Assuntos
Anemia/diagnóstico , Glucocorticoides/efeitos adversos , Hipoalbuminemia/diagnóstico , Hanseníase/diagnóstico , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Adulto , Anemia/etiologia , Animais , Diagnóstico Diferencial , Glucocorticoides/administração & dosagem , Humanos , Hipoalbuminemia/etiologia , Hanseníase/tratamento farmacológico , Masculino , Estrongiloidíase/complicaçõesRESUMO
Diagnosis of Strongyloides stercoralis hyperinfection can be a challenge. The key to a timely diagnosis is to have a high index of suspicion. We present a rare case of a 36-year-old human immunodeficiency virus negative male patient, who was on multidrug therapy for lepromatous leprosy and was treated for type 2 lepra reactions with steroids in the past. The patient presented with vomiting and pain abdomen, persistent hyponatremia, and terminal hypoglycemia. He had features of malnutrition and had a rapid downhill course following admission. A diagnosis of S. stercoralis hyperinfection with sepsis and multiorgan failure, adrenal hemorrhage, and syndrome of inappropriate antidiuretic hormone secretion was established on a postmortem examination.
Assuntos
Sepse/etiologia , Sepse/patologia , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Estrongiloidíase/patologia , Dor Abdominal/etiologia , Adulto , Animais , Humanos , Hipoglicemia/etiologia , Hiponatremia/etiologia , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/tratamento farmacológico , Masculino , Estrongiloidíase/complicações , Vômito/etiologia , Redução de PesoRESUMO
120 patients attending a Hansen's disease public health satellite clinic were evaluated for selected latent co-morbidities, consisting of strongyloidiasis, Chagas disease, hepatitis B, HIV, and tuberculosis, and potential exacerbation by immunosuppressive therapy. Implications for treatment of Hansen's disease are discussed.
Assuntos
Anti-Infecciosos/uso terapêutico , Hanseníase/complicações , Doença de Chagas/sangue , Doença de Chagas/complicações , Doença de Chagas/tratamento farmacológico , Infecções por HIV/sangue , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Hepatite B/sangue , Hepatite B/complicações , Hepatite B/tratamento farmacológico , Antígenos de Superfície da Hepatite B/sangue , Humanos , Hanseníase/sangue , Hanseníase/epidemiologia , Estrongiloidíase/sangue , Estrongiloidíase/complicações , Estrongiloidíase/tratamento farmacológico , Tuberculose/sangue , Tuberculose/complicações , Tuberculose/tratamento farmacológico , Estados Unidos/epidemiologiaRESUMO
The human immunodeficiency virus (HIV) pandemic has disproportionately affected tropical regions of the world, where dermatoses, such as leprosy and leishmaniasis, rarely encountered in temperate climates, are endemic. Although the introduction of highly active antiretroviral therapy (HAART) has been lifesaving, a few patients undergoing HAART experience clinical deterioration caused by immune reconstitution inflammatory syndrome (IRIS). This article explores the range of tropical dermatoses that are reported to date with associated IRIS events.
Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Dermatopatias/complicações , Dermatopatias/imunologia , Humanos , Leishmaniose/complicações , Leishmaniose/imunologia , Hanseníase/complicações , Hanseníase/imunologia , Micoses/microbiologia , Penicillium , Esporotricose/complicações , Esporotricose/imunologia , Estrongiloidíase/complicações , Clima TropicalRESUMO
Systemic strongyloidiasis is a rare but serious complication of intestinal strongyloidiasis. The condition occurs mainly in immunosuppressed patients and has a significant mortality rate. A case of systemic strongyloidiasis is described in a patient who received systemic steroid treatment, and a short review of the literature is given. The increased use of immunosuppressive and cytotoxic treatment necessitates increased awareness of this infection. HIV-infection, however, does not appear to increase the risk of developing systemic strongyloidiasis. Patients from endemic areas and travellers to such areas, even in the remote past, should be examined for strongyloidiasis before being given immunosuppressive treatment. Awareness of the possibility of systemic strongyloidiasis is essential if such a patient develops gastrointestinal or pulmonary symptoms or has repeated episodes of unexplained gram-negative infections while undergoing immunosuppressive treatment.