Ciliocytophthoria is a phenomenon where degenerated cells in infections or malignancy can present as ciliated cells on microscopy and so may be confused with ciliated parasitic infection. We present ...an interesting case of recurrent shortness of breath, misdiagnosed as chronic obstructive pulmonary disease exacerbations leading to unnecessary exposure to antimicrobials and steroids. The case was diagnosed as Strongyloides hyper-infection syndrome. Another finding worth mentioning was that ciliated cells noted on broncho-alveolar lavage were thought to be a co-infection with Balantidium coli but were later confirmed as ciliocytophthoria.
We report a case of a fatal Strongyloides stercoralis hyperinfection syndrome (SHS) in a migrant from Kenya, who had been living in Germany for three decades. A short-course oral steroid treatment ...for Chronic Obstructive Pulmonary Disease (COPD) exacerbation had been administered four weeks prior to the presentation. The initial clinical and radiological findings suggested a mechanical small bowel obstruction as a cause of ileus. Our case highlights the importance of maintaining a high index of suspicion for strongyloidiasis in patients from endemic areas even years after they left the country of origin. It demonstrates that even a five-day course of prednisolone is able to trigger SHS in patients with underlying strongyloidiasis. History of frequent previous administration of oral prednisolone for COPD exacerbations in our case raises the question why and how the last steroid regimen provoked SHS. SHS can present with multiple gastrointestinal symptoms including ileus and the absence of eosinophilia during the whole course of the disease should not lower the level of suspicion in the appropriate clinical setting.
Widespread use of corticosteroids for COVID-19 treatment has led to Strongyloides reactivation and severe disease in patients from endemic areas. We describe a US patient with COVID-19 and ...Strongyloides hyperinfection syndrome and review other reported cases. Our findings highlight the need for Strongyloides screening and treatment in high-risk populations.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Strongyloidiasis is a soil-transmitted helminthiasis, a neglected tropical disease that affects 300-900 million individuals globally. Strongyloides stercoralis is associated with cutaneous, ...respiratory, and gastrointestinal clinical manifestations. Chronicity is due to an autoinfective cycle, and host immunosuppression can lead to severe and fatal disease. Lung involvement is significant in severe strongyloidiasis, and Strongyloides has a complex association with a number of lung diseases, which will be discussed in this review.
The treatment of chronic lung diseases such as asthma and chronic obstructive pulmonary disease with corticosteroids is an important risk factor for Strongyloides hyperinfection syndrome (SHS)/disseminated strongyloidiasis. The use of corticosteroids in the treatment of coronavirus disease 2019 (COVID-19) and potentially COVID-19-induced eosinopenia are risk factors for severe strongyloidiasis. Recent findings have demonstrated a significant immunomodulatory role of Strongyloides in both latent and active pulmonary tuberculosis associated to an impaired immune response and poor outcomes in active pulmonary tuberculosis.
Strongyloides lung involvement is a common finding in severe infection. Prompt recognition of Strongyloides infection as well as prevention of severe disease by screening or presumptive treatment are important goals in order to improve Strongyloides outcomes in at-risk population.
Dermatologists can take advantage of numerous immunosuppressive drugs to treat several conditions such as autoimmune bullous dermatoses, psoriasis, and connective tissue diseases. In particular, ...corticosteroids often play an important role in the management of these diseases. However, prior to the start of immunosuppressive therapy, screening for opportunistic infections is crucial. Strongyloidiasis is one such disease. The parasite Strongyloides stercoralis is a nematode with a complex life cycle and the ability to autoinfect its host. Although it currently is a rare disease in Portugal, it has a widespread distribution especially amongst low-income countries. It is usually responsible for a chronic asymptomatic infection, albeit frequently with intermittent eosinophilia. Certain comorbidities may increase the risk for hyperinfection or disseminated disease. Such factors are the presence of immunocompromising conditions such as haematological malignancies, AIDS, HTLV-1 infection and therapies such as transplantation and corticosteroids. The screening and diagnosis are usually performed with parasitological and serological tests, and the treatment of choice is ivermectin. As such, since chronic infection can be asymptomatic and hyperinfection potentially lethal, screening prior to the start of immunosuppressive treatment is imperative. Dermatologists that prescribe such regimens should be familiar with the need of parasite screening and management prior to the start of therapy.
Background
Strongyloides stercoralis infects 100 million people worldwide. Mortality rates in hyperinfection syndrome exceed 50%. Donor‐derived Strongyloides infection has occurred after heart, ...kidney, kidney‐pancreas and liver transplantation; yet, only 10% of the US organ procurement organizations currently screen donors for strongyloidiasis.
Methods
We report a fatal case of donor‐derived disseminated Strongyloides infection in a liver transplant recipient. Following this case, we implemented universal screening and treatment of donors and recipients. We reviewed our local epidemiology and outcomes after protocol implementation.
Results
From a total of 355 deceased donors accepted at our center between January 2016, and March 2018, 14 (3.9%) had positive Strongyloides serology. Except for the index case, all other recipients of Strongyloides antibody‐positive donors within that period (including 10 kidneys, 3 livers, one combined liver/kidney, and one kidney/pancreas from eight seropositive donors) received post‐transplant prophylaxis with ivermectin, and to date are alive and doing well without signs of infection. Between October 2015, and September 2016, a total of 441 deceased donor solid organ transplants were performed at our center. 220 of these recipients had pretransplant Strongyloides serology available, and 23 of them were seropositive (10.5%). Within the first two years after the implementation of universal screening and treatment of donors and recipients, we had no cases of Strongyloides reactivation in our center.
Conclusions
Implementation of a Strongyloides screening and treatment protocol in our center was an effective strategy to prevent both recipient‐ and donor‐derived strongyloidiasis. Transplant centers should consider implementation of Strongyloides preventive strategies.
Abstract
Eosinopenia was frequently encountered in patients with coronavirus disease 2019 (COVID-19). We describe a case of a 59-year-old man who was treated with high-dose corticosteroids and ...anti-interleukin 1 receptor antagonist therapy because of severe acute respiratory distress syndrome due to a so-called cytokine storm in COVID-19. He had chronic eosinophilia for many years due to an unknown
Strongyloides stercoralis
infection, proven by serology and a positive polymerase chain reaction test on a stool sample. COVID-19 led to a complete resolution of eosinophilia, even before immunosuppressive treatment was started. Eosinophilia returned after recovery from COVID-19 and started to decline under treatment with ivermectin. Our case confirms previous reports of eosinopenia in COVID-19, as it appears even in patients with chronic eosinophilia. Presence of eosinophilia should prompt screening for strongyloidiasis in all patients eligible for immunosuppressive therapy because of the risk of
Strongyloides
hyperinfection syndrome, especially if this treatment is empirical.
Chronic Strongyloidiasis in the Primary Care Setting Sy, Hendrik; Zalcgendler, Sara; Edelman, Deborah
Infectious diseases in clinical practice (Baltimore, Md.),
11/2022, Letnik:
30, Številka:
6
Journal Article
Recenzirano
Abstract Strongyloides stercoralis can persist for decades in the human host through autoinfection. It can lead to hyperinfection syndrome, which has a high mortality rate and is associated with ...corticosteroid use. Twelve patients presented to our primary care clinic in New York with eosinophilia and were found to have chronic strongyloidiasis. The patients' characteristics are summarized and the current literature on screening of strongyloidiasis is reviewed. We aim to increase awareness for this condition among primary care providers that care for immigrant populations, especially with widespread use of corticosteroids for the treatment of coronavirus disease 2019.
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