Strongyloides hyperinfection in two patients with lymphoma, purulent meningitis, and sepsis

Tabacof, Jacques; Feher, Olavo; Katz, Artur; Simon, Sérgio Daniel; Gansl, Rene Claúdio

doi:10.1002/1097-0142(19911015)68:8<1821::aid-cncr2820680829>3.0.co;2-j

Cited by 20 publications

(8 citation statements)

References 18 publications

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“…Vinca alkaloids. Vincristine use has been associated with a number of cases of hyperinfection (54,94,118). Although most of these patients also received glucocorticoids, it has been proposed that vinca alkaloids exert a toxic effect on myenteric neurons, decreasing intestinal motility and increasing the amount of time that rhabdtiform larvae have to molt to invasive filariform larvae.…”

Section: Immunosuppressive Drug Therapymentioning

confidence: 99%

“…Numerous other drugs have contributed to immunosuppressive states associated with hyperinfection, including azathioprine (129), cyclophosphamide (29,99,118), antithymocyte globulin (74, 131), anti-CD3 (87), chlorambucil (94), 6-mercaptopurine (94), methotrexate (99,118), bleomycin (118), adriamycin (99), doxorubicin (104,118), daunorubicin (23), ifosfamide (118), melphalan (104), carmustine (104), VP16 (96,118), and mitoxantrone (118), as well as total body irradiation (95). In all of these cases, glucocorticoids were administered contemporaneously.…”

Section: Immunosuppressive Drug Therapymentioning

confidence: 99%

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Strongyloides stercoralisin the Immunocompromised Population

2004

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Strongyloides stercoralis is an intestinal nematode of humans that infects tens of millions of people worldwide. S. stercoralis is unique among intestinal nematodes in its ability to complete its life cycle within the host through an asexual autoinfective cycle, allowing the infection to persist in the host indefinitely. Under some conditions associated with immunocompromise, this autoinfective cycle can become amplified into a potentially fatal hyperinfection syndrome, characterized by increased numbers of infective filariform larvae in stool and sputum and clinical manifestations of the increased parasite burden and migration, such as gastrointestinal bleeding and respiratory distress. S. stercoralis hyperinfection is often accompanied by sepsis or meningitis with enteric organisms. Glucocorticoid treatment and human T-lymphotropic virus type 1 infection are the two conditions most specifically associated with triggering hyperinfection, but cases have been reported in association with hematologic malignancy, malnutrition, and AIDS. Anthelmintic agents such as ivermectin have been used successfully in treating the hyperinfection syndrome as well as for primary and secondary prevention of hyperinfection in patients whose exposure history and underlying condition put them at increased risk

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Section: Immunosuppressive Drug Therapymentioning

confidence: 99%

Section: Immunosuppressive Drug Therapymentioning

confidence: 99%

Strongyloides stercoralisin the Immunocompromised Population

2004

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“…In immunocompromised patients, this parasite may cause a superinfection or a disseminated infection. [1][2][3][4][5] In this paper we report a rare case of a patient who contracted ileus and whose symptoms recurred four times in a six-month period. …”

mentioning

confidence: 99%

Paralytic ileus due to strongyloidiasis: case report and review of the literature.

Nonaka

Takaki

Tanaka

et al. 1998

The American Journal of Tropical Medicine and Hygiene

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Abstract. We report a rare case of a patient with ileus due to Strongyloides infection that occurred four times within a six-month period. The ileus was improved by treatment with ivermectin and there has not been a recurrence of the symptoms within the last two years.Strongyloides stercoralis is an intestinal nematode that is widely distributed in the soil throughout tropical and subtropical areas. Patients infected with this parasite may be asymptomatic or may develop a wide variety of complaints. The common symptoms are abdominal pain, weight loss, diarrhea, nausea, and vomiting. In immunocompromised patients, this parasite may cause a superinfection or a disseminated infection. [1][2][3][4][5] In this paper we report a rare case of a patient who contracted ileus and whose symptoms recurred four times in a six-month period. CASE REPORTA 70-year-old man was admitted to Sawara Hospital with constipation, abdominal pain, and vomiting. He had not lived in or visited an area endemic for S. stercoralis. In December 1994, he visited a local hospital with obstipation, but a barium enema did not show any abnormalities. On February 18, 1995, he was hospitalized at a local hospital due to nausea, vomiting, and abdominal pain. Ileus was diagnosed and treated conservatively with bowel rest and intravenous fluids. His condition soon improved and he was discharged on February 25; however, the same complaints reappeared and he was referred to our hospital on March 5th. He was treated with bowel rest and intravenous fluids for paralytic ileus, the symptoms disappeared, and he was discharged. On April 3, 1995, he was hospitalized once again at our hospital, and it was at this time that ileus reappeared for the fourth time. The patient was then readmitted on May 16, 1995.The patient was 163 cm tall and weighed 53.5 kg. The head and neck were normal. No lymphadenopathy was found. The lungs were clear and the heart was normal. The abdomen was flat and bowel sounds were present, and there was diffuse abdominal tenderness, without guarding or rebound tenderness. The liver and spleen were not palpated. No peripheral edema was noted.Stools tested for occult blood were negative. The hemoglobin level was 11.3 mg/dL, the white blood cell count was 9,200/l, with 71% neutrophils, 1% bands, 4% eosinophils, 17% lymphocytes, and 5% monocytes, and the platelet count was 233,000/l. The erythrocyte sedimentation rate was 50 m/hr. The C-reactive protein level was 0.1 mg/dL and the human T cell lymphotropic virus type-1 (HTLV-1) antibody titer was 512. Results of other studies, including blood chemistries, were all within normal limits. An abdominal radiograph demonstrated a marked air fluid level in the intestine (Figure 1) and a small bowel series showed atrophy and loss of intestinal fold and dilatation of the viscera. Gastroduodenoscopy showed coarse mucosa and loss of folds in the duodenum. A duodenum biopsy revealed Strongyloides larvae in the mucosa ( Figure 2). A microscopic examination of a stool sample was then performed and it demonst...

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“…The eosinophilic response is important for its association to a better prognosis 4 and for its proposed role to monitor amplification of existing infections or recent acquisition 15 . Other clinical manifestations lack especificity, since they are common to the neoplasic processes.…”

Section: Discussionmentioning

confidence: 99%

“…Sensitive techniques must be employed, like the classical Baermann method or the new agar-plate method 8 14 , in order to isolate larvae, from stools or from duodenal aspirates 15 .…”

Section: Discussionmentioning

confidence: 99%