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Strongyloidiasis - diagnostic and therapeutic dilemmas in hyperinfection patients: a case series.
Balen Topic, M; Grubisic, B; Kovacevic, E; Sviben, M; Santini, M.
  • Balen Topic M; University Hospital for Infectious Diseases 'Dr. Fran Mihaljevic', Mirogojska 8, 10000 Zagreb, Croatia.
  • Grubisic B; School of Medicine, University of Zagreb, Salata 3b, 10000 Zagreb, Croatia.
  • Kovacevic E; University Hospital for Infectious Diseases 'Dr. Fran Mihaljevic', Mirogojska 8, 10000 Zagreb, Croatia.
  • Sviben M; University Hospital for Infectious Diseases 'Dr. Fran Mihaljevic', Mirogojska 8, 10000 Zagreb, Croatia.
  • Santini M; School of Medicine, University of Zagreb, Salata 3b, 10000 Zagreb, Croatia.
J Helminthol ; 96: e76, 2022 Oct 20.
Article in English | MEDLINE | ID: covidwho-2076938
ABSTRACT
The helminth infection caused by Strongyloides stercoralis is widespread in tropical regions, but rare in European countries. Unfamiliarity with the disease and diagnostic obstacles could contribute to its lethal outcome. Frequent use of corticosteroids during the COVID-19 pandemic could increase its significance. The aim of this retrospective descriptive study was to explore disease patterns and discuss clinical dilemmas in patients with S. stercoralis hyperinfection treated at the University Hospital for Infectious Diseases 'Dr. Fran Mihaljevic' in Zagreb, Croatia, between 2010 and 2021. Five out of 22 (22.7%) immunosuppressed patients treated due to strongyloidiasis developed hyperinfection. All patients were male, median 64 years; four were immunosuppressed by corticosteroids (although ileum resection could have been the trigger in one) and one by rituximab. The diagnosis was established after a median of 1.5 months of symptom duration, accidentally in all patients, by visualizing the parasite in the gastric/duodenal mucosa in four cases, and bronchial aspirate in one. All patients were cachectic, four out of five had severe hypoalbuminemia and all suffered secondary bacterial/fungal infection. Despite combined antibiotic, antifungal and antihelmintic therapy, three out of five of the patients died, after failing to clear living parasites from stool samples. We can conclude that significant delays in diagnosis and lack of clinical suspicion were observed among our patients with the most severe clinical presentations of strongyloidiasis. Although being beyond diagnostic recommendations for strongyloidiasis, an early upper gastrointestinal endoscopy with mucosal sample analysis could expedite diagnosis in severe, immunosuppressed patients. The persistence of viable parasites in the stool despite antihelmintic therapy should be further investigated.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Strongyloidiasis / Strongyloides stercoralis / COVID-19 / Anthelmintics Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Animals / Female / Humans / Male Language: English Journal: J Helminthol Year: 2022 Document Type: Article Affiliation country: S0022149X22000633

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Strongyloidiasis / Strongyloides stercoralis / COVID-19 / Anthelmintics Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Animals / Female / Humans / Male Language: English Journal: J Helminthol Year: 2022 Document Type: Article Affiliation country: S0022149X22000633