Strongyloides Stercoralis- An Underdiagnosed Parasitic Infection?- A Study From a Tertiary Care Hospital in North India

Abstract

BACKGROUND Strongyloidiasis is an infectious parasitic disease caused by Strongyloides stercoralis-the soil transmitted intestinal nematode pathogenic to humans. The infection is prevalent throughout, infecting more than 100 million people worldwide with predominance in the warm and humid climates of tropical and sub-tropical regions of the world including India. Strongyloides stercoralis assumes a special status due to its versatile life cycle (Autoinfection) and its potential to cause long-lasting infections, particularly in immunosuppressed individuals with a defective cell-mediated immunity, in whom it may lead to hyperinfection syndrome and disseminated strongyloidiasis involving several organs. Aims and Objectives-The aim of this study is to look for the prevalence of Strongyloidiasis in various clinical samples (stool, sputum, BAL, CSF and pleural fluid, etc.) and to determine the predisposing conditions for it. MATERIALS AND METHODSThis is a hospital-based observational study from September 2016 to August 2017. The various samples were received to look for opportunistic parasitic infections. They were processed by macroscopic examination, microscopic wet mount examination (Saline and Iodine Preparations) and modified Ziehl-Neelsen staining as per the standard techniques. RESULTSA total of 318 samples were screened for opportunistic parasitic infections. 16 cases (5.03%) were found to be positive for Strongyloides stercoralis larvae. 11 were males and 5 were females (Male: Female ratio= 2.2: 1). Of the 16 cases, 5 cases were found to have Strongyloides hyperinfection diagnosed by the simultaneous presence of multiple larvae in their stool and sputum samples. Similarly, 2 cases were suggestive of Strongyloides disseminated disease as diagnosed by the presence of larvae in their cerebrospinal fluid samples. Out of 16 cases 13 cases had immunosuppression history, most commonly prolonged steroid therapy and diabetes. CONCLUSIONActive surveillance of S. stercoralis should be emphasised as Strongyloidiasis is frequently underdiagnosed and remains a neglected parasitic disease. A high index of suspicion, keen observation and an attentive mind is the key to make prompt and accurate diagnosis of Strongyloidiasis.

Epidemiological and Clinical Profile of Strongyloidiasis - Experience From a Tertiary Care Centre

“…Under rare circumstances, strongyloidiasis infection can develop into a lethal fulminant disease, compromising the host's immunological system. [10,15]. Assteroids predisposetoimmuno suppression in the host, female worms of Strongyloides produce more eggs in the host body.…”

“…with a prominent genital primordium) or filariform (~500 μm in size, long esophagus, and a notched tail) stages of differentiating them from hookworm larvae [9,10]. Data were collected for details such as age, gender, presenting complaints, personal history, occupation, TLC, and absolute eosinophil count.…”

“…Most of the information available over the internet regarding the parasite S. stercoralis was either discussed with other soil-transmitted helminths [23][24][25] or as case reports [26,27]. Very few studies across the globe have focused exclusively on S. stercoralis epidemiology and risk factors for acquisition [3,22], infection rates [22,28], and clinical presentation [10,18,29]. The present study includes the rate, clinical presentations, predisposing factors, and underlying conditions associated with Strongyloidiasis in our clinical settings.…”