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Strongyloides Stercoralis


Presentation

  • Strongyloidiasis is presently rare in Western Countries, often with delayed diagnosis due to a lack of clinical suspicion, nonspecific presentation, and low parasite intestinal output.[ncbi.nlm.nih.gov]
  • The time course of the disease and present knowledge concerning the pathogenic mechanisms of HSP suggest that Strongyloides stercoralis infection could have caused HSP in the presented patient, which was complicated by nephritis.[ncbi.nlm.nih.gov]
  • We report a case of a 36-year-old Ethiopian female who presented with abdominal pain and hypotension. Shortly thereafter, she developed acute respiratory failure and progressed to acute respiratory distress syndrome and septic shock.[ncbi.nlm.nih.gov]
  • The second patient also presented with acute pulmonary disease, which responded to antihelmintic treatment and supportive care; however, he died later due to his primary disease.[ncbi.nlm.nih.gov]
  • We present a 75-year-old male with stage II multiple myeloma who presented with relapse of Strongyloides infection after initial treatment, negative surveillance testing, and subsequent resumption of chemotherapy for his multiple myeloma.[ncbi.nlm.nih.gov]
Weight Loss
  • We report the case of a Gabonese HIV-patient who presented with haemoptysis, weight loss, fulminant diarrhoea and subsequent ileus and elevated CD4 T-cell counts.[ncbi.nlm.nih.gov]
  • loss in 85.7 % of the cases, 3 of whom described skin lesions compatible with larva currens.[ncbi.nlm.nih.gov]
  • loss, abdominal pain, malabsorption or other symptoms Infection usually occurs in the small intestine but may occur in the stomach, colon or rarely elsewhere Rhabditiform larvae may change into filariform larvae that penetrate the intestinal wall and[pathologyoutlines.com]
  • Abdominal symptoms may occur after the parasite matures to adults resembling peptic ulcer, weight loss, vomiting and diarrhea. Hives-like rashes may be seen in the area of the buttocks and around the trunk.[outbreaknewstoday.com]
Leg Swelling
  • A 58-year-old male diabetic who was operated for carcinoma larynx 4 years back was admitted with exertional dyspnoea and bilateral leg swelling for the past 2 years. Over the last 2 months, there was a progressive worsening of symptoms.[ncbi.nlm.nih.gov]
Leg Edema
  • A 58-year-old Japanese woman came to our institution because of leg edema and abdominal distention. She had developed acute pancreatitis 5 times in the past 3 years.[ncbi.nlm.nih.gov]
High Fever
  • In this article, we describe the case of a 49-year-old male gypsy on hemodialysis that was referred to our center due to high fever, breathlessness, and productive cough with bloody sputum.[ncbi.nlm.nih.gov]
Gastric Lavage
  • 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.[ncbi.nlm.nih.gov]
Cough
  • In this article, we describe the case of a 49-year-old male gypsy on hemodialysis that was referred to our center due to high fever, breathlessness, and productive cough with bloody sputum.[ncbi.nlm.nih.gov]
  • The patient was successfully treated with vancomycin; although fever and productive cough persisted. Severe gastrointestinal symptoms and pneumonia developed three weeks later.[ncbi.nlm.nih.gov]
  • Ten days later, the patient developed diarrhea, vomiting, fever, cough, skin rash, and a deteriorating mental status. She was diagnosed with disseminated S. stercoralis.[ncbi.nlm.nih.gov]
  • 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/µL.[ncbi.nlm.nih.gov]
  • This is partially digested blood tinged sputum coughed up, or perhaps swallowed, then coughed up. It has the apperance of wet coffee grounds, hence the description.[thunderhouse4-yuri.blogspot.com]
Hemoptysis
  • Sign In A 47-year-old man who had lived in Laos and was taking prednisone for dermatomyositis presented with hemoptysis, rash, abdominal pain, and melena. He was found to have Strongyloides stercoralis hyperinfection syndrome. Heidi H.[nejm.org]
  • A 47-year-old man who had lived in Laos and was taking prednisone for dermatomyositis presented with a 4-day history of abdominal pain, fever, melena, and hemoptysis and a 2-week history of rash.[nejm.org]
  • Hemoptysis increased and mechanical ventilation was started when confusion, hypercapnia, and hypoxemia developed. Six hours later, the patient died.[archbronconeumol.org]
  • Three days thereafter, he presented with bronchospasm, cough, hemoptysis, and dyspnea. The chest x-ray showed bilateral pulmonary infiltrates suggesting severe infection or pulmonary embolism.[scielo.br]
Diarrhea
  • He was initially diagnosed to have diarrhea secondary to norovirus and later with Escherichia coli. He was treated with levofloxacin but the diarrhea persisted.[ncbi.nlm.nih.gov]
  • Eight patients (22.8 %) had no predisposing illness; 3 (8.6 %) received steroid treatment, 29/35 (82.8 %) presented with persistent diarrhea and 24/35 (68.5 %) presented following comorbidities: HIV/AIDS (31.4 %), alcoholism alone (11.4 %) or with other[ncbi.nlm.nih.gov]
  • Keywords Strongyloides Diagnostic Eosinophilia Diarrhea Tropical medicine Parasitic infection Introduction Case Presentation A 63-year-old-male Vietnam War veteran noted a 6-month history of watery diarrhea.[doi.org]
  • Abstract A 50-year-old villager with chronic inflammatory demyelinating polyradiculoneuropathy developed pain abdomen, diarrhea, and vomiting after 8 weeks of prednisolone (40 mg/day) therapy.[ncbi.nlm.nih.gov]
  • A 49-year-old man with CD was admitted to our clinic with complaints of recurrent diarrhea and abdominal pain despite strict adherence to a gluten-free diet. The duodenum was seen to be edematous on gastroduodenoscopic examination.[ncbi.nlm.nih.gov]
Chronic Diarrhea
  • CONCLUSIONS Our case highlights that S. stercoralis may be an underdiagnosed/under-reported cause of chronic diarrhea among HIV-infected patients.[ncbi.nlm.nih.gov]
  • "Strongyloidiasis as a Cause of Chronic Diarrhea, Identified Using Next-Generation Strongyloides stercoralis-Specific Immunoassays". Current Tropical Medicine Reports. 1 (3): 145–147. doi : 10.1007/s40475-014-0026-7.[en.wikipedia.org]
  • Clinicians must consider invasive strongyloidiasis in patients with chronic diarrhea and peripheral eosinophilia, especially in people who have lived in or traveled to endemic areas.[doi.org]
  • In addition, peripheral eosinophilia, chronic diarrhea, malabsortion syndrome, and chronic anemia are unspecific indications of S. stercoralis infection and should alert clinicians.[archcid.com]
  • Chronic diarrhea can be a symptom. In severe cases, edema may result in obstruction of the intestinal tract, as well as loss of peristaltic contractions. Strongyloidiasis in immunocompetent individuals is usually an indolent disease.[monsterologist.blogspot.com]
Back Pain
  • He had a medical history including aortic valve replacement, diabetes mellitus, spinal stenosis, and low back pain treated with repeated local steroid injections.[ncbi.nlm.nih.gov]
Pruritus
  • […] infection occurs in immunocompetent individuals, the infection is usually asymptomatic, as occurs with clinical manifestations, they usually include general symptoms unspecific (fever, malaise, chronic wasting), dermatologic (generalized urticaria, pruritus[ivami.com]
  • Although symptoms can include pruritus, cough, dyspnea, diarrhea, and abdominal pain [ 2 ], patients can also remain asymptomatic.[doi.org]
  • When evaluating candidates for receiving a kidney transplant, special attention must be paid to the presence of unexplained eosinophilia and a history of corticoidresistant pruritus or asthma in order to diagnose a possible parasitic infection and eradicate[revistanefrologia.com]
Cutaneous Larva Migrans
  • Larva currens (creeping infection) is a form of cutaneous larva migrans specific to Strongyloides infection; it results from autoinfection. The eruption usually begins in the perianal region and is accompanied by intense pruritus.[merckmanuals.com]
Neck Mass
  • CASE REPORT: This is a case of angioimmunoblastic T-cell lymphoma (AITL) in a patient with lymphadenopathy and bulky neck mass.[ncbi.nlm.nih.gov]
Lethargy
  • We report the case of a 59-year-old Afro-Caribbean woman who presented with symptoms of anorexia, lethargy, abdominal distension and vomiting on the background of newly diagnosed multiple myeloma, treated with one cycle of cyclophosphamide-thalidomide-dexamethasone[ncbi.nlm.nih.gov]
  • The first definitive accounts of sleeping sickness are by an English naval surgeon, John Atkins, in 1721 ( 10 ) and Thomas Winterbottom, who coined the term “negro lethargy” in 1803 ( 276 ).[dx.doi.org]
Brudzinsky Sign
  • Pertinent physical examination findings included cachexia with bitemporal wasting, dry mucus membranes, adherent white patches on the oral mucosa, and negative Kernig's and Brudzinski's signs.[ncbi.nlm.nih.gov]

Workup

  • The finding of S. stercoralis eggs should be considered in the diagnostic workup of persisting hematuria that occurs after stem cell transplantation.[doi.org]
Microcytic Anemia
  • A complete blood count with differential revealed microcytic anemia with hemoglobin 3.1 g/dL and eosinophilia 26.4%.[acgcasereports.gi.org]
Paracoccidioides Brasiliensis
  • Examination of a smear prepared from aspirated tracheobronchial secretion and stained by Grocott-methenamine-silver revealed structures consistent with Paracoccidioides brasiliensis and Strongyloides stercoralis.[ncbi.nlm.nih.gov]

Treatment

  • FINDINGS: Treatment success was achieved in 62% to 79% of cases dependent on the methods employed for the diagnosis of infection and assessment of treatment outcome.[ncbi.nlm.nih.gov]
  • Eight new cases of T2DM were recorded, 7 in the treatment group and 1 in the non-treatment group (Unadjusted RR 7.71, CI 0.98-60.48, p 0.052. Adjusted RR 5.45, CI 075-35.92, p 0.093).[ncbi.nlm.nih.gov]
  • Treatment options include ivermectin, thiabendazole, or albendazole. Information on the best treatment for disseminated disease and hyperinfection is limited.[ncbi.nlm.nih.gov]
  • Early identification and initiation of treatment improves mortality rates.[ncbi.nlm.nih.gov]
  • Even with appropriate treatment, patients may experience infectious complications and failure of therapy.[ncbi.nlm.nih.gov]

Prognosis

  • Aneosinophilia is frequent and is associated with a poor prognosis and elevated mortality rate.[archcid.com]
  • Absence of eosinophilia indicates poor prognosis. 2 Although thiabendazole was the treatment of choice for strongyloidosis and still a first choice of drug, it has now been replaced by ivermectin. 8 It is fairly well tolerated and has a higher cure rate[omjournal.org]
  • […] count, the worse the prognosis.[infectiousdiseaseadvisor.com]
  • Eosinopenia and increased IgE levels have been associated with poor prognosis [ 14 , 24 ]. A high index of suspicion is essential for correct diagnosis of S. Stercoralis related duodenal obstruction. Travel history plays an important role.[omicsgroup.org]

Etiology

  • Stercoralis is an uncommon etiology for proximal bowel obstruction, high index of suspicion should be exercised in patients presenting as above and recent travel to areas endemic for S. Stercoralis.[omicsgroup.org]
  • Manifestations of infection can range from asymptomatic eosinophilia to severe, life-threatening disease in immunocompromised patients. [2] Etiology Strongyloides stercoralis is a soil-transmitted helminth.[ncbi.nlm.nih.gov]
  • Case 3 A 38-year-old Saudi male was diagnosed with ESRD of unknown etiology and was started on hemodialysis. His past medical and travel history as well as pre-transplant work up were not significant.[sjkdt.org]
  • Molbak K, Wested N, Hojlyng N, Scheutz F, Gottschau A, et al. (1994) The etiology of early childhood diarrhea: a community study from Guinea-Bissau. J Infect Dis 169: 581–587. View Article Google Scholar 88.[doi.org]

Epidemiology

  • Box, CH-4002 Basel, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, P.O. Box, CH-8001 Zurich, Switzerland. 8 Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O.[ncbi.nlm.nih.gov]
  • Epidemiologically, S. stercoralis is often missed in surveys as it is difficult to identify by standard stool examination procedures.[ncbi.nlm.nih.gov]
  • A questionnaire collecting clinical and epidemiological variables was used, and two stool samples were collected. A concentration technique (Ritchie) and a technique for detection of larvae migration (Baermann) were performed.[ncbi.nlm.nih.gov]
  • We aimed at defining the epidemiology of strongyloidiasis in immigrants and Italians living in three northern Italian Regions.[ncbi.nlm.nih.gov]
  • These epidemiological data, together with the close phylogenetic relationship of S. stercoralis with S. procyonis, a Strongyloides parasite of raccoons, possibly indicates that S. stercoralis originally evolved as a canid parasite, and later spread into[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • […] who have sex with men Sites Infection usually occurs in the lung and small intestine The stomach, colon, appendix and liver may also be affected Involvement of the central nervous system may occur with disseminated disease Esophageal disease is rare Pathophysiology[pathologyoutlines.com]
  • Pathophysiology Infection occurs through skin contact with soil that contains the filariform (infective) larvae. After penetrating the skin, larvae travel to the lungs where it matures. It then travels up the trachea.[ncbi.nlm.nih.gov]
  • While the pathophysiology of this process is unknown, some experts have postulated that reconstitution of the Th-1 immune response may promote development of invasive filariform larvae capable of autoinfection and migration [ 6 , 9 ].[link.springer.com]
  • Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test Strongyloidiasis is caused by Strongyloides stercoralis, a nematode endemic to tropical and subtropical regions worldwide.[mayomedicallaboratories.com]

Prevention

  • From the Department of Preventive Medicine and Community Health and the Department of Pathology, New Jersey Medical School Newark, New Jersey Search for other works by this author on: Purnendu Sen From the Department of Preventive Medicine and Community[doi.org]
  • This study aimed to evaluate the impact of the Health Education and Preventive Equipment Package (HEPEP), a package we developed to improve awareness and aid in the prevention of Strongyloides stercoralis infection among rural communities in northeast[ncbi.nlm.nih.gov]
  • Preventive chemotherapy with ivermectin should be recommended in areas where S. stercoralis is endemic.[ncbi.nlm.nih.gov]
  • Finally, routine screening for S. stercoralis infection in donors from endemic areas may prevent future complications.[ncbi.nlm.nih.gov]
  • Evaluation for strongyloidiasis should occur in alcoholics, especially in endemic areas, to prevent occult asymptomatic infections from progressing to life-threatening cases.[ncbi.nlm.nih.gov]

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