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3.
Medicine (Baltimore) ; 98(49): e18247, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804353

RESUMO

RATIONALE: Patients with chronic Strongyloides stercoralis infection are usually asymptomatic; therefore, their condition is easily overlooked. In immunosuppressed patients, mortality is high because of disseminated infection and hyperinfection. This report describes a fatal S stercoralis hyperinfection in a patient with nephrotic syndrome after treatment with steroids. PATIENT CONCERNS: A 70-year-old male presented with a history of progressive edema, skin infection, persistent fever, cough, intermittent abdominal pain, and progressive respiratory failure after steroid treatment. DIAGNOSIS: Nephrotic syndrome; cellulitis; S stercoralis hyperinfection; Klebsiella pneumonia. INTERVENTIONS: During the first hospital admission, the patient was administered full-dose glucocorticoid and antibiotic therapy after suffering from cellulitis. During the second admission, he was diagnosed and treated for normal digestive discomfort and a bacterial infection. The patient had progressive respiratory failure and was placed on a ventilator. He was immediately treated with albendazole when S stercoralis was found in samples of his sputum and feces. OUTCOMES: The patient died despite treatment with albendazole and antibiotic therapy. LESSONS: It is essential to consider the possibility of S stercoralis infection in immunosuppressed patients with nephrotic syndrome. Given the lack of classic manifestations and high mortality rate of advanced disease, continuous monitoring, early diagnosis, and proper treatment are imperative.


Assuntos
Infecções por Klebsiella/diagnóstico , Síndrome Nefrótica/diagnóstico , Estrongiloidíase/diagnóstico , Idoso , Animais , Doença Crônica , Coinfecção , Diagnóstico Diferencial , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Infecções por Klebsiella/tratamento farmacológico , Masculino , Síndrome Nefrótica/tratamento farmacológico , Strongyloides stercoralis , Estrongiloidíase/tratamento farmacológico
4.
BMC Infect Dis ; 19(1): 776, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488073

RESUMO

BACKGROUND: Due to the similarity of Strongyloides stercoralis with free-living nematodes of Rhabditis species they might be miss-diagnosed with each other in microscopical examination of stool samples. The aim of this study was molecular characterization and differentiation of human derived isolates of S. stercoralis and Rhabditis species based on the mitochondrial gene of cytochrome c oxidase subunit 1 (cox1) amplification. METHODS: Using parasitological methods, ten isolates of S. stercoralis and three isolates of Rhabditis spp. were obtained from fresh stool samples of patients and the genomic DNA of the samples were extracted. PCR amplification of cox1 gene was carried out for all the isolates and the products were sequenced. RESULTS: The phylogenetic analysis illustrated that S. stercoralis and Rhabditis spp. isolates were placed in two distinguishable separate clades. Inter-species genetic variation between isolates of S. stercoralis and Rhabditis spp. were ranged from 13.5 to 14.5%. CONCLUSIONS: Cox1 gene was a suitable marker for discrimination of S. stercoralis from Rhabditis spp. retrieved from human in the current study. The availability of gene sequence information will be helpful in the future development and validation of discriminatory PCR-based assays of these nematodes.


Assuntos
Complexo IV da Cadeia de Transporte de Elétrons/genética , Rhabditoidea/genética , Rhabditoidea/isolamento & purificação , Strongyloides stercoralis/genética , Strongyloides stercoralis/isolamento & purificação , Animais , DNA Mitocondrial/análise , DNA Mitocondrial/genética , Fezes/parasitologia , Variação Genética , Humanos , Irã (Geográfico) , Tipagem Molecular/métodos , Filogenia , Reação em Cadeia da Polimerase , Subunidades Proteicas/genética , Infecções por Rhabditida/diagnóstico , Infecções por Rhabditida/parasitologia , Estrongiloidíase/diagnóstico , Estrongiloidíase/parasitologia
5.
Int J Infect Dis ; 88: 60-64, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31499208

RESUMO

OBJECTIVES: The aim of this cross-sectional study was to describe the results of a systematic serological screening programme for strongyloidiasis. METHODS: A prospective serological screening programme for strongyloidiasis was performed between 2009 and 2014 for all immigrant patients attending the Tropical Medicine Unit. Three formalin-ether concentrated stool samples and an ELISA for anti-Strongyloides stercoralis antibodies were used as screening tools. RESULTS: Of 659 patients screened, 79 (12%) were positive for S. stercoralis regardless of the diagnostic method used. The prevalence of infection was 42.9% in East African patients, 16.3% in Central African patients, 10.9% in those from South America, and 10% in the case of West Africa. Univariate analysis showed that infection by S. stercoralis was significantly more frequent in patients from Central Africa (p=0.026; OR 1.72, 95% CI 1.03-2.85) and East Africa (p<0.001; OR 5.88, 95% CI 1.75-19.32). Taking West Africa as the reference (as the area of lowest prevalence among the positive prevalence areas), the statistical analysis showed that the risk of infection was higher in East Africa (p=0.001; OR 6.750, 95% CI 2.127-21.423) and Central Africa (p=0.065; OR 1.747, 95% CI 0.965-3.163). CONCLUSIONS: Due to the potential complications of strongyloidiasis infection, we recommend that immigrant patients from developing countries be routinely screened for S. stercoralis, especially those from East Africa. A serological test is a highly appropriate screening tool.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Strongyloides/imunologia , Estrongiloidíase/diagnóstico , Adulto , África , América , Animais , Ásia , Estudos Transversais , Fezes/parasitologia , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Soroepidemiológicos , Espanha/epidemiologia , Strongyloides/isolamento & purificação , Estrongiloidíase/epidemiologia , Estrongiloidíase/parasitologia , Adulto Jovem
6.
Internist (Berl) ; 60(11): 1201-1208, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31511906

RESUMO

This article reports about a 73-year-old woman of Bosnian descent who presented with acute renal failure. A renal biopsy was diagnostic for a postinfect necrotizing and extracapillary proliferative glomerulonephritis. The patient reported a febrile infection fever 2 weeks previously. The diagnostics did not reveal any indications of an ongoing infection. The glomerulonephritis responded to treatment with systemic steroids. The patient was readmitted to hospital 6 weeeks later in a severely ill condition. A gastric biopsy revealed a Strongyloides stercoralis infestation. Due to the systemic steroid therapy the patient had developed a so-called hyperinfection syndrome and died despite treatment on the intensive care unit. This case illustrates the need for awareness of this rare parasitosis, particularly in patients from endemic areas. A likely causal relationship with the glomerulonephritis is discussed and an overview of the diagnostics, course of the disease and treatment of this parasitosis is given.


Assuntos
Lesão Renal Aguda/etiologia , Glomerulonefrite/tratamento farmacológico , Prednisolona/efeitos adversos , Esteroides/efeitos adversos , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/diagnóstico , Idoso , Animais , Antiparasitários/uso terapêutico , Evolução Fatal , Feminino , Glomerulonefrite/diagnóstico , Humanos , Ivermectina/uso terapêutico , Prednisolona/uso terapêutico , Esteroides/uso terapêutico , Estômago/microbiologia , Estômago/patologia , Estrongiloidíase/complicações , Estrongiloidíase/tratamento farmacológico
7.
PLoS One ; 14(7): e0218895, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31329601

RESUMO

The tenacious human parasitic helminth Strongyloides stercoralis is a significant health problem worldwide. The current lack of a definitive diagnostic laboratory test to rule out this infection necessitates designing more specific diagnostic methods. Fatty acid and retinol-binding protein (FAR) plays a crucial role in the development and reproduction of nematodes. We generated a recombinant form of this protein and determined its applicability for immunodiagnosis of S. stercoralis. The L3 form of S. stercoralis was harvested and used for RNA extraction and cDNA synthesis. The coding sequence of S. stercoralis FAR (SsFAR) was cloned into pET28a(+) vector, expressed in E. coli BL21 and purified. ELISA and immunoblotting were employed to determine the specificity and sensitivity of rSsFAR using a set of defined sera. In addition, we analyzed the phylogenetic relationship of SsFAR with different FAR sequences from other nematodes. The cloned SsFAR had an open reading frame of 447 bp encoding 147 amino acids, with a deduced molecular mass of 19 kD. The SsFAR amino acid sequence was 93% identical to FAR of S. ratti. For differential immunodiagnosis of strongyloidiasis, rSsFAR exhibited 100% sensitivity and 97% specificity. However, cross-reactivity with FAR proteins of other parasites, namely Toxocara canis and Echinococcus granulosus, was noted. Our results provide a novel approach for immunodiagnosis of S. stercoralis infections using rSsFAR with reliable sensitivity and specificity.


Assuntos
Proteínas Recombinantes/genética , Proteínas de Ligação ao Retinol/genética , Strongyloides stercoralis/genética , Estrongiloidíase/diagnóstico , Animais , Anticorpos Anti-Helmínticos/imunologia , Antígenos de Helmintos/imunologia , Antígenos de Helmintos/isolamento & purificação , Testes Diagnósticos de Rotina , Ensaio de Imunoadsorção Enzimática , Escherichia coli/genética , Ácidos Graxos/genética , Ácidos Graxos/metabolismo , Humanos , Testes Imunológicos/métodos , Filogenia , Proteínas Recombinantes/imunologia , Proteínas Recombinantes/isolamento & purificação , Proteínas de Ligação ao Retinol/isolamento & purificação , Strongyloides stercoralis/imunologia , Strongyloides stercoralis/patogenicidade , Estrongiloidíase/genética , Estrongiloidíase/imunologia , Estrongiloidíase/parasitologia
8.
Infect Dis Poverty ; 8(1): 53, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200770

RESUMO

BACKGROUND: Strongyloidiasis is a gastrointestinal infection caused by the parasitic nematode Strongyloides stercoralis. It is estimated to infect up to 370 million people globally and is predominately found in tropical and subtropical areas of socioeconomic disadvantage. MAIN BODY: This systematic literature review identified studies published in the last ten years on the risk factors, diagnosis, prevalence and/or clinical outcomes of strongyloidiasis in Ethiopia. The prevalence of S. stercoralis ranged from 0.2 to 11.1% in adults, 0.3% to 20.7% in children, 1.5% to 17.3% in HIV positive adults and 5% in HIV positive children. The identified studies primarily used microscopy based techniques that potentially underestimated the prevalence four fold compared with serology and PCR. Strongyloidiasis in children presents a particularly significant issue in Ethiopia as children often presented with anemia, which is associated with impaired mental and cognitive development. The most significant risk factor for strongyloidiasis was HIV status and although other risk factors were identified for helminth infections, none were statistically significant for S. stercoralis specifically. Several studies detected S. stercoralis in dogs and non-biting cyclorrhaphan flies. However, future research is needed to explore the role of these reservoirs in disease transmission. CONCLUSIONS: This review demonstrated that strongyloidiasis is an overlooked and neglected disease in Ethiopia. There is a need for a systematic approach using a combination of molecular and serology based diagnostic methods to ascertain the true incidence and burden of strongyloidiasis in Ethiopia. Further research is also needed to break the cycle of transmission by identifying environmental reservoirs, risk factors and exploring the potential for zoonotic transfer.


Assuntos
Estrongiloidíase , Animais , Cães , Etiópia/epidemiologia , Humanos , Prevalência , Fatores de Risco , Estrongiloidíase/diagnóstico , Estrongiloidíase/epidemiologia , Estrongiloidíase/parasitologia , Resultado do Tratamento
9.
Clinics (Sao Paulo) ; 74: e698, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31188909

RESUMO

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.


Assuntos
Antígenos de Helmintos/imunologia , Imunoglobulina G/sangue , Transplante de Órgãos , Strongyloides stercoralis/imunologia , Estrongiloidíase/diagnóstico , Adolescente , Adulto , Animais , Anticorpos Anti-Helmínticos/sangue , Antígenos de Helmintos/isolamento & purificação , Biomarcadores/sangue , Criança , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Estrongiloidíase/sangue , Estrongiloidíase/parasitologia , Adulto Jovem
10.
Bull Soc Pathol Exot ; 112(1): 12-13, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31225731

RESUMO

Srongyloidiasis can sometimes be a source of diagnostic wandering in a patient with an autoimmune disease living in a tropical environment, despite systematic deworming with albendazole (400 mg/day/3 days), prior to the starting of a corticotherapy. We report an observation of a febrile gastroenteritis complicated by signs of intra and extracellular dehydration, in a 37-year-old lupus patient, including duodenal biopsies, and stool parasitology, which led to the diagnosis of strongyloidiasis effectively treated by ivermectin per os (two doses) of 200 micrograms/kg, once every 2 weeks apart), following failure of a first 5-days course of albendazole (400 mg/day).


Assuntos
Gastroenterite/parasitologia , Lúpus Eritematoso Cutâneo/complicações , Estrongiloidíase/complicações , Corticosteroides/uso terapêutico , Adulto , Albendazol/uso terapêutico , Antiparasitários/uso terapêutico , Biópsia , Duodeno/parasitologia , Duodeno/patologia , Fezes/parasitologia , Feminino , Febre , Gabão , Gastroenterite/tratamento farmacológico , Humanos , Ivermectina/uso terapêutico , Estrongiloidíase/diagnóstico , Estrongiloidíase/tratamento farmacológico
11.
J Pak Med Assoc ; 69(5): 761-763, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31105313

RESUMO

Strongyloidiasis is a human parasitic disease caused by infection of Strongyloidesstercoralis. It can manifest from asymptomatic eosinophilia in an immunocompetent host and disseminate the disease in the immunocompromised ones. The inconsistency of eosinophilia and low sensitivity of a standard microscopic stool examination makes it difficult to diagnose the disease. We report a case of chronic strongyloidiasis who, despite being immunocompetent, developed dissemination. The patient was a 30-years-old male who presented with diarrhoea, vomiting, high-grade fever and dyspnoea. On examination, he was pale, oedematous and had ascites with systolic murmurs in tricuspid area. After a fullworkup for differentials, biopsy confirmed the diagnosis of strongyloidiasis. Echocardiogram revealed vegetations on mitral and tricuspid valves and regurgitation through the valves, which confirmed dissemination to endocardium. A course of Ivermectin 9 mg daily for two weeks eradicated the infection in time. In conclusion, awareness for physicians and the use of various diagnostic methods like serology, endoscopy and biopsy should be considered for high risk patients.


Assuntos
Endocardite/diagnóstico , Imunocompetência , Estrongiloidíase/diagnóstico , Adulto , Anemia/diagnóstico , Anemia/terapia , Antiparasitários/uso terapêutico , Ascite/diagnóstico por imagem , Transfusão de Sangue , Dieta Rica em Proteínas , Duodeno/patologia , Endocardite/terapia , Hidratação , Hematínicos/uso terapêutico , Humanos , Hipoalbuminemia/diagnóstico , Hipoalbuminemia/terapia , Imunoglobulina E/imunologia , Ivermectina/uso terapêutico , Masculino , Insuficiência da Valva Mitral/diagnóstico por imagem , Derrame Pleural/diagnóstico por imagem , Estrongiloidíase/imunologia , Estrongiloidíase/patologia , Estrongiloidíase/terapia , Tomografia Computadorizada por Raios X , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Ultrassonografia
12.
Acta Parasitol ; 64(2): 394-405, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31069645

RESUMO

INTRODUCTION: Patients on corticosteroids therapy (POCT) are more likely to flare up concealed Strongyloides infection and develop Strongyloides hyperinfection syndrome and/or dissemination. Such critical complications can lead to high mortality rates. Rapid detection methods are, therefore, necessary to detect Strongyloides infection in POCT with the advantage of being applicable in a developing country. METHODS: Two hundred POCT have been enrolled in this study to determine the rate of infection with Strongyloides. Three different groups of POCT (Strongyloides infected, non-infected, infected with other parasites) were used to evaluate the antibodies detection capability of two serological techniques (enzyme-linked immunosorbent assay (ELISA) and gelatin particles indirect agglutination (GPIAT) against the results of the gold standard agar plate culture (APC). RESULTS: With APC, the infection rate of Strongyloides stercoralis in POCT was 9.5% (19/200). POCT with Strongyloides infection displayed related risk factors (job, rural settlements, and soil contact) for infection combined with the subtropical nature of Ismailia Governorate. With regard to serology, ELISA detection results were poor compared to APC with sensitivity and specificity of 42.1% and 82.6%, respectively, and positive and negative predictive values of 72% and 30%. GPIAT appeared to be closely related to APC with sensitivity and specificity of 89.4% and 81.8%, respectively, and positive and negative predictive values of 80.9% and 96.7%. Statistical moderate correlation was detected between GPIAT and ELISA. CONCLUSION: The GPIAT technique is more convenient, easier, cheaper and faster to rule out the infection of Strongyloides in POCT. It might be the test of choice for routine immunodiagnosis of human strongyloidiasis.


Assuntos
Corticosteroides/efeitos adversos , Anticorpos Anti-Helmínticos/sangue , Estrongiloidíase/diagnóstico , Adolescente , Adulto , Testes de Aglutinação , Animais , Criança , Ensaio de Imunoadsorção Enzimática , Feminino , Gelatina/química , Humanos , Testes Imunológicos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sensibilidade e Especificidade , Strongyloides stercoralis , Adulto Jovem
13.
Rural Remote Health ; 19(2): 4787, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31084034

RESUMO

Strongyloides stercoralis is a nematode that can cause fatal systemic or disseminated infections in immunocompromised persons. It is known to be endemic in tropical Australia. Sporadic cases arising from temperate regions are reported in Russia and North America. An Aboriginal woman aged 71 years with ovarian carcinoma developed worsening lethargy and tiredness. She was diagnosed with strongyloidiasis based on serology in 2015. She had resided in the state of New South Wales all her life. This case report provides further evidence that strongyloides transmission is possible in temperate areas of Australia and has occurred in the past when sanitation was not as advanced as it is today.


Assuntos
Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/complicações , Estrongiloidíase/diagnóstico , Idoso , Animais , Austrália , Feminino , Humanos , Neoplasias Ovarianas/complicações , Estrongiloidíase/parasitologia
15.
Parasitol Int ; 72: 101933, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31128257

RESUMO

Due to the epidemiological problem of the neglected condition of human strongyloidiasis, rapid and effective diagnosis is extremely important, with the development of new diagnostic tools being essential to reduce infections and chronic cases. Avian immunoglobulin Y (IgY) technology is an alternative for antibody production that has high specificity and profitability. This study aimed to produce and fractionate IgY antibodies from the egg yolks of hens that were immunized with the total antigenic extracts of Strongyloides venezuelensis infectious filariform larvae (iL3) and parthenogenetic females (pF). IgY antibodies were then evaluated by their recognition of antigenic proteins, evolutive helminth forms, and serological diagnosis of human strongyloidiasis by the detection of immune complexes in serum samples. Egg yolks were fractionated to obtain IgY antibodies by thiophilic interaction chromatography. Immune complex detection in serum samples showed diagnostic values for anti-iL3 IgY and anti-pF IgY antibodies at 95.56% and 88.89% sensitivity and 95.56% and 91.11% specificity, respectively. Therefore, IgY technology is a promising tool for the detection of blood circulating Strongyloides antigens, with possible application as a serological diagnostic method.


Assuntos
Imunoglobulinas/imunologia , Testes Imunológicos/métodos , Strongyloides/imunologia , Estrongiloidíase/diagnóstico , Animais , Anticorpos Anti-Helmínticos/sangue , Antígenos de Helmintos , Galinhas , Gema de Ovo , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Larva/imunologia , Sensibilidade e Especificidade , Testes Sorológicos , Estrongiloidíase/imunologia
16.
Rev Med Suisse ; 15(649): 901-904, 2019 May 01.
Artigo em Francês | MEDLINE | ID: mdl-31050236

RESUMO

When travelling to a tropical country, the tourist can be exposed to different pathogens that can cause symptoms after a long period of latency. The physician should be informed about the geographical distribution of these diseases (schistosomiasis, Chagas disease, strongyloidiasis), the situations in which an exposure can occur and the presentation of an acute or chronic infection, in order to diagnose them in the presence of symptoms. Moreover, a screening should be offered to certain groups of people considered more at risk of contracting a cosmopolitan illness (HIV) whilst travelling. A specific screening in the returning traveler is thus only justified under particular circumstances that are to be determined by a detailed history or specific signs (screening for schistosomiasis when bathing in fresh water in an endemic area).


Assuntos
Esquistossomose , Estrongiloidíase , Viagem , Humanos , Programas de Rastreamento , Esquistossomose/diagnóstico , Estrongiloidíase/diagnóstico
17.
BMJ Case Rep ; 12(4)2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31036733

RESUMO

Hypereosinophilic syndromes are rare in children. Sporadic, mild-severity FIP1L1-platelet-derived growth factor receptor α (PDGFRα) rearrangement cases have been reported, mainly in boys. We present the case of a 5-year-old girl referred from her African country of birth, due to severe constitutional symptoms, multifocal bone pain, headache, gastrointestinal complaints, cardiomyopathy and unexplained hypereosinophilia. She presented multiple end-organ diseases and striking bone involvement. Although she had a positive serology for Strongyloides stercoralis, extensive evaluation detected a FIP1L1-PDGFRA fusion gene. Systemic corticosteroids and low-dose imatinib were started and the child became asymptomatic. After 9 months of treatment, FIP1L1-PDGFRA was no longer detected.


Assuntos
Corticosteroides/uso terapêutico , Síndrome Hipereosinofílica/genética , Estrongiloidíase/parasitologia , Corticosteroides/administração & dosagem , África/epidemiologia , Albendazol/administração & dosagem , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Antiparasitários/uso terapêutico , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/patologia , Pré-Escolar , Combinação de Medicamentos , Feminino , Humanos , Síndrome Hipereosinofílica/tratamento farmacológico , Síndrome Hipereosinofílica/patologia , Mesilato de Imatinib/administração & dosagem , Mesilato de Imatinib/uso terapêutico , Ivermectina/administração & dosagem , Ivermectina/uso terapêutico , Proteínas de Fusão Oncogênica , Inibidores de Proteínas Quinases/uso terapêutico , Doenças Raras , Receptor alfa de Fator de Crescimento Derivado de Plaquetas , Strongyloides stercoralis/imunologia , Estrongiloidíase/complicações , Estrongiloidíase/diagnóstico , Resultado do Tratamento , Fatores de Poliadenilação e Clivagem de mRNA
18.
PLoS Negl Trop Dis ; 13(5): e0007399, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31095570

RESUMO

BACKGROUND: Imported strongyloidiasis is increasingly being diagnosed in non-endemic areas. The aim of this study was to describe the epidemiological, clinical and microbiological characteristics of patients with imported strongyloidiasis in Spain. METHODOLOGY: This is an observational retrospective study that included all patients diagnosed of strongyloidiasis registered in the +REDIVI Collaborative Network from 2009 to 2017. Demographic, epidemiological and clinical information was collected from the +REDIVI database, and extra information regarding microbiological techniques, treatment and follow-up was requested to participant centers. FINDINGS: Overall, 1245 cases were included. Most of them were immigrants (66.9%), and South America was the most frequent area of origin. Detection of larvae in stool samples was observed in 21.9% of the patients, and serological tests allowed making the diagnosis in the rest of the cases. Eosinophilia was present in 82.2% of cases. Treatment with ivermectin (compared with albendazole) was the most strongly associated factor to achieve the cure (OR 2.34). CONCLUSIONS: Given the long latency of the infection and the risk of developing a severe presentation, screening of S. stercoralis infection should be mandatory in patients coming from or had traveling to endemic areas, especially in those with immunosuppressant conditions.


Assuntos
Anti-Helmínticos/uso terapêutico , Estrongiloidíase/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Albendazol/uso terapêutico , Animais , Criança , Pré-Escolar , Emigrantes e Imigrantes/estatística & dados numéricos , Eosinofilia/etiologia , Feminino , Humanos , Lactente , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , América do Sul , Espanha/epidemiologia , Strongyloides stercoralis/efeitos dos fármacos , Strongyloides stercoralis/isolamento & purificação , Strongyloides stercoralis/fisiologia , Estrongiloidíase/complicações , Estrongiloidíase/diagnóstico , Estrongiloidíase/parasitologia , Viagem , Adulto Jovem
19.
J Med Case Rep ; 13(1): 121, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31030665

RESUMO

BACKGROUND: In clinical practice, identification of a case of severe asthma exacerbation prompts initiation of corticosteroids. However, not all that wheezes is asthma. CASE PRESENTATION: A 61-year-old man from the Peruvian Amazon presented with progressive dyspnea, abdominal pain, and cough for the past week. His medical history was remarkable for asthma since childhood; he was treated with beta-agonists, ipratropium, and orally administered corticosteroids. On evaluation, he was febrile and ill-appearing. His chest examination revealed diffuse wheezing and bilateral crackles. He was diagnosed as having community-acquired pneumonia and asthma exacerbation and was started on empiric antibiotics, nebulized beta-agonists, and orally administered corticosteroids. His clinical status continued deteriorating and he became critically ill despite broad-spectrum antibiotics and antifungals. Considering the epidemiological background of our patient, bronchoalveolar and fecal samples were obtained to investigate soil-transmitted helminths. Larvae of Strongyloides stercoralis were found in both specimens. Ivermectin was initiated and corticosteroids were discontinued. He experienced remarkable improvement of clinical condition over the next weeks. The literature on this topic was reviewed. CONCLUSION: Cases of severe asthma exacerbation warrant careful evaluation before the initiation of corticosteroids, especially in patients at risk for parasitic infections. A high index of suspicion is critical. Alternative etiologies of respiratory decompensation should be considered in patients who fail to improve with broad-spectrum antibiotics and antifungals.


Assuntos
Corticosteroides/efeitos adversos , Asma/tratamento farmacológico , Estrongiloidíase/diagnóstico , Animais , Antiparasitários/uso terapêutico , Asma/complicações , Diagnóstico Tardio , Humanos , Ivermectina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/complicações , Estrongiloidíase/tratamento farmacológico
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