1887

Abstract

is an intestinal nematode that is endemic in tropical countries. It can have a variable presentation ranging from asymptomatic eosinophilia in immunocompetent hosts to disseminated disease with sepsis in immunocompromised hosts.

We report a case of chronic diarrhoea and decreased appetite in a 53-year-old man. He was a chronic alcoholic with diabetes, hypertension and dyslipidaemia and had earlier been treated for pulmonary tuberculosis. He was treated symptomatically for loose stools at a primary health care facility without relief. Following referral to our tertiary care centre, microscopic examination of the stool showed numerous larvae and a few eggs of . Additionally, was isolated from stool culture. The patient was discharged following improvement with a combination therapy of ivermectin, albendazole and ciprofloxacin. However, within 3 days, he was readmitted and succumbed to sepsis.

Strongyloidiasis can be diagnosed easily using a very simple but often neglected investigation, namely stool microscopy. This provides an early diagnosis, based on which prompt treatment with the appropriate antihelminthics can be started, thereby reducing the probability of disseminated infection. Disseminated strongyloidiasis is a medical emergency with a poor prognosis, especially in an immunocompromised state. Such patients should be treated aggressively with antihelminthics. They must be monitored for sufficient duration in the hospital for early signs of complication. Their discharge from hospital should be planned based on a negative stool microscopy report in addition to clinical improvement, so as to decrease the mortality reported for both untreated and treated individuals.

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2021-07-22
2021-07-29
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References

  1. Requena-Méndez A, Chiodini P, Bisoffi Z, Buonfrate D, Gotuzzo E et al. The laboratory diagnosis and follow up of strongyloidiasis: a systematic review. PLoS Negl Trop Dis 2013; 7:e2002 [View Article] [PubMed]
    [Google Scholar]
  2. Teixeira MC, Pacheco FT, Souza JN, Silva ML, Inês EJ et al. Strongyloides stercoralis infection in alcoholic patients. Biomed Res Int 2016; 2016:4872473 [View Article] [PubMed]
    [Google Scholar]
  3. Tuyizere A, Ndayambaje A, Walker TD, Bayingana C, Ntirenganya C et al. Prevalence of Strongyloides stercoralis infection and other soil-transmitted helminths by cross-sectional survey in a rural community in Gisagara District, Southern Province, Rwanda. Trans R Soc Trop Med Hyg 2018; 112:97–102 [View Article] [PubMed]
    [Google Scholar]
  4. Schär F, Trostdorf U, Giardina F, Khieu V, Muth S et al. Strongyloides stercoralis: global distribution and risk factors. PLoS Negl Trop Dis 2013; 7: [View Article]
    [Google Scholar]
  5. Montes M, Sawhney C, Barros N. Strongyloides stercoralis: there but not seen. Curr Opin Infect Dis 2010; 23:500 [View Article] [PubMed]
    [Google Scholar]
  6. Viney ME, Brown M, Omoding NE, Bailey JW, Gardner MP et al. Why does HIV infection not lead to disseminated strongyloidiasis?. J Infect Dis 2004; 190:2175–2180 [View Article] [PubMed]
    [Google Scholar]
  7. Mejia R, Nutman TB. Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis. Curr Opin Infect Dis 2012; 25:458 [View Article] [PubMed]
    [Google Scholar]
  8. Ghosh K, Ghosh K. Strongyloides stercoralis septicaemia following steroid therapy for eosinophilia: report of three cases. Trans R Soc Trop Med Hyg 2007; 101:1163–1165 [View Article] [PubMed]
    [Google Scholar]
  9. Chordia P, Christopher S, Abraham OC, Muliyil J, Kang G et al. Risk factors for acquiring Strongyloides stercoralis infection among patients attending a tertiary hospital in south India. Indian J Med Microbiol 2011; 29:147 [View Article] [PubMed]
    [Google Scholar]
  10. de Souza JN, Oliveira CD, Araújo WA, Souza A, Silva ML et al. Strongyloides stercoralis in Alcoholic Patients: Implications of Alcohol Intake in the Frequency of Infection and Parasite Load. Pathogens 2020; 9:422 [View Article]
    [Google Scholar]
  11. Nagayasu E, Htwe MP, Hortiwakul T, Hino A, Tanaka T et al. A possible origin population of pathogenic intestinal nematodes, Strongyloides stercoralis, unveiled by molecular phylogeny. Scientific Reports 2017; 7:1–3 [View Article]
    [Google Scholar]
  12. Sanpool O, Intapan PM, Rodpai R, Laoraksawong P, Sadaow L et al. Dogs are reservoir hosts for possible transmission of human strongyloidiasis in Thailand: molecular identification and genetic diversity of causative parasite species. J Helminthol 2020; 94: [View Article]
    [Google Scholar]
  13. Buonfrate D, Requena-Mendez A, Angheben A, Muñoz J, Gobbi F et al. Severe strongyloidiasis: a systematic review of case reports. BMC Infect Dis 2013; 13:78 [View Article] [PubMed]
    [Google Scholar]
  14. Igra-Siegman Y, Kapila R, Sen P, Kaminski ZC, Louria DB. Syndrome of hyperinfection with Strongyloides stercoralis. Rev Infect Dis 1981; 3:397–407 [View Article] [PubMed]
    [Google Scholar]
  15. Ghoshal UC, Ghoshal U, Jain M, Kumar A, Aggarwal R et al. Strongyloides stercoralis infestation associated with septicemia due to intestinal transmural migration of bacteria. J Gastroenterol Hepatol 2002; 17:1331–1333 [View Article] [PubMed]
    [Google Scholar]
  16. Kane MG, Luby JP, Krejs GJ. Intestinal secretion as a cause of hypokalemia and cardiac arrest in a patient with strongyloidiasis. Dig Dis Sci 1984; 29:768–772 [View Article] [PubMed]
    [Google Scholar]
  17. Glenn K, Lindholm DA, Meis G, Watts L, Conger N. Case report: a case of recurrent Strongyloides stercoralis colitis in a patient with multiple myeloma. Am J Trop Med Hyg 2017; 97:1619–1622 [View Article] [PubMed]
    [Google Scholar]
  18. Janda JM, Abbott SL. The genus Aeromonas: taxonomy, pathogenicity, and infection. Clin Microbiol Rev 2010; 23:35–73 [View Article] [PubMed]
    [Google Scholar]
  19. Fasih N, Irfan S, Sheikh U, Beg MS. A fatal case of gram negative bacterial sepsis associated with disseminated strongyloidiasis in an immunocompromised patient. J Pak Med Assoc 2008; 58:91 [PubMed]
    [Google Scholar]
  20. Heyworth MF. Parasitic diseases in immunocompromised hosts: Cryptosporidiosis, isosporiasis and strongyloidiasis. Gastroenterol Clin North Am 1996; 25:691–707 [View Article] [PubMed]
    [Google Scholar]
  21. Sipali AM, Damidao AOM, Simionato CS. Small bowel bacterial overgrowth in strongyloidiasis. Digestion 1991; 49:120–124 [View Article] [PubMed]
    [Google Scholar]
  22. CDC Parasite Strongyloides Resource for health Professionals; 2021 https://www.cdc.gov/parasites/strongyloides/health_professionals/index.html#tx
  23. Pornsuriyasak P, Niticharoenpong K, Sakapibunnan A. Disseminated strongyloidiasis successfully treated with extended duration ivermectin combined with albendazole: a case report of intractable strongyloidiasis. Southeast Asian J Trop Med Public Health 2004; 35:531–534
    [Google Scholar]
  24. Hays R, Giacomin P, Olma L, Esterman A, McDermott R. The relationship between treatment for Strongyloides stercoralis infection and type 2 diabetes mellitus in an Australian Aboriginal population: A three-year cohort study. Diabetes Res Clin Pract 2017; 134:8 [View Article] [PubMed]
    [Google Scholar]
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