Diagnóstico de las infecciones por geohelmintos. Un problema sin resolver en la era de las ómicas / Diagnosis of soil-transmitted helminth infections. An unsolved problemin the omics era

Las infecciones producidas por Strongyloides stercoralis y otros geohelmintos, como las uncinarias (Necator americanus y Ancylostoma duodenale), representan un importante problema a nivel mundial, especialmente en áreas en vías de desarrollo. Clínicamente son difíciles de sospechar ya que producen cuadros inespecíficos y muchas veces solapados entre ellos. Asimismo, los largos períodos prepatentes que presentan dificultan la detección de las formas parasitarias. El diagnóstico microscópico continúa siendo la herramienta más utilizada en los laboratorios asistenciales, pero aún dista mucho de ser la herramienta ideal para detectarlos debido a su baja sensibilidad. Además, morfológicamente estos nematodos presentan similitudes importantes, por lo que el diagnóstico microbiológico aún es un reto. La serología ha permitido avanzar en cuanto al diagnóstico de la infección por S. stercoralis, pero esta opción no está disponible todavía para las uncinarias. Las técnicas de biología molecular han demostrado aumentar discretamente esta falta de sensibilidad, pero al igual que en otras infecciones parasitarias, actualmente no están disponibles para su uso en los laboratorios de microbiología clínica. Información sobre el suplemento: este artículo forma parte del suplemento titulado "Programa de Control de Calidad Externo SEIMC. Año 2016", que ha sido patrocinado por Roche, Vircell Microbiologists, Abbott Molecular y Francisco Soria Melguizo, S.A

Infections caused by Strongyloides stercoralis and other soil-transmitted worms such as hookworms (Necator americanus and Ancylostoma duodenale) represent a major problem worldwide, especially in developing areas. They are difficult to suspect clinically since they produce non-specific and often overlapping signs and symptoms. Likewise, their long prepatent periods hamper the detection of parasitic structures. Microscopic diagnosis is still the most commonly used tool in healthcare laboratories but it is still far from being the ideal technique to detect these infections due to its low sensitivity. In addition, these nematodes have strong morphologic similarities and consequently microbiological diagnosis remains a challenge. Serology has made progress in the diagnosis of S. stercoralis infection but this option is not yet available for hookworms. Molecular biology techniques have been shown to slightly increase this lack of sensitivity, but as with other parasitic infections, they are not currently available for use in clinical microbiology laboratories. Supplement information: This article is part of a supplement entitled "SEIMC External Quality Control Programme. Year 2016", which is sponsored by Roche, Vircell Microbiologists, Abbott Molecular and Francisco Soria Melguizo, S.A

[Small bowel obstruction secondary to massive hookworm infestation complicated by fatal plurimicrobial bacteriemia]. / Occlusion iléale par infestation massive par des ankylostomes responsable d'une septicémie plurimicrobienne d'évolution fatale.

INTRODUCTION: Intestinal symptoms (cramping, flatulence) and iron deficient anemia are classical presenting manifestations of duodenal hookworm infestation in patients living in endemic area. CASE REPORT: We report a 45-year-old immunocompetent metropolitan man who presented with intestinal obstruction secondary to massive hookworm infestation complicated by fatal plurimicrobial bacteriemia with refractory septic shock. CONCLUSION: We report a case of acute surgical abdominal presentation with septicemia and refractory shock syndrome due to ileal translocation secondary to massive hookworm infestation. To the best of our knowledge, such a case has not yet been reported.

Paradoxical associations between soil-transmitted helminths and Plasmodium falciparum infection.

Evidence on the comorbidity between soil-transmitted helminth infections and malaria is scarce and divergent. This study explored the interactions between soil-transmitted helminth infections and uncomplicated falciparum malaria in an endemic area of Colombia. A paired case-control study matched by sex, age and location in Tierralta, Cordoba, was done between January and September 2010. The incident cases were 68 patients with falciparum malaria and 178 asymptomatic controls. A questionnaire was used to gather information on sociodemographic variables. Additionally physical examinations were carried out, stool samples were analysed for intestinal parasites and blood samples for Ig E concentrations. We found associations between infection with hookworm (OR: 4.21; 95% CI: 1.68-11.31) and Ascaris lumbricoides (OR 0.43; 95% CI: 0.18-1.04) and the occurrence of falciparum malaria. The effects of soil-transmitted helminths on the occurrence of malaria were found to be paradoxical. While hookworm is a risk factor, A. lumbricoides has a protective effect. The findings suggest that, in addition to the comorbidity, the presence of common determinants of soil-transmitted helminth infections and malaria could also exist. While the biological mechanisms involved are not clear, public health policies aimed at the control of their common social and environmental determinants are suggested.