Strongyloidiasis: new endoscopic findings

Choudhry, Umesh; Choudhry, Rachna; Romeo, David P.; Cammerer, Richard C.; Gopalswamy, N.

doi:10.1016/s0016-5107(95)70077-3

Cited by 21 publications

(9 citation statements)

References 15 publications

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“…However, pathognomonic findings are apparently not evident [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . Our present study confirmed the aforementioned frequent findings.…”

Section: P R I O R R E P O R T S H a V E I N D I C A T E D T H A T F mentioning

confidence: 99%

“…Brasitus et al [3] 1980 1 None Brisk bleeding, deformed bulb Milder et al [4] 1981 2 ND Enlarged folds Bone et al [5] 1982 1 ND Deformed cap, obliterated second part Bhatt et al [6] 1990 1 None Mild erythema Chen et al [7] 1994 1 Corticosteroids Flattened folds, swelling mucosa, tiny ulcer Choudhry et al [8] 1995 3 DM, none Multiple serpiginous lesions, duodenal nodule Hizawa et al [9] 1996 1 HTLV-1 and corticosteroids Edema, tiny white spots Friedenberg et al [10] 1999 1 HTLV-1 Severe stenosis Overstreet et al [11] 2003 1 HIV White punctate dotting mucosa Asano et al [12] 2004 1 HTLV-1 Fine granule, coarse mucosa, disappeared folds Thompson et al [13] 2004 6 Corticosteroids, DM, HIV, none Edema, brown discoloration, erythematous spots, subepithelial hemorrhage, megaduodenum Seet et al [14] 2005 1 Anti-myeloma drugs Erythematous and granular mucosa Karmo et al [15] 2006 1 Corticosteroids Normal Ghoshal et al [16] 2006 1 Corticosteroids Multiple nodules Werneck-Silva et al [17] 2006 4 ND Erythema, erosion Csermely et al [18] 2006 1 Anti-myeloma drugs Necrotic ulcerations Suarez and Sanchez [19] 2006 11 ND Swollen folds of nodular aspect ND: Not determined.…”

Section: Authors Year No Of Cases Immunosuppressive State Endoscopicmentioning

confidence: 99%

“…As S. stercoralis colonizes in the duodenum where the larvae mature, endoscopic evaluation has been recognized as an important tool for diagnosing strongyloidiasis. Although there have been several reports demonstrating endoscopic findings of strongyloidiasis, most of these are case reports or small case series [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . This study aims at investigating the relationship of endoscopic markers to clinical and histopathological findings of the duodenum in patients with S. stercoralis hyperinfection in an endemic region.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Kishimoto

Hokama²,

Hirata³

et al. 2008

WJG

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AIM:To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis (S. stercoralis ) hyperinfection. METHODS:Over a period of 23 years , we investigated 25 patients with S. stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis. The clinical and endoscopic findings were analyzed retrospectively. R E S U LT S :Tw e n t y -f o u r ( 9 6 % ) o f t h e p a t i e n t s investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1 (HTLV-1) infection. The abnormal endoscopic findings, mainly edematous mucosa, white villi and erythematous mucosa, were observed in 23 (92%) patients. The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy. The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative (Endoscopic severity score: 4.86 ± 2.47 vs 2.71 ± 1.38, P < 0.05). CONCLUSION:Our study clearly demonstrates that, in addition to stool analysis, endoscopic observation and biopsies are very important. We also emphasize that S. stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.

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Section: P R I O R R E P O R T S H a V E I N D I C A T E D T H A T F mentioning

confidence: 99%

Section: Authors Year No Of Cases Immunosuppressive State Endoscopicmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Kishimoto

Hokama²,

Hirata³

et al. 2008

WJG

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“…1,4 Strongyloidiasis can also be diagnosed with a low yield by straight stool microscopy. 13 The sensitivity of stool microscopy improves with serial sampling 1 or when combined with serological testing where sensitivity has been reported to be ∼95%, but this requires clinical suspicion, which is not always apparent in industrialized countries. 1 Special tests on stools that are more sensitive to detect Strongyloides larvae, including polymerase chain reaction, agar plate culture, and Baermann concentration, were not performed on samples from this patient because there was no suspicion for this infection before the final set of endoscopies and biopsies were performed; such tests are available in specialized laboratories.…”

Section: Discussionmentioning

confidence: 99%

Strongyloides stercoralis Hyperinfection Syndrome Presenting as Severe, Recurrent Gastrointestinal Bleeding, Leading to a Diagnosis of Cushing Disease

Yee¹,

Chi²,

Hansen³

et al. 2015

The American Society of Tropical Medicine and Hygiene

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Abstract.A 50-year-old male immigrant from Ethiopia presented for consultation after 3 years of hematochezia/melena requiring > 25 units of blood transfusions. Physical examination revealed severe proximal muscle wasting and weakness, central obesity, proptosis, and abdominal striae, accompanied by eosinophilia, elevated hemoglobin A1c, elevated 24-hour urinary cortisol, lack of suppression of 8 AM cortisol levels by 1 mg dexamethasone, and inappropriately elevated random adrenocorticotropic hormone (ACTH) level. Histopathological examination of gastrointestinal biopsies showed large numbers of Strongyloides stercoralis, indicating Strongyloides hyperinfection. Treatment with 2 days of ivermectin led to resolution of gastrointestinal bleeding. This syndrome was due to chronic immunosuppression from a pituitary ACTH (corticotroph) microadenoma, of which resection led to gradual normalization of urine cortisol, improved glycemic control, resolution of eosinophilia, and no recurrence of infection.

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“…Strongyloidiasis has a broad range of colonoscopic features, including loss of vascular pattern, edema, erythema, aphthous ulcers, erosions, serpiginous ulcerations, xanthoma-like lesions, yellowish-white nodules and friable mucosa [5,11,12,13,14,15,16,17]. Our present study shows that the colonoscopic findings of asymptomatic and mild strongyloidiasis may present three of the above findings, such as yellowish-white nodules, erythema and loss of vascular pattern.…”

Section: Discussionmentioning

confidence: 99%

Colonoscopic Findings and Pathologic Characteristics of Strongyloides Colitis: A Case Series

Matsui¹,

Hokama

Makishi³

et al. 2011

Digestion

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Background/Aims: Strongyloidiasis, which is caused by Strongyloides stercoralis, is one of the prevalent infections in the tropical and subtropical regions worldwide. The larvae mainly infect the small intestine and cause serious disseminated strongyloidiasis. Although upper gastrointestinal features in strongyloidiasis are well known, colonoscopic evaluation has not been established yet. The aim of this study is to clarify the characteristic findings on colonic lesions in strongyloidiasis. Method: From January 2005 to December 2009, 10 cases with strongyloidiasis underwent colonoscopy at a single center on an endemic island of Japan. The clinical and colonoscopic findings were analyzed retrospectively. Results: Six (60%) cases had an immunocompromised condition, including human T lymphotropic virus type 1 infection, corticosteroids, and chemotherapy. Hyperinfection or disseminated strongyloidiasis was not presented. Endoscopic features included yellowish-white nodules, erythema, and loss of vascular pattern, which were mainly observed in the right colon. Pathological examination revealed the filariform Strongyloides larvae and the eosinophilic infiltration of the lamina propria. Conclusion: This study demonstrates that colonoscopic observation and biopsies are very useful to diagnose strongyloidiasis. Asymptomatic cases with strongyloidiasis can have colonic involvement. Yellowish-white nodules may be a characteristic finding of colonic lesions in strongyloidiasis and can be a cautious marker to prevent fatal disseminated strongyloidiasis in endemic regions.

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Strongyloidiasis: new endoscopic findings

Cited by 21 publications

References 15 publications

Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Strongyloides stercoralis Hyperinfection Syndrome Presenting as Severe, Recurrent Gastrointestinal Bleeding, Leading to a Diagnosis of Cushing Disease

Colonoscopic Findings and Pathologic Characteristics of Strongyloides Colitis: A Case Series

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