Invasive Enteric Infections in Hospitalized Patients with Underlying Strongyloidiasis

Department of Pathology & Laboratory Medicine, University of Kentucky, Lexington, Kentucky, United States
American Journal of Clinical Pathology (Impact Factor: 2.51). 11/2007; 128(4):622-7. DOI: 10.1309/PK0RDQWB764C3WQ2
Source: PubMed


Disseminated strongyloidiasis is often associated with enteric bacterial infections. This study was undertaken to determine if enteric organisms caused extraintestinal infections in patients infected with Strongyloides stercoralis but without apparent dissemination. The medical records of hospitalized patients from central Kentucky with strongyloidiasis (1993-2003) were examined to determine the occurrence of extraintestinal infections with enteric organisms. Of 30 patients with S stercoralis, 16 had invasive infections, including sepsis, meningitis, pneumonia, peritonitis, and endocarditis caused by enteric bacteria and Candida organisms. Infections were seen in 8 (62%) of 13 patients with disseminated strongyloidiasis and 8 (47%) of 17 with disease apparently limited to the gastrointestinal tract. Fifteen patients were receiving corticosteroids or other immunosuppressive therapy. Peripheral eosinophilia was seen in only 23% (7/30). Infection with S stercoralis, even without obvious dissemination, may predispose to invasive infections caused by enteric organisms. In Strongyloides-endemic areas, patients with invasive infections caused by enteric organisms should be examined for coinfection with S stercoralis.

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Available from: Julie Ribes, Jun 27, 2014
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    • "Due to the patient epidemiological history and gastrointestinal manifestations, such as weight loss, diarrhea, hematochezia , and ileum, SS infection should have been considered in the differential diagnosis. Clinicians should have a high level of clinical suspicion for the diagnosis of strongyloidiasis in patients with severe extraintestinal infections by enteric organisms without a clear underlying predisposing factor [3] [9]. If a patient is found to have SS and a concomitant serious bacterial infection, an aggressive treatment is warranted. "
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    ABSTRACT: Introduction. Spontaneous Escherichia coli meningitis is an infrequent condition in adults and is associated with some predisposing factors, including severe Strongyloides stercoralis (SS) infections. Case Presentation. A 43-year-old Hispanic man, with history of travelling to the jungle regions of Peru and Brazil two decades ago, and who received prednisone due to Bell's palsy for three weeks before admission, presented to the Emergency Department with diarrhea, fever, and hematochezia. A week after admission he developed drowsiness, meningeal signs, abdominal distension, and constipation. A cerebrospinal fluid culture showed extended spectrum β -lactamase producing E. coli. A colonoscopy was performed and showed pancolitis. Three days after the procedure the patient became unstable and developed peritoneal signs. He underwent a laparotomy, which ended up in a total colectomy and partial proctectomy due to toxic megacolon. Three days later the patient died in the intensive care unit due to septic shock. Autopsy was performed and microscopic examination revealed the presence of multiple Strongyloides larvae throughout the body. Conclusion. Strongyloides stercoralis infection should be excluded in adults with spontaneous E. coli meningitis, especially, if gastrointestinal symptoms and history of travelling to an endemic area are present. Even with a proper diagnosis and management, disseminated strongyloidiasis has a poor prognosis.
    Full-text · Article · Nov 2013
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    • "The fact that S. stercoralis was detected only in GI tract specimens in 69.7 % of cases supports the previously suggested theory that localized strongyloidiasis can cause enteric meningitis [2]. "
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    ABSTRACT: Meningitis caused by enteric flora is a known complication of strongyloidiasis, and human T-lymphotropic virus-1 (HTLV-1) predisposes individuals to severe strongyloidiasis. We reviewed the clinical features of bacterial meningitis associated with strongyloidiasis seen at a single center in subtropical Japan, in an area endemic for both strongyloidiasis and HTLV-1. We found 33 episodes in 21 patients between 1990 and 2010. The results were remarkable for the high incidence of meningitis due to Gram-positive cocci (27.3 %), especially Streptococcus bovis, and culture-negative cases (42.4 %). Given the high incidence of Gram-positive meningitis, a modified approach to corticosteroid use would be advisable in areas where strongyloidiasis is endemic, due to the potentially adverse consequences of glucocorticoid therapy.
    Full-text · Article · Jun 2013 · Infection
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    • "Key words: Strongyloides venezuelensis -faecal egg counts -DNA -PCR -diagnosis -Lewis rats Strongyloides stercoralis infects 30 million people in 70 countries (Siddiqui & Berk 2001). This parasitosis can occur without symptoms, as a disseminated infection or potentially fatal hyperinfection (Concha et al. 2005, Vadlamudi et al. 2006, Al-Hasan et al. 2007). Diagnosis of strongyloidiasis is usually based on detection of larvae in stool samples. "
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    ABSTRACT: More sensitive methodologies are necessary to improve strongyloidiasis diagnosis. This study compared the sensitivities of the McMaster modified technique and polymerase chain reaction (PCR) assays, both performed in faecal samples. Lewis rats were subcutaneously infected with 4,000, 400 or 40 infective third-stage larvae, considered as high, moderate or low infection, respectively. Seven days later, they were euthanized to count adult nematodes recovered from the small intestine. Stool samples were used to count the number of eggs per gram (EPG) of faeces and to detect parasite DNA by PCR performed with a species and a genus primer pair. The sensitivity of these assays depended upon parasite burden and the primer specificity. All assays presented 100% sensitivity at the highest parasite load. In the moderate infection, EPG and PCR with the genus primer maintained 100% specificity, whereas PCR sensitivity with the species primer decreased to 77.7%. In low infection, the sensitivity was 60% for EPG, 0% for PCR with the species primer and 90% for PCR done with the genus primer. Together, these results suggest that PCR with a genus primer can be a very sensitive methodology to detect Strongyloides venezuelensisin faeces of Lewis rats infected with very low parasite burden.
    Full-text · Article · Feb 2010 · Memórias do Instituto Oswaldo Cruz
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