Dysregulation of strongyloidiasis: a new hypothesis

Genta, Robert M.

doi:10.1128/cmr.5.4.345

Cited by 156 publications

(78 citation statements)

References 92 publications

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“…Two patients have received chemotherapy, three received radiation therapy and two had hematological malignancies. In addition, corticosteroids cause depression of cell-mediated immunity and are postulated to be a direct stimulator of Strongyloides [11,12]. The heavy burden of immunosuppression probably contributed to the overwhelming infection.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?

Salluh¹,

Bozza²,

Pinto³

et al. 2005

Braz J Infect Dis

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Cutaneous manifestations in disseminated strongyloidiasis are infrequent but should raise the suspicion for its diagnosis. We retrospectively evaluated the charts of six patients with cancer and a proven diagnosis of disseminated strongyloidiasis. All patients had received prophylaxis with albendazole before starting antineoplastic therapy, which included high-dose steroids. They presented with septic shock, acute respiratory failure and characteristic purpuric periumbilical skin lesions. Strongyloides larvae were identified in tracheal aspirates (n=5), gastric aspirates (n=4), lung (n=2) and skin biopsies (n=2). All patients died despite antihelminthic therapy and intensive care support.

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Section: Discussionmentioning

confidence: 99%

Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?

Salluh¹,

Bozza²,

Pinto³

et al. 2005

Braz J Infect Dis

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“…1,24,25 If such migration persists, it is associated with persistent eosinophilia. 2,26 In a percentage of patients eosinophilia may be absent.…”

Section: Discussionmentioning

confidence: 99%

High Rate of Strongyloidosis Infection, Out of Endemic Area, in Patients with Eosinophilia and without Risk of Exogenous Reinfections

Repetto¹,

Durán²,

Lasala³

et al. 2010

The American Society of Tropical Medicine and Hygiene

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Strongyloides stercoralis chronic infections are usually asymptomatic and underestimated. We used direct fresh stool examination, Ritchie's method, and agar plate culture for diagnosis in patients with eosinophilia and previous residence in endemic areas. The frequency of strongyloidosis detected among these patients was high: 21 of 42 were positive. Among them, 10 were positive only by agar plate culture. After ivermectin treatment, patients resulted negative for parasitological tests and reduced their eosinophil counts. Half of the submitted patients that were followed 4–12 months after treatment remained negative without eosinophilia, except one who showed an eosinophil ascending curve before reappearance of larvae in stools. The high frequency of strongyloidosis found in this group emphasizes the relevance of including this parasitosis among differential diagnosis in patients with eosinophilia and past risk of S. stercoralis infection to prevent disseminated infections secondary to corticoid therapy.

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“…Genta 5 raised the hypothesis that glucocorticoids and corticoids metabolites would enhance the fecundity of S. stercoralis females in duodenum and the maturation of rhabditiform larvae in the gut. He based his hypothesis on the fact that disseminated strongyloidiasis is more frequently associated with use of corticoids than with other kinds of immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of intestinal nematodes in alcoholic patients

Zago-Gomes¹,

Aikawa

Perazzio

et al. 2002

Rev. Soc. Bras. Med. Trop.

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We report the results of a retrospective study on the frequency of intestinal nematodes among 198 alcoholic and 440 nonalcoholic patients at the University Hospital Cassiano Antonio Moraes in Vitória, ES, Brazil. The control sample included 194 nonalcoholic patients matched according to age, sex and neighborhood and a random sample of 296 adults admitted at the same hospital. Stool examination by sedimentation method (three samples) was performed in all patients. There was a significantly higher frequency of intestinal nematodes in alcoholics than in controls (35.3% and 19.2%, respectively), due to a higher frequency of Strongyloides stercoralis (21.7% and 4.1%, respectively). Disregarding this parasite, the frequency of the other nematodes was similar in both groups. The higher frequency of S. stercoralis infection in alcoholics could be explained by immune modulation and/or by some alteration in corticosteroid metabolism induced by chronic ethanol ingestion. Corticosteroid metabolites would mimic the worm ecdisteroids, that would in turn increase the fecundity of females in duodenum and survival of larvae. Consequently, the higher frequency of Strongyloides larvae in stool of alcoholics does not necessarily reflect an increased frequency of infection rate, but only an increased chance to present a positive stool examination using sedimentation methods. Key-words: Alcoholism. Strongyloidiasis. Strongyloides stercoralis. Intestinal nematodes.Resumo Foi feito um estudo retrospectivo da freqüência de nematóides intestinais em 198 alcoolistas e em 440 controles, não alcoólatras, atendidos no Hospital Universitário C.A. Morais, em Vitória, ES. O grupo controle foi formado por 194 pacientes não alcoólatras, pareados por idade, sexo e procedência, e por 296 pacientes adultos, internados no mesmo hospital, escolhidos aleatoriamente. Fez-se exame parasitológico pelo método de sedimentação em todos os casos. Houve uma freqüência signifcativamente maior de nematóides intestinais no grupo de alcoólatras do que nos controles (35,3% e 18,7%, respectivamente), devido a freqüência maior de Strongyloides stercoralis (21,7% e 4,1%, respectivamente). A freqüência dos outros nematóides foi semelhante nos dois grupos. A maior freqüência de S. sterocralis nos alcoólatras poderia ser explicada pela imunomodulação induzida pela ingestão abusiva de etanol e/ou por alteração do metabolismo dos corticosteróides induzidas pelo etanol, aumentando a quantidade de metabólitos que podem mimetizar os ecdisteróides do verme, aumentando a fecundidade das fêmeas no duodeno e a sobrevivência das larvas. Desse modo, a maior freqüência de S. stercoralis nos alcoólatras não refletiria um real aumento na prevalência, mas sim um aumento na positividade do exame parasitólogico devido ao aumento do número de larvas rabdtóides eliminadas pelas fêmeas no duodeno.

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Dysregulation of strongyloidiasis: a new hypothesis

Cited by 156 publications

References 92 publications

Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?

Cutaneous periumbilical purpura in disseminated strongyloidiasis in cancer patients: a pathognomonic feature of potentially lethal disease?

High Rate of Strongyloidosis Infection, Out of Endemic Area, in Patients with Eosinophilia and without Risk of Exogenous Reinfections

Prevalence of intestinal nematodes in alcoholic patients

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