Strongyloides stercoralis hyperinfection after allogeneic stem cell transplantation

Dulley, F L; Costa, Silvia Fiqueiredo; R, Cosentino; Gamba, Conrado de Oliveira; Saboya, Rosaura

doi:10.1038/bmt.2008.383

Cited by 20 publications

(18 citation statements)

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“…Reports from highly endemic countries were 65/244 (27%), with India ( [6-23]), Argentina ( [24-28]), Brazil ( [29-39]) and Peru ( [40-42]) accounting for more than two thirds. Only four cases were reported from the whole of Africa [43-46], three of which in South Africa, a state where adequate diagnostic facilities are available.…”

Section: Resultsmentioning

confidence: 99%

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Severe strongyloidiasis: a systematic review of case reports

et al. 2013

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BackgroundStrongyloidiasis is commonly a clinically unapparent, chronic infection, but immuno suppressed subjects can develop fatal disease. We carried out a review of literature on hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), in order to describe the most challenging aspects of severe strongyloidiasis.MethodsWe conducted a structured search using PubMed to collect case reports and short case series on HS/DS published from 1991 to 2011. We restricted search to papers in English, Spanish, Italian and French. Case reports were classified as HS/DS according to given definitions.ResultsRecords screened were 821, and 311 were excluded through titles and abstract evaluation. Of 510 full-text articles assessed for eligibility, 213 were included in qualitative analysis. As some of them were short case series, eventually the number of cases analyzed was 244.Steroids represented the main trigger predisposing to HS and DS (67% cases): they were mostly administered to treat underlying conditions (e.g. lymphomas, rheumatic diseases). However, sometimes steroids were empirically prescribed to treat signs and symptoms caused by unsuspected/unrecognized strongyloidiasis. Diagnosis was obtained by microscopy examination in 100% cases, while serology was done in a few cases (6.5%). Only in 3/29 cases of solid organ/bone marrow transplantation there is mention of pre-transplant serological screening. Therapeutic regimens were different in terms of drugs selection and combination, administration route and duration. Similar fatality rate was observed between patients with DS (68.5%) and HS (60%).ConclusionsProper screening (which must include serology) is mandatory in high - risk patients, for instance candidates to immunosuppressive medications, currently or previously living in endemic countries. In some cases, presumptive treatment might be justified. Ivermectin is the gold standard for treatment, although the optimal dosage is not clearly defined in case of HS/DS.

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Section: Resultsmentioning

confidence: 99%

“…A couple of patients who developed hyper infection also had co infection with CMV [21,107]. All the surviving patients received ivermectin, either as single treatment (1 patient) or in combination with albendazole (7) or thiabendazole (1) [29,54,60,71,90,92,94,142,145,150]. …”

Section: Resultsmentioning

confidence: 99%

Severe strongyloidiasis: a systematic review of case reports

et al. 2013

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“…Techniques to detect rhabditiform larvae in stool include direct smear in saline-lugol iodine stain, formalin-ethyl acetate concentration, harada-Mori filter paper culture, and nutrient agar plate cultures [4, 6]. A single stool examination fails to detect larvae in up to 70% of cases [4, 7], while the diagnostic sensitivity for S. stercoralis increases to 60–70% with 3 or more stool samples [6, 8, 9] and can approach 100% if 7 consecutive daily stool specimens are examined [3, 4, 6, 7]. …”

Section: Discussionmentioning

confidence: 99%

“…Even when stool specimens are unreliable, an ELISA test for detecting the serum IgG against a crude extract of the larvae of S. stercoralis may be positive [6, 8–11]. …”

Section: Discussionmentioning

confidence: 99%

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FatalStrongyloidesHyperinfection Complicating a Gram-Negative Sepsis after Allogeneic Stem Cell Transplantation: A Case Report and Review of the Literature

Izquierdo¹,

Briones²,

Lluch

et al. 2013

Case Reports in Hematology

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Strongyloides stercoralis is an intestinal nematode that causes strongyloidiasis, which affects 30 to 100 million people worldwide. Risk factors for hyperinfection and disseminated disease include immunosuppressive drug therapy, human T-lymphotropic virus-1 (HTLV-1) infection, solid organ and bone marrow transplantation, hematologic malignant diseases, hypogammaglobulinemia, and severe malnutrition and associated conditions. The diagnosis can be difficult because a single stool examination fails to detect larvae in up to 70% of the cases, and the symptoms are nonspecific. Although eosinophilia is a common finding in patients with chronic Strongyloides infection, it is an unreliable predictor of hyperinfection. Furthermore, the lack of eosinophilia while receiving immunosuppressive therapy cannot reliably exclude the underlying chronic Strongyloides infection. We report here a fatal Strongyloides hyperinfection in a patient receiving allogeneic stem cell transplantation; risk factors and outcome in this clinical setting are discussed.

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Parasitic Diseases

Weese

Peregrine

Anderson

et al. 2010

Companion Animal Zoonoses

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Companion animals can harbor a wide range of parasites, some of which are transmissible to humans. The overall burden of human diseases attributable to companion animal -associated parasites is unknown and varies greatly between regions. The risks associated with some are often overstated while others are largely ignored, and the range of illness can extend from mild and selflimited to fatal. Ascaris l umbricoides Companion Animal ZoonosesEdited by J. S. Weese and M. B. Fulford

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Strongyloides stercoralis hyperinfection after allogeneic stem cell transplantation

Cited by 20 publications

References 8 publications

Severe strongyloidiasis: a systematic review of case reports

Severe strongyloidiasis: a systematic review of case reports

FatalStrongyloidesHyperinfection Complicating a Gram-Negative Sepsis after Allogeneic Stem Cell Transplantation: A Case Report and Review of the Literature

Parasitic Diseases

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