Strongyloides Duodenitis: Case Report and Review of Literature

Kakati, Bobby; Dang, Shyam; Heif, Muhannad; Caradine, Kari D.; Mcknight, William; Aduli, Farshad

doi:10.1016/s0027-9684(15)30246-7

Cited by 18 publications

(25 citation statements)

References 21 publications

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“…An alternative cycle happens when rhabditiform larvae turn into pathogenic filariform larvae while they are still inside the host intestinal tract. In that stage, they can penetrate the colonic mucosa or perianal skin, perpetuating the parasitism for decades through a mechanism known as autoinfection [1,5]. …”

Section: Discussionmentioning

confidence: 99%

“…S. stercoralis can be found in any continent except Antarctica [5]. Tropical and subtropical regions are the most affected, with a prevalence of 85% in lower socioeconomic population [4,5].…”

Section: Discussionmentioning

confidence: 99%

“…Tropical and subtropical regions are the most affected, with a prevalence of 85% in lower socioeconomic population [4,5]. In the USA, rural Appalachia and some areas of the southeast are endemic regions.…”

Section: Discussionmentioning

confidence: 99%

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Strongyloides Stercoralis Infection Among Human Immunodeficiency Virus (HIV)-Infected Patients in the United States of America: A Case Report and Review of Literature

et al. 2017

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Patient: Male, 61Final Diagnosis: Strongyloides stercolaris-associated diarrheaSymptoms: Diarrhea • epigastric pain • nausea • weight lossMedication: IvermectinClinical Procedure: Colonic biopsiesSpecialty: Infectious DiseasesObjective:Rare diseaseBackground:Strongyloides stercoralis infection is endemic in subtropical and tropical regions but is reported rather sporadically in temperate countries. In the USA, the highest rates of infection are from the southeastern states, predominantly among immigrants. There is paucity of case reports on S. stercoralis infection among HIV-infected patients who were born and raised in the USA.Case Report:A 61-year-old male with known HIV infection (CD4 count: 235 cells/uL, undetectable HIV RNA, on antiretroviral therapy) presented with a 3-month history of diarrhea. He was initially diagnosed to have diarrhea secondary to norovirus and later with Escherichia coli. He was treated with levofloxacin but the diarrhea persisted. Stool PCR, Clostridium difficile enzyme-linked immunoassay, cryptosporidium and giardia antigen, cyclospora and isospora smear, and fecal microscopy were all negative. Peripheral blood eosinophil count was 1,000 eosinophils/mcL. Colonic biopsies revealed fragments of S. stercoralis larvae within the crypts. The patient was treated with ivermectin with improvement of symptoms. Social history revealed that he was born and raised in the northeastern USA. He was a daily methamphetamine user and engaged in anal sex with men. He denied travel to endemic areas, except for a visit to Japan more than 30 years ago.Conclusions:Our case highlights that S. stercoralis may be an underdiagnosed/under-reported cause of chronic diarrhea among HIV-infected patients. What makes this case peculiar is that the patient was born and raised in the continental USA, absence of recent travel to endemic areas, and relatively high CD4 counts. Parasitic infections, such as S. stercoralis, should be considered among HIV-infected patients with persistent diarrhea and eosinophilia regardless of ethnicity or recent travel history.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Strongyloides Stercoralis Infection Among Human Immunodeficiency Virus (HIV)-Infected Patients in the United States of America: A Case Report and Review of Literature

et al. 2017

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“…Invasive methods like endoscopy with duodenal aspirate or biopsy can also be used in patients with strong clinical suspicion of infection. Upper endoscopic exam may show normal looking mucosa with eosinophilic infiltration on pathological examination or it may show abnormal mucosa in the form of erosions and ulcerations with pathological examination characterized by cryptitis, crypt abscess and eosinophilic infiltration [36,37] . Similarly the colon, particularly rightsided colon, may get involved in the presence of overwhelming parasite burden.…”

Section: Diagnostic Methodsmentioning

confidence: 99%

Strongyloidiasis: A case with acute pancreatitis and a literature review

Makker¹,

Balar²,

Niazi³

et al. 2015

WJG

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Strongyloides stercoralis, a soil transmitted helminth infection, affects millions with varying prevalence worldwide. A large number of affected hosts are asymptomatic. Symptoms pertaining to pulmonary and gastrointestinal involvement may be present. Manifestations of involvement beyond lung and intestine can be seen with dissemination of infection and lethal hyperinfection. Immunosuppression secondary to use of steroids or other immunosuppressants and coexistence of human T-lymphotropic virus type-1 are the known risk factors for dissemination and hyperinfection. Diagnostic modalities comprise stool examination, serology and molecular testing. Stool tests are inexpensive but are limited by low sensitivity, whereas serologic and molecular tests are more precise but at the expense of higher cost. Treatment with Ivermectin or Albendazole as an alternative is safe and efficacious. We present a rare case of acute pancreatitis secondary to Strongyloides. High index of suspicion in patients specifically from endemic countries of origin and lack of other common etiologies of acute pancreatitis may help in early diagnosis and prompt treatment of this potentially fatal infection.

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“…Bronchoalveolar lavage fluid and bronchial washings and brushings are other ways for the identification of the larvae. Upper and lower endoscopy can also establish the diagnosis of strongyloidiasis, as larvae may be seen on biopsies of the affected mucosa (11,12).…”

Section: Discussionmentioning

confidence: 99%

An Unusual Presentation of Duodenal Strongyloides stercoralis Enteritis Ulcerative Colitis Patient: A Case Report

Hamidian¹,

Seyfi²

2016

Arch Crit Care Med

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Introduction: Strongyloidiasis is a parasitic disease, which is more prevalent in tropical regions of the world. It is usually found in a chronic and limited disease form yet in some immunocompromised patients, it may become a life -threatening disease. Case Presentation: A 55 -year -old female, who was a known case for ulcerative colitis, referred to the hospital with nausea and vomiting. The patient was diagnosed with Strongyloidiasis due to Strongyloides stercoralis larvae, detected in the stool examination test and the biopsy specimens taken from the duodenum. The patient received subcutaneous ivermectin and reached a complete recovery. Conclusions: Strongyloides stercoralis often causes chronic and clinically asymptomatic infection; parasite number can increase substantially in the immunocompromised host, leading to hyperinfection, dissemination, and death if unrecognized. It is noteworthy to mention that screening for Strongyloides infection before the initiation of immunosuppressive therapy should be considered, particularly in endemic areas.

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Strongyloides Duodenitis: Case Report and Review of Literature

Cited by 18 publications

References 21 publications

Strongyloides Stercoralis Infection Among Human Immunodeficiency Virus (HIV)-Infected Patients in the United States of America: A Case Report and Review of Literature

Strongyloides Stercoralis Infection Among Human Immunodeficiency Virus (HIV)-Infected Patients in the United States of America: A Case Report and Review of Literature

Strongyloidiasis: A case with acute pancreatitis and a literature review

An Unusual Presentation of Duodenal Strongyloides stercoralis Enteritis Ulcerative Colitis Patient: A Case Report

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