Strongyloides stercoralis hyperinfection: an unusual cause of gastrointestinal bleeding

Franco, Matheus Cavalcante; Martins, Bruno Costa; Baba, Elisa Ryoka; Safatle‐Ribeiro, Adriana Vaz; Sakai, Paulo; Retes, Felipe Alves; Maluf‐Filho, Fauze

doi:10.1590/1806-9282.61.04.311

Cited by 5 publications

(3 citation statements)

References 5 publications

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“…It was found that Strongyloides produced more eggs when the patient was on steroids because of the immunosuppressive effect. 4 The larvae were able to mature in greater proportion in patients on steroids, leading to a greater larval load and hyperinfection in the host. The larvae then directly invade the GI tract mucosa, leading to nausea, vomiting, diarrhea, ulcerations, and massive hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Strongyloides stercoralis Hyperinfection Syndrome as a Cause of Fatal Gastrointestinal Hemorrhage

Rao

Tsai

et al. 2019

ACG Case Rep J

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Strongyloides stercoralis is a small intestinal nematode that is widespread in regions with poor sanitation. We present a 57-year-old man from Colombia who was undergoing corticosteroid therapy for a meningioma who presented after neurosurgery with abdominal pain and a profound gastrointestinal (GI) bleed. The patient underwent an esophagogastroduodenoscopy (EGD), an attempted embolization, and an exploratory laparotomy to remove the necrosed duodenum. His pathology examination revealed Strongyloides infection of the duodenum, and he died of profound blood loss. This rare diagnosis displays the importance of screening patients at a high risk of Strongyloides infection before starting glucocorticoid therapy.

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Section: Discussionmentioning

confidence: 99%

Strongyloides stercoralis Hyperinfection Syndrome as a Cause of Fatal Gastrointestinal Hemorrhage

Rao

Tsai

et al. 2019

ACG Case Rep J

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“…According to Geri et al, 18 gastrointestinal symptoms are common clinical manifestations in 71.2% of patients. According to Rios et al, 19 the hyperinfection syndrome is frequently associated with the administration of corticoids and other immunosuppressive conditions. Paredes et al 13 state that this parasitosis can relate to primary and secondary morbidities due to underestimated digestive bleeds.…”

Section: Discussionmentioning

confidence: 99%

Hemorragia Digestiva Ocasional Em Criança Por Estrongiloidíase: Importância Do Exame Parasitológico

Brandelero

Dambrós

Gonçalves

et al. 2019

Rev. paul. pediatr.

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Objective: To describe an uncommon case of infection byStrongyloides stercoralis (S. stercoralis) in a 4-month-old child and to highlight the importance of early diagnosis.Case description: The patient was a male child from the city of Videira, State of Santa Catarina, Southern Brazil, who was born preterm by Cesarean-section, weighing 1,655 g, and stayed in the neonatal intensive care unit for 20 days. At four months of age, the child started presenting blood in stools and the possibility of cow's milk protein allergy was considered, given the symptoms and the use of infant formula in his 1 st semester of life, which was then replaced by infant formula with hydrolyzed protein.White blood cell count and a parasitological stool sample were requested. Both tested positive and the stool ova and parasite examination showed a rhabditoid larva of S. stercoralis. The clinician maintained the initial hypothesis and diet, but requested three new stool samples, which tested positive for rhabditoid larvae of S. stercoralis. Since the child presented abdominal pain and vomiting, and there was still blood in stools, treatment with thiabendazole was initiated twice a day for two days. Treatment was repeated after seven days along with a new parasitological examination, which was then negative.Comments: Although strongyloidiasis is usually a mild parasitic infection, it may be severe and disseminated in immunocompromised patients. This agent must be considered in patients who live in endemic areas, and the diagnosis should be established by searching S. stercoralis larvae in tracheal secretions and in stools.

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“…Strongyloides stercoralis is one of the most neglected soil‐transmitted helminthiases and is highly prevalent in tropical and subtropical regions . The infection is usually asymptomatic and limited to the gastro‐intestinal tract; however, hyperinfection may occur, and systemic invasion by parasite larvae in immunocompromised patients can be fatal…”

Section: Introductionmentioning

confidence: 99%

Inducible nitric oxide synthase controls experimental Strongyloides infection

Rodrigues

Gonçalves

Silva

et al. 2018

Parasite Immunology

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Infection with Strongyloides sp. induces a host immune response, predominantly the Th2 type, that is able to eliminate the parasite. However, little is known about the role of the nitric oxide (NO) mediator, induced by the enzyme nitric oxide synthase (NOS), in strongyloidiasis. Therefore, in this study, we investigated the immune response of mice genetically deficient in the enzyme inducible nitric oxide synthase (iNOS ), infected with Strongyloides venezuelensis. C57BL/6 wild-type (WT) and iNOS mice were individually inoculated by subcutaneous injection of 3000 S. venezuelensis L3 larvae. In the absence of iNOS, mice were more susceptible to the infection than WT animals, in which the parasite was completely eliminated. The overall production of cytokines and specific IgG, IgG1 or IgE antibodies against the parasite was significantly lowered in infected iNOS mice. The expression of iNOS was observed in the intestine of WT hosts but mainly in the wall of the parasite, despite the presence of iNOS in mice. Altogether, we concluded that iNOS expression may play an important role in the control of S. venezuelensis infection.

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Strongyloides stercoralis hyperinfection: an unusual cause of gastrointestinal bleeding

Cited by 5 publications

References 5 publications

Strongyloides stercoralis Hyperinfection Syndrome as a Cause of Fatal Gastrointestinal Hemorrhage

Strongyloides stercoralis Hyperinfection Syndrome as a Cause of Fatal Gastrointestinal Hemorrhage

Hemorragia Digestiva Ocasional Em Criança Por Estrongiloidíase: Importância Do Exame Parasitológico

Inducible nitric oxide synthase controls experimental Strongyloides infection

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