Terminal ileum resection as a trigger for Strongyloides stercoralis hyperinfection and ensuing serial sepsis in a 37-year-old patient with complicated Crohn's disease: a case report.

The nematode Strongyloides stercoralis, outside the tropics and subtropics present in small endemic foci, can cause an infection after direct skin contact with contaminated soil containing infective filariform larvae and, rarely, after intimate interhuman contact or after transplantation of an infected solid organ. Following skin penetration, migration, and maturation through several stages, a small number of invasive filariform larvae can develop anew in the gut lumen, perpetuating new cycles of penetration, tissue migration, and reproduction, without leaving the host.In a state of immunosuppression, autoinfection can progress to life-threatening hyperinfection and/or infection disseminated through virtually any organ. In developed countries, the most frequently recognized risk for severe hyperinfection is corticosteroid therapy, but this has been also described in malnourished, alcoholic, cancer, and transplant patients. Due to the frequent need for immunosuppressive therapy, patients suffering from inflammatory bowel disease (IBD) are susceptible to develop overwhelming strongyloidiasis. Strongyloidiasis can be easily overlooked in clinical settings, and in many European regions there is poor insight into the epidemiological burden of this disease.We present a case of S. stercoralis hyperinfection that triggered 3 successive episodes of sepsis caused by pathogens of the gut flora in a young patient suffering from stenotic form of Crohn's disease. S. stercoralis hyperinfection occurred in the corticosteroid-free period, shortly after resection of the terminal ileum, which was probably the trigger for the overwhelming course. The patient was successfully treated with 10-day albendazole therapy.

[Colorectal cancer in Krapina-Zagorje County: the Zabok General Hospital experience]. / Kolorektalni karcinom u Krapinsko-zagorskoj zupaniji--iskustva Opce bolnice Zabok.

AIM: To analyze data and current experience in diagnosing and treating colorectal cancer at Zabok General Hospital in Krapina-Zagorje County during a 5-year period (2002-2006). METHODS: Retrospective study of 265 cases of colorectal carcinoma treated at Departments of Internal Medicine and of Abdominal Surgery, Zabok General Hospital, and analysis of epidemiological data obtained from the Croatian Public Health Institute for this County. RESULTS: The incidence rate of this malignancy in Krapina-Zagorje County was between 47.8 and 52 per 100 000, which puts our County at the bottom of the list of all Croatian counties. During the study period, the incidence rate was on a decrease and mortality rate increased, which could be attributed to the late diagnosis of this malignancy (3 months of the occurrence of the first alarming symptoms). Most patients were men, average age 68. The most common symptoms were rectal bleeding, abdominal pain, anemia and changes in defecation habits. The average hospitalization was 13 and 17 days at Departments of Internal Medicine and of Abdominal Surgery, respectively. The most common tumor seats were rectum and sigmoid colon. Colorectal cancer was mostly diagnosed in an advanced stage of disease. More than one third of patients (35.2%) were admitted to the hospital with bowel obstruction or perforation. According to Duke's classification, most patients were in stage C (39.5%), D (22.7%) and A (6.9%). Histologic studies revealed adenocarcinoma in all but one case that proved to be lymphoma. CONCLUSION: We conclude that Zabok General Hospital has valuable experience in diagnosing and treatment of colorectal cancer, with high rank performance since 68.0% of patients from Krapina-Zagorje County are managed at this hospital.