Strongyloidiasis pre and post autologous peripheral blood stem cell transplantation

Schaffel, Rony; Portugal, Rodrigo de Souza; Maiolino, Ângelo; Nucci, Márcio

doi:10.1038/sj.bmt.1704309

Cited by 9 publications

(8 citation statements)

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“…In these cases, the result for the serological test was positive from the first date, suggesting, as already mentioned, that a single serological test might be more sensitive than several stool examinations (17). As already reported for other EIAs (13,14), the high NPV value (99.9% in our case) makes this test very suitable for screening patients at risk for strongyloidiasis and having to undergo solid organ transplantation or an immunosuppressive therapy course.…”

Section: Discussionsupporting

confidence: 50%

“…In our experience, when the cutoff value proposed by the manufacturer was used, the sensitivity reached only 84.2%, a value that may be insufficient for a screening approach, even though this test is probably more sensitive than a single stool examination (14). Negative results occurred for 9 patients having strongyloidiasis and concomitantly exhibiting an immunocompromised status such as that involving HIV infection or immunosuppressive treatment for kidney transplantation.…”

Section: Discussionmentioning

confidence: 98%

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Evaluation of a Rapid Enzyme-Linked Immunosorbent Assay for Diagnosis of Strongyloidiasis

et al. 2010

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Diagnosis of strongyloidiasis using stool examination remains unsatisfactory due to the lack of sensitivity and fastidious techniques. In this work, we investigated the value of an anti-Strongyloides IgG enzyme immunoassay (EIA), using a panel of 207 sera retrospectively collected from patients with definitive diagnoses of strongyloidiasis (n ‫؍‬ 57), other helminthic infections (n ‫؍‬ 46), eosinophilia without parasitic infection diagnosis (n ‫؍‬ 54), and digestive disturbances following a tropical journey (n ‫؍‬ 30) and from 20 negative controls. By following a receiver operating characteristic (ROC) curve analysis, it was possible to optimize the test to reach a sensitivity of 91.2% and a specificity of 93.3%, with 92.8% of patients correctly classified. Considering the incidence of strongyloidiasis diagnosed in our own laboratory, the negative predictive value was calculated at 99.9%. In conclusion, this test is very rapid and easy to perform and may be valuable for diagnosis of strongyloidiasis both in cases where the infection is unrevealed by a parasitological stool examination and in patients at risk for severe clinical forms, such as patients receiving immunosuppressive therapy.Strongyloidiasis is due to the intestinal nematode Strongyloides stercoralis. Due to poor sanitary conditions (lack of latrines) and because warm and moist climates promote the achievement of the life cycle of the parasite, the prevalence of the disease remains high in tropical and subtropical regions of the world (11). Thus, in temperate-climate countries, the infection is almost exclusively seen in patients originating from or having lived in these regions of the world. Usually, strongyloidiasis is responsible for mild abdominal troubles such as pains, alternation of diarrhea, and constipation (15). This infection may also be present with pruritus and crawling sensations under the skin. A peculiar form is the larva currens syndrome, where larvae migrate into the derma. It is considered that the intensity of the symptoms is correlated with the digestive parasitic burden. However, in cases of immunosuppression, such as that induced by human T-cell leukemia virus type 1 (HTLV-1) infection, corticosteroid treatment, or cytotoxic chemotherapy, an uncontrolled life cycle can take place, leading to the so-called hyperinfestation syndrome and even to dissemination of larvae through the body, the latter being associated with a very bleak prognosis (1,5,10,12).Thus, it is essential to diagnose strongyloidiasis in patients coming from areas of endemicity, notably patients with mild or no symptomatic forms, before the initiation of any kind of immunosuppressive treatment. Indeed, the endogenous autoinfection cycle of the parasite promotes the persistence of the parasite for decades, and strongyloidiasis has to be screened for even in cases where the patient stayed in an area of endemicity in the distant past (8). Eosinophilia is indicative of the disease but is frequently mild and nonspecific. To date, diagnosis of strongyloidiasis relies ...

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 98%

Evaluation of a Rapid Enzyme-Linked Immunosorbent Assay for Diagnosis of Strongyloidiasis

et al. 2010

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“…Laboratory diagnosis of strongyloidiasis is primarily based on the detection of Strongyloides stercoralis larvae by microscopic examination of stool samples [3–10]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…Schaffel et al have reported a double-blind randomized study comparing thiabendazole and placebo given once every month to all the patients from endemic areas. They do not find a benefit of giving prophylaxis, with similar incidences of strongyloidiasis and fewer side effects in the placebo group [10]. …”

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 Lung Infections

Timsit

Brion

Pelloux

2010

Pulmonary Involvement in Patients With Hematological Malignancies

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Strongyloidiasis pre and post autologous peripheral blood stem cell transplantation

Cited by 9 publications

References 4 publications

Evaluation of a Rapid Enzyme-Linked Immunosorbent Assay for Diagnosis of Strongyloidiasis

Evaluation of a Rapid Enzyme-Linked Immunosorbent Assay for Diagnosis of Strongyloidiasis

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

Parasitic Lung Infections

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