A Practical Approach to Screening for Strongyloides stercoralis

Strongyloides stercoralis, causative agent of a neglected tropical disease, is a soil-transmitted helminth which may cause lifelong persisting infection due to continuous autoinfection. In the case of immunosuppression, life-threatening hyperinfection and disseminated strongyloidiasis can develop. We propose a pragmatic screening algorithm for latent strongyloidiasis based on epidemiologic exposure and immunosuppression status that can be applied for any kind of immunosuppressive therapy. The algorithm allows the diagnosis of latent strongyloidiasis with optimal accuracy in a well-equipped setting, while for endemic settings where the complete testing array is unavailable, an empiric treatment is generally recommended. Accurate diagnosis and extensive empiric treatment will both contribute to decreasing the current neglect of strongyloidiasis.

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From strongyloidiasis to disseminated mucormycosis: the story of an HTLV-1-infected migrant

Journal of Travel Medicine ◽

10.1093/jtm/taaa229 ◽

2020 ◽

Author(s):

Brice Autier ◽

Adélaïde Chesnay ◽

Claire Mayence ◽

Stéphanie Houcke ◽

Hélène Guégan ◽

...

Keyword(s):

Immune Deficiency ◽

Strongyloides Stercoralis ◽

The Body ◽

Life Threatening ◽

Disseminated Strongyloidiasis ◽

Disseminated Mucormycosis

Strongyloidiasis manifestations range from asymptomatic cases to the life-threatening disseminated strongyloidiasis in case of immune deficiency: larvae migrate throughout the body, disseminating germs from the digestive flora to various organs. Here, we described a case of disseminated mucormycosis consecutive to Strongyloides stercoralis hyperinfestation in a Surinamese migrant infected with HTLV-1.

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Life-Threatening Subglottic Stenosis of Granulomatosis with Polyangiitis: A Case Report

Medicina ◽

10.3390/medicina57050423 ◽

2021 ◽

Vol 57 (5) ◽

pp. 423

Author(s):

Jin An ◽

Jae-Won Song

Keyword(s):

Immunosuppressive Therapy ◽

Granulomatosis With Polyangiitis ◽

Granulomatous Inflammation ◽

Subglottic Stenosis ◽

Emergency Tracheostomy ◽

Intralesional Steroid ◽

Intralesional Steroid Injection ◽

Life Threatening ◽

Carbon Dioxide Co2 ◽

Laryngotracheal Resection

Granulomatosis with polyangiitis (GPA) is an autoimmune disease characterized by necrotizing granulomatous inflammation. Subglottic stenosis, which is defined as narrowing of the airway below the vocal cords, has a frequency of 16–23% in GPA. Herein, we present the case of a 39-year-old woman with subglottic stenosis manifesting as life-threatening GPA, which was recurrent under systemic immunosuppressive therapy. The patient underwent an emergency tracheostomy, intratracheal intervention, such as carbon dioxide (CO2) laser surgery and intralesional steroid injection via laryngomicroscopic surgery, and laryngotracheal resection with remodeling. Severe subglottic stenosis treatment requires active intratracheal intervention, surgery, and systemic immunosuppressive therapy.

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A case of fatal disseminated strongyloidiasis accompanied with intestinal obstruction

Oxford Medical Case Reports ◽

10.1093/omcr/omz087 ◽

2019 ◽

Vol 2019 (10) ◽

Author(s):

Peyman Heydarian ◽

Iraj Mobedi ◽

Mohamad Ali Mohaghegh ◽

Abozar Hosseini ◽

Fatemeh Goudarzvand Chegini ◽

...

Keyword(s):

Intestinal Obstruction ◽

Signs And Symptoms ◽

Strongyloides Stercoralis ◽

Final Diagnosis ◽

High Humidity ◽

Important Message ◽

Disseminated Strongyloidiasis ◽

Endemic Areas

Abstract Strongyloides stercoralis is an endemic parasite in some regions including the tropical and subtropical areas with high humidity. Most infections are asymptomatic with nonspecific signs and symptoms, making the final diagnosis complicated. Here, we report a patient referred to our hospital with signs consistent with sepsis, intestine obstruction, which finally died with the diagnosis of strongyloidiasis. The patient was from northern parts of Iran which are considered as endemic areas for S. stercoralis. In conclusion, there is an important message in this history, i.e. physicians should be aware of specific and non-specific signs of strongyloidiasis especially in people living in endemic areas to make an accurate final diagnosis by proper clinical and paraclinical examinations.

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Terminal ileum resection as a trigger for Strongyloides stercoralis hyperinfection and ensuing serial sepsis in a 37-year-old patient with complicated Crohnʼs disease: a case report

Zeitschrift für Gastroenterologie ◽

10.1055/a-0578-9799 ◽

2018 ◽

Vol 56 (04) ◽

pp. 380-383 ◽

Cited By ~ 1

Author(s):

Mirjana Topić ◽

Silvija Čuković-Čavka ◽

Marko Brinar ◽

Mirjana Kalauz ◽

Ivica Škrlec ◽

...

Keyword(s):

Terminal Ileum ◽

Skin Penetration ◽

Strongyloides Stercoralis ◽

Developed Countries ◽

Clinical Settings ◽

Solid Organ ◽

Transplant Patients ◽

Skin Contact ◽

Life Threatening ◽

The Tropics

AbstractThe nematode Strongyloides stercoralis, outside the tropics and subtropics present in small endemic foci, can cause an infection after direct skin contact with contaminated soil containing infective filariform larvae and, rarely, after intimate interhuman contact or after transplantation of an infected solid organ. Following skin penetration, migration, and maturation through several stages, a small number of invasive filariform larvae can develop anew in the gut lumen, perpetuating new cycles of penetration, tissue migration, and reproduction, without leaving the host.In a state of immunosuppression, autoinfection can progress to life-threatening hyperinfection and/or infection disseminated through virtually any organ. In developed countries, the most frequently recognized risk for severe hyperinfection is corticosteroid therapy, but this has been also described in malnourished, alcoholic, cancer, and transplant patients. Due to the frequent need for immunosuppressive therapy, patients suffering from inflammatory bowel disease (IBD) are susceptible to develop overwhelming strongyloidiasis. Strongyloidiasis can be easily overlooked in clinical settings, and in many European regions there is poor insight into the epidemiological burden of this disease.We present a case of S. stercoralis hyperinfection that triggered 3 successive episodes of sepsis caused by pathogens of the gut flora in a young patient suffering from stenotic form of Crohn’s disease. S. stercoralis hyperinfection occurred in the corticosteroid-free period, shortly after resection of the terminal ileum, which was probably the trigger for the overwhelming course. The patient was successfully treated with 10-day albendazole therapy.

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Ehlers–Danlos syndrome: how to diagnose and when to perform genetic tests

Archives of Disease in Childhood ◽

10.1136/archdischild-2013-304822 ◽

2014 ◽

Vol 100 (1) ◽

pp. 57-61 ◽

Cited By ~ 40

Author(s):

Glenda Sobey

Keyword(s):

Genetic Basis ◽

Correct Diagnosis ◽

Clinical Signs ◽

Accurate Diagnosis ◽

Connective Tissue Disorders ◽

Internal Organs ◽

Ehlers Danlos Syndrome ◽

Starting Point ◽

Life Threatening ◽

Danlos Syndrome

The term Ehlers–Danlos syndrome (EDS) encompasses a group of inherited connective tissue disorders. The manifestations of EDS can be seen in skin, joints, blood vessels and internal organs and vary from mild to severe and life threatening. Each subtype is a separate and different condition. The genetic basis of many subtypes has now been elucidated, confirming heterogeneity. An awareness of the different conditions within this group is the starting point towards accurate diagnosis. Accurate elicitation of history and clinical signs is vital in selecting the correct confirmatory investigation. Skin biopsy with electron microscopy can be helpful in the decision process of whether and when to perform genetic testing. Correct diagnosis within the EDSs allows targeted management, family screening and prenatal diagnosis.

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Non-traumatic Tension Gastrothorax: A Potential Mimicker of Tension Pneumothorax

Journal of Radiology Case Reports ◽

10.3941/jrcr.v15i8.4144 ◽

2021 ◽

Vol 15 (8) ◽

pp. 1-7

Author(s):

Jonathan D. Pierce ◽

Neal R. Shah ◽

Ata A. Rahnemai-Azar ◽

Amit Gupta

Keyword(s):

Clinical Presentation ◽

Tension Pneumothorax ◽

Accurate Diagnosis ◽

Imaging Features ◽

Elderly Female ◽

Hemodynamic Compromise ◽

Mediastinal Shift ◽

Increased Risk ◽

Life Threatening ◽

Tension Gastrothorax

Tension gastrothorax is a rare, life-threatening clinical condition caused by intrathoracic herniation of the stomach through a diaphragmatic defect which becomes increasingly distended over time. If not recognized promptly, this can rapidly progress to respiratory distress, mediastinal shift, and hemodynamic compromise. Initial clinical presentation and imaging findings closely mirror those of tension pneumothorax, confounding diagnosis and potentially leading to unnecessary interventions with increased risk of morbidity and mortality. Here, we present a case of an elderly female who presented with a non-traumatic tension gastrothorax and a review of key imaging features and strategies to aid in recognition and accurate diagnosis of this emergent clinical entity.

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Fatal Multiorgan Failure Syndrome in a Strongyloides-HTLV-1 Coinfected Patient, after Treatment with Ivermectin

Case Reports in Critical Care ◽

10.1155/2021/5554810 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Emmanuelle Guérin ◽

Paule Poirier ◽

Marine Nervo ◽

Christophe Le Terrier

Keyword(s):

Multiorgan Failure ◽

Severe Disease ◽

Intestinal Bacteria ◽

Strongyloides Stercoralis ◽

T Lymphotropic Virus ◽

E Coli ◽

Multiple Organs ◽

Disseminated Strongyloidiasis ◽

Characteristic Features ◽

Coinfected Patient

Because of its characteristic features of autoinfection, the parasitic nematode Strongyloides stercoralis can infect patients for years. An acceleration of its autoinfective cycle can be triggered by human T-lymphotropic virus-1 (HTLV-1) infection, mainly by the deviation of the protective Th2- to Th1-type immune response and can lead to severe disease by dissemination of Strongyloides stercoralis larvae carrying intestinal bacteria to multiple organs. Meningitis caused by enteric Gram-negative bacteria is a potentially fatal complication of disseminated strongyloidiasis. Herein, we present the case of a Strongyloides-HTLV-1 coinfected patient, admitted for E. coli meningitis. One day after initiation of ivermectin, the patient developed significant S. stercoralis dissemination, complicated by multiorgan failure syndrome, and died from neurological failure. While the initial clinical scenario of our case has already been well described in the literature, its course after antihelminthic treatment initiation remains unclear and needs to be discussed.

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Designed Antimicrobial Peptides Against Trauma-Related Cutaneous Invasive Fungal Wound Infections

Journal of Fungi ◽

10.3390/jof6030184 ◽

2020 ◽

Vol 6 (3) ◽

pp. 184

Author(s):

Kathryn W. Woodburn ◽

Jesse M. Jaynes ◽

L. Edward Clemens

Keyword(s):

Antimicrobial Peptides ◽

Broad Spectrum ◽

Clinical Care ◽

Structural Analog ◽

Wound Infections ◽

First Line ◽

Empiric Treatment ◽

Patients At Risk ◽

Life Threatening ◽

Traumatic Wound

Cutaneous invasive fungal wound infections after life-threatening dismounted complex blast injury (DCBI) and natural disasters complicate clinical care. These wounds often require aggressive repeated surgical debridement, can result in amputations and hemipelvectomies and have a 38% mortality rate. Given the substantial morbidity associated with cutaneous fungal wound infections, patients at risk need immediate empiric treatment mandating the use of rapidly acting broad-spectrum antimicrobials, acting on both fungi and bacteria, that are also effective against biofilm and can be administered topically. Designed antimicrobial peptides (dAMPs) are engineered analogues of innate antimicrobial peptides which provide the first line of defense against invading pathogens. The antifungal and antibacterial effect and mammalian cytotoxicity of seven innovative dAMPs, created by iterative structural analog revisions and physicochemical and functional testing were investigated. The dAMPs possess broad-spectrum antifungal activity, in addition to being effective against Gram-negative and Gram-positive bacteria, which is crucial as many wounds are polymicrobial and require immediate empiric treatment. Three of the most potent dAMPs—RP504, RP556 and RP557—possess limited mammalian cytotoxicity following 8 h incubation. If these encouraging broad-spectrum antimicrobial and rapid acting results are translated clinically, these novel dAMPs may become a first line empiric topical treatment for traumatic wound injuries.

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