Evaluation of Strongyloides stercoralis infection in patients with HTLV-1 / Evaluación de la infestación por Strongyloides stercoralis en pacientes con HTLV-1

Introduction: Individuals infected with the human T-lymphotropic virus type 1 (HTLV-1) may present severe and disseminated forms of Strongyloides stercoralis infection with low therapeutic response. Objective: To investigate the S. stercoralis infection and the seroprevalence of IgG anti-S. stercoralis antibodies in individuals infected with HTLV-1 attending the Reference Center for HTLV-1 (CHTLV) in Salvador, Bahia, Brazil. Materials and methods: We conducted a cross-sectional study in 178 HTLV-1-infected individuals treated at the HTLV specialized center between January, 2014, and December, 2018. The parasitological diagnosis of S. stercoralis was performed using the Hoffman, Pons and Janer, agar plate culture, and Baermann-Morais methods. The IgG anti-S. stercoralis detection was performed using an in house enzyme-linked immunosorbent assay (ELISA). The HTLV-1 infection was diagnosed using a commercial ELISA and confirmed by Western blot. Results: The frequency of S. stercoralis infection was 3.4% (6/178). Individuals infected with S . stercoralis from rural areas (50.0%; 3/6) also showed S. stercoralis hyperinfection (>3,000 larvae/gram of feces). The frequency of circulating anti-S. stercoralis IgG antibodies was 20.8% (37/178). Conclusions: HTLV-1-infected people living in precarious sanitary conditions are more prone to develop severe forms of S. stercoralis infection. Considering the high susceptibility and unfavorable outcome of the infection in these individuals, the serological diagnosis for S. stercoralis should be considered when providing treatment.

Introducción. Los individuos infectados por el virus linfotrópico T humano tipo 1 (HTLV-1) pueden presentar formas graves y diseminadas de infestación por Strongyloides stercoralis con poca mejoría terapéutica. Objetivo. Investigar la infestación por S. stercoralis y la seroprevalencia de IgG anti-S. stercoralis en individuos infectados por HTLV-1 atendidos en el Centro de Referencia para HTLV-1 (CHTLV), en Salvador, Bahía, Brasil. Materiales y métodos. Se hizo un estudio transversal con 178 individuos infectados por HTLV-1 atendidos en el centro especializado de HTLV entre enero de 2014 y diciembre de 2018. El diagnóstico parasitológico de S. stercoralis se hizo mediante los métodos de Hoffman, Pons y Janer, cultivo en placa de agar y Baermann-Morais. Para la detección de IgG anti-S. stercoralis, se utilizó una prueba casera de inmunoabsorción ligada a enzimas (ELISA). La infección por HTLV-1 se diagnosticó usando un ELISA comercial y se confirmó mediante Western blot. Resultados. La frecuencia de infestación por S. stercoralis fue del 3,4 % (6/178). Además, los individuos infestados por S. stercoralis provenientes de la zona rural (50,0 %; 3/6) también mostraron hiperinfestación por S. stercoralis (>3.000 larvas/gramo de heces). La frecuencia de anticuerpos IgG anti-S. stercoralis fue del 20,8 % (37/178). Conclusiones. Las personas infectadas por HTLV-1 que viven en condiciones sanitarias precarias son más propensas a desarrollar formas graves de infestación por S. stercoralis. Teniendo en cuenta la gran vulnerabilidad y el resultado desfavorable de la infección en estos individuos, se debe considerar el diagnóstico serológico de S. stercoralis para administrar el tratamiento

Hiperinfección por Strongyloides stercoralis en un paciente joven con infección por HTLV-1 y colitis ulcerativa / Strongyloides stercolaris hyperinfection in a young patient with HTLV-1 infection and ulcerative colitis

Resumen La estrongiloidiasis es una infección causada por el parásito Strongyloides stercoralis (SS) y se asocia con una alta mortalidad en pacientes inmunosuprimidos debido a una diseminación larvaria y síndrome de hiperinfección. El compromiso de la mucosa gástrica es raro, pero cuando se presenta se caracteriza por sangrado digestivo y emesis persistente. A continuación, se presenta el caso de un paciente de 27 años con síntomas gastrointestinales, antecedente de infección por el virus linfotrópico humano de células T tipo 1 (HTLV-1) y colitis ulcerativa, quien desarrolló síndrome de hiperinfección por SS. Se describe la presentación clínica, diagnóstico, tratamiento y complicaciones derivadas del cuadro infeccioso.

Abstract Strongyloidiasis is an infection caused by the parasite Strongyloides stercolaris (SS) and is associated with high mortality in immunosuppressed patients due to larval spread and hyperinfection syndrome. Gastric mucosal involvement is rare, but when it occurs, it is characterized by digestive bleeding and persistent emesis. The following is the case of a 27-year-old patient with gastrointestinal symptoms, a history of HTLV-1 infection and ulcerative colitis, who developed hyperinfection syndrome with SS. The clinical presentation, diagnosis, treatment and complications arising from the infectious disease are described.

Hallazgo histopatológico de Strongyloides stercoralis en enfermedad de Crohn: reporte de caso / Histopathologic finding of Strongyloides stercoralis in a patient with Crohn's disease: Case report

Resumen Caso clínico: Se describe un caso clínico poco frecuente en un paciente inmunocomprometido con hallazgo histopatológico de infestación parasitaria. Es un paciente masculino de edad media que habita en zona subtropical con diagnóstico de enfermedad de Crohn tratado con corticoide e inmunomoduladores, presentaba dolor abdominal y anemia crónica de 1 año de evolución, analítica negativa para parásitos, reactantes de fase aguda normales, gastroscopia y colonoscopia previas (6 meses) sin hallazgos relevantes. Por la persistencia del cuadro clínico se repitieron los estudios endoscópicos en los que se visualizaron hemorragias subepiteliales con resultados histopatológicos de Strongyloides stercoralis. Conclusión: En el contexto de un paciente inmunocomprometido, en zona endémica y con evolución tórpida, debe obligar a realizar un diagnóstico diferencial en el que se debe sospechar siempre de infestación parasitaria. Aunque la endoscopia no se necesita para el diagnóstico de estrongiloidiasis, su intervención puede ser oportuna.

Abstract Clinical case: The following is a rare clinical case in an immunocompromised patient with histopathological findings of parasitic infestation. The patient is a middle-aged male who lives in a subtropical area and has a diagnosis of Crohn's disease treated with corticosteroids and immunomodulators. The patient presented with abdominal pain and chronic anemia for 1 year, with negative laboratory tests for parasites and normal acute phase reactants. Gastroscopy and colonoscopy were performed before the consultation (6 months) without relevant findings. Due to the persistence of the symptoms, endoscopic studies were repeated, finding subepithelial bleeding with histopathological results of Strongyloides stercoralis. Conclusion: In the context of an immunocompromised patient living in an endemic area and with a torpid evolution, a differential diagnosis should be made always suspecting a parasitic infestation. Although endoscopy is not necessary to diagnose strongyloidiasis, its use may be convenient.

Innovative approaches to improve serodiagnosis of Strongyloides stercoralis infection

ABSTRACT Strongyloidiasis is a helminthiasis of neglected condition that has no gold standard parasitological diagnosis due to the intermittent release of larvae in feces. This study aimed to use an scFv (single chain variable fragment) obtained by Phage Display, previously validated to detect immune complexes in serum samples from individuals infected with Strongyloides stercoralis by enzyme-linked immunosorbent assay (ELISA). Now the ability of scFv to detect the immune complexes was verified by immunofluorescence, flow cytometry using magnetic beads and surface plasmon resonance (SPR). As ELISA, the SPR, immunofluorescence and flow cytometry demonstrated the ability of scFv to detect immune complexes in sera from individuals with strongyloidiasis and discriminate them from sera of individuals with other parasitic diseases and healthy individuals. Besides de conventional ELISA, the novel approaches can also be promptly applied as auxiliary diagnostic tools to the existing parasitological method for accurate diagnosis of human strongyloidiasis.

Geohelmintiasis, estado nutricional y antropometría de niños de 3 a 6 años del Centro Escolar de la ciudad de Guayaquil, Ecuador / Geohelminthiasis, nutritional status and anthropometry of children from 3 to 6 years old from the School Center of the city of Guayaquil, Ecuador

Las geohelmintiasis son nematodos que afectan al hombre a través de la ingesta de huevos parasitarios, afectando el estado nutricional antropométrico de la población infantil, motivo por el cual se planteó como objetivo determinar incidencia de las helmintiasis transmitidas por el suelo en el estado nutricional antropométrico de niños de 3 a 6 años en un centro escolar Guayaquil en Ecuador, durante el último semestre del 2018. Se aplicó la metodología descriptiva de corte transversal; donde se incluyeron 92 preescolares de 3 a 6 años. A cada niño(a) se le hizo su estudio antropométrico nutricional, unido a un estudio coprológico realizado a 45 niños. Se obtuvo el Índice de Masa Corporal (IMC) con el cual se determinó el estado nutricional (IMC/Edad/Sexo), usando los percentiles del Ministerio de Salud Pública de Ecuador. Se revisaron los IMC de los 35 niños que presentaron geohelminiasis quienes evidenciaron una ligera disminución en la ganancia de los valores de las variables antropométricas. Se encontró predominio del sexo femenino (54,35%), la edad fue 3,78 años, peso: 15,21 Kg y talla: 100,23 cm2, el IMC fue 16,62 Kg/cm2, sin diferencias entre el sexo; la especie de mayor ocurrencia fue la Trichuris. trichiura 43,47% (niñas 10/23) y 66,67% (niños 8/12). Se concluye que 29,34% de los preescolares estudiados están malnutridos, presentan geohelmintiasis, por ello es recomendable realizar intervenciones dirigidas a representantes, estudiantes y docentes, para atender paralelamente geohelmintiasis y nutrición para garantizar la calidad de vida(AU)

Geohelminthiasis are nematodes that affect man through the ingestion of parasitic eggs, affecting the anthropometric nutritional status of the infant population, which is why the objective was to determine the incidence of soil-transmitted helminthiasis in the anthropometric nutritional status in children aged 3 to 6 years of a school in Ecuador, during the last semester of 2018. A cross-sectional descriptive methodology was applied; where 92 preschoolers from 3 to 6 years old were included. Each child was given his or her nutritional anthropometric study, together with a coprological study of 45 children. There was obtained the Body Mass Index (BMI) with which there decided the nutritional state (BMI / Age / Sex), using the centiles of the Department of Public health of Ecuador. The BMI of the 35 children with geohelminiasis were reviewed and showed a slight decrease in the gain of anthropometric variables. The prevalence of female sex was found (54,35%), the age was 3,78 years, weight: 15,21 Kg and height: 100,23 cm2, the BMI was 16,62 Kg/cm2, with no differences between sex; the species of greatest occurrence was Trichuris trichiura 43,47% (girls 10/23) and 66,67% (boys 8/12). It is concluded that 29.34% of the preschools studied are malnourished, have geohelminthiasis, so it is advisable to make interventions aimed at representatives, students and teachers, to attend parallel geohelminthiasis and nutrition to ensure quality of life(AU)

Fatal Strongyloides stercoralis hyperinfection syndrome in an alcoholic diabetic patient from México / Síndrome de hiperinfección mortal por Strongyloides stercoralis en un paciente diabético y alcohólico de México

Strongyloides stercoralis hyperinfection syndrome is a medical emergency that requires a high level of suspicion. Immunocompromised patients are at high risk of hyperinfection syndrome; however, malnutrition, alcoholism, and diabetes mellitus also need to be considered as predisposing factors. The diagnosis and treatment of Strongyloides hyperinfection are challenging and patients often have severe complications. Consequently, mortality is overwhelmingly high, with proportions above 60%. Herein, we report a case of Strongyloides hyperinfection in a 40-year-old alcoholic diabetic patient living in México. Unfortunately, the late diagnosis resulted in his death despite the treatment and supportive measures. Increased awareness is needed to prevent the dire consequences of strongyloidiasis.

El síndrome de hiperinfección por Strongyloides stercoralis es una emergencia médica que requiere una aguda sospecha clínica. Los pacientes inmunocomprometidos tienen alto riesgo de sufrir el síndrome de hiperinfección; sin embargo, la desnutrición, el alcoholismo y la diabetes mellitus también deben considerarse factores predisponentes. El diagnóstico y el tratamiento de la hiperinfección por S. stercoralis constituyen un desafío y los pacientes a menudo tienen complicaciones graves. Como consecuencia, la mortalidad es abrumadoramente alta, con proporciones superiores al 60 %. Se presenta un caso de hiperinfección por S. stercoralis en un paciente diabético y alcohólico de 40 años que vivía en México. Infortunadamente, el diagnóstico tardío causó su muerte a pesar del tratamiento y las medidas de soporte. Se necesita un mayor conocimiento para prevenir las terribles consecuencias de la estrongiloidiasis.

Strongyloides stercoralis como causa infrecuente de infección de líquido ascítico en cirrosis / Strongyloides stercoralis as uncommon cause of ascitic fluid infection in cirrhosis

Resumen Se comunica el caso clínico de un varón, con antecedentes de una cirrosis hepática alcohólica y gota, usuario crónico de antiinflamatorios, incluyendo corticoesteroides. Consultó por una melena secundaria a una úlcera bulbar. Durante su internación presentó fiebre, tratándose con ceftriaxona por un probable foco urinario. Por persistir febril, se realizó una paracentesis diagnóstica. En la muestra de líquido ascítico se observaron larvas de Strongyloides stercoralis. Recibió tratamiento antiparasitario con ivermectina, con buena respuesta clínica. Aunque la infección por S. stercoralis es relativamente frecuente en pacientes con cirrosis hepática alcohólica, la ascitis infectada por Strongyloides corresponde a una forma de presentación infrecuente. Este caso muestra la importancia de la paracentesis diagnóstica en todo paciente con ascitis secundaria a una cirrosis. Es importante considerar la presentación atípica de la infestación por Strongyloides en el contexto del paciente inmunocomprometido, ya que sin tratamiento puede tener una alta mortalidad.

Abstract Male patient, with a history of alcoholic cirrhosis frequent user of anti-inflammatory drugs including corticosteroids. He consulted for digestive bleeding secondary to a bulbar ulcer. During the admission, he had fever and antibiotic treatment with ceftriaxone is started, for a urinary infection. Fever persisted for 48 hours, so a diagnostic paracentesis was made: Strongyloides stercoralis larvae were seen in the direct microscopic exam. The patient started antiparasitic treatment with ivermectin. He was discharged and did not returned for follow up. Although infection with S. stercoralis is relatively common in patients with alcoholic liver cirrhosis, ascites infected with Strongyloides corresponds to an infrequent form of presentation. This case shows the importance of diagnostic paracentesis in every cirrhotic patient. It is important to consider atypical presentation of Strongyloides infection in the immunocompromised host, considering it could be fatal without treatment.

Hiperinfección por Strongyloides en paciente de la Patagonia con co-infección por HTLV-1 / Strongyloides hyperinfection in patient from Patagonia with HTLV-1 co-infection

La estrongiloidiasis es una afección desatendida causada por el parásito Strongyloides stercoralis. En los individuos inmunosuprimidos, fundamentalmente en los que tienen depresión de la inmunidad celular, puede desarrollarse el síndrome de hiperinfección por Strongyloides. La coinfección con virus linfotrópico de células T humanas (HTLV) es un factor de riesgo para el desarrollo de formas graves de estrongiloidiasis. Presentamos el caso de un hombre de 50 años con hiperinfección por Strongyloides y coinfección con HTLV. Se demoró el diagnóstico debido a su epidemiología inusual y a la sospecha inicial de enfermedad inflamatoria intestinal. El diagnóstico se confirmó mediante la identificación del parásito en muestras de lavado bronquio-alveolar y biopsias de mucosa duodenal y colónica. Se utilizó ivermectina subcutánea como tratamiento antihelmíntico con adecuada respuesta terapéutica.

Strongylodiasis is an unattended condition caused by the parasite Strongyloides stercoralis. The Strongyloides hyperinfection syndrome can develop in immunosuppressed hosts, mainly in those with depression of cellular immunity. Co-infection with human T-cell lymphotropic virus (HTLV) is a risk factor for the development of severe forms of strongyloidiasis. We present the case of a 50-year-old man with Strongyloides hyperinfection and coinfection with HTLV. The diagnosis was delayed owing to its unusual epidemiology and an initial suspicion of inflammatory bowel disease. Identification of the parasite in bronchioalveolar lavage and duodenal and colonic mucosa biopsies confirmed the diagnosis. Subcutaneous ivermectin was used as an anthelmintic treatment with an adequate therapeutic response.

Obstrucción duodenal por Strongyloides stercoralis, una complicación inusual / Duodenal obstruction by Strongyloides stercoralis, an unusual complication

Resumen La estrongiloidiasis es una enfermedad desatendida en Latinoamérica. Las manifestaciones gastrointestinales son inespecíficas y la obstrucción duodenal es una complicación infrecuente. Presentamos el caso clínico de un varón de 31 años, procedente de la selva central de Perú, que ingresó por una obstrucción intestinal alta, con úlceras y una estenosis duodenal evidenciadas en la endoscopia digestiva alta. El informe histopatológico reveló la presencia de larvas de Strongyloides stercoralis. La evolución clínica y endoscópica fueron favorables con el tratamiento con ivermectina. Existen poco más de 20 casos publicados de obstrucción duodenal por S. stercoralis. Adicionalmente, se confirmó una infección por HTLV-1, asociación descrita frecuente.

Strongyloidiasis is a neglected disease in Latin America. Gastrointestinal manifestations are nonspecific and duodenal obstruction is a rare complication. Here we present the case of a 31-year-old male from the central jungle of Peru, admitted due to a high intestinal obstruction, with duodenal ulcers and stenosis evidenced in the upper endoscopy. The histopathological report revealed presence of larvae of Strongyloides stercoralis. Clinical and endoscopic follow up were favorable with ivermectin treatment. There are near 20 reported cases of duodenal obstruction due to S. stercoralis. Additionally, infection by HTLV-1 was confirmed, being this a frequent association.

Hemorragia digestiva ocasional em criança por estrongiloidíase: importância do exame parasitológico / Occasional digestive hemorrhage in children due to strongyloidiasis: importance of parasitologic testing

RESUMO Objetivo: Descrever um caso incomum de infecção por Strongyloides stercoralis (S. stercoralis) em paciente de quatro meses de idade e ressaltar a importância do diagnóstico precoce. Descrição do caso: Paciente masculino, procedente e residente de Videira, Santa Catarina, Brasil, nasceu pré-termo, parto cesárea, peso de nascimento 1.655 g, e permaneceu na Unidade de Terapia Intensiva neonatal e intermediária por 20 dias. Aos quatro meses de idade, começou a evacuar fezes sanguinolentas e foi feita hipótese de alergia à proteína do leite de vaca, em razão da sintomatologia e do uso da fórmula infantil para o primeiro semestre, para o qual foi indicada a substituição por fórmula infantil com proteína hidrolisada. Foram solicitados a pesquisa de leucócitos e o exame parasitológico das fezes). Ambos se mostraram positivos e o parasitológico revelou a presença de larva rabditoide de S. stercoralis. O clínico manteve a hipótese inicial e a dieta, mas solicitou a coleta de três amostras de fezes, que resultaram em uma amostra para larvas rabditoide, em muda, de S. stercoralis. Como a criança apresentava dor abdominal, vômito e as fezes permaneciam sanguinolentas, foi iniciado o tratamento com tiabendazol - duas vezes/dia por dois dias -, repetido após sete dias, e, em seguida, realizado o exame parasitológico de fezes, tendo sido negativo. Comentários: A estrongiloidíase, apesar de ser uma infecção parasitária frequentemente leve, em pacientes imunocomprometidos pode se apresentar de forma grave e disseminada. Deve-se suspeitar desse agente em pacientes que vivem em áreas endêmicas, sendo o diagnóstico estabelecido por meio da pesquisa das larvas do S. stercoralis na secreção traqueal e nas fezes.

ABSTRACT Objective: To describe an uncommon case of infection by Strongyloides stercoralis (S. stercoralis) in a 4-month-old child and to highlight the importance of early diagnosis. Case description: The patient was a male child from the city of Videira, State of Santa Catarina, Southern Brazil, who was born preterm by Cesarean-section, weighing 1,655 g, and stayed in the neonatal intensive care unit for 20 days. At four months of age, the child started presenting blood in stools and the possibility of cow's milk protein allergy was considered, given the symptoms and the use of infant formula in his 1st semester of life, which was then replaced by infant formula with hydrolyzed protein. White blood cell count and a parasitological stool sample were requested. Both tested positive and the stool ova and parasite examination showed a rhabditoid larva of S. stercoralis. The clinician maintained the initial hypothesis and diet, but requested three new stool samples, which tested positive for rhabditoid larvae of S. stercoralis. Since the child presented abdominal pain and vomiting, and there was still blood in stools, treatment with thiabendazole was initiated twice a day for two days. Treatment was repeated after seven days along with a new parasitological examination, which was then negative. Comments: Although strongyloidiasis is usually a mild parasitic infection, it may be severe and disseminated in immunocompromised patients. This agent must be considered in patients who live in endemic areas, and the diagnosis should be established by searching S. stercoralis larvae in tracheal secretions and in stools.

Strongyloidiasis Presenting as Yellowish Nodules in Colonoscopy of an Immunocompetent Patient

Strongyloides stercoralis is endemic to tropical and subtropical regions, and infections are usually asymptomatic. However, immunocompromised patients, such as those receiving immunosuppressive therapy, high-dose steroids, or chemotherapy, can develop fatal hyperinfections. An 84-year-old man without any symptoms was diagnosed with strongyloidiasis during a regular screening colonoscopy. His medical history only involved a gastric endoscopic submucosal dissection for early gastric cancer 6 months previously. Few cases have been published about asymptomatic strongyloidiasis diagnosed in an immunocompetent host via endoscopic mucosal resection with characteristic colonoscopic findings. We report a case of colon-involved asymptomatic strongyloidiasis with specific colonic findings of yellowish-white nodules. This finding may be an important marker of S. stercoralis infection, which could prevent hyperinfections.

A Case of Chronic Strongyloidiasis with Recurrent Hyperinfection

Strongyloides stercoralis is an intestinal nematode that often causes chronic diarrhea and may develop severe complicated form of hyperinfection or disseminated infection in immunocompromised patients. Here, we report a case of recurrent strongyloidiasis presenting with pulmonary and meningeal involvement. A 55-year-old male diagnosed with pancreatic cancer 4 months ago was admitted due to chronic diarrhea, abdominal pain, and weight loss for 2–3 months. He had been treated with albendazole for chronic recurrent strongyloidiasis 13 years ago and again 2 years ago. He developed sepsis of Klebsiella pneumoniae and Escherichia coli on Days 3 and 7, respectively, and then meningitis of E. coli on Day 42. Strongyloidiasis was diagnosed by detection of abundant filariform larvae in sputum specimens on Day 15. He was treated for disseminated strongyloidiasis with albendazole and ivermectin for five weeks until clearance of larvae was confirmed in sputum and stool specimens. Laboratory diagnosis is important to guide appropriate treatment and to prevent chronic and recurrent strongyloidiasis.

Hiperinfecção por Strongyloides stercoralis em paciente com sepse de foco abdominal e distúrbio imunitário: relato de caso / Strongyloides stercoralis hyperinfection in a patient with abdominal sepsis and immune disorder: a case report

RESUMO Strongyloides stercoralis é um nematodo intestinal de grande importância por ser um dos únicos enteroparasitas que pode proliferar no hospedeiro, produzindo autoinfecção. Em indivíduos submetidos a terapias com corticosteróides, com outros imunossupressores ou co-infectados com o HTLV-1 e S. stercoralis, pode haver hiperinfecção ou infecção disseminada podendo levar a morte. Em contraste com pacientes infectados pelo HIV que raramente apresentam hiperinfecção por S. stercoralis. O presente relato de caso, descreve a hiperinfecção por S. stercoralis, em um paciente de 24 anos, com quadro de suboclusão intestinal, que evolui para sepse de foco abdominal, acompanhado de lesões cutâneas urticariformes. O diagnóstico foi confirmado com a realização de endoscopia digestiva alta, que demonstrou atrofia duodenal e duodenite crônica ulcerada, e cuja biópsia evidenciou formas adultas de S. stercoralis em grande quantidade. Posteriormente, o tratamento foi realizado com ivermectina, apresentando melhora clínica e laboratorial. Na pesquisa para identificar possíveis causas, para explicar o quadro de hiperinfecção, detectou-se sorologia positiva para HTLV-1. A infecção por estrongiloides é superior a 25% da população em áreas tropicais, mas a hiperinfecção como apresentada neste caso é rara. Diversas formas de imunodeficiência estão associadas a apresentação grave, entre elas a infecção pelo HTLV-1, comum no Brasil. Uma característica fundamental ilustrada por este caso é que a presença de estrongiloidíase grave deve levar à suspeita de imunodeficiência subjacente. Os médicos devem manter um alto índice de suspeita ao tratar pacientes em países desenvolvidos ou áreas urbanas, onde a infecção por estrongiloidíase pode ser incomum. Histórias de viagens e imigração são essenciais para avaliar os riscos de exposição.. Palavras-chave: Strongyloides stercoralis, sepse, hiperinfecção, Imunodeficiência.

Estrongiloidiasis gastrointestinal en paciente inmunocompetente: a propósito de un caso / Gastrointestinal strongyloidosis in an immunocompetent patient: a case report

Intestinal parasitic infections cause a not insignificant number of chronic diarrhea in children, however, with the sociodemographic change that our country has experienced, the number of cases and new parasites (immigration from tropical endemic areas) could increase. We report the case of an immunocompetent patient who presents with chronic diarrhea associated with Strongyloides stercoralis infection. The patient migrated two years ago from an endemic area for this helminth. The diagnosis is challenging, and the chances of a successful outcome depend on the administration of the antiparasitic.

Las infecciones parasitarias intestinales provocan un número no despreciable de causas de diarrea crónica en niños, sin embargo, con el cambio sociodemográfico que ha vivido nuestro país se podría incrementar el número de casos y de nuevos parásitos (inmigración de áreas endémicas tropicales). Reportamos el caso de un paciente inmunocompetente, que presenta cuadro de diarrea crónica asociada a infección por Strongyloides stercoralis. El paciente habría migrado hace dos años desde zona endémica para este helminto. El diagnóstico es desafiante y las posibilidades de un resultado exitoso dependen de la administración del antiparasitario.

Screening of Strongyloides infection using an ELISA test in transplant candidates

OBJECTIVES: Hyperinfection or disseminated strongyloidiasis has been frequently reported after transplants and is related to high mortality. This study aimed to screen for strongyloidiasis using serological diagnoses in transplant candidates. METHODS: An ELISA test was performed with filariform larvae of Strongyloides venezuelensis as a source of antigen. RESULTS: In the serum from transplant candidates, anti-Strongyloides IgG antibodies were detected in 35/150 (23.3%) samples by soluble fractions in phosphate buffered saline (PBS), 31/150 (20.7%) samples by soluble fractions in Tris-HCl, 27/150 (18.0%) samples by membrane fractions in PBS and 22/150 (14.7%) samples by membrane fractions in Tris-HCl. CONCLUSIONS: The present results suggest the ELISA test, ideally using soluble fractions of filariform larvae S. venezuelensis in PBS, as an additional strategy for the diagnosis of strongyloidiasis in transplant candidates.

Seroepidemiological aspects of human infection by Strongyloides stercoralis in Alfenas, southern Minas Gerais, Brazil

Abstract INTRODUCTION: In most Strongyloides stercoralis infected individuals, nematoidosis occurs asymptomatically, but in immunocompromised patients, it can cause hyperinfection. Serological techniques seem to be a good alternative for detecting this parasite. METHODS The frequency of seropositivity for strongyloidiasis in Alfenas, MG, was estimated using the enzyme linked immunosorbent assay on blood samples, between May and August of 2015. RESULTS: Out of 258 samples tested, 53.9% were positive, and the frequency of seropositive individuals was higher in the peripheral districts of the municipality. CONCLUSIONS: The results indicate high seropositivity rates for strongyloidiasis among the residents of Alfenas city.

Enteroparasitoses e aspectos socioeconômicos em pacientes alcoolistas / Intestinal parasites and socioeconomic aspects of alcoholic patients

Introdução: as enteroparasitoses constituem um problema de saúde pública que atinge as populações mais vulneráveis. O alcoolismo é um problema que afeta milhões de pessoas em todo o mundo, apresenta efeitos nocivos à saúde dos indivíduos e predispõe à infecção por S. stercoralis e às formas mais graves da estrongiloidíase. Objetivo: avaliar a prevalência da infecção das enteroparasitoses, bem como fatores socioeconômicos e sanitários de pacientes alcoolistas atendidos em um centro de tratamento especializado em Salvador, Bahia. Metodologia: trata-se de um estudo transversal, realizado com pacientes alcoolistas (n=277), do sexo masculino, atendidos em um centro de tratamento entre julho de 2014 e junho de 2017. O estudo foi realizado através da aplicação de um questionário estruturado para obtenção de dados socioeconômicos, demográficos e sanitários, sendo solicitadas, ainda, pelo menos duas amostras de fezes em dias alternados. O diagnóstico parasitológico foi realizado pelos métodos de sedimentação espontânea, Baermann-Moraes e cultura em placa de ágar. Resultados: a média de idade dos pacientes inclusos foi de 44,8 ± 9,5 anos. Verificouse que 35,7% dos pacientes estavam infectados com algum enteroparasito e, desses, 30,3% eram monoparasitados. Os parasitos mais frequentes foram S. stercoralis, Endolimax nana e ancilostomídeos, correspondendo 16,6%, 11,2% e 5,8%, respectivamente. Conclusão: dessa forma, S. stercoralis foi o parasito mais frequente, e a associação entre a infecção por esse parasito e o alcoolismo pode levar à estrongiloidíase grave. A elevada frequência de enteroparasitoses nesses pacientes, principalmente por protozoários, deve-se à ausência de higiene pessoal, pois esses indivíduos são suscetíveis à infecção oral fecal. A implementação de medidas de saneamento básico e de campanhas de conscientização para prevenção de infecções parasitárias é imprescindível para a saúde das populações mais vulneráveis.

Introduction: intestinal parasitoses are a public health issue that notably affects vulnerable populations. Alcoholism is a problem that affects millions worldwide by causing damaging effects to the health of individuals as it predisposes them to that infection through stercralisàs and more evolved forms of strongyloidiasis. Objective: evaluate the prevalence of intestinal parasite infections as well as socioeconomic and sanitation factors in a population of alcoholic patients at a specialized treatment facility in Salvador, Bahia. Methodology: this cross-sectional study was carried out with male alcoholic patients (n=277) at a treatment facility from July/2014 to June/2017. The research data were collected through a structured questionnaire aimed to obtain socioeconomic, demographic and sanitation information. Stool tests were ordered in alternate days. The parasitological diagnosis was based on methods of spontaneous sedimentation, Baermann-Moraes and Agar plate growth medium. Results: the patients' average age was 44,8 ± 9,5 years. A total of 35% of the patients was infected with a type of enteroparasite, of whom 30,3% was mono-infected. The most commonly found parasites were S. stercoralis, Endolimax nana and hookworm, corresponding to 16,6%, 11,2% e 5,8%, respectively. Conclusion: as such, S. Stercoralis was the most frequent parasite in this population and the association between the infection by this parasite and alcoholism may lead to severe strongyloidiasis. The high rates of enteroparasitism in those patients, particularly protozoa, are due to the lack of adequate personal hygiene, given those individuals are prone to acquire infections transmitted through the oral fecal route. An implementation of public health sanitation measures and the launch of public awareness campaigns in order to prevent parasite infections are vital to the health of vulnerable populations.

Diferencias morfológicas relevantes para la identificación específica de larvas de uncinarias y Strongyloides stercoralis / Relevant morphological differences for the specific identification of larvae of hookworms and Strongyloides stercoralis

Objetivos: Describir las características morfológicas diferenciales más relevantes de los estadios larvarios de uncinarias (Ancylostoma duodenale y Necator americanus), y S. stercoralis, para su identificación específica en laboratorio clínico convencional. Material y métodos: Estudio observacional durante julio del 2015 a agosto del 2016. Se realizaron cultivos en placa de agar de muestras fecales positivas por microscopía a larvas de nematodos o huevos de uncinaria. Las larvas desarrolladas en cultivo fueron descritas morfológicamente mediante claves, se identificaron las características morfológicas diferenciales más relevantes y se ilustraron mediante microfotografías. Resultados: Las características morfológicas más relevantes para la diferenciación específica fueron la longitud de la cavidad bucal y la prominencia del poro genital en el estadio rabditiforme; y la forma del cuerpo, el extremo terminal de la cola y el diámetro del extremo anterior del intestino en relación al esófago en el estadio filariforme. Conclusiones: Las uncinarias A. duodenale y N. americanus, y S. stercoralis pueden identificarse específicamente por microscopía óptica mediante el análisis morfológico de sus estadíos larvarios desarrollados en cultivo. Debido al requerimiento de equipos e insumos de uso común en laboratorio de microbiología, se recomienda esta metodología para uso en laboratorios clínicos convencionales. (AU)

Objectives: To determine the most relevant morphologic differences of larval stages of hookworms (Ancylostoma duodenale y Necator americanus) and S. stercoralis for their specific identification in a conventional laboratory. Methods: An observational study was carried-out between July and August 2016. Positive fecal samples at microscopy to nematode larvae or to eggs of hookworms were cultured in agar plate. Larvae that developed in culture were described morphologically using passwords. We identified the most relevant differential morphologic features and illustrated them using microphotography. Results: The most relevant morphologic features that allow differentiating these nematodes were the longitude of the oral cavity and the prominence of the genital primordium for the rabditiform larva; the shape of the body, the terminal end of the tail and the diameter of the anterior extreme of the intestine in relation to the esophagus for the filariform larvae. Conclusions: Hookworms and S. stercoralis can be specifically identified by optic microscopic examination of their larval stages developed in culture. We recommend this methodology for conventional microbiology laboratories due to the requirement of simple equipment. (AU)