Strongyloidiasis – diagnostic and therapeutic dilemmas in hyperinfection patients: a case series

The helminth infection caused by Strongyloides stercoralis is widespread in tropical regions, but rare in European countries. Unfamiliarity with the disease and diagnostic obstacles could contribute to its lethal outcome. Frequent use of corticosteroids during the COVID-19 pandemic could increase it...

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Bibliographic Details
Published in:Journal of helminthology 2022-01, Vol.96, p.e76-e76, Article e76
Main Authors: Balen Topić, M., Grubišić, B., Kovačević, E., Sviben, M., Santini, M.
Format: Article
Language:English
Subjects:
Anorexia
Antibiotics
Bacterial infections
Blood & organ donations
Chronic illnesses
Corticoids
Corticosteroids
COVID-19
Crohns disease
Cysts
Diagnosis
Diagnostic systems
E coli
Endoscopy
Fatalities
Fungicides
Hospitals
Ileum
Immunotherapy
Infections
Infectious diseases
Lymphoma
Meningitis
Microscopy
Monoclonal antibodies
Mucosa
Pandemics
Parasites
Parasitic diseases
Patients
Public health
Rituximab
Sepsis
Short Communication
Steroids
Strongyloidiasis
Tropical environment
Tropical environments
Worms
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Summary:The helminth infection caused by Strongyloides stercoralis is widespread in tropical regions, but rare in European countries. Unfamiliarity with the disease and diagnostic obstacles could contribute to its lethal outcome. Frequent use of corticosteroids during the COVID-19 pandemic could increase its significance. The aim of this retrospective descriptive study was to explore disease patterns and discuss clinical dilemmas in patients with S. stercoralis hyperinfection treated at the University Hospital for Infectious Diseases ‘Dr. Fran Mihaljević’ in Zagreb, Croatia, between 2010 and 2021. Five out of 22 (22.7%) immunosuppressed patients treated due to strongyloidiasis developed hyperinfection. All patients were male, median 64 years; four were immunosuppressed by corticosteroids (although ileum resection could have been the trigger in one) and one by rituximab. The diagnosis was established after a median of 1.5 months of symptom duration, accidentally in all patients, by visualizing the parasite in the gastric/duodenal mucosa in four cases, and bronchial aspirate in one. All patients were cachectic, four out of five had severe hypoalbuminemia and all suffered secondary bacterial/fungal infection. Despite combined antibiotic, antifungal and antihelmintic therapy, three out of five of the patients died, after failing to clear living parasites from stool samples. We can conclude that significant delays in diagnosis and lack of clinical suspicion were observed among our patients with the most severe clinical presentations of strongyloidiasis. Although being beyond diagnostic recommendations for strongyloidiasis, an early upper gastrointestinal endoscopy with mucosal sample analysis could expedite diagnosis in severe, immunosuppressed patients. The persistence of viable parasites in the stool despite antihelmintic therapy should be further investigated.
ISSN:0022-149X
1475-2697
DOI:10.1017/S0022149X22000633