Strongyloidosis Hyperinfection Syndrome in an HIV-Infected Patient: A Rare Manifestation of Immune Reconstitution Inflammatory Syndrome

Natrajan, Kartik; Medisetty, Mahenderkumar; Gawali, Raviraj; Tambolkar, Ajit; Patel, Divya; Thorat, Vinay; Dubale, Nachiket; Khirid, Vrushali; Saraf, Chinmay; Dravid, Ameet

doi:10.1155/2018/6870768

Cited by 11 publications

(7 citation statements)

References 16 publications

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“…In this review, HIV positive individuals represented the highest risk group for S. stercoralis infection in Ethiopia. This finding supports several previous studies conducted across the globe [66, 67]. It is interesting to note that the increased risk of strongyloidiasis in HIV positive individuals is not associated with an increase incidence of disseminated or hyperinfection [68].…”

Section: Discussionsupporting

confidence: 90%

Strongyloidiasis in Ethiopia: systematic review on risk factors, diagnosis, prevalence and clinical outcomes

2019

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Background: Strongyloidiasis is a gastrointestinal infection caused by the parasitic nematode Strongyloides stercoralis. It is estimated to infect up to 370 million people globally and is predominately found in tropical and subtropical areas of socioeconomic disadvantage. Main body: This systematic literature review identified studies published in the last ten years on the risk factors, diagnosis, prevalence and/or clinical outcomes of strongyloidiasis in Ethiopia. The prevalence of S. stercoralis ranged from 0.2 to 11.1% in adults, 0.3% to 20.7% in children, 1.5% to 17.3% in HIV positive adults and 5% in HIV positive children. The identified studies primarily used microscopy based techniques that potentially underestimated the prevalence four fold compared with serology and PCR. Strongyloidiasis in children presents a particularly significant issue in Ethiopia as children often presented with anemia, which is associated with impaired mental and cognitive development. The most significant risk factor for strongyloidiasis was HIV status and although other risk factors were identified for helminth infections, none were statistically significant for S. stercoralis specifically. Several studies detected S. stercoralis in dogs and non-biting cyclorrhaphan flies. However, future research is needed to explore the role of these reservoirs in disease transmission. Conclusions: This review demonstrated that strongyloidiasis is an overlooked and neglected disease in Ethiopia. There is a need for a systematic approach using a combination of molecular and serology based diagnostic methods to ascertain the true incidence and burden of strongyloidiasis in Ethiopia. Further research is also needed to break the cycle of transmission by identifying environmental reservoirs, risk factors and exploring the potential for zoonotic transfer.

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Section: Discussionsupporting

confidence: 90%

Strongyloidiasis in Ethiopia: systematic review on risk factors, diagnosis, prevalence and clinical outcomes

2019

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“…Brain involvement may lead to venous thrombosis, cerebral oedema and rapid death of the patient. Strongyloidiasis is considered an opportunistic parasitic infection in HIV [4,6,10,17,21].…”

Section: стронгилоидоз в клинической практике: вопросы диагностики и лечения (краткий обзор и клинические наблюдения)mentioning

confidence: 99%

Strongyloidiasis in clinical practice: challenges in diagnostics and treatment (brief review and clinical observations)

Tokmalaev

Кожевникова

Zavoĭkin

et al. 2020

Russian Journal of Infection and Immunity

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High priority of soil-transmitted helminths worldwide and in theRussian Federationis due to their vast distribution and the severe pathological features they induce in humans. Recently, it was observed that awareness of clinicians regarding this disease category was markedly decreased, although no significant decline of the disease occurrence has been recorded, whereas rate of imported cases of parasitic diseases including soil-transmitted helminths like strongyloidiasis mainly originating from subtropical or tropical countries rose in non-endemic regions. Lack of alertness on diseases like strongyloidiasis impedes timely diagnostics and treatment. Global prevalence of strongyloidiasis was estimated to range within 30-100 million people, however the World Health Organization (WHO) suggests that it was underestimated as precise data in endemic countries remain unknown. The occurrence of these helminths has been recorded in regions of temperate-continental climate: Western Ukraine,Belarus,Moldova, the Caucasus, Central Asia, as well as inEastern Europeand the Mediterranean region. In theRussian Federationlocally acquired infections are frequently recorded in theKrasnodarTerritoryand Rostov Region. Here, based on multi-year experience in management of patients with strongyloidiasis we present our data and brief review of publications and systematic literature related to the challenges of its clinical picture, diagnostics and treatment. Life cycle, basic biological parameters of free-living helminth in nature and distinctive features of autoinfection related to strongyloidiasis were reviewed. Special attention was paid to the risk of developing severe forms (hyper-infection and disseminated strongyloidiasis) especially in immunocompromised hosts: HIV infection, radiotherapy followed by chemotherapy, long term corticosteroid use. Difficulties in diagnosing Strongyloides stercoralis infection are due to its polymorphic and non-specific clinical manifestations, as well as the lack of clinical knowledge and awareness about the disease. Clinical importance of parasitological methods for larvae detection was underlined. It was noted that the drug of choice in therapy of strongyloidiasis is ivermectin unapproved yet inRussia, whereas albendazole as an alternative drug exerts poorer efficacy, justifying a need to repeat treatment courses to establish full recovery from the disease.

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“…However, when the host's immune mechanisms fail to control the normal cycle of autoinfection, disseminated strongyloidiasis may occur (hyperinfection syndrome). 66,67 CNS involvement is the most severe complication of such dissemination, and may occur as a direct result of larval invasion of the CNS or may be secondary to bacteremia associated with migration of the larvae. Cerebral infarctions and brain abscesses may occur in patients with disseminated strongyloidiasis.…”

Section: Strongyloidiasis (Strongyloides Stercoralis)mentioning

confidence: 99%

Parasitic Infections of the Nervous System

2019

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Parasitic infections of the central nervous system are much more common than suspected, although most infections are asymptomatic. For example, parasites like the ubiquitous protozoa Toxoplasma gondii or the nematode larvae Toxocara canis infect significant proportions of the human population. Other parasitic infections such as malaria and neurocysticercosis are widespread in developing countries and become major causes of neurological morbidity in these regions as well in immigrants and travelers. This article reviews parasitic pathogens causing neurological morbidity and mortality, including an extensive list of less common parasitic infections of the human nervous system.

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Strongyloidosis Hyperinfection Syndrome in an HIV-Infected Patient: A Rare Manifestation of Immune Reconstitution Inflammatory Syndrome

Cited by 11 publications

References 16 publications

Strongyloidiasis in Ethiopia: systematic review on risk factors, diagnosis, prevalence and clinical outcomes

Strongyloidiasis in Ethiopia: systematic review on risk factors, diagnosis, prevalence and clinical outcomes

Strongyloidiasis in clinical practice: challenges in diagnostics and treatment (brief review and clinical observations)

Parasitic Infections of the Nervous System

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