  
Infective Larvae ◽  
Hyperinfection Syndrome ◽  
And Migration

SummaryStrongyloidiasis is a parasitic disease that may progress to a disseminated form, called hyperinfection syndrome, in patients with immunosuppression. The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy.

scholarly journals Epidemiology and etiopathogenesis of multiple myeloma and monoclonal gammapathy of undetermined significance

2018 ◽  
Vol 72 ◽  
pp. 953-965
Author(s):  
Anna Suska ◽  
Artur Jurczyszyn
Keyword(s):  
Risk Factors ◽  
Multiple Myeloma ◽  
Genetic Predisposition ◽  
Hematologic Malignancy ◽  
Clinical Manifestations ◽  
Bone Lesions ◽  
First Degree Relatives ◽  
Monoclonal Gammapathy ◽  
Increased Risk ◽  
Undetermined Significance

Multiple myeloma (MM) accounts for about 13% of haematological malignancies. Etiopathogenesis is still not fully understood. Confirmed risk factors include the following: age, male sex, black race and MM among first-degree relatives. MM may be preceded by monoclonal gammapathy of undetermined significance (MGUS). The risk of progression is about 1% per year. Genetic changes, proinflammatory and proangiogenic cytokines and some infections may play a role in this risk. With regard to lifestyle risk factors, only obesity and overweight were associated with increased MM incidence and elevated risk for transformation of MGUS to MM. Regarding occupational exposure, there is an increased risk of MM among farmers, firefighters and hairdressers. As far as autoimmune diseases are concerned, only ankylosing spondylitis and pernicious anemia are associated with significantly increased MM risk. Increased risk of MM was also reported in relatives of MM patients, especially in first-degree relatives and in African-American families. The risk of MGUS is elevated in both first-degree relatives of MM and MGUS patients. Data from genetic analysis indicated translocations involving immunoglobulin heavy chain (IGH) loci, hyperphosphorylation of several proteins which are the targets for paraproteins produced by malignant plasma cells and single nucleotide polymorphisms (susceptibility loci) as the potential genetic predisposition to multiple myeloma. The mechanism of heterogeneity of clinical manifestations of MM is not known. Anemia is less frequent in patients whose relatives were diagnosed with hematologic malignancy compared to those with a negative family history. In patients from a younger age group, osteolytic bone lesions were more common than in older patients. In conclusion, environmental exposures modify the genetic predisposition to MM and MGUS.

scholarly journals ACUTE AND CHRONIC STRONGYLOIDIASIS IN RUSSIAN TOURISTS TRAVELLED TO THAILAND, THE COAST OF BLACK SEA IN RUSSIA AND ABKHAZIA: PROBLEMS OF DIAGNOSIS AND TREATMENT. ANALYSIS OF CASES AND REVIEW

2017 ◽  
Vol 22 (3) ◽  
pp. 156-161
Author(s):  
Aleksandr M. Bronshteyn ◽  
L. V Fedyanina ◽  
N. A Malyshev ◽  
V. Ya Lashin ◽  
S. V Burova ◽  
...  
Keyword(s):  
Black Sea ◽  
Strongyloides Stercoralis ◽  
Abdominal Discomfort ◽  
Peripheral Eosinophilia ◽  
Increased Risk ◽  
Hyperinfection Syndrome ◽  
Risk Patients ◽  
Treatment Analysis ◽  
High Level ◽  
Disseminated Disease

Cases of acute and chronic Strongyloides stercoralis are presented as tourists travelled to Thailand, the coast of Black sea in Russia and Abkhazia. A high level of clinical suspicion is required to make the diagnosis of strongyloidiasis in at-risk patients presenting with peripheral eosinophilia, unexplained intermittent diarrhea, abdominal discomfort and skin rashes. Owing to increased risk of developing disseminated disease or hyperinfection syndrome, early detection and treatment of strongyloidiasis are extremely important. Strongyloidiasis should be routinely investigated in patients with chronic diseases who will undergo immunosuppressive therapy. Ivermectin or thiabendazole currently is the treatment of choice which are more effective than albendazole.

scholarly journals Strongyloides hyperinfection syndrome, Cytomegalovirus enteritis with viremia and recurrent gram-negative sepsis in a patient with recurrent thymoma: a case report

2021 ◽  
Vol 9 (4) ◽  
pp. 1212
Author(s):  
Rama Narasimhan ◽  
Neetu Mariam Alex ◽  
Phani Machiraju ◽  
Meera Shankar
Keyword(s):  
Strongyloides Stercoralis ◽  
Severe Form ◽  
Immunosuppressed Patient ◽  
Myasthenic Crisis ◽  
Intravenous Ganciclovir ◽  
Gram Negative ◽  
Multiple Risk Factors ◽  
Intestinal Nematode ◽  
Hyperinfection Syndrome ◽  
High Index Of Suspicion

Strongyloides stercoralis is an intestinal nematode which is endemic in tropical and subtropical countries.  It may cause asymptomatic infections, mild eosinophilia or hyperinfection syndrome in the most severe form. We are reporting a case of Strongyloides hyperinfection syndrome in an immunosuppressed patient with recurrent thymoma and myasthenic crisis. This patient is a 51-year-old man with myasthenia gravis on long term pyridostigmine and prednisolone and mycophenolate. He presented with copious diarrhoea and was in septic shock. His blood and urine cultures grew Klebsiella pneumoniae and Pseudomonas aeruginosa. Oesophago-gastro-duodenoscopy (OGD scopy) and biopsy showed severe active duodenitis with strongyloidiasis and moderate active antral gastritis with strongyloidiasis. He was diagnosed to have Strongyloides hyperinfection and was treated with oral Ivermectin. He recovered well. He was subsequently diagnosed to have CMV enteritis with viraemia and was treated with intravenous Ganciclovir. Our case emphasizes the association of Strongyloides hyperinfection with superimposed CMV infection and gram-negative sepsis due to prolonged immunosuppression and autoimmunity in Thymoma patients. Recurrent thymoma and high-grade infiltrative thymoma often poses difficulty in the management of myasthenia patients. A high index of suspicion and aggressive treatment is paramount in approaching a patient with multiple risk factors of hyperinfection syndrome and autoimmunity. This case is reported in view of its rarity and significance regarding the multidisciplinary approach in decreasing morbidity and mortality in hyperinfection syndrome with an autoimmune background.

scholarly journals Strongyloidiasis in the gastrointestinal biopsy

Pulse ◽  
1970 ◽  
Vol 3 (1) ◽  
pp. 27-28
Author(s):  
A Khaled ◽  
N Ara ◽  
LL Chawdhury ◽  
TA Nasir
Keyword(s):  
Strongyloides Stercoralis ◽  
Precise Estimate ◽  
Stool Examination ◽  
Disseminated Infection ◽  
Human Host ◽  
Infective Larvae ◽  
Intestinal Nematode ◽  
Hyperinfection Syndrome ◽  
Detection And Diagnosis

Strongyloides stercoralis is an intestinal nematode of humans. It is estimated that tens of millions of persons are infected worldwide, although no precise estimate is available [1].S. stercoralis is distinguished by its ability-unusual among helminths-to replicate in the human host. This capacity permits ongoing cycles of autoinfection as infective larvae are internally produced. Strongyloides can thus persist for decades without further exposure of the host to exogenous infective larvae [2]. Most infected individuals are asymptomatic, but under some conditions associated with immunocompromise, this autoinfective cycle can become amplified into a potentially fatal hyperinfection syndrome and disseminated infection [3]. Diagnosis of Strongyloides stercoralis is usually made by stool examination. Detection and diagnosis of strongyloidiasis in the gastrointestinal biopsy is relatively rare [4].DOI: 10.3329/pulse.v3i1.6551Pulse Vol.3(1) July 2009 p27-28

Comparative analysis of polymorphic variants of IL-17A and MMP-1 genes with the risk of developing chronic periodontitis in petrochemical workers

2020 ◽  
Vol 60 (10) ◽  
pp. 687-693
Author(s):  
Iskander I. Zaidullin ◽  
Denis O. Karimov ◽  
Lilija K. Karimova ◽  
Milyausha F. Kabirova ◽  
Rasima R. Galimova ◽  
...  
Keyword(s):  
Ethylene Oxide ◽  
Chronic Periodontitis ◽  
Periodontal Diseases ◽  
Clinical Manifestations ◽  
Control Group ◽  
Periodontal Tissues ◽  
Dental Examination ◽  
Number Of Patients ◽  
Increased Risk ◽  
Harmful Substances

The susceptibility to the development and progression of inflammatory periodontal diseases, which depends on genetic and external factors (smoking, stress, oral hygiene), varies widely. In the development of these diseases, an important role is played not only by the presence of periodontal pathogenic microorganisms, but also by the presence of congenital or acquired immunodeficiency, immunoregulatory defects. The immune system plays a key role in the physiological and pathological processes of periodontal tissues. In this regard, IL17, produced by CD4+ Th cells, which has both Pro-inflammatory and protective activity, is of particular interest in the pathogenesis of periodontitis. The aim of study was to identify the relationship between polymorphic loci of the IL-17A (rs2275913) and MMP-1 (rs1799750) genes and clinical manifestations of chronic periodontitis in petrochemical workers. Dental examination was performed in 92 ethylene oxide production workers with chronic periodontitis and 74 patients with chronic periodontitis who did not come into contact with chemical factors (control group). Genotyping of polymorphisms rs2275913 of the IL17A gene and rs1799750 of the MMP1 gene was performed by allele-specific real-time polymerase chain reaction (PCR). Hygienic assessment of the degree of air pollution of the working area with harmful substances was carried out by gas chromatography according to the guidelines for the determination of harmful substances in the air № 5098-89, № 3119-84. When comparing the results of studies of both groups, there were no statistically significant differences in the frequency distributions of allelic variants and genotypes of the IL-17A and MMP-1 genes. The AA/AG genotypes of the IL-17A gene were associated with an increased risk of severe disease compared to the GG genotype in workers in the main group (OR=6.1; 95% CI 1.33-28.5; p=0.021) and in the control group (OR=7.26; 95% CI 1.34-39.25; p=0.016). Carriers of the A allele in the control group increased the risk of severe chronic periodontitis by 2.4 times compared to carriers of the G allele (OR=2.41; 95% CI 1.19-4.87; p=0.014). During the dental examination of employees of the ethylene oxide plant, the clinical course of periodontal diseases was more severe in comparison with the control group, and the number of patients with severe periodontitis was twice as high. It was found that the AA/AG genotypes of the IL-17A gene and the carrier of the A allele are associated with increased susceptibility to the development of severe chronic periodontitis. The association between the MMP-1 gene polymorphism and the risk of severe forms of chronic periodontitis has not been established. A risk factor for the development of inflammatory periodontal diseases in employees of the petrochemical complex is a complex of harmful production factors.

scholarly journals 1095. Investigation of Risk Factors Associated with Serious Bacterial, Viral and Invasive Fungal Infections in Hematologic Patients on Ibrutinib

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S576-S577
Author(s):  
Thomas Holowka ◽  
Harry Cheung ◽  
Maricar F Malinis ◽  
Sarah Perreault ◽  
Iris Isufi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fungal Infections ◽  
Antimicrobial Prophylaxis ◽  
Hematologic Malignancy ◽  
Invasive Fungal Infections ◽  
Risk Of Infection ◽  
Factors Associated ◽  
Serious Infection ◽  
Increased Risk ◽  
Serious Infections

Abstract Background Ibrutinib is a tyrosine kinase inhibitor used to treat hematologic malignancies that may increase the risk of serious infection including invasive fungal infections (IFI). In a study of 378 patients with hematologic malignancy on ibrutinib, serious infection and IFI occurred in 11% and 4% respectively (Varughese et al. Clin Infect Dis). The primary aims of our study were to determine the incidence of serious infection and associated risk factors in patients on ibrutinib. Methods We performed a retrospective analysis of patients with hematologic malignancy prescribed ibrutinib for ≥ 1 week at Yale New Haven Hospital from 2014 to 2019 to identify serious infections defined as those requiring inpatient management. We collected demographic, clinical and oncologic data. Chi-squared tests were used to determine factors associated with an increased risk of infection. Results A total of 254 patients received ibrutinib including 156 with CLL, 89 with NHL and 9 with other leukemias. Among these, 21 underwent HSCT, 9 complicated by GVHD. There were 51 (20%) patients with serious infections including 45 (17.7%) bacterial, 9 (3.5%) viral and 5 (2%) IFI (1 pulmonary cryptococcosis, 4 pulmonary aspergillosis). Anti-mold prophylaxis was prescribed to 7 (2.8%) patients, none of whom developed IFI. Risk factors associated with serious infection included ECOG score ≥ 2 (OR 4.6, p < 0.001), concurrent steroid use (≥ 10 mg prednisone daily for ≥ 2 weeks; OR 3.0, p < 0.001), neutropenia (OR 3.6, p < 0.01), lymphopenia (OR 2.4, p < 0.05) and maximum ibrutinib dose of 560 mg (OR 2, p < 0.05). There was a dose dependent increase in infections based on number of chemotherapy regimens prior to ibrutinib initiation: 14.3% with 0, 19.7% with 1-2 and 28.7% with ≥ 3 prior treatments. Conclusion The incidence of serious infection in hematologic patients on ibrutinib was higher than previously reported (20% versus 11%) but the rate of IFI was lower (2% versus 4%). High ECOG score, leukopenia, steroids, and higher ibrutinib doses were associated with an increased risk for serious infection. Targeted antimicrobial prophylaxis should be considered for patients on ibrutinib with these risk factors. Improving functional status may also reduce the risk of infection in patients on ibrutinib. Disclosures All Authors: No reported disclosures

scholarly journals 1707. Clinical Profile of Human T-Lymphotropic Virus Type I Infection in Pediatric Population in a Referral Hospital in Colombia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S836-S837
Author(s):  
Juliana Mejia- Mertel ◽  
Juan P Rojas -Hernandez
Keyword(s):  
Virus Type ◽  
Low Income ◽  
Pacific Coast ◽  
Vision Loss ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Low Income Countries ◽  
Nutritional Deficiencies ◽  
Type I ◽  
T Lymphotropic Virus

Abstract Background The Human T-lymphotropic virus type 1 (HTLV-1), affects around ten to twenty million people worldwide, predominantly in intertropical regions (Africa, Japan, Melanesia, Australia, and South America Pacific Coast). The most common disorders associated are T-cell leukemia/lymphoma (ALT) and HTLV-1-associated myelopathy (HAM). Studies have reported other clinical manifestations in HTLV-1, still studies are needed in pediatric population to improve diagnosis and treatment of infected patients. Methods Descriptive, retrospective cohort study, conducted in our referral pediatric hospital in Cali, Colombia. Included pediatric patients (1 to 18 years of age) diagnosed with HTLV-1 infection, between January 2017 to March 2020. Results Twelve patients were included, seven males and five females. Eleven patients were from and resided in the Colombian Pacific coast. Ten patients showed nutritional deficiencies. None showed clinical or laboratory signs of ALT, neither neurological symptoms or physical exam suggesting HAM. In terms of associated diseases and opportunistic infections, none had a positive HIV ELISA test, and stool tests were all negative for Strongiloydes. Four presented infective dermatitis, and two showed lesions suggesting scabies. Eight patients presented respiratory symptoms with chest CT scans showing signs of chronic inflammation, bronchiectasis, and subpleural bullae as the major findings. Additional tests were carried out in bronchoalveolar fluid, four had positive galactomannan test,suggesting pulmonary aspergillosis, two exhibited positive gene PCR testing for Mycobacterium tuberculosis. Regarding inflammatory diseases, one patient presented with symptoms of Inflammatory Bowl Disease, with biopsy confirming Crohn’s disease. Another patient presente abrupt vision loss, diagnosed with Vogt Koyanagi Hadara Syndrome after ophthalmological evaluation. Summary features HTLV-1 patients Ground-glass opacity diffusely distributed in both lungs with multiple bronchiectasis involving predominantly lung bases. Cystic images diffusely distributed in both lungs, some subpleural and other centrilobular. Conclusion It is important to consider alternative manifestations of HTLV-1 infection in the pediatric population, including pulmonary disease, opportunistic co-infections, and inflammatory disorders. It is crucial to diagnose this disease in childhood to reach a better control of this neglected infection that affects predominantly vulnerable population in low-income countries. Disclosures All Authors: No reported disclosures

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