Infection and Hyperinfection with Strongyloides stercoralis: Clinical Presentation, Etiology of Disease, and Treatment Options

Barros, Nicolas; Montes, Martín

doi:10.1007/s40475-014-0030-y

Cited by 12 publications

(32 citation statements)

References 61 publications

(61 reference statements)

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“…Its worldwide prevalence varies between 10 and 40% in tropical and subtropical countries, but can reach up to 70% in HIV-positive patients co-infections. It is important to mention that this parasitic disease can be more severe and even attain high mortality rates in immunocompromised patients (Barros and Montes, 2014; Mejia and Nutman, 2012). The Baermann-Moraes technique (specific for S. stercoralis) was not used in this study due to the use of MIF in collecting bottles distributed among patients, which prevents larva thermo-hydrotropism.…”

Section: Discussionmentioning

confidence: 99%

Intestinal parasites in cancer patients in the South of Brazil

et al. 2017

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Intestinal parasitic infections in immunocompromised patients can lead to serious complications when not diagnosed and treated early. This study aimed to investigate the frequency of intestinal parasites in cancer patients undergoing chemotherapy in the South of Brazil. Three fecal samples collected from each patient (73 individuals) were processed by Ritchie and Faust techniques and submitted to specific staining methods for intestinal protozoa. A 61.6% parasite and/or commensal positivity was found. Helminths identified were Ascaris lumbricoides (33.3%), Taenia spp. (6.6%), Strongyloides stercoralis (4.4%) and Trichuris trichiura (2.2%). Among protozoans, Giardia lamblia (26.6%), Cryptosporidium spp. (13.3%) and Cystoisospora belli (4.4%) were identified. The presence of Entamoeba coli, Endolimax nana and Entamoeba hartmanni was also recorded. The results obtained warn of the importance of fecal parasitological diagnosis and the use of specific staining methods for the detection of intestinal parasites in cancer patients. These exams should be regularly requested at the patient's first clinic visit, given the high prevalence found in this study and the possible severity of such conditions for these individuals.Keywords: intestinal parasites, immunocompromised patients, cancer. Parasitos intestinais em pacientes com câncer do Sul do Brasil ResumoAs parasitoses intestinais em pacientes imunocomprometidos podem levar a graves complicações se não diagnosticadas e tratadas precocemente. Este estudo teve como objetivo investigar a frequência de parasitos intestinais em pacientes oncológicos submetidos ao tratamento quimioterápico. Foram coletadas três amostras de fezes de cada paciente, sendo processadas pelas técnicas de Ritchie e Faust e submetidas à métodos de coloração específicos para protozoários intestinais. Foi encontrada positividade de 61,6% para parasitos e/ou comensais. Os helmintos identificados foram Ascaris lumbricoides (33,3%), Taenia spp. (6,6%), Strongyloides stercoralis (4,4%) e Trichuris trichiura (2,2%). Dentre os protozoários, foram identificados Giardia lamblia (26,6%), Cryptosporidium spp. (13,3%) e Cystoisospora belli (4,4%). Também foi registrada presença de Entamoeba coli, Endolimax nana e Entamoeba hartmanni. Os resultados encontrados alertam para a importância do diagnóstico parasitológico de fezes junto à utilização de colorações específicas para parasitos intestinais em pacientes oncológicos, sendo que os mesmos deveriam ser requeridos como conduta já na primeira consulta clínica destes pacientes, dada à elevada prevalência aqui constatada e a possível severidade que tais moléstias podem acarretar nestes indivíduos.Palavras-chave: parasitos intestinais, pacientes imunocomprometidos, câncer.

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Section: Discussionmentioning

confidence: 99%

Intestinal parasites in cancer patients in the South of Brazil

et al. 2017

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“…Susceptibility of NSG mice to infection with S. stercoralis was compared in the present study with the susceptibility of B6.CB17-Prkdc scid /SzJ (SCID) (18), NOD/ ShiLtJ (NOD) (16,21), and NOD.CB17-Prkdc scid /J (NOD/SCID) (17) mice. A second study hypothesis, based on the current accepted dogma that hyperinfection develops in humans due to the absence of a functional immune response (1,5,6,26,27), was that NSG mice would spontaneously develop hyperinfection. Finally, we asked whether the naturally occurring C. elegans steroid, Δ7-DA, could suppress formation of L3a in NSG mice.…”

Section: Significancementioning

confidence: 99%

Methylprednisolone acetate induces, and Δ7-dafachronic acid suppresses,Strongyloides stercoralishyperinfection in NSG mice

Patton

Bonne-Année

Deckman

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

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hyperinfection causes high mortality rates in humans, and, while hyperinfection can be induced by immunosuppressive glucocorticoids, the pathogenesis remains unknown. Since immunocompetent mice are resistant to infection with , we hypothesized that NSG mice, which have a reduced innate immune response and lack adaptive immunity, would be susceptible to the infection and develop hyperinfection. Interestingly, despite the presence of large numbers of adult and first-stage larvae in-infected NSG mice, no hyperinfection was observed even when the mice were treated with a monoclonal antibody to eliminate residual granulocyte activity. NSG mice were then infected with third-stage larvae and treated for 6 wk with methylprednisolone acetate (MPA), a synthetic glucocorticoid. MPA treatment of infected mice resulted in 50% mortality and caused a significant >10-fold increase in the number of parasitic female worms compared with infected untreated mice. In addition, autoinfective third-stage larvae, which initiate hyperinfection, were found in high numbers in MPA-treated, but not untreated, mice. Remarkably, treatment with Δ7-dafachronic acid, an agonist of the parasite nuclear receptor -DAF-12, significantly reduced the worm burden in MPA-treated mice undergoing hyperinfection with Overall, this study provides a useful mouse model for autoinfection and suggests a therapeutic strategy for treating lethal hyperinfection.

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“…Although the absence of eosinophilia and the presence of important extraintestinal manifestations may deviate the clinical suspicion toward other etiologies, it is important to consider hyperinfection in the differential diagnosis of patients with multiorgan dysfunction from endemic areas . Diagnosis of SS can be very complicated in immunocompetent hosts, as the larvae output may be intermittent and in small concentrations . Therefore, a relatively high index of false‐negative results have been described with conventional stool‐based methods .…”

Section: Casementioning

confidence: 99%

Strongyloides stercoralis larvae or egg: Which came first?

Poloni

Zanotelli²,

Pedroso

et al. 2019

Transplant Infectious Dis

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Strongyloides stercoralis (SS) hyperinfection is a well-documented condition. However, SS eggs in stool samples are not commonly observed during routine analysis. Here, we report a case on SS hyperinfection where both larvae and eggs were observed in the stool sample of an immunossupressed liver allograft transplanted patient. K E Y W O R D Sliver transplantation, stercoralis hyperinfection, Strongyloides, Strongyloides stercoralis eggs

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Infection and Hyperinfection with Strongyloides stercoralis: Clinical Presentation, Etiology of Disease, and Treatment Options

Cited by 12 publications

References 61 publications

Intestinal parasites in cancer patients in the South of Brazil

Intestinal parasites in cancer patients in the South of Brazil

Methylprednisolone acetate induces, and Δ7-dafachronic acid suppresses,Strongyloides stercoralishyperinfection in NSG mice

Strongyloides stercoralis larvae or egg: Which came first?

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