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Lung Apr 2022Strongyloidiasis has been estimated to affect over 600 million people worldwide. It is caused by Strongyloides stercoralis, a roundworm endemic to the tropics and... (Review)
Review
Strongyloidiasis has been estimated to affect over 600 million people worldwide. It is caused by Strongyloides stercoralis, a roundworm endemic to the tropics and subtropics, especially areas where sanitation is suboptimal Autochthonous transmission has been documented in rural areas of the USA and Europe. Humans are infected when larvae penetrate the skin or are ingested. Autoinfection, in which larvae generated in the host go on to re-infect the host, leads to a state of chronic asymptomatic infection often with eosinophilia. Hyperinfection syndrome may develop when patients develop immune suppression, due to medications such as corticosteroids or following solid-organ transplantation. Hyperinfection is characterized by exponential increase in parasitic burden, leading to tissue invasion and life-threatening disease and associated bloodstream infections due to enteric organisms. Cases following use of corticosteroids for COVID-19 pneumonia have been described. Strongyloidiasis can be diagnosed by direct visualization of larvae in stool or other body fluids, or by serology. Ivermectin is highly effective in treating the disease. Patients with exposure to endemic areas and those expected to become immune suppressed should be screened and treated before starting immune suppressive agents. Empiric treatment should be considered when timely testing is not readily available.
Topics: Animals; COVID-19; Eosinophilia; Humans; Sepsis; Strongyloides stercoralis; Strongyloidiasis
PubMed: 35396957
DOI: 10.1007/s00408-022-00528-z -
Nature Reviews. Disease Primers Jan 2024Strongyloidiasis is a neglected tropical disease caused primarily by the roundworm Strongyloides stercoralis. Strongyloidiasis is most prevalent in Southeast Asia and... (Review)
Review
Strongyloidiasis is a neglected tropical disease caused primarily by the roundworm Strongyloides stercoralis. Strongyloidiasis is most prevalent in Southeast Asia and the Western Pacific. Although cases have been documented worldwide, global prevalence is largely unknown due to limited surveillance. Infection of the definitive human host occurs via direct skin penetration of the infective filariform larvae. Parasitic females reside in the small intestine and reproduce via parthenogenesis, where eggs hatch inside the host before rhabditiform larvae are excreted in faeces to begin the single generation free-living life cycle. Rhabditiform larvae can also develop directly into infectious filariform larvae in the gut and cause autoinfection. Although many are asymptomatic, infected individuals may report a range of non-specific gastrointestinal, respiratory or skin symptoms. Autoinfection may cause hyperinfection and disseminated strongyloidiasis in immunocompromised individuals, which is often fatal. Diagnosis requires direct examination of larvae in clinical specimens, positive serology or nucleic acid detection. However, there is a lack of standardization of techniques for all diagnostic types. Ivermectin is the treatment of choice. Control and elimination of strongyloidiasis will require a multifaceted, integrated approach, including highly sensitive and standardized diagnostics, active surveillance, health information, education and communication strategies, improved water, sanitation and hygiene, access to efficacious treatment, vaccine development and better integration and acknowledgement in current helminth control programmes.
Topics: Animals; Female; Humans; Strongyloidiasis; Strongyloides stercoralis; Ivermectin; Immunocompromised Host; Feces
PubMed: 38272922
DOI: 10.1038/s41572-023-00490-x -
Acta Dermatovenerologica Croatica : ADC Dec 2018Strongyloidiasis is a parasitic infestation caused by the helminth Strongyloides stercoralis. It is essentially gastrointestinal and in general asymptomatic but can...
Strongyloidiasis is a parasitic infestation caused by the helminth Strongyloides stercoralis. It is essentially gastrointestinal and in general asymptomatic but can sometimes present with skin signs. Immunocompromised patients can develop the disseminated form of the disease due to the parasite's opportunistic behavior, as in cases of coinfection by the human T-lymphotropic type 1 virus (HTLV-1). This article presents a case of a patient infected with HTLV-I and Strongyloides stercoralis who developed the disseminated form. There were purpuric reticulated periumbilical lesions as well as vibices on the patient's flanks. Histopathologic exam of a skin lesion revealed the presence of larvae in the deep reticular dermis. We emphasize the relevance of awareness regarding interaction between HTLV-1 and strongyloidiasis, besides identification of the cutaneous manifestations of the disease to reach an appropriate therapeutic diagnosis.
Topics: Animals; HTLV-I Infections; Human T-lymphotropic virus 1; Humans; Immunocompromised Host; Male; Middle Aged; Purpura; Strongyloides stercoralis; Strongyloidiasis
PubMed: 30665485
DOI: No ID Found -
Der Pathologe Feb 2022
Topics: Animals; Strongyloides stercoralis; Strongyloidiasis
PubMed: 35015129
DOI: 10.1007/s00292-021-01046-0 -
Journal of Microbiology, Immunology,... Jun 2019Strongyloidiasis is a major neglected tropical disease with the potential of causing lifelong infection and mortality. One of the ways for effective control of this... (Review)
Review
Strongyloidiasis is a major neglected tropical disease with the potential of causing lifelong infection and mortality. One of the ways for effective control of this disease is developing improved diagnostics, particularly using serological approaches. A serological test can achieve high diagnostic sensitivity and specificity, has the potential for point-of-care translation, and can be used as a screening tool for early detection. More research is needed to find clinically important antibody biomarkers for early disease detection, mapping, and epidemiological surveillance. This article summarizes human strongyloidiasis and the available diagnostic tools for the disease, focusing on describing the current antibody assays for strongyloidiasis. Finally, prospects of developing a more effective serodiagnostic tool for strongyloidiasis are discussed.
Topics: Animals; Antibodies, Helminth; Early Diagnosis; Enzyme-Linked Immunosorbent Assay; Humans; Immunoglobulin E; Immunoglobulin G; Sensitivity and Specificity; Serologic Tests; Strongyloides stercoralis; Strongyloidiasis
PubMed: 30482708
DOI: 10.1016/j.jmii.2018.10.001 -
Journal of Helminthology Feb 2022Strongyloides stercoralis is an intestinal parasitic helminth that mainly affects humans and dogs throughout the world. Canine strongyloidosis is generally characterized... (Meta-Analysis)
Meta-Analysis Review
Strongyloides stercoralis is an intestinal parasitic helminth that mainly affects humans and dogs throughout the world. Canine strongyloidosis is generally characterized by asymptomatic infection, with fatal disease in cases of immunodeficiency. This study was conducted in order to evaluate the global prevalence of S. stercoralis in dogs. Six electronic databases were searched for this purpose. The random effects model and 95% confidence intervals (CI) were applied to determine the overall and subgroup pooled prevalence. Heterogeneity was assessed by Cochran's Q test and I2 statistic. In total, 56 datasets from 50 studies from 1,202 peer-reviewed papers were included in the current meta-analysis. 20,627 dogs were assessed in 27 countries across six World Health Organization (WHO) regions. The global prevalence of S. stercoralis infection among dogs was 6% (95% CI 4-8%; 868/20,627). According to WHO regions, the estimated prevalence ranges 2% to 11% as follows: Western Pacific (11%, 0-31%); Africa (9%, 2-19%); America (6%, 3-11%); South-East Asia (5%, 1-13%)' Europe (3%, 2-5%); and Eastern Mediterranean (2%, 0-6%). The pooled prevalence of S. stercoralis infection in dog owners was 7% (1-18%). The prevalence of S. stercoralis infection in studies based on serological assays was significantly higher than other techniques (29%, 20-39%). Younger female dogs, less than one year old, from rural areas had higher prevalence rates than their male counterparts, with no statistically significant differences. From this review, it is concluded that the low global prevalence of S. stercoralis in dogs may be strongly associated with low sensitivity diagnostic methods applied in most studies leading to the underestimation of infection rates. Therefore, the improvement of diagnostic techniques is recommended for precise evaluation of the disease.
Topics: Animals; Dogs; Feces; Female; Intestinal Diseases, Parasitic; Male; Parasites; Prevalence; Strongyloides stercoralis; Strongyloidiasis
PubMed: 35184771
DOI: 10.1017/S0022149X21000808 -
Journal of Gastroenterology and... Feb 2023
Review
Topics: Animals; Humans; Strongyloides stercoralis; Gastrointestinal Tract; Cholangiocarcinoma; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Strongyloidiasis
PubMed: 35831976
DOI: 10.1111/jgh.15934 -
PLoS Neglected Tropical Diseases Feb 2022Strongyloidiasis and Chagas disease are endemic in northern Argentina. In this study we evaluate the association between S. stercoralis and T. cruzi infections in...
BACKGROUND
Strongyloidiasis and Chagas disease are endemic in northern Argentina. In this study we evaluate the association between S. stercoralis and T. cruzi infections in villages with diverse prevalence levels for these parasites. Further understanding in the relationship between these Neglected Tropical Diseases of South America is relevant for the design of integrated control measures as well as exploring potential biologic interactions.
METHODOLOGY
Community based cross-sectional studies were carried in different villages of the Chaco and Yungas regions in Argentina. Individuals were diagnosed by serology for S. stercoralis and T. cruzi. The association between S. stercoralis and T. cruzi, and between anemia and the two parasites was evaluated using two approaches: marginal (Ma) and multilevel regression (Mu).
RESULTS
A total of 706 individuals from six villages of northern Argentina were included. A total of 37% were positive for S. stercoralis, 14% were positive for T. cruzi and 5% were positive for both. No association was found between infection with S. stercoralis and T. cruzi in any of the models, but we found a negative correlation between the prevalence of these species in the different villages (r = -0.91). Adults (> 15 years) presented association with S. stercoralis (Ma OR = 2.72; Mu OR = 2.84) and T. cruzi (Ma OR = 5.12; Mu OR = 5.48). Also, 12% and 2% of the variance of infection with S. stercoralis and T. cruzi, respectively, could be explained by differences among villages. On the other hand, anemia was associated with infection with S. stercoralis (Ma OR = 1.73; Mu OR = 1.78) and was more prevalent in adults (Ma OR = 2.59; Mu OR = 2.69).
CONCLUSION
We found that coinfection between S. stercoralis and T. cruzi is not more frequent than chance in endemic areas. However, the high prevalence for both parasites, raises the need for an integrated strategy for the control of STH and Chagas disease.
Topics: Adolescent; Adult; Animals; Argentina; Chagas Disease; Child; Child, Preschool; Coinfection; Cross-Sectional Studies; Emigrants and Immigrants; Endemic Diseases; Feces; Female; Humans; Male; Middle Aged; Prevalence; Strongyloides stercoralis; Strongyloidiasis; Trypanosoma cruzi; Young Adult
PubMed: 35120117
DOI: 10.1371/journal.pntd.0010179 -
Infection Dec 2015Strongyloides stercoralis may lead to overwhelming infestation [Strongyloides hyperinfection syndrome (SHS)]. We aimed at describing a case series of patients admitted... (Review)
Review
BACKGROUND
Strongyloides stercoralis may lead to overwhelming infestation [Strongyloides hyperinfection syndrome (SHS)]. We aimed at describing a case series of patients admitted in intensive care unit (ICU) with SHS and report a literature review of such cases.
PATIENTS AND METHODS
Retrospective multicenter study of 11 patients admitted to the ICU of tertiary hospitals with SHS between 2000 and 2013. Literature review with Pubmed retrieved 122 cases. Logistic regression analysis was performed to identify predictive factors of ICU mortality and shock occurrence.
RESULTS
133 patients [median age 53 (39, 64), 72.2 % males] were included. Underlying immunosuppression was present in 127 patients, mostly long-term corticosteroid treatment in 111 (83.5 %) patients. Fever (80.8 %), respiratory (88.6 %), and gastrointestinal (71.2 %) symptoms were common clinical manifestations. Shock occurred in 75 (57.3 %) patients and mechanical ventilation was required in 89 (67.9 %) patients. Hypereosinophilia and a concomitant bacterial infection were observed in 34 (34.3 %) and 51 (38.4 %) patients, respectively. The in-ICU mortality rate was 60.3 %. Predictive factors of ICU mortality were shock occurrence [Odds ratio (OR) 18.1, 95 % confidence interval (95 % CI) 3.03-107.6, p < 0.01] and mechanical ventilation (OR 28.1, 95 % CI 3.6-217, p < 0.01). Hypereosinophilia (OR 0.21, 95 % CI 0.06-0.7, p = 0.01) and a concomitant bacterial infection (OR 4.68, 95 % CI 1.3-16.8, p = 0.02) were independent predictors of shock occurrence.
CONCLUSION
SHS remains associated with a poor outcome, especially when associated with shock and mechanical ventilation. Deterioration to shock is often related to concomitant bacterial infection. The poor outcome of established SHS pleads for a large application of antiparasitic primary prophylaxis in at-risk patients.
Topics: Adult; Animals; Female; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Shock, Septic; Strongyloides stercoralis; Strongyloidiasis; Survival Analysis
PubMed: 26008854
DOI: 10.1007/s15010-015-0799-1 -
BioMed Research International 2016The course of infection is usually asymptomatic with a low discharge of rhabditoid larva in feces. However, the deleterious effects of alcohol consumption seem to... (Review)
Review
The course of infection is usually asymptomatic with a low discharge of rhabditoid larva in feces. However, the deleterious effects of alcohol consumption seem to enhance the susceptibility to infection, as shown by a fivefold higher strongyloidiasis frequency in alcoholics than in nonalcoholics. Moreover, the association between infection and alcoholism presents a risk for hyperinfection and severe strongyloidiasis. There are several possible mechanisms for the disruption of the host-parasite equilibrium in ethanol-addicted patients with chronic strongyloidiasis. One explanation is that chronic ethanol intake stimulates the hypothalamic-pituitary-adrenal (HPA) axis to produce excessive levels of endogenous cortisol, which in turn can lead to a deficiency in type 2 T helper cells (Th2) protective response, and also to mimic the parasite hormone ecdysone, which promotes the transformation of rhabditiform larvae to filariform larvae, leading to autoinfection. Therefore, when untreated, alcoholic patients are continuously infected by this autoinfection mechanism. Thus, the early diagnosis of strongyloidiasis and treatment can prevent serious forms of hyperinfection in ethanol abusers.
Topics: Alcoholism; Animals; Humans; Hypothalamo-Hypophyseal System; Pituitary-Adrenal System; Risk Factors; Strongyloides stercoralis; Strongyloidiasis; Th2 Cells
PubMed: 28105424
DOI: 10.1155/2016/4872473