Mesenteric Arteriographic Findings in a Patient with Strongyloides stercoralis Hyperinfection

Reiman, Steven; Fisher, Richard G.; Dodds, Colin J.; Trinh, Charles; Laucirica, Rodolfo; Whigham, Cliff J.

doi:10.1016/s1051-0443(07)61660-1

Cited by 20 publications

(7 citation statements)

References 11 publications

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“…Exogenous and endogenous corticosteroids are recognized signals that increase the molting ratio of S. stercoralis and may result in hyperinfection and dissemination of the parasite (8), without an increase in peripheral eosinophiles count. As an alternative hypothesis, the molting of the parasite could be confined to the organs that are closer to the small intestine (where the adult stages of the parasite live), such as the liver and the pancreas, and the mesenteric vessels (9). To our knowledge, this is the first confirmed case of S. stercoralis infection transmission from the same donor to two solid allograft recipients (liver and pancreas–kidney) reported on the literature.…”

Section: Discussionmentioning

confidence: 99%

“…Strongyloides is unique among helmiths because of its ability to develop an autoinfective cycle within the human host. The noninfective rhabditiform larvae can molt, while still in the intestine, into infective filariform larvae, which invade the bowel wall (internal autoinfection) or the perianal skin (external autoinfection) to reinitiate migration and development in the lungs (1,9).…”

Section: Introductionmentioning

confidence: 99%

“…In immunocompetents, strongyloidiasis may be asymptomatic, and in symptomatic infections, the most common findings are abdominal pain, diarrhea and eosinophilia. In immunocompromised patients, mostly in those with alteration in their cellular immunity (treatment with corticosteroids, which is the most important and frequent risk factor; HTLV‐1 or HIV infection, organ transplantation, hematologic malignancies), a hyperinfection syndrome can develop due to a disruption in Th2 immune responses (9,10). It results in an acceleration of the autoinfective cycle, with the rapid multiplication, migration and increased burden of infective filariform larvae in the gastrointestinal and respiratory systems.…”

Section: Introductionmentioning

confidence: 99%

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Strongyloides Stercoralis Hyperinfection Transmitted by Liver Allograft in a Transplant Recipient

Rodríguez-Hernández¹,

Ruiz-Perez-Pipaon²,

Cañas³

et al. 2009

American Journal of Transplantation

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We describe a case of Strongyloides stercoralis hyperinfection in a liver allograft recipient 2.5 months after transplantation. The patient lives in Spain, which is not considered an endemic country for strongyloidiasis, and denied prior residence or travel to any known endemic area. The initial symptoms were fever and vomiting, and he subsequently developed a severe respiratory disease. An endoscopic biopsy of ulcerative lesions of the duodenum revealed massive mucosa infiltration by larvae and adult worms, which were also found in respiratory samples. The patient was successfully treated with combined therapy with albendazole and ivermectin. The strongyloides infection was transmitted by the liver allograft. The donor was from Ecuador and, retrospectively, his serum tested positive for S. stercoralis IgG antibodies. Additionally, the pancreas-left kidney allograft recipient from the same donor later developed an intestinal strongyloidiasis without hyperinfection syndrome. To our knowledge, this is the first confirmed case of S. stercoralis infection transmission from the same donor to two solid allograft recipients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Strongyloides Stercoralis Hyperinfection Transmitted by Liver Allograft in a Transplant Recipient

Rodríguez-Hernández¹,

Ruiz-Perez-Pipaon²,

Cañas³

et al. 2009

American Journal of Transplantation

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“…[8][9][10][11][12][13][14][15][16][17] The duration of SLE before the onset of strongyloidiasis was variable (5 weeks to 12 years), but all of the patients reported therapeutic contents were using corticosteroids. Symptoms that resembled those of Strongyloidiasis causes anemia, eosinophilia, hypocholesterolemia (due to abnormal fat absorption), and hypoalbuminemia (due to protein-losing enteropathy).…”

Section: Discussionmentioning

confidence: 99%

Recurrent paralytic ileus associated with strongyloidiasis in a patient with systemic lupus erythematosus

et al. 2006

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We present an interesting case of recurrent paralytic ileus due to strongyloidiasis in a woman who was being treated with corticosteroids and immunosuppressants for systemic lupus erythematosus (SLE). She was also a carrier of human T-cell leukemia virus type I. She had a history of strongyloidiasis 8 years earlier. Recurrent episodes of paralytic ileus due to strongyloidiasis occurred during treatment of her SLE with corticosteroids. Ivermectin was given and improved the symptoms. This case shows that symptomatic strongyloidiasis can be induced in immunocompromised hosts by immunosuppressive therapy. It is important to rule out strongyloidiasis prior to starting immunosuppressive therapy in patients from endemic areas.

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“…For most of these cases, the diagnosis was either made too late in the disease course to prevent death, [18][19][20][21][22] or after the patient succumbed to disease. 8,[23][24][25] In only four of these thirteen cases was the diagnosis made and treatment initiated sufficiently early to provide a favorable clinical outcome for the patient. 8,10,26,27 Compounding the issue is that these diagnoses were also reported in non-endemic areas, where index of suspicion is low, 7 made possible because of the long periods that S. stercoralis can reside in a host.…”

mentioning

confidence: 99%

Strongyloidiasis Hyperinfection in a Patient with a History of Systemic Lupus Erythematosus

Yung¹,

Lee²,

Boys³

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis, a nematode predominately endemic to tropical and subtropical regions, such as Southeast Asia. Autoinfection enables the organism to infect the host for extended periods. Symptoms, when present, are non-specific and may initially lead to misdiagnosis, particularly if the patient has additional co-morbid conditions. Immunosuppressive states place patients at risk for the Strongyloides hyperinfection syndrome (SHS), whereby the organism rapidly proliferates and disseminates within the host. Left untreated, SHS is commonly fatal. Unfortunately, the non-specific presentation of strongyloidiasis and the hyperinfection syndrome may lead to delays in diagnosis and treatment. We describe an unusual case of SHS in a 30-year-old man with a long-standing history of systemic lupus erythematosus who underwent a partial colectomy. The diagnosis was rendered on identification of numerous organisms during histologic examination of the colectomy specimen.Strongyloidiasis is an infection caused predominantly by the helminth Strongyloides stercoralis. This nematode is endemic to tropical and subtropical regions such as Southeast Asia, but is also present in more temperate climates, such as the northern United States and Canada.1 Infection can rarely occur in areas thought to be non-endemic for the disease. Most chronically infected persons are asymptomatic. Clinical manifestations, when present, are usually mild and non-specific. 2Immunosuppression places infected persons at risk for the Strongyloides hyperinfection syndrome (SHS), where the organism proliferates unchecked. This syndrome can cause exacerbation of the patient's symptoms related to an increased parasite load in the intestine and lungs. Additional symptoms may arise as the organism involves organs not normally associated with the auto-infective life cycle. 2,3 We describe an unusual case of SHS in a patient undergoing chronic corticosteroid treatment for systemic lupus erythematosus (SLE). We review the literature regarding SLS in immunosuppressed patients, with emphasis on those with a history of SLE.A 30 year-old Hispanic man with an eight-year history of poorly controlled SLE came to an emergency department with fever, diffuse generalized pain, and bilateral upper and lower extremity edema. He was treated with antibiotics and methylprednisolone for presumed sepsis and lupus flare. The patient's symptoms eventually resolved, but he was found to have nephrotic range protein and erythrocyte casts in his urine. He underwent an ultrasound-guided left renal biopsy, which later confirmed class IV G lupus nephritis. The next day, the patient's systolic blood pressure decreased to 90 mm of Hg, and he began to experience diffuse abdominal pain, rebound tenderness, guarding, rigidity, and emesis. His leukocyte count and lactate dehydrogenase level were increased, and his hemoglobin level decreased significantly.Based on the clinical examination and findings of a computed tomographic (CT) an...

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Mesenteric Arteriographic Findings in a Patient with Strongyloides stercoralis Hyperinfection

Cited by 20 publications

References 11 publications

Strongyloides Stercoralis Hyperinfection Transmitted by Liver Allograft in a Transplant Recipient

Strongyloides Stercoralis Hyperinfection Transmitted by Liver Allograft in a Transplant Recipient

Recurrent paralytic ileus associated with strongyloidiasis in a patient with systemic lupus erythematosus

Strongyloidiasis Hyperinfection in a Patient with a History of Systemic Lupus Erythematosus

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