scholarly journals Common Presentation of an Uncommon DiseaseStrongyloidiasis could be Devastating in an Immunocompromised Host

2021 ◽  
Vol 2 (1) ◽  
pp. 47-49
Author(s):  
Mohammad Shohidul Islam
Keyword(s):  
Early Diagnosis ◽  
Immunocompromised Patient ◽  
Parasitic Infection ◽  
Immunocompromised Host ◽  
Strongyloides Stercoralis ◽  
Endoscopic Biopsy ◽  
Common Presentation ◽  
Hyperinfection Syndrome ◽  
Nonspecific Sign ◽  
Disseminated Disease

Strongyloidiasis is a chronic self-limited parasitic infection associated with mostly nonspecific sign symptoms. But in immunocompromised patient’s morbidity and mortality is high due to hyperinfection syndrome and disseminated disease. So early diagnosis is very important. Here we report a case of hyperinfection with Strongyloides stercoralis in an elderly immunocompromised patient diagnosed by endoscopic biopsy who was treated successfully later on. Keywords: Strongyloidiasis; parasitic infection; Immunocompromised host, Hyperinfection Disseminated disease

scholarly journals Strongyloidosis Hyperinfection Syndrome in an HIV-Infected Patient: A Rare Manifestation of Immune Reconstitution Inflammatory Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Kartik Natrajan ◽  
Mahenderkumar Medisetty ◽  
Raviraj Gawali ◽  
Ajit Tambolkar ◽  
Divya Patel ◽  
...  
Keyword(s):  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
Immunocompromised Host ◽  
Strongyloides Stercoralis ◽  
Parasitic Infections ◽  
Infected Female ◽  
Resource Limited ◽  
Hyperinfection Syndrome ◽  
Advanced Hiv Disease ◽  
Inflammatory Syndrome

Parasitic infections such as Strongyloides stercoralis and HIV have been reported to coexist, particularly in resource-limited settings such as India. In an immunocompromised host, S. stercoralis can progress to strongyloidiasis hyperinfection syndrome (SHS). However, SHS is not common in patients with advanced HIV disease. Immune reconstitution inflammatory syndrome (IRIS) developing after initiation of antiretroviral therapy (ART) can target multiple pathogens including S. stercoralis. The authors present here a 46-year-old HIV-infected female who was recently diagnosed with HIV-1 infection, started ART, and developed SHS. Her upper GI endoscopy revealed severe gastroduodenitis, and X-ray chest showed extensive bilateral pneumonitis. We could identify S. stercoralis in induced sputum and duodenal biopsy. We could also identify gut inflammation to restrict invading parasites. After receiving antihelminthic therapy, she showed improvement, a course of events that fit the diagnosis of unmasking S. stercoralis IRIS.

scholarly journals A Case of Bacteremia and Meningitis Associated with Piperacillin-Tazobactam Nonsusceptible, Ceftriaxone Susceptible Escherichia coli during Strongyloides Hyperinfection in an Immunocompromised Host

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Santosh Dahal ◽  
Jeffrey Lederman ◽  
Jesse Berman ◽  
Marius Viseroi ◽  
Stephen Jesmajian
Keyword(s):  
Escherichia Coli ◽  
Antibiotic Therapy ◽  
Bacterial Infections ◽  
Parasitic Infection ◽  
Immunocompromised Host ◽  
Resistance Pattern ◽  
Susceptibility Pattern ◽  
Extreme Caution ◽  
E Coli ◽  
Hyperinfection Syndrome

Strongyloidiasis is an emerging parasitic infection with intriguing epidemiology, presentation, and clinical management. We report a case of hyperinfection syndrome complicated by E. coli bacteremia and meningitis with one of the isolates showing a unique resistance pattern recently being recognized. This report describes the aspect of invasive bacterial infections in strongyloidiasis and highlights the unique susceptibility pattern of the E. coli isolate and the extreme caution required during the antibiotic therapy.

scholarly journals Ivermectin treatment for Strongyloides infection in patients with COVID-19

2021 ◽  
Vol 47 (7/8) ◽  
pp. 316-321
Author(s):  
Keyword(s):  
At Risk ◽  
Strongyloides Stercoralis ◽  
Parasitic Infections ◽  
Evidence Based ◽  
Ivermectin Treatment ◽  
Inappropriate Use ◽  
Hyperinfection Syndrome ◽  
Disseminated Disease ◽  
Immunomodulatory Therapies ◽  
To Receive

Ivermectin, an antiparasitic agent, is not recommended for prophylaxis or treatment of coronavirus disease 2019 (COVID-19). Inappropriate use of ivermectin for treatment of COVID-19 may make it less available for patients with serious parasitic infections who could benefit from its use and worsen the current shortage of ivermectin in Canada. However, patients with COVID-19 who are candidates to receive immunomodulatory therapies (e.g. corticosteroids and interleukin-6 inhibitors) may be at risk of hyperinfection syndrome and disseminated disease from Strongyloides stercoralis. These complications can be severe and even fatal. It is important to recognize and screen patients who may be at risk of strongyloidiasis, as these patients may require treatment with ivermectin to avoid the potential for a hyperinfection syndrome and disseminated disease, which is frequently deadly. Clinicians should follow evidence-based recommendations to screen and treat for Strongyloides infection in patients with COVID-19 who are under consideration to receive specific COVID-19 therapies that alter immune response and may lead to hyperinfection syndrome or disseminated disease.

scholarly journals Immunosuppression with Antitumour Necrosis Factor Therapy Leading to Strongyloides Hyperinfection Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Muhammad Farhan Khaliq ◽  
Rayan E. Ihle ◽  
James Perry
Keyword(s):  
Respiratory Failure ◽  
Multidisciplinary Approach ◽  
Parasitic Infection ◽  
Strongyloides Stercoralis ◽  
Diagnostic Challenge ◽  
Travel History ◽  
Hyperinfection Syndrome ◽  
Factor Therapy ◽  
Low Prevalence ◽  
Necrosis Factor

Strongyloides stercoralis is an endemic parasitic infection that can remain asymptomatic for years, but it can cause death in immunosuppressed individuals. Here, we present a case of Strongyloides hyperinfection in a 75-year-old male secondary to sepsis and chronic immunosuppression due to TNF-α inhibitors. Despite aggressive treatment including broad-spectrum antibiotics and antihelminths, his respiratory failure worsened and he died after palliative extubation. S. stercoralis infection remains a diagnostic challenge. Presentation with Strongyloides is often nonspecific, and eosinophilia is absent in hyperinfection. Diagnosis can be delayed, especially in low-prevalence areas where suspicion is low. Strongyloides should be considered in the differential diagnosis in the presence of risk factors including immunosuppressive therapy, and a travel history should be carefully obtained. Patients with recurrent enterobacterial sepsis or respiratory failure with diffuse infiltrates in the setting of eosinophilia should undergo testing for Strongyloides. A multidisciplinary approach can result in earlier diagnosis and favorable outcomes.

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.

Cutaneous Strongyloides Infection Postchemotherapy

2016 ◽  
Vol 20 (4) ◽  
pp. 337-339 ◽  
Author(s):  
Erica Merman ◽  
Sanjay Siddha ◽  
Jay S. Keystone ◽  
Ayman Al Habeeb ◽  
Danny Ghazarian ◽  
...  
Keyword(s):  
Skin Biopsy ◽  
Clinical Symptoms ◽  
Immunocompromised Patient ◽  
Diagnosis And Treatment ◽  
Larva Currens ◽  
Increased Risk ◽  
Hyperinfection Syndrome ◽  
Disseminated Disease

Background and Objective: While clinical symptoms of strongyloidiasis are often nonspecific, larva currens (with erythematous, serpiginous, and pruritic papules and plaques) should prompt investigation including stool microscopy, serology, and skin biopsy of the lesion. Appropriate diagnosis and treatment with ivermectin is necessary, especially in the immunocompromised patient who is at increased risk for hyperinfection syndrome and disseminated disease. Conclusion: We present a 61-year-old immunocompromised man with presentation of larva currens of cutaneous strongyloides infection without symptoms of hyperinfection or disseminated disease.

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

2006 ◽  
Vol 130 (12) ◽  
pp. 1792-1798 ◽  
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.

scholarly journals Parasitic Infections Associated with Unfavourable Outcomes in Transplant Recipients

Medicina ◽  
2018 ◽  
Vol 54 (2) ◽  
pp. 27 ◽  
Author(s):  
Wojciech Wołyniec ◽  
Małgorzata Sulima ◽  
Marcin Renke ◽  
Alicja Dębska-Ślizień
Keyword(s):  
Bone Marrow ◽  
Opportunistic Infections ◽  
Immunosuppressive Treatment ◽  
Parasitic Infection ◽  
Parasitic Infections ◽  
Solid Organ ◽  
Tropical Countries ◽  
Real Risk ◽  
Increased Risk ◽  
Disseminated Disease

Introduction. The immunosuppression used after transplantation (Tx) is associated with an increased risk of opportunistic infections. In Europe, parasitic infections after Tx are much less common than viral, bacterial and fungal ones. However, diseases caused by parasites are very common in tropical countries. In the last years the number of travellers with immunosuppression visiting tropical countries has increased. Methods. We performed a literature review to evaluate a risk of parasitic infections after Tx in Europe. Results. There is a real risk of parasitic infection in patients after Tx travelling to tropical countries. Malaria, leishmaniasis, strongyloidiasis and schistosomiasis are the most dangerous and relatively common. Although the incidence of these tropical infections after Tx has not increased, the course of disease could be fatal. There are also some cosmopolitan parasitic infections dangerous for patients after Tx. The greatest threat in Europe is toxoplasmosis, especially in heart and bone marrow recipients. The most severe manifestations of toxoplasmosis are myocarditis, encephalitis and disseminated disease. Diarrhoea is one of the most common symptoms of parasitic infection. In Europe the most prevalent pathogens causing diarrhoea are Giardia duodenalis and Cryptosporidium. Conclusions. Solid organ and bone marrow transplantations, blood transfusions and immunosuppressive treatment are associated with a small but real risk of parasitic infections in European citizens. In patients with severe parasitic infection, i.e., those with lung or brain involvement or a disseminated disease, the progression is very rapid and the prognosis is bad. Establishing a diagnosis before the patient’s death is challenging.

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