Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis

Mejia, Rojelio; Nutman, Thomas B.

doi:10.1097/qco.0b013e3283551dbd

Cited by 303 publications

(327 citation statements)

References 46 publications

(54 reference statements)

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“…T-cell receptor and immunoglobulin (IgH) rearrangement studies showed a polyclonal pattern, and flow cytometry did not detect aberrant T-or B-cell populations. Serum B 12 and tryptase levels were within normal limits. Methylprednisolone 1 g intravenously was administered, and prednisone 80 mg by mouth daily was started for presumed idiopathic HES.…”

Section: Case (Continued)mentioning

confidence: 94%

“…Although clinical and laboratory findings associated with aggressive disease and poor prognosis include AEC . 100.0 3 10 9 /L, signs of congestive heart failure, features suggestive of a myeloproliferative neoplasm (eg, splenomegaly, presence of early myeloid precursors on the peripheral smear, elevated serum B 12 , and/or tryptase levels), and resistance to corticosteroid therapy, 9-11 specific biomarkers of disease progression have not been identified to date. Consequently, the decision to initiate urgent therapy depends on both the acuity and severity of the clinical presentation and the perceived risk of rapid progression.…”

Section: Initial Approach To the Patient With Hesmentioning

confidence: 99%

“…Early studies demonstrated a dramatic response to imatinib in a subset of male patients with aggressive disease 17 and features suggestive of a myeloproliferative process (eg, dysplastic eosinophils, circulating myeloid precursors, anemia, thrombocytopenia, splenomegaly, elevated serum B 12 and/or tryptase levels, atypical mast cells). 10 The majority of these imatinib-responders with HES were ultimately found to have an interstitial deletion in chromosome 4q12 causing the constitutively active fusion tyrosine kinase, FIP1L1-PDGFRA, which can be detected by FISH or reverse transcriptase-polymerase chain reaction (RT-PCR) in peripheral blood or bone marrow.…”

Section: Myeloproliferative He/hes (M-he or M-hes; He Or Hes With Docmentioning

confidence: 99%

“…Patients with a history of potential exposure to Strongyloides should receive concomitant empiric ivermectin therapy (200 mg/kg orally daily for 2 days) to prevent corticosteroid-associated hyperinfection syndrome. 12 Although every effort should be made to obtain appropriate diagnostic studies (Table 2) before initiating corticosteroid therapy, treatment should not be delayed in the face of worsening signs and symptoms.…”

Section: Initial Approach To the Patient With Hesmentioning

confidence: 99%

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How I treat hypereosinophilic syndromes

Klion

2015

Blood

192

123

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Hypereosinophilic syndromes (HESs) are a group of rare disorders characterized by peripheral blood eosinophilia of 1.5 × 109/L or higher and evidence of end organ manifestations attributable to the eosinophilia and not otherwise explained in the clinical setting. HESs are pleomorphic in clinical presentation and can be idiopathic or associated with a variety of underlying conditions, including allergic, rheumatologic, infectious, and neoplastic disorders. Moreover, the etiology of the eosinophilia in HESs can be primary (myeloid), secondary (lymphocyte-driven), or unknown. Although corticosteroids remain the first-line therapy for most forms of HESs, the availability of an increasing number of novel therapeutic agents, including tyrosine kinase inhibitors and monoclonal antibodies, has necessarily altered the approach to treatment of HESs. This review presents an updated treatment-based approach to the classification of patients with presumed HES and discusses the roles of conventional and novel agents in the management of these patients.

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Section: Case (Continued)mentioning

confidence: 94%

Section: Initial Approach To the Patient With Hesmentioning

confidence: 99%

Section: Myeloproliferative He/hes (M-he or M-hes; He Or Hes With Docmentioning

confidence: 99%

Section: Initial Approach To the Patient With Hesmentioning

confidence: 99%

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How I treat hypereosinophilic syndromes

Klion

2015

Blood

192

123

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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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Abdominal Pain and Petechial Rash in a 95-Year-Old Farmer

Kadekaru

Yano

Kinjo

2023

JAMA

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A 95-year-old farmer taking prednisolone for bullous pemphigoid had 24 hours of abdominal pain, 2 weeks of diarrhea, and 3 months of intermittent abdominal bloating and anorexia. Evaluation showed purpuric macules and small thumbprint-like patches on her upper abdomen and central chest and a white blood cell count of 13 600/μL (89.9% neutrophils, 0.2% eosinophils). What is the diagnosis and what would you do next?

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Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis

Cited by 303 publications

References 46 publications

How I treat hypereosinophilic syndromes

How I treat hypereosinophilic syndromes

Intestinal parasites in cancer patients in the South of Brazil

Abdominal Pain and Petechial Rash in a 95-Year-Old Farmer

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