Case series of four patients with strongyloides after occupational exposure

Abstract

Case series of four patients with strongyloides after occupational exposure TO THE EDITOR: Strongyloidosis in Australia has been reported in Indigenous Australians, war veterans who have served in SouthEast Asia and travellers and immigrants from regions in which strongyloidosis is endemic. 1,2 The condition is caused by Strongyloides stercoralis, and chronic infection with the nematode is maintained by an autoinfective life cycle. The consequences of infection range from asymptomatic minor infection to chronic symptomatic strongyloidosis. In immunocompromised people, lifethreatening dissemination can occur 3 with a mortality of nearly 90%. 2 In the past 8 years at Alice Springs Hospital, four people have presented with strongyloidosis, in whom the only identifiable exposure was their occupation. Work-related exposure resulting in S. stercoralis infection has been documented previously in healthy Australian medical professionals volunteering in the Solomon Islands. 4 In our series, Patient 1 was a middle-aged white man who had previously worked as a teacher in an Indigenous school. He had documented Still's disease treated with prednisolone, methotrexate and hydroxychloroquine, and presented with urticaria, diarrhoea and a cough. Patient 2 was a child care worker with rheumatoid arthritis, treated with methotrexate and hydroxychloroquine. She presented with a rash, cough, wheezing and eosinophilia. Patient 3 was a middle-aged ex-nurse treated with methotrexate for rheumatoid arthritis, who presented with recurrent epigastric pain. Patient 4 was a paediatrician with systemic lupus erythematosis, who developed abdominal pain, nausea, diarrhoea and eosinophilia after commencing prednisolone for worsening arthralgia and vasculitis. All four patients tested positive for S. stercoralis in serological tests.

Methotrexate exposure and risk of strongyloidiasis

“…Though limited to case reports, this study identified only one case of hyperinfection and no cases of dissemination or death due to Strongyloides with the use of low‐dose MTX monotherapy. Of the subjects exposed to low doses of MTX, only three cases were not exposed to corticosteroids, of these one had hyperinfection and none had dissemination or died . Eosinophilia is known to be a poor diagnostic tool for identifying dissemination or hyperinfection ; this was confirmed in this report.…”

Strongyloides stercoralis: Systematic Review of Barriers to Controlling Strongyloidiasis for Australian Indigenous Communities

“…Australia's Indigenous communities have high prevalence of strongyloidiasis (disease resulting from S. stercoralis ) as do immigrants from other endemic countries, travellers to these countries and military personnel who have spent time in endemic regions [6], [7]. Soulsby, Hewagama and Brady [8] report four cases of strongyloidiasis in non-Indigenous people resulting from work-related exposure presenting at Alice Springs Hospital and by implication acquired indirectly from Indigenous populations. Those infected included a teacher at an Indigenous school, a child care worker, an ex-nurse and a paediatrician.…”

Strongyloides Stercoralis and Its Risk Factors: An Experience at a Tertiary Care Hospital

“…Hyperinfection by Strongyloides stercoralis is mainly seen amongst immunocompromised individuals with a high case fatality rate of around 60%. (19)(20)(21) The mortality rate of the patients having hyperinfection of the present study was 33.3%. This is characterized by an acceleration of the normal life cycle of Strongyloides stercoralis that increases its burden either in the skin or lungs or gastrointestinal tract.…”