Fatal strongyloidiasis in three kidney recipients in Kuwait

It was the aim of this study to report 3 rare fatal cases of strongyloidiasis in Kuwait renal transplant patients. All 3 cases received allografts from cadaveric donors of Asian origin, the first 2 from an Indian [transplanted on the same day] and the third from a Bangladeshi. In all 3 cases, Strongyloides stercoralis larvae were first isolated from bronchoalveolar lavage. All 3 patients were on immunosuppressive therapy which included prednisolone, thereby leading to the hyperinfection syndrome. All patients presented with gastrointestinal symptoms [abdominal pain, vomiting, diarrhea, constipation and paralytic ileus], as well as pulmonary symptoms [cough, dyspnea and blood-stained sputum]. Albendazole 800 mg twice daily orally was started. Cyclosporine A was started after discontinuing prograf. The patients continued to deteriorate with a fall in blood pressure and platelets. All 3 patients died from adult respiratory distress syndrome following hyperinfection with S. stercoralis. Hyperinfection with S. stercoralis is a rare but preventable complication of immunosuppressive therapy. A high index of suspicion is required for the diagnosis of this infection. Persistent examination of sputum, bronchial washings and upper intestinal aspirates should be done as part of surveillance following cadaveric renal transplantation. Adult respiratory distress syndrome is indeed a red flag in patients who are on steroids, not on cyclosporine and receiving a kidney from donors in endemic countries of S. stercoralis

Disseminated peritoneal Schistosoma japonicum: a case report and review of the pathological manifestations of the helminth

Schistosomiasis [also known as bilharzia, bilharziasis, bilharziosis or snail fever] is a human disease syndrome caused by infection from one of several species of parasitic trematodes of the genus Schistosoma. The three main species infecting humans are S haematobium, S japonicum, and S mansoni. S japonicum is most common in the fareast, mostly in China and the Philippines. We present an unusual case of S japonicum in a 32-year-old Filipino woman who had schistosomal ova studding the peritoneal cavity and forming a mass in the right iliac fossa

Status of imported malaria in Kuwait: experience from Al-Jahra Hospital

To illustrate the incidence of malaria positive cases reported at Al-Jahra hospital, compared to the total number of patients whose blood was examined for malaria parasites over a period of four years from 1996-1999 in the same hospital. Subjects and method: The present study involved 1446 in- and out-patients who suffered from fever of unknown origin. The method applied involved examination of Giemsa -stained thick and thin blood films. Over a period of four years, blood samples from 1446 Kuwaiti and non-Kuwaiti patients were examined for malaria, and only 202 [14%] were positive. Of the positive cases, 183 patients [90.6%] showed P. vivax parasites in their peripheral blood, 15 patients [7.4%] showed P. falciparaum and four patients [2%] showed mixed infections. Tn 1996, 60/432 [14%] of examined patients were positive and in succeeding years 1997, 76/ 431 [17.6%]; 1998, 32/317 [10.1%] arid in 1999, 34/266 [12.8%] of examined patients were positive. The male:female ratio of positive patients was 83.7%:16.3%, and 42% arid 54% of positive patients were of age groups 21-30 years and 31-40 years, respectively. The massive economical development achieved in Kuwait and other Arabian gulf countries, following oil production, necessitated the importation of skilled workers of productive age. A significant number of these workers originated from malaria-endemic countries, and some of them were found to be positive for malaria. From the results of this study, it is clear that the problem of imported malaria still exists, although the number of positive cases has decreased in the last few years. This decrease can be traced to many reasons including prior examination of blood samples of imported workers in their countries, a step of great help in the process of controlling the disease in Kuwait