Surveillance of strongyloidiasis in Spanish in-patients (1998–2014)

Belhassen-García, Moncef; Alonso‐Sardón, Montserrat; Martínez-Pérez, Ángela; Soler, Cristina; Carranza-Rodríguez, Cristina; Pérez-Arellano, José Luís; Muro, Antonio; Salvador, Fernando

doi:10.1371/journal.pone.0189449

Cited by 18 publications

(12 citation statements)

References 25 publications

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“…The global distribution of the helminth has been well documented in literature and so far, Central Europe has not been described as a high endemic area 1 . However, the incidence of strongyloidiasis is increasing regionally in Europe 17 . This can be explained by an increasing number of travelers to and migration from endemic countries and an increase in immunosuppressed patients 17 .…”

Section: Introductionmentioning

confidence: 99%

“…However, the incidence of strongyloidiasis is increasing regionally in Europe 17 . This can be explained by an increasing number of travelers to and migration from endemic countries and an increase in immunosuppressed patients 17 . These facts should alert transplant physicians to start screening for parasitic infections even in asymptomatic patients at risk before enrollment into transplant procedures and start of immunosuppressive therapy.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Strongyloides stercoralis infection and hyperinfection syndrome among renal allograft recipients in Central Europe

Winnicki

Eder

Mazal

et al. 2018

Sci Rep

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Strongyloides stercoralis is not hyperendemic in European countries but has been increasing in prevalence due to migration and travel. The infection is characterized by a mostly asymptomatic course or nonspecific symptoms in healthy subjects. However, immunosuppression or chemotherapy have been described as leading triggers for Strongyloides stercoralis hyperinfection syndrome and may have a fatal course. A post hoc analysis was performed among renal transplant patients during a 5-year period. Plasma samples of two hundred kidney allograft recipients were retrospectively analyzed for Strongyloides stercoralis seropositivity by established ELISA testing. Positive Strongyloides stercoralis serology was found in 3% of allograft recipients. One patient developed a life-threatening hyperinfection syndrome. His Strongyloides IgG signal had been elevated for years before the outbreak of the disease. Stronglyoides infections in transplant recipients are an important issue that physicians also in Central Europe should be aware of, given the risk of hyperinfection syndrome and the challenges in clinical diagnosis. Our study suggests that recipient and donor screening should be recommended in kidney transplantation programs in Central Europe as Strongyloides infection rates increase and its prevalence may be underestimated. Further research is needed to understand why some Strongyloides stercoralis seropositive individuals develop hyperinfection syndrome and others do not.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prevalence of Strongyloides stercoralis infection and hyperinfection syndrome among renal allograft recipients in Central Europe

Winnicki

Eder

Mazal

et al. 2018

Sci Rep

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“…Recently published data from our group have shown a tenfold increase in hospital admissions where S . stercoralis is involved over the last decade [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Management of severe strongyloidiasis attended at reference centers in Spain

et al. 2018

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IntroductionStrongyloides stercoralis is a globally distributed nematode that causes diverse clinical symptoms in humans. Spain, once considered an endemic country, has experienced a recent increase in imported cases. The introduction of serology helps diagnosis and is currently replacing microbiological techniques in some settings, but its sensitivity is variable and can be low in immunocompromised patients. Diagnosis can only be confirmed by identification of larvae. Often, this “gold standard” can only be achieved in severe cases, such as disseminated S.stercoralis infection, or S.stercoralis hyperinfection syndrome, where parasite load is high. In addition, these clinical presentations are not well-defined. Our aim is to describe severe cases of S.stercoralis, their epidemiological profile, and their clinical details.MethodsAn observational retrospective study of disseminated S.stercoralis infection, or hyperinfection syndrome. Inclusion criteria: aged over 18, with a diagnosis of disseminated S.stercoralis infection, or hyperinfection syndrome, confirmed by visualization of larvae. Patients were identified through revision of clinical records for the period 2000–2015, in collaboration with eight reference centers throughout Spain.ResultsFrom the period 2000–2015, eighteen cases were identified, 66.7% of which were male, with a median age of 40 (range 21–70). Most of them were foreigners (94.4%), mainly from Latin America (82.3%) or Western Africa (17.6%). Only one autochthonous case was identified, from 2006. Immunosuppressive conditions were present in fourteen (77%) patients, mainly due steroids use and to retroviral coinfections (four HIV, two HTLV). Transplant preceded the clinical presentation in four of them. Other comorbidities were coinfection with HBV, Trypanosoma cruzi, Mycobacterium leprae or Aspergillus spp. All presented with digestive disorders, with 55.6% also presenting malaise. 44.4% of cases had fever, 27.8% skin complaints, and 16.7% respiratory or neurological disorders. One patient presented anemia, and one other nephrotic syndrome. Diagnosis was confirmed by identification of larvae in fresh stool samples (n = 16; 88.9%), concentration techniques (n = 6; 33.3%), larval culture (n = 5; 29.4%), or digestive biopsies (n = 8; 44%). S.stercoralis forms were identified during necropsy in one case. In addition, ten (55%) had a positive serology. All the cases were treated with ivermectin, six (33%) also received albendazole and one case received thiabendazole followed by ivermectin. All needed inpatient management, involving a mean hospitalization stay of 25 days (range 1–164). Two cases received intensive care and eventually died.ConclusionsOnly eighteen cases of disseminated S.stercoralis infection/hyperinfection syndrome were identified from the 15-year period, most of which were considered to have been imported cases. Among those, immunosuppression was frequent, and mortality due to S.stercoralis was lower than previously described.

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“…This can result in severe systemic bacterial infections that may lead to multiorgan failure and death [ 4 , 5 , 6 ]. Hyperinfection and disseminated strongyloidiasis can be fatal, especially among immunocompromised individuals, with a reported mortality up to 62% [ 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Asymptomatic Strongyloidiasis among Latin American Migrants in Spain: A Community-Based Approach

et al. 2020

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Strongyloides stercoralis infection is frequently underdiagnosed since many infections remain asymptomatic. Aim: To estimate the prevalence and characteristics of asymptomatic S. stercoralis infection in Latin American migrants attending a community-based screening program for Chagas disease in Spain. Methodology: Three community-based Chagas disease screening campaigns were performed in Alicante (Spain) in 2016, 2017, and 2018. Serological testing for S. stercoralis infection was performed using a non-automatized IVD-ELISA detecting IgG (DRG Instruments GmbH, Marburg, Germany). Results: Of the 616 migrants from Central and South America who were screened, 601 were included in the study: 100 children and adolescents (<18 years of age) and 501 adults. Among the younger group, 6 participants tested positive (prevalence 6%, 95% confidence interval [CI] 2.5% to 13.1%), while 60 adults did so (prevalence 12%, 95% CI 9.3% to 15.3%). S. stercoralis infection was more common in men than in women (odds ratio adjusted [ORa] 2.28, 95% CI 1.289 to 4.03) and in those from Bolivia (ORa 2.03, 95% CI 1.15 to 3.59). Prevalence increased with age (ORa 1.02, 95% CI 0.99 to 1.05). In contrast, a university education had a protective effect (ORa 0.29, 95% CI 0.31 to 0.88). Forty-one (41/66; 62.1%) of the total cases of S. stercoralis infection were treated at the health care center. Positive stool samples were observed in 19.5% of the followed-up positive cases. Conclusion: Incorporating serological screening for S. stercoralis into community-based screening for Chagas disease is a useful intervention to detect asymptomatic S. stercoralis infection in Central and South American migrants and an opportunity to tackle neglected tropical diseases in a transversal way. The remaining challenge is to achieve patients’ adherence to the medical follow-up.

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Surveillance of strongyloidiasis in Spanish in-patients (1998–2014)

Cited by 18 publications

References 25 publications

Prevalence of Strongyloides stercoralis infection and hyperinfection syndrome among renal allograft recipients in Central Europe

Prevalence of Strongyloides stercoralis infection and hyperinfection syndrome among renal allograft recipients in Central Europe

Management of severe strongyloidiasis attended at reference centers in Spain

Asymptomatic Strongyloidiasis among Latin American Migrants in Spain: A Community-Based Approach

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