BACKGROUND Strongyloides stercoralis(S.stercoralis),is a prevalent parasitic worm that infects humans.It is found all over the world,particularly in tropical and subtropical areas.Strongyloidiasis is caused mostly by ...BACKGROUND Strongyloides stercoralis(S.stercoralis),is a prevalent parasitic worm that infects humans.It is found all over the world,particularly in tropical and subtropical areas.Strongyloidiasis is caused mostly by the parasitic nematode S.stercoralis.Filariform larvae typically infest humans by coming into contact with dirt,such as by walking barefoot or through exposure to human waste or sewage.CASE SUMMARY A 35-year-old male presented to our department with a 10-year history of abdominal pain and diarrhea,which had recently recurred for the past 3 months.A computed tomography(CT)scan revealed acute cholecystitis accompanied by a gallbladder stone.Additionally,a 5 mm stone was found obstructing the lower portion of the common bile duct,resulting in dilatation of both the intrahepatic and extrahepatic bile ducts to 8 mm,in contrast to a previous CT scan.Endoscopic ultrasonography revealed a prominent echogenicity in the lower portion of the common bile duct.Consequently,an endoscopic retrograde cholangiopancreatography was conducted via endoscopic sphincterotomy and balloon dilatation.The microscope revealed the presence of viable S.stercoralis rhabditiform larvae in the biliary fluid.We documented an uncommon instance of S.stercoralis infection in the biliary fluid of a patient suffering from gallstones and cholangitis.CONCLUSION The film we created provides a visual representation of the movement of the living S.stercoralis in biliary fluid.展开更多
AIM:To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis(S.stercoralis)hyperinfection. METHODS:Over a period of 23 years(1984-2006),we investigated 25 pat...AIM:To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis(S.stercoralis)hyperinfection. METHODS:Over a period of 23 years(1984-2006),we investigated 25 patients withS.stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis.The clinical and endoscopic findings were analyzed retrospectively. RESULTS:Twenty-four(96%)of the patients investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1(HTLV-1)infection.The abnormal endoscopic findings,mainly edematous mucosa,white villi and erythematous mucosa,were observed in 23(92%) patients.The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy.The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative(Endoscopic severity score:4.86±2.47vs 2.71 ±1.38,P<0.05). CONCLUSION:Our study clearly demonstrates that,in addition to stool analysis,endoscopic observation and biopsies are very important.We also emphasize that S.stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.展开更多
A case of pulmonary coinfection by Strongyloides stercoralis and Pneumocystis jiroveci has been detected in an AIDS patient treated in the Respiratory Intensive Care Unit of the Muniz Hospital.At diagnosis,the patient...A case of pulmonary coinfection by Strongyloides stercoralis and Pneumocystis jiroveci has been detected in an AIDS patient treated in the Respiratory Intensive Care Unit of the Muniz Hospital.At diagnosis,the patient presented cough with mucopurulent expectoration,dyspnea,fever,bilateral pulmonary infiltrates on the chest X-ray,negative bacilloscopy for acid fast bacteria and a CD4^+ T lymphocytes count of 52 cells/μ L.The microbiological diagnosis was achieved by microscopic observation of the respiratory secretions obtained by bronchoalveolar lavage,while the wet mount examination revealed rhabditiform and filariform larvae of the nematode and foamy exudates,pathognomonic of the pulmonary pneumocystosis.It was the unique case of this association among about 3 000 samples performed in our laboratory in the last 10 years and diagnosed by microscopy.Other complementary stains(a rapid modification of Grocott,Kinyoun and Giemsa) were applied to the smears after the diagnosis of mycotic and parasitary infections achieved by fresh microscopy.Both physicians and microbiologists should take into account the possible coexistence of respiratory pathogens in immunocompromised patients,such as those with AIDS.展开更多
Objective:To communicate the presence of adult females,rabditoid larvae and eggs of Strongyloides stercoralis(S.stercoralis)in the respiratory secretions obtained by tracheal aspirate from a HIV-negative patient who w...Objective:To communicate the presence of adult females,rabditoid larvae and eggs of Strongyloides stercoralis(S.stercoralis)in the respiratory secretions obtained by tracheal aspirate from a HIV-negative patient who was suffering from polymyositis,and treated with corticoids and amethopterin and assisted by pneumonia.Methods:The respiratory secretions submitted to the Parasitology Laboratory of the Mu(?)iz Hospital were made more concentrated by centrifugation(1 500 r/min for 15 seconds).Wet mount microscopy was performed with the pellet.Results:It revealed adult females,rabditoid larvae and eggs of S.stercoralis.Further parasitological studies performed after the start of the treatment with ivermectin on fresh fecal samples,gastric lavages and tracheal aspirates showed scanty mobile filariform and rabditoid larvae of the same parasite.Conclusions:The presence of adult female S.stercoralis which has never been observed before in the clinical samples submitted to our Laboratory for investigation can be considered as an indirect marker of the severe immunosupression of the patient.展开更多
Objective: To investigate the status of Strongyloides(S.) stercoralis infections among migrant workers in Malaysia for the first time and identify risk factors.Methods: Four diagnostic methods were employed for the de...Objective: To investigate the status of Strongyloides(S.) stercoralis infections among migrant workers in Malaysia for the first time and identify risk factors.Methods: Four diagnostic methods were employed for the detection of S. stercoralis including microscopy, enzyme-linked immunosorbent assay(ELISA) using a commercial kit, ELISA using the rSs1a antigen and polymerase chain reaction(PCR). Low and semi-skilled workers from five working sectors(i.e. manufacturing, food service, agriculture and plantation, construction and domestic service) were tested on a voluntary basis. Results: The overall seroprevalence of S. stercoralis from 483 workers employing the ELISA commercial kit for IgG was 35.8%(n=173;95% CI: 31.5%-40.1%) whereas seroprevalence using the rSs1a-ELISA was 13.0%(n=63;95% CI: 10.0%-16.0%). Cross tabulation between the ELISA commercial kit and rSs1a-ELISA showed that only 6.4%(n=31;95% CI: 4.2%-8.6%) of the samples were positive in both tests. Microscopic examination of all 388 fecal samples were negative;however subsequent testing by a nested PCR against DNA from the same samples successfully amplified DNA from three male subjects(0.8%;3/388). Male workers, India and Myanmar nationality, food service occupation and those living in the hostel were statistically significant with seroprevalence(P<0.005). Conclusion: This is the first report on the epidemiology of S. stercoralis infections among the migrant workers in Malaysia. Our results highlight the importance of using appropriate diagnostic tools for detection. The presence of anti-S. stercoralis antibodies in the study population calls for improvements in personal hygiene and sanitation standards among migrant workers in Malaysia through control strategies including health education campaigns and programs aimed at increasing awareness and healthy behaviors.展开更多
A 55-year old male patient was diagnosed with strongy- loides hyper-infection with stool analysis and intestinal biopsy shortly after his chemotherapy for myeloma. He was commenced on albendazole anthelmintic therapy....A 55-year old male patient was diagnosed with strongy- loides hyper-infection with stool analysis and intestinal biopsy shortly after his chemotherapy for myeloma. He was commenced on albendazole anthelmintic therapy. After initiation of the treatment he suffered life- threatening gastrointestinal (GI) bleeding. Repeated endoscopies showed diffuse multi-focal intestinal bleeding. The patient required huge amounts of red blood cells and plasma transfusions and correction of haemostasis with recombinant activated factor Ⅶ. Abdominal aorto-angiography showed numerous micro- aneurysms (‘berry aneurysms’) in the superior and inferior mesenteric arteries’ territories. While the biopsy taken prior to the treatment with albendazole did not show evidence of vasculitis, the biopsy taken after initiation of therapy revealed leukoclastic aggregations around the vessels. These findings suggest that, in addition to direct destruction of the mucosa, vasculitis could be an important additive factor causing the massive GI bleeding during the anthelmintic treatment. This might result from substances released by the worms that have been killed with anthelmintic therapy. Current guidelines advise steroids to be tapered and stopped in case of systematic parasitic infections as they might reduce immunity and precipitate parasitic hyper-infection. In our opinion, steroid therapy might be of value in the management of strongyloides hyper- infection related vasculitis, in addition to the anthelmintic treatment. Indeed, steroid therapy of vasculitis with other means of supportive care resulted in cessation of the bleeding and recovery of the patient.展开更多
Super-imposed infection with intestinal organisms can mimic a flare-up of underlying disease in patients with inflammatory bowel disease (IBD). We report a case of patient with long standing ulcerative colitis (UC), w...Super-imposed infection with intestinal organisms can mimic a flare-up of underlying disease in patients with inflammatory bowel disease (IBD). We report a case of patient with long standing ulcerative colitis (UC), who presented with abdominal pain, diarrhea and low- grade fever after receiving systemic corticosteroids for an unrelated disorder. Despite a negative stool examination, a peripheral eosinophilia reappeared upon tapering down of a corticosteroid dose. Subsequently, duodenal biopsies showed evidence for Strongyloides, presumably acquired 20 years ago when the patient was residing in Brazil. The patient fully recovered following anti-helmintic therapy. This case underscores the importance of considering Strongyloides in the work-up of flaring-up IBD patients, even if a history of residing or traveling to endemic areas is in the distant past.展开更多
BACKGROUND Strongyloides sterocoralis is a parasitic infection caused by a roundworm that is transmitted through soil contaminated with larvae.It can infrequently cause hepatic abscesses in immunocompromised patients ...BACKGROUND Strongyloides sterocoralis is a parasitic infection caused by a roundworm that is transmitted through soil contaminated with larvae.It can infrequently cause hepatic abscesses in immunocompromised patients and is rarely reported to form hepatic lesions in immunocompetent hosts.CASE SUMMARY We present a case study of a 45-year-old female who presented with right upper quadrant abdominal pain and constitutional symptoms for several weeks.Crosssectional imaging identified several malignant-appearing liver masses.Further investigation,including serological testing and histopathologic examination,revealed the presence of serum Strongyloides antibodies and hepatic granulomas with extensive necrosis.Following treatment with ivermectin for 2 wk,there was complete resolution of the liver lesions and associated symptoms.CONCLUSION This case highlights the importance of considering parasitic infections,such as Strongyloides,in the differential diagnosis of hepatic masses.Early recognition and appropriate treatment can lead to a favorable outcome and prevent unnecessary invasive procedures.Increased awareness among clinicians is crucial to ensure the timely diagnosis and management of such cases.展开更多
Objective:To determine the prevalence of intestinal parasitic infections among mentally retarded residents of rehabilitation center of Bandar Abbas,Hormozgan province,southern Iran.Methods:A cross-sectional study was ...Objective:To determine the prevalence of intestinal parasitic infections among mentally retarded residents of rehabilitation center of Bandar Abbas,Hormozgan province,southern Iran.Methods:A cross-sectional study was carried out in central rehabilitation institute of Hormozgan province in summer 2010.Fecal samples of all 133 residents(72 males,61 females)aged 3-52,were collected in triplicate.Specimens were examined by direct smear,formalin-ether concentration techniques and stained by permanent Trichrome,Ziehl-Neelsen stains.Statistical analysis was conducted by SPSS 13.5.Results:Intestinal parasitic infections were seen in 48.5%(64 out of 133 subjects:53.4%in males and 46.6%in females).Strongyloides stercoralis with17.3%showed the highest incidence followed by Entamoeba coli(9.8%),Blastocystis hominis(7.5%),Giardia lamblia(2.3%),Endolimax nana(2.3%),Hymenolepis nana(0.8%),Oxyuris vermicularis(0.8%),and Chilomasix mesnili(0.8%).Double infections were found to be as:Strongyloides stercoralis+Giardia lamblia(2.3%),Entamoeba coli+Giardia lamblia(1.5%),Entamoeba coli+Blastocystis hominis(1.5%),Oxyuris vermicularis+Entamoeba coli(0.8%),Strongyloides stercoralis+Entamoeba coli(0.8%),respectively.Conclusions:Our findings reveal that strongyloidiasis is a common disease among mentally retarded population in southern Iran.展开更多
Strongyloides stercoralis infects at least 100 million humans worldwide each year, but its prevalence is underestimated. It is endemic in hot and humid climates as well as resource poor countries with inadequate sanit...Strongyloides stercoralis infects at least 100 million humans worldwide each year, but its prevalence is underestimated. It is endemic in hot and humid climates as well as resource poor countries with inadequate sanitary conditions. The rise of international travel and immigration has a positive impact in strongyloidiasis. Due to its unique auto infection life-cycle, Strongyloides may lead to chronic infections remaining undetected for decades. Strongyloidiasis is most often asymptomatic but it has a wide range of clinical presentations. The two most severe forms of strongyloidiasis are hyperinfection and disseminated syndromes. These occur most often in patients with impaired cell mediated immunity. A 42-year-old immunocompetent man presented with chronic watery diarrhea, malaise, upper abdominal pain, anorexia and weight lost. Strongyloides stercoralis was identified in stool samples and duodenal biopsy. The patient was successfully treated with albendazole. The authors report a case of strongyloidiasis hyperinfection in an immunocompetent host 20 years away from an endemic area and make a literature review.展开更多
Background:Strongyloidiasis,a neglected disease caused by intestinal nematodes of the genus,is endemic to tropical and subtropical areas such as Vietnam.Morphological methods only identify the genus,while DNA-molecula...Background:Strongyloidiasis,a neglected disease caused by intestinal nematodes of the genus,is endemic to tropical and subtropical areas such as Vietnam.Morphological methods only identify the genus,while DNA-molecular techniques are susceptible in Strongyloides spp.detection.The study aims to determine the prevalence of dominant Strongyloides species among the population in Duc Hoa district,Long An,Vietnam.Methods:A cross-sectional study used 1190 stool specimens collected from July 2017 to November 2018.All samples were transported within 2 h,stored at 2-8℃,and processed within 48 h for microscopy smear and culture at the Laboratory of Medical Parasitology,Pham Ngoc Thach University of Medicine(PNT).Then all positive samples with the above 2 methods were verified by real-time PCR technique.Real-time PCR amplification was conducted at the Laboratory of Molecular Biology,PNT.Results:Direct microscopy and modified Harada-Mori culture detected Strongyloides spp.larvae in 79/1190 sam-ples(6.6%).About 94.2%of the DNA samples were Strongyloides stercoralis,2.9%were co-infections with Strongy-loides ratti and S.stercoralis,and 2.9%were patients with S.ratti.The identity of 12/14 sequences was confirmed as S.stercoralis with a high level of similarity(91.3%-100%)and over 98%for S.ratti.Conclusion:DNA-molecular techniques and sequence analysis are highly suitable for identifying Strongyloides species isolated from stool samples.It is remarkable evidence of the presence of zoonosis S.ratti disease in human,not just the known S.stercoralis.It is likely to result in a certain proportion of people being infected by this animal-borne infectious pathogen.展开更多
Background:Despite the high prevalence of strongyloidiasis in the Laotian population,Laotian hospitals still lack diagnostic capacity to appropriately diagnose Strongyloides stercoralis infections.This cross-sectional...Background:Despite the high prevalence of strongyloidiasis in the Laotian population,Laotian hospitals still lack diagnostic capacity to appropriately diagnose Strongyloides stercoralis infections.This cross-sectional hospital-based study was conducted to assess the prevalence of Strongyloides stercoralis infection among hospitalized patients treated at Mahosot Hospital,the primary reference hospital of Lao People’s Democratic Republic(Lao PDR),and to validate feasible methods for diagnosing S.stercoralis infection at hospital’s laboratory.Methods:Between September and December 2018,stool samples of 104 inpatients were investigated for S.stercoralis infection by wet smear,Baermann technique,Koga Agar plate culture(KAPC),and real-time detection polymerase chain reaction(RTD-PCR)at the Infectious Diseases Ward of the Mahosot Hospital in Vientiane.The sensitivity,the specificity,the negative predictive value(NPV)of each diagnostic test,as well as their combination(s)was calculated using a composite reference standard(CRS).The correlation of the different test methods was assessed by chi-square or Fisher’s exact test.Cohen’s kappa coefficient was used to assess the diagnostic agreement of the different test methods.Results:The overall prevalence of S.stercoralis infections among the study population was 33.4%.The cumulative infection prevalence statistically significantly increased from the lowest age group of 40 years and below(22.4%),to the medium(40.0%)and to the oldest age group of 61 year and above(72.7%)(P=0.003).The cumulative infection prevalence of CRS was considerably higher in male(40.4%)compared to female patients(28.1%),but not statistically different(P=0.184).The diagnostic sensitivity of Baermann technique,KAPC,RTD-PCR,and the combination of Baermann technique and KAPC were 60.0,60.0,74.3,and 77.1%,respectively.Only 13 patients(37.1%)of the total 35 S.stercoralis patients diagnosed with any technique had a simultaneously positive diagnostic test with Baermann,KAPC and RTD-PCR.Conclusions:We identified Baermann technique and KAPC to be currently the most feasible and implementable standard methods for diagnosing S.stercoralis at a hospital setting such as Mahosot Hospital and provincial and district hospitals in Lao PDR and other low-and middle income countries in Southeast Asia.Trial registration:This study was approved by the National Ethics Committee for Health Research in Lao PDR(reference no.083/NECHR)and by the Ethics Committee Northwest and Central Switzerland(reference no.2018–00594).展开更多
Background Strongyloidiasis,caused by the nematodes Strongyloides stercoralis and Strongyloides fuelleborni,is estimated to afect over 600 million individuals worldwide.The disease is endemic in Southeast Asia,where a...Background Strongyloidiasis,caused by the nematodes Strongyloides stercoralis and Strongyloides fuelleborni,is estimated to afect over 600 million individuals worldwide.The disease is endemic in Southeast Asia,where a warmhumid climate and socio-economic conditions maintain the parasite’s life cycle and transmission.However,the current diagnostic methods may not be sufciently sensitive,suggesting that the true prevalence of strongyloidiasis could be seriously underestimated in this.This study aims to determine the prevalence of strongyloidiasis in Southeast Asia through a systematic review and meta-analysis and to discuss the implications of the estimated prevalence on diagnostic approaches and control strategies.Methods Following PRISMA guidelines,we conducted a systematic literature search in PubMed and Google Scholar databases to identify studies reporting Strongyloides prevalence data in the 11 Southeast Asian countries up to December 2022.A random efects model was employed to estimate the pooled prevalence of S.stercoralis at both regional and country levels.Results Out of 3722 articles identifed,224 met our inclusion criteria.For S.stercoralis specifcally,we found 187 articles,of which 52.4%were from Thailand.All Southeast Asian countries,except Brunei,had at least one study on Strongyloides prevalence.The estimated pooled prevalence of S.stercoralis regionally was 12.7%(95%CI 10.70-14.80%),ranging from 0.4 to 24.9%at the country level.Cambodia had the highest pooled prevalence(24.9%,95%CI 15.65-35.38%),followed by Lao PDR(16.5%,95%CI 9.50-24.95%).Moreover,we obtained a pooled prevalence of 10%(95%CI 7.06-13.52%)in a group comprising immigrants,workers,and veterans from Southeast Asian countries.S.stercoralis infects various host types,including nonhuman primates,domestic dogs and cats,rodents,and transport carriers such as cockroaches and vegetables.Conclusions A high prevalence of strongyloidiasis in Southeast Asia was revealed,highlighting the importance of the region’s ongoing research,surveillance,and control eforts.Factors contributing to the strongyloidiasis transmission include the role of animal hosts,the impact of global connectivity,and the signifcance of the co-endemicity of other Strongyloides species.Based on these fndings,a multi-pronged One-Health approach is essential for sustainable intervention and control.展开更多
Strongyloides stercoralis,a soil transmitted helminth infection,affects millions with varying prevalence worldwide.A large number of affected hosts are asymptomatic.Symptoms pertaining to pulmonary and gastrointestina...Strongyloides stercoralis,a soil transmitted helminth infection,affects millions with varying prevalence worldwide.A large number of affected hosts are asymptomatic.Symptoms pertaining to pulmonary and gastrointestinal involvement may be present.Manifestations of involvement beyond lung and intestine can be seen with dissemination of infection and lethal hyperinfection.Immunosuppression secondary to use of steroids or other immunosuppressants and coexistence of human T-lymphotropic virus type-1 are the known risk factors for dissemination and hyperinfection.Diagnostic modalities comprise stool examination,serology and molecular testing.Stool tests are inexpensive but are limited by low sensitivity,whereas serologic and molecular tests are more precise but at the expense of higher cost.Treatment with Ivermectin or Albendazole as an alternative is safe and efficacious.We present a rare case of acute pancreatitis secondary to Strongyloides.High index of suspicion in patients specifically from endemic countries of origin and lack of other common etiologies of acute pancreatitis may help in early diagnosis and prompt treatment of this potentially fatal infection.展开更多
Multiple lymphomatous polyposis (MLP) is an unusual form of non-Hodgkin's lymphoma characterized by polyps throughout the gastrointestinal tract. It has been reported that most MLP are observed in cases with mantl...Multiple lymphomatous polyposis (MLP) is an unusual form of non-Hodgkin's lymphoma characterized by polyps throughout the gastrointestinal tract. It has been reported that most MLP are observed in cases with mantle cell lymphoma of B-cell type. We herein present a case of a 66-year-old man with adult T-cell leukemia/lymphoma (ATLL). Colonoscopy revealed MLP throughout the colon and histopathological findings of ATLL cell infiltration. The patient died despite combination of chemotherapy. The literature of manifestations of colonic involvement of ATLL isreviewed and the importance of endoscopic evaluation to differentiate ATLL intestinal lesions from opportunistic infectious enterocolitis is discussed.展开更多
Infections caused by Strongyloides stercoralis(S.stercoralis) in human are generally asymptomatic,however in immunocompromised individual,hyperinfection may develop with dissemination of larvae to extra-intestinal org...Infections caused by Strongyloides stercoralis(S.stercoralis) in human are generally asymptomatic,however in immunocompromised individual,hyperinfection may develop with dissemination of larvae to extra-intestinal organs.The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself,which may lead to low index of suspicion as a consequence.In this report,a case of a Malaysian male with underlying diabetes mellitus,hypertension,cerebrovascular accident,bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented.However,he developed septicemic shock later,and S.stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli.Regardless of aggressive resuscitation,the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome.It was revealed that the current case has alarmed us via incidental finding of S.stercoralis larvae in the tracheal aspirate,indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.展开更多
Rationale: Strongyloides stercoralis (S. stercoralis) is an intestinal nematode with a complicated life cycle that can involve the gastrointestinal system. Infected patients are generally asymptomatic;but if symptomat...Rationale: Strongyloides stercoralis (S. stercoralis) is an intestinal nematode with a complicated life cycle that can involve the gastrointestinal system. Infected patients are generally asymptomatic;but if symptomatic, the symptoms will include skin rash, respiratory and gastrointestinal symptoms like abdominal pain, diarrhea, nausea and vomiting. Patient concerns: A 77-year old man presented with edema of the lower extremities and insignificant tenderness in the epigastric region. Diagnosis: The histopathology of gastric tissue showed severe inflammation and multiple ulcers in the cardia, antrum and proximal duodenum. A large number of rhabditiform larvae of S. stercoralis along with tissue hyperemia and infiltration of lymphoplasma cells, eosinophils, and neutrophils were found. Intervention: Treatment with albendazole. Outcome: Despite the albendazole treatment, the patient's condition deteriorated and eventually died because of a sepsis-like syndrome. Lesson: Physicians should remain alert to the urgency due to threadworm, especially among the elderly people and immunosuppressed cases;and should ensure accurate diagnosis, suitable treatment and careful follow-up of these cases.展开更多
Chronic infections caused by Strongyloides stercoralis and Schistosoma spp.can present with longstanding gastrointestinal symp-toms that mimic irritable bowel syndrome(IBS).In this case report,we describe a patient wh...Chronic infections caused by Strongyloides stercoralis and Schistosoma spp.can present with longstanding gastrointestinal symp-toms that mimic irritable bowel syndrome(IBS).In this case report,we describe a patient who was misdiagnosed with IBS for several decades before receiving a definitive diagnosis of chronic helminthiasis.Treatment with first-line antihelminthics resulted in complete and sustained resolution of symptoms.We review the life cycle,epidemiology,clinical presentations,diagnosis,and management of chronic helminthiases in the context of IBS.We further discuss the impact of misdiagnosis on both the patient and the healthcare system.Given the significant individual and economic burdens of IBS and the diagnostic uncertainty associated with low sensitivity of standard diagnostic tests for helminth infections,healthcare professionals should maintain a low threshold for testing and empiric treatment in patients with relevant travel and medical history.展开更多
基金Sanming Project of Medicine in Shenzhen,No.SZSM202311017.
文摘BACKGROUND Strongyloides stercoralis(S.stercoralis),is a prevalent parasitic worm that infects humans.It is found all over the world,particularly in tropical and subtropical areas.Strongyloidiasis is caused mostly by the parasitic nematode S.stercoralis.Filariform larvae typically infest humans by coming into contact with dirt,such as by walking barefoot or through exposure to human waste or sewage.CASE SUMMARY A 35-year-old male presented to our department with a 10-year history of abdominal pain and diarrhea,which had recently recurred for the past 3 months.A computed tomography(CT)scan revealed acute cholecystitis accompanied by a gallbladder stone.Additionally,a 5 mm stone was found obstructing the lower portion of the common bile duct,resulting in dilatation of both the intrahepatic and extrahepatic bile ducts to 8 mm,in contrast to a previous CT scan.Endoscopic ultrasonography revealed a prominent echogenicity in the lower portion of the common bile duct.Consequently,an endoscopic retrograde cholangiopancreatography was conducted via endoscopic sphincterotomy and balloon dilatation.The microscope revealed the presence of viable S.stercoralis rhabditiform larvae in the biliary fluid.We documented an uncommon instance of S.stercoralis infection in the biliary fluid of a patient suffering from gallstones and cholangitis.CONCLUSION The film we created provides a visual representation of the movement of the living S.stercoralis in biliary fluid.
文摘AIM:To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis(S.stercoralis)hyperinfection. METHODS:Over a period of 23 years(1984-2006),we investigated 25 patients withS.stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis.The clinical and endoscopic findings were analyzed retrospectively. RESULTS:Twenty-four(96%)of the patients investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1(HTLV-1)infection.The abnormal endoscopic findings,mainly edematous mucosa,white villi and erythematous mucosa,were observed in 23(92%) patients.The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy.The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative(Endoscopic severity score:4.86±2.47vs 2.71 ±1.38,P<0.05). CONCLUSION:Our study clearly demonstrates that,in addition to stool analysis,endoscopic observation and biopsies are very important.We also emphasize that S.stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.
基金Supported by Scientific Research Fund for Education Departmentof the the School of Medicine-Buenos Aires University(No:J500798759)
文摘A case of pulmonary coinfection by Strongyloides stercoralis and Pneumocystis jiroveci has been detected in an AIDS patient treated in the Respiratory Intensive Care Unit of the Muniz Hospital.At diagnosis,the patient presented cough with mucopurulent expectoration,dyspnea,fever,bilateral pulmonary infiltrates on the chest X-ray,negative bacilloscopy for acid fast bacteria and a CD4^+ T lymphocytes count of 52 cells/μ L.The microbiological diagnosis was achieved by microscopic observation of the respiratory secretions obtained by bronchoalveolar lavage,while the wet mount examination revealed rhabditiform and filariform larvae of the nematode and foamy exudates,pathognomonic of the pulmonary pneumocystosis.It was the unique case of this association among about 3 000 samples performed in our laboratory in the last 10 years and diagnosed by microscopy.Other complementary stains(a rapid modification of Grocott,Kinyoun and Giemsa) were applied to the smears after the diagnosis of mycotic and parasitary infections achieved by fresh microscopy.Both physicians and microbiologists should take into account the possible coexistence of respiratory pathogens in immunocompromised patients,such as those with AIDS.
基金Supported in part by a grant from the Louis Albert FoundationTolosaArgentina(Grant No.G06 LM008655)
文摘Objective:To communicate the presence of adult females,rabditoid larvae and eggs of Strongyloides stercoralis(S.stercoralis)in the respiratory secretions obtained by tracheal aspirate from a HIV-negative patient who was suffering from polymyositis,and treated with corticoids and amethopterin and assisted by pneumonia.Methods:The respiratory secretions submitted to the Parasitology Laboratory of the Mu(?)iz Hospital were made more concentrated by centrifugation(1 500 r/min for 15 seconds).Wet mount microscopy was performed with the pellet.Results:It revealed adult females,rabditoid larvae and eggs of S.stercoralis.Further parasitological studies performed after the start of the treatment with ivermectin on fresh fecal samples,gastric lavages and tracheal aspirates showed scanty mobile filariform and rabditoid larvae of the same parasite.Conclusions:The presence of adult female S.stercoralis which has never been observed before in the clinical samples submitted to our Laboratory for investigation can be considered as an indirect marker of the severe immunosupression of the patient.
基金funded by University of Malaya,PPP grant(PG040-2014A)Fundamental Research Grant Scheme(FRGS)from Ministry of Higher Education(FP015-2014B)+1 种基金UM/MoHE High Impact Research Grant(UM.C/625/1/HIR/MOHE/MED/23)Universiti Sains Malaysia,Malaysian Ministry of Higher Education grant(HICoE 311/CIPPM/4401005)
文摘Objective: To investigate the status of Strongyloides(S.) stercoralis infections among migrant workers in Malaysia for the first time and identify risk factors.Methods: Four diagnostic methods were employed for the detection of S. stercoralis including microscopy, enzyme-linked immunosorbent assay(ELISA) using a commercial kit, ELISA using the rSs1a antigen and polymerase chain reaction(PCR). Low and semi-skilled workers from five working sectors(i.e. manufacturing, food service, agriculture and plantation, construction and domestic service) were tested on a voluntary basis. Results: The overall seroprevalence of S. stercoralis from 483 workers employing the ELISA commercial kit for IgG was 35.8%(n=173;95% CI: 31.5%-40.1%) whereas seroprevalence using the rSs1a-ELISA was 13.0%(n=63;95% CI: 10.0%-16.0%). Cross tabulation between the ELISA commercial kit and rSs1a-ELISA showed that only 6.4%(n=31;95% CI: 4.2%-8.6%) of the samples were positive in both tests. Microscopic examination of all 388 fecal samples were negative;however subsequent testing by a nested PCR against DNA from the same samples successfully amplified DNA from three male subjects(0.8%;3/388). Male workers, India and Myanmar nationality, food service occupation and those living in the hostel were statistically significant with seroprevalence(P<0.005). Conclusion: This is the first report on the epidemiology of S. stercoralis infections among the migrant workers in Malaysia. Our results highlight the importance of using appropriate diagnostic tools for detection. The presence of anti-S. stercoralis antibodies in the study population calls for improvements in personal hygiene and sanitation standards among migrant workers in Malaysia through control strategies including health education campaigns and programs aimed at increasing awareness and healthy behaviors.
文摘A 55-year old male patient was diagnosed with strongy- loides hyper-infection with stool analysis and intestinal biopsy shortly after his chemotherapy for myeloma. He was commenced on albendazole anthelmintic therapy. After initiation of the treatment he suffered life- threatening gastrointestinal (GI) bleeding. Repeated endoscopies showed diffuse multi-focal intestinal bleeding. The patient required huge amounts of red blood cells and plasma transfusions and correction of haemostasis with recombinant activated factor Ⅶ. Abdominal aorto-angiography showed numerous micro- aneurysms (‘berry aneurysms’) in the superior and inferior mesenteric arteries’ territories. While the biopsy taken prior to the treatment with albendazole did not show evidence of vasculitis, the biopsy taken after initiation of therapy revealed leukoclastic aggregations around the vessels. These findings suggest that, in addition to direct destruction of the mucosa, vasculitis could be an important additive factor causing the massive GI bleeding during the anthelmintic treatment. This might result from substances released by the worms that have been killed with anthelmintic therapy. Current guidelines advise steroids to be tapered and stopped in case of systematic parasitic infections as they might reduce immunity and precipitate parasitic hyper-infection. In our opinion, steroid therapy might be of value in the management of strongyloides hyper- infection related vasculitis, in addition to the anthelmintic treatment. Indeed, steroid therapy of vasculitis with other means of supportive care resulted in cessation of the bleeding and recovery of the patient.
文摘Super-imposed infection with intestinal organisms can mimic a flare-up of underlying disease in patients with inflammatory bowel disease (IBD). We report a case of patient with long standing ulcerative colitis (UC), who presented with abdominal pain, diarrhea and low- grade fever after receiving systemic corticosteroids for an unrelated disorder. Despite a negative stool examination, a peripheral eosinophilia reappeared upon tapering down of a corticosteroid dose. Subsequently, duodenal biopsies showed evidence for Strongyloides, presumably acquired 20 years ago when the patient was residing in Brazil. The patient fully recovered following anti-helmintic therapy. This case underscores the importance of considering Strongyloides in the work-up of flaring-up IBD patients, even if a history of residing or traveling to endemic areas is in the distant past.
文摘BACKGROUND Strongyloides sterocoralis is a parasitic infection caused by a roundworm that is transmitted through soil contaminated with larvae.It can infrequently cause hepatic abscesses in immunocompromised patients and is rarely reported to form hepatic lesions in immunocompetent hosts.CASE SUMMARY We present a case study of a 45-year-old female who presented with right upper quadrant abdominal pain and constitutional symptoms for several weeks.Crosssectional imaging identified several malignant-appearing liver masses.Further investigation,including serological testing and histopathologic examination,revealed the presence of serum Strongyloides antibodies and hepatic granulomas with extensive necrosis.Following treatment with ivermectin for 2 wk,there was complete resolution of the liver lesions and associated symptoms.CONCLUSION This case highlights the importance of considering parasitic infections,such as Strongyloides,in the differential diagnosis of hepatic masses.Early recognition and appropriate treatment can lead to a favorable outcome and prevent unnecessary invasive procedures.Increased awareness among clinicians is crucial to ensure the timely diagnosis and management of such cases.
基金supported by Research Deputy of Hormozgan University of Medical Science(grant No.90/108/1977)
文摘Objective:To determine the prevalence of intestinal parasitic infections among mentally retarded residents of rehabilitation center of Bandar Abbas,Hormozgan province,southern Iran.Methods:A cross-sectional study was carried out in central rehabilitation institute of Hormozgan province in summer 2010.Fecal samples of all 133 residents(72 males,61 females)aged 3-52,were collected in triplicate.Specimens were examined by direct smear,formalin-ether concentration techniques and stained by permanent Trichrome,Ziehl-Neelsen stains.Statistical analysis was conducted by SPSS 13.5.Results:Intestinal parasitic infections were seen in 48.5%(64 out of 133 subjects:53.4%in males and 46.6%in females).Strongyloides stercoralis with17.3%showed the highest incidence followed by Entamoeba coli(9.8%),Blastocystis hominis(7.5%),Giardia lamblia(2.3%),Endolimax nana(2.3%),Hymenolepis nana(0.8%),Oxyuris vermicularis(0.8%),and Chilomasix mesnili(0.8%).Double infections were found to be as:Strongyloides stercoralis+Giardia lamblia(2.3%),Entamoeba coli+Giardia lamblia(1.5%),Entamoeba coli+Blastocystis hominis(1.5%),Oxyuris vermicularis+Entamoeba coli(0.8%),Strongyloides stercoralis+Entamoeba coli(0.8%),respectively.Conclusions:Our findings reveal that strongyloidiasis is a common disease among mentally retarded population in southern Iran.
文摘Strongyloides stercoralis infects at least 100 million humans worldwide each year, but its prevalence is underestimated. It is endemic in hot and humid climates as well as resource poor countries with inadequate sanitary conditions. The rise of international travel and immigration has a positive impact in strongyloidiasis. Due to its unique auto infection life-cycle, Strongyloides may lead to chronic infections remaining undetected for decades. Strongyloidiasis is most often asymptomatic but it has a wide range of clinical presentations. The two most severe forms of strongyloidiasis are hyperinfection and disseminated syndromes. These occur most often in patients with impaired cell mediated immunity. A 42-year-old immunocompetent man presented with chronic watery diarrhea, malaise, upper abdominal pain, anorexia and weight lost. Strongyloides stercoralis was identified in stool samples and duodenal biopsy. The patient was successfully treated with albendazole. The authors report a case of strongyloidiasis hyperinfection in an immunocompetent host 20 years away from an endemic area and make a literature review.
文摘Background:Strongyloidiasis,a neglected disease caused by intestinal nematodes of the genus,is endemic to tropical and subtropical areas such as Vietnam.Morphological methods only identify the genus,while DNA-molecular techniques are susceptible in Strongyloides spp.detection.The study aims to determine the prevalence of dominant Strongyloides species among the population in Duc Hoa district,Long An,Vietnam.Methods:A cross-sectional study used 1190 stool specimens collected from July 2017 to November 2018.All samples were transported within 2 h,stored at 2-8℃,and processed within 48 h for microscopy smear and culture at the Laboratory of Medical Parasitology,Pham Ngoc Thach University of Medicine(PNT).Then all positive samples with the above 2 methods were verified by real-time PCR technique.Real-time PCR amplification was conducted at the Laboratory of Molecular Biology,PNT.Results:Direct microscopy and modified Harada-Mori culture detected Strongyloides spp.larvae in 79/1190 sam-ples(6.6%).About 94.2%of the DNA samples were Strongyloides stercoralis,2.9%were co-infections with Strongy-loides ratti and S.stercoralis,and 2.9%were patients with S.ratti.The identity of 12/14 sequences was confirmed as S.stercoralis with a high level of similarity(91.3%-100%)and over 98%for S.ratti.Conclusion:DNA-molecular techniques and sequence analysis are highly suitable for identifying Strongyloides species isolated from stool samples.It is remarkable evidence of the presence of zoonosis S.ratti disease in human,not just the known S.stercoralis.It is likely to result in a certain proportion of people being infected by this animal-borne infectious pathogen.
文摘Background:Despite the high prevalence of strongyloidiasis in the Laotian population,Laotian hospitals still lack diagnostic capacity to appropriately diagnose Strongyloides stercoralis infections.This cross-sectional hospital-based study was conducted to assess the prevalence of Strongyloides stercoralis infection among hospitalized patients treated at Mahosot Hospital,the primary reference hospital of Lao People’s Democratic Republic(Lao PDR),and to validate feasible methods for diagnosing S.stercoralis infection at hospital’s laboratory.Methods:Between September and December 2018,stool samples of 104 inpatients were investigated for S.stercoralis infection by wet smear,Baermann technique,Koga Agar plate culture(KAPC),and real-time detection polymerase chain reaction(RTD-PCR)at the Infectious Diseases Ward of the Mahosot Hospital in Vientiane.The sensitivity,the specificity,the negative predictive value(NPV)of each diagnostic test,as well as their combination(s)was calculated using a composite reference standard(CRS).The correlation of the different test methods was assessed by chi-square or Fisher’s exact test.Cohen’s kappa coefficient was used to assess the diagnostic agreement of the different test methods.Results:The overall prevalence of S.stercoralis infections among the study population was 33.4%.The cumulative infection prevalence statistically significantly increased from the lowest age group of 40 years and below(22.4%),to the medium(40.0%)and to the oldest age group of 61 year and above(72.7%)(P=0.003).The cumulative infection prevalence of CRS was considerably higher in male(40.4%)compared to female patients(28.1%),but not statistically different(P=0.184).The diagnostic sensitivity of Baermann technique,KAPC,RTD-PCR,and the combination of Baermann technique and KAPC were 60.0,60.0,74.3,and 77.1%,respectively.Only 13 patients(37.1%)of the total 35 S.stercoralis patients diagnosed with any technique had a simultaneously positive diagnostic test with Baermann,KAPC and RTD-PCR.Conclusions:We identified Baermann technique and KAPC to be currently the most feasible and implementable standard methods for diagnosing S.stercoralis at a hospital setting such as Mahosot Hospital and provincial and district hospitals in Lao PDR and other low-and middle income countries in Southeast Asia.Trial registration:This study was approved by the National Ethics Committee for Health Research in Lao PDR(reference no.083/NECHR)and by the Ethics Committee Northwest and Central Switzerland(reference no.2018–00594).
文摘Background Strongyloidiasis,caused by the nematodes Strongyloides stercoralis and Strongyloides fuelleborni,is estimated to afect over 600 million individuals worldwide.The disease is endemic in Southeast Asia,where a warmhumid climate and socio-economic conditions maintain the parasite’s life cycle and transmission.However,the current diagnostic methods may not be sufciently sensitive,suggesting that the true prevalence of strongyloidiasis could be seriously underestimated in this.This study aims to determine the prevalence of strongyloidiasis in Southeast Asia through a systematic review and meta-analysis and to discuss the implications of the estimated prevalence on diagnostic approaches and control strategies.Methods Following PRISMA guidelines,we conducted a systematic literature search in PubMed and Google Scholar databases to identify studies reporting Strongyloides prevalence data in the 11 Southeast Asian countries up to December 2022.A random efects model was employed to estimate the pooled prevalence of S.stercoralis at both regional and country levels.Results Out of 3722 articles identifed,224 met our inclusion criteria.For S.stercoralis specifcally,we found 187 articles,of which 52.4%were from Thailand.All Southeast Asian countries,except Brunei,had at least one study on Strongyloides prevalence.The estimated pooled prevalence of S.stercoralis regionally was 12.7%(95%CI 10.70-14.80%),ranging from 0.4 to 24.9%at the country level.Cambodia had the highest pooled prevalence(24.9%,95%CI 15.65-35.38%),followed by Lao PDR(16.5%,95%CI 9.50-24.95%).Moreover,we obtained a pooled prevalence of 10%(95%CI 7.06-13.52%)in a group comprising immigrants,workers,and veterans from Southeast Asian countries.S.stercoralis infects various host types,including nonhuman primates,domestic dogs and cats,rodents,and transport carriers such as cockroaches and vegetables.Conclusions A high prevalence of strongyloidiasis in Southeast Asia was revealed,highlighting the importance of the region’s ongoing research,surveillance,and control eforts.Factors contributing to the strongyloidiasis transmission include the role of animal hosts,the impact of global connectivity,and the signifcance of the co-endemicity of other Strongyloides species.Based on these fndings,a multi-pronged One-Health approach is essential for sustainable intervention and control.
文摘Strongyloides stercoralis,a soil transmitted helminth infection,affects millions with varying prevalence worldwide.A large number of affected hosts are asymptomatic.Symptoms pertaining to pulmonary and gastrointestinal involvement may be present.Manifestations of involvement beyond lung and intestine can be seen with dissemination of infection and lethal hyperinfection.Immunosuppression secondary to use of steroids or other immunosuppressants and coexistence of human T-lymphotropic virus type-1 are the known risk factors for dissemination and hyperinfection.Diagnostic modalities comprise stool examination,serology and molecular testing.Stool tests are inexpensive but are limited by low sensitivity,whereas serologic and molecular tests are more precise but at the expense of higher cost.Treatment with Ivermectin or Albendazole as an alternative is safe and efficacious.We present a rare case of acute pancreatitis secondary to Strongyloides.High index of suspicion in patients specifically from endemic countries of origin and lack of other common etiologies of acute pancreatitis may help in early diagnosis and prompt treatment of this potentially fatal infection.
文摘Multiple lymphomatous polyposis (MLP) is an unusual form of non-Hodgkin's lymphoma characterized by polyps throughout the gastrointestinal tract. It has been reported that most MLP are observed in cases with mantle cell lymphoma of B-cell type. We herein present a case of a 66-year-old man with adult T-cell leukemia/lymphoma (ATLL). Colonoscopy revealed MLP throughout the colon and histopathological findings of ATLL cell infiltration. The patient died despite combination of chemotherapy. The literature of manifestations of colonic involvement of ATLL isreviewed and the importance of endoscopic evaluation to differentiate ATLL intestinal lesions from opportunistic infectious enterocolitis is discussed.
文摘Infections caused by Strongyloides stercoralis(S.stercoralis) in human are generally asymptomatic,however in immunocompromised individual,hyperinfection may develop with dissemination of larvae to extra-intestinal organs.The diagnosis could be easily missed due to asymptomatic presentation and insufficient exposure towards the infection itself,which may lead to low index of suspicion as a consequence.In this report,a case of a Malaysian male with underlying diabetes mellitus,hypertension,cerebrovascular accident,bullous pemphigus and syndrome of inappropriate antidiuretic hormone secretion who initially complained of generalized body weakness and poor appetite without any history suggestive of sepsis is presented.However,he developed septicemic shock later,and S.stercoralis larvae was incidentally found in the tracheal aspirate that was sent to look for acid fast bacilli.Regardless of aggressive resuscitation,the patient succumbed due to pulmonary hemorrhage and acute respiratory distress syndrome.It was revealed that the current case has alarmed us via incidental finding of S.stercoralis larvae in the tracheal aspirate,indicating that the importance of the disease should be emphasized in certain parts of the world and population respectively.
文摘Rationale: Strongyloides stercoralis (S. stercoralis) is an intestinal nematode with a complicated life cycle that can involve the gastrointestinal system. Infected patients are generally asymptomatic;but if symptomatic, the symptoms will include skin rash, respiratory and gastrointestinal symptoms like abdominal pain, diarrhea, nausea and vomiting. Patient concerns: A 77-year old man presented with edema of the lower extremities and insignificant tenderness in the epigastric region. Diagnosis: The histopathology of gastric tissue showed severe inflammation and multiple ulcers in the cardia, antrum and proximal duodenum. A large number of rhabditiform larvae of S. stercoralis along with tissue hyperemia and infiltration of lymphoplasma cells, eosinophils, and neutrophils were found. Intervention: Treatment with albendazole. Outcome: Despite the albendazole treatment, the patient's condition deteriorated and eventually died because of a sepsis-like syndrome. Lesson: Physicians should remain alert to the urgency due to threadworm, especially among the elderly people and immunosuppressed cases;and should ensure accurate diagnosis, suitable treatment and careful follow-up of these cases.
文摘Chronic infections caused by Strongyloides stercoralis and Schistosoma spp.can present with longstanding gastrointestinal symp-toms that mimic irritable bowel syndrome(IBS).In this case report,we describe a patient who was misdiagnosed with IBS for several decades before receiving a definitive diagnosis of chronic helminthiasis.Treatment with first-line antihelminthics resulted in complete and sustained resolution of symptoms.We review the life cycle,epidemiology,clinical presentations,diagnosis,and management of chronic helminthiases in the context of IBS.We further discuss the impact of misdiagnosis on both the patient and the healthcare system.Given the significant individual and economic burdens of IBS and the diagnostic uncertainty associated with low sensitivity of standard diagnostic tests for helminth infections,healthcare professionals should maintain a low threshold for testing and empiric treatment in patients with relevant travel and medical history.
