Disseminated strongyloides home disseminated strongyloides 20200424. There is overlapping histomorphology between strongyloides colitis and inflammatory bowel disease. Strongyloidiasis is of primary medical importance, and fatal disease can occur. We report a case of disseminated strongyloidiasis following the treatment of myeloma. Disseminated autoinfection transports intestinal fauna into the. Serologic testing is available through commercial laboratories and through the national institutes of health and cdc. For example, mccoy 1 discusses precautions taken by the army to prevent the introduction of tropical disease. Well explain the symptoms and risk factors, as well as the tests used to diagnose this condition. A 55yearold chinese male presented to hospital with diarrhea and abdominal pain. Although information concerning some diseases endemic in more remote portions of the world has been widely disseminated, a few, such as strongyloidiasis, have not been sufficiently emphasized. Strongyloidiasis is a disease caused by a nematode, or a roundworm, in the genus strongyloides.
Strongyloides parasitology practical at auburn university studyblue. Clinically apparent strongyloidiasis can lead to cutaneous, gastrointestinal and pulmonary symptoms. Strongyloidiasis is mainly prevalent in the tropics and subtropics, but there is as yet no global public health strategy for controlling the parasite. Autoinfection caused by strongyloides stercoralis frequently becomes a lifelong disease unless it is effectively treated. Strongyloides stercoralis is an intestinal nematode acquired primarily in the tropics or subtropics, estimated to infect approximately 100 million people worldwide. Whereas in chronic strongyloidiasis and in hyperinfection syndrome the larvae are limited to the gi tract and the lungs, in disseminated. Strongyloides stercoralis is an intestinal nematode endemic in the tropics and subtropics. This study aimed to screen for strongyloidiasis using serological diagnoses in transplant candidates. Co strongyloides stercoralisin solid organ transplantation. In either case, patients symptoms are a result of the parasites larval form migrating through various organs of the body. It may persist for many years but could occasionally progress to a disseminated state with a high mortality rate.
Screening of strongyloides infection using an elisa test. Strongyloidiasis among patients with chronic kidney disease is rarely reported. Cdc strongyloides resources for health professionals. Strongyloidiasis can be a severe disease, causing both hyperinfection syndrome and disseminated disease, particularly in transplantation patients. Strongyloides stercoralis is a human pathogenic parasitic roundworm causing the disease strongyloidiasis. Peripheral blood eosinophilia is common in intestinal strongyloidiasis but often absent in hyperinfection and disseminated strongyloidiasis. In the uk and australia, however, the term threadworm can also refer to nematodes of the genus enterobius, otherwise known as pinworms. Parasitic worm wikipedia list of parasites of humans wikipedia, the free encyclopedia. Strongyloidiasis is an infection caused by strongyloides stercoralis, an intestinal nematode roundworm parasite found in the tropics and subtropics and sporadically in some temperate areas. Strongyloides stercoralis hyperinfection syndrome and. However, strongyloides infection in immunocompromised individuals particularly following the administration of steroids, for example following transplant surgery can result in disseminated strongyloidiasis, in which worms move beyond the confines of the gut into other organs see section 5, below. Strongyloides stercoralis an overview sciencedirect topics. It belongs to a group of nematodes called roundworms. Strongyloidiasis is mainly prevalent in the tropics and subtropics, but there is as yet no.
It commonly causes chronic, asymptomatic infection, but a change in immune status can lead to an increase in parasite burden, hyperinfection syndrome, dissemination, and death if unrecognized. We have been able to identify only four cases in the literature of hivinfected patients with disseminated strongyloidiasis and cns involvement evidenced by direct finding of filariform larvae in csf 6, 7, in meningeal vessels, or in meningeal spaces. Cutaneous manifestations in disseminated strongyloidiasis are infrequent, but they may be a valuable diagnostic sign 37. Strongyloidiasis caused by strongyloides stercoralis is usually asymptomatic or mildly symptomatic in the gastrointestinal system. Strongyloides stercoralis infection in alcoholic patients.
Immunocompetent hosts typically are asymptomatic, despite chronic strongyloides infection. Strongyloidiasis is a parasitic infection affecting millions of people worldwide. Strongyloidiasis is caused by infection with the helminth strongyloides stercoralis. Strongyloidiasis is the name given to the disease process, which results from infection with. The symptomatic spectrum of strongyloides infection ranges from subclinical in acute and chronic infection to severe and fatal in hyperinfection syndrome and disseminated strongyloidiasis, which have casefatality rates that approach 90%. Molecular characterization of human isolates of strongyloides. A fatal strongyloides stercoralis hyperinfection syndrome. Strongyloides and veterans health p869 to call dva, ring 3 254 from regional australia, ring 1800 555 254 what is strongyloides. Strongyloides stercoralis hyperinfection syndrome is a rare but fatal disease, which occurs commonly in immunocompromised patients. Disseminated strongyloidiasis successfully treated with extended duration ivermectin combined with albendazole. In contrast, immunocompromised patients are at risk for hyperinfection syndrome and disseminated disease, with a fatality rate 50%.
Strongyloides is a parasite that is very prevalent in the tropical and subtropical regions of the world and is endemic in the southeastern united states. We report a case of strongyloides stercoralis hyperinfection syndrome and disseminated cryptococcosis, in a patient with. Strongyloides stercoralis is a unique nematode having both parasitic and freeliving cycles, with males and females present in the freeliving cycle see figure 1951 and only females present in the parasitic cycle. Hyperinfection or disseminated strongyloidiasis has been frequently reported after transplants and is related to high mortality. Disseminated strongyloidiasis is a disease with high mortality rate, especially in immunocompromised individuals. We restricted search to papers in english, spanish, italian and french. Disseminated strongyloidiasis mostly occurs in immunosuppressed patients. This intestinal worm can cause a number of symptoms in people, principally skin symptoms, abdominal pain, diarrhea and weight loss, among many other specific and vague symptoms in.
An elisa test was performed with filariform larvae of strongyloides venezuelensis as a source of antigen. Infection is particularly serious, and may be disseminated outside the alimentary tract, in immunocompromised peoplethose with human tcell lymphotropic virus type i. Strongyloidiasis is found in warm climates and this infection is seen in subtropical and tropical countries. Strongyloides stercoralis is a parasitic nematode found in. Strongyloides stercoralis is a soiltransmitted helminth, but it has a unique lifecycle that can be completed in the human host, in a process known as autoinfection. Strongyloidiasis annals of internal medicine american.
Acg case reports journal volume 4 strongyloides stercoralis colitis and colon cancer 2. Pulmonary infection with numerous roundworms developed, as suspected by bronchoalveolar lavage, and while he was receiving therapy, dissemination occurred. Clinical characteristics of disseminated strongyloidiasis, the severest form of strongyloidiasis, are not well described. Untreated hyperinfection and disseminated strongyloidiasis are associated with high mortality rates. We conducted a structured search using pubmed to collect case reports and short case series on hsds published from 1991 to 2011.
Strongyloides stercoralis introduction to diagnostic medical parasitology. Infection by htlv1 is a significant risk factor for developing strongyloides hyperinfection, and strongyloidiasis. Disseminated strongyloidiasis in a patient with acquired. Full text full text is available as a scanned copy of the original print version. Worldwide, the burden of disease is substantial 300400 million infections. Thus, any patient who came from or traveled to an endemic area of the world may potentially be infected with this parasite, particularly if symptoms and blood andor tissue eosinophilia are present. A syndrome of ss hyperinfection with dissemination was made after stool, and sputum samples also revealed ss larvae. We report the successful treatment of disseminated strongyloidiasis with a parenteral veterinary formulation of ivermectin in a patient presenting with severe malabsorption and paralytic ileus. Strongyloides stercoralis hyperinfection syndrome and disseminated disease. However, these serological test cannot distinguish between recent and old infections. Disseminated strongyloidiasis in an immunocompromised host. We describe a north american human immunodeficiency virus hivpositive patient with strongyloides stercoralis infection of the gastrointestinal tract, who required repeated standard courses of thiabendazole.
We report six immunosuppressed cancer patients with proven. Central nervous system strongyloidiasis and cryptococcosis. Delayed diagnosis results in hyperinfection syndrome and disseminated strongyloidiasis leading to mortality rates approaching 80%. Strongyloides stercoralis is a nematode roundworm which occurs in many tropical and a few temperate countries. Describe classification of disseminated strongyloidiasis into 3 clinical phenotypes, according to a case series determine clinical and laboratory findings in disseminated strongyloidiasis, according to a case series identify treatment of disseminated strongyloidiasis, according to a case series. Pdf disseminated strongyloidiasis successfully treated with.
This organism is capable of completing its life cycle entirely within the human host. Wgo practice guideline management of strongyloidiasis. Disseminated strongyloidiasis is a known complication of im. Research article open access severe strongyloidiasis. Severe disseminated strongyloidiasis has a high mortality rate of up to 87%.
Hyperinfection and disseminated strongyloidiasis are diagnosed by examining stool, sputum, cerebrospinal fluid, and other body fluids and tissues, which typically contain high numbers of filariform larvae. There are no parenteral antihelminthic drugs licensed for use in humans. Strongyloidiasis is a human parasitic infection caused by strongyloides stercoralis, which is a roundworm or nematode. Full text is available as a scanned copy of the original print version. Disseminated strongyloidiasis in a patient with acquired immunodeficiency syndrome strongyloides stercoralis, the human threadworm, is an intestinal helminth with an estiestiglobal prevalence of 3 to 30 million. Elisa, iha and ifa are useful for the diagnosis of the disease. Get a printable copy pdf file of the complete article 1. Know the causes, symptoms, treatment, complications and prevention of strongyloidiasis. Treatment of human disseminated strongyloidiasis with a. Disseminated strongyloidiasis in a patient with acquired immunodeficiency syndrome. Strongyloidiasis is a parasitic infection caused by the roundworm s. Paralytic ileus and intestinal malabsorption are frequent symptoms caused by this.
Therefore, clinical suspicion is essential for early diagnosis and improvement in survival. Strongyloidiasis is caused by infection of humans with the small length, 2. Fernando cobo, in imported infectious diseases, 2014. Cutaneous purpura is a rare manifestation of hyperinfection syndrome andor disseminated strongyloidiasis resulting from massive larval migration though intradermal vessels. Complications of infection are strongly associated with alcoholism, immunosuppression, and organ transplantation. The lymph nodes were involved by atll and rare parasites were seen within sinuses panel e. Links to pubmed are also available for selected references. We present a case of strongyloides colitis mimicking the clinical and pathologic features of. This disease is more frequent in areas where hygienic conditions are poor and in areas with a warm and humid climate. Therefore, chronic asymptomatic infection can be sustained for decades, and clinical manifestations can occur long. Though there are over 40 species within this genus that can infect birds, reptiles, amphibians, livestock and other primates, strongyloides stercoralis is the primary species that accounts for human disease.
Strongyloidiasiscausessymptomstreatmentcomplications. Disseminated strongyloidiasis with cerebral involvement. Clinical characteristics of disseminated strongyloidiasis. In case of disseminated strongyloidiasis the larva can also be found in sputum, bronchial washings, bronchoalveolar lavage and sometimes in csf. Strongyloides stercoralis hyperinfection remain quiescent indefinitely, immunosuppression can lead to the hyperinfection syndrome, which is. Strongyloidiasis is a human parasitic disease caused by the nematode called strongyloides stercoralis, or sometimes s. Htlv1associated adult tcell leukemialymphoma with disseminated strongyloidiasis, blood, volume 3, issue 24, june 2019, p. For routine use, positive results for ifat are indicated by a titre of at least 1. Pdf catmat statement on disseminated strongyloidiasis. Disease burden and endemicity strongyloides stercoralis is endemic in the tropical and subtropical regions and infects up to one hundred million people.