OBJECTIVETo communicate the presence of adult females, rabditoid larvae and eggs of Strongyloides stercoralis (S. stercoralis) in the respiratory secretions obtained by tracheal aspirate from a HIV-negative patient who was suffering from polymyositis, and treated with corticoids and amethopterin and assisted by pneumonia.

METHODSThe respiratory secretions submitted to the Parasitology Laboratory of the Muñiz Hospital were made more concentrated by centrifugation (1 500 r/min for 15 seconds). Wet mount microscopy was performed with the pellet.

RESULTSIt revealed adult females, rabditoid larvae and eggs of S. stercoralis. Further parasitological studies performed after the start of the treatment with ivermectin on fresh fecal samples, gastric lavages and tracheal aspirates showed scanty mobile filariform and rabditoid larvae of the same parasite.

CONCLUSIONSThe presence of adult female S. stercoralis which has never been observed before in the clinical samples submitted to our Laboratory for investigation can be considered as an indirect marker of the severe immunosupression of the patient.

Animals ; Female ; Humans ; Life Cycle Stages ; Middle Aged ; Strongyloides stercoralis ; cytology ; growth & development ; Strongyloidiasis ; diagnosis ; parasitology

We compared the efficacy and applicability of a modified formalin-ether concentration technique (M-FECT) to the conventional FECT (C-FECT) and the agar plate culture (APC) method for the detection of Strongyloides stercoralis larvae. For this purpose, we used 600 human fecal specimens collected in an endemic area of southern Thailand. In the M-FECT, we used 2 layers of wire meshes, instead of gauze, to avoid the loss by absorption/adhesion of larvae to the gauze during filtration, and we reduced the exposure time of S. stercoralis larvae in stool samples to formalin. By such simple modifications, the efficacy of M-FECT has become comparable to APC and was much better than that of C-FECT for the diagnosis of strongyloidiasis.
Animals ; Ether ; Feces/parasitology ; Formaldehyde ; Humans ; Parasitology/*methods ; Specimen Handling/*methods ; Strongyloides stercoralis/*isolation & purification ; Strongyloidiasis/*diagnosis ; Thailand

Pulmonary strongyloidiasis is an uncommon presentation of Strongyloides infection, usually seen in immunocompromised hosts. The manifestations are similar to that of acute exacerbation of chronic obstructive pulmonary disease (COPD). Therefore, the diagnosis of pulmonary strongyloidiasis could be challenging in a COPD patient, unless a high index of suspicion is maintained. Here, we present a case of Strongyloides hyperinfection in a COPD patient mimicking acute exacerbation, who was on chronic steroid therapy.
Acute Disease ; Adrenal Cortex Hormones ; Diagnosis ; Humans ; Immunocompromised Host ; Pulmonary Disease, Chronic Obstructive* ; Strongyloides ; Strongyloides stercoralis ; Strongyloidiasis*

A 69-year-old Korean man was admitted to emergency room with complaints of abdominal pain, vomiting, and diarrhea. Laboratory tests revealed eosinophilia, anemia, hypoproteinemia, and hyponatremia. The gastric mucosa showed whitish mottled and slightly elevated lesions on the body angle of antrum. Microscopically, chronic gastritis with incomplete intestinal metaplasia was observed. Many adult worms, larvae, and eggs in cross sections were located in the crypts. Furthermore, the filariform larvae of Strongyloides stercoralis with a notched tail were detected through the culture.
Aged ; Albendazole/therapeutic use ; Animals ; Anthelmintics/therapeutic use ; Feces/parasitology ; Female ; Humans ; Intestines/parasitology ; Korea ; Male ; Strongyloides stercoralis/*isolation & purification ; Strongyloidiasis/*diagnosis/drug therapy/parasitology

Strongylodiasis is universal in distribution but is most abundant in countries with a tropical climate. Although infestation by Strongyloides stercoralis is usually limited to the intestines, dessemination of this helminth in debilitated host can be lead to death with various clinical disorders. characterized by profound malabsorption, diarrhea, electrolyte imbalance, gram negative or opportunistic fungal sepsis, coma and death. Cell-mediated immunity contributing significantly to the control of helminthic infections, may be suppressed by carcinoma, immunosuppressive chemotherapy and use of corticosteroids. Diagnosis of Strongyloidiasis is achieved by an examination of samples of feces, duodenal aspirates and sputum of patients for Strongyloides stercoralis. Treatment of strongyloidiasis is twofold : correction of the immunosuppressive state by withdrawal of immunosuppressive drug, if possible, and vigorous treatment with thiabendazole. Testing for strongyloidiasis is especially recommanded before treating a patients should be monitored for infection by Strongyloides stercoralis and other opportunistic infection. We are reporting a case patient with Strongyloides stercoralis hyperinfection and pulmonary tuberculosis who had been. used corticosteroid for persisting polyarthritis.
Adrenal Cortex Hormones ; Arthritis ; Coma ; Diagnosis ; Diarrhea ; Drug Therapy ; Feces ; Helminths ; Humans ; Immunity, Cellular ; Intestines ; Opportunistic Infections ; Sepsis ; Sputum ; Strongyloides stercoralis* ; Strongyloides* ; Strongyloidiasis ; Thiabendazole ; Tropical Climate ; Tuberculosis, Pulmonary

Korea Strongyloidiasis is a parasitic disease caused by Strongyloides stercoralis which exists in two forms : the free living and parasitic forms. It exists in warm, moist climate in areas where there is frequent fecal contamination of the soil. After cutaneous invasion by the filariform larvae, petechial hemorrage, pruritus, papular rashes, edema, and urticaria occur. Infection commonly occurs in the proximal intestine of the gastrointestinal (G-I) tract but may extend from the stomach to the anus. Once the worm is established in the small intestine, the physical findings may include epigastric tenderness to palpation. The mucosal biopsy is an inefficient way of making the diagnosis because the worm is found in the biopsy specimen in only 2% of patients. Gastric strongyloidiasis is rare. We experienced a case of gastric strongyloidiasis diagnosed by the endoscopic biopsy and serologic test for parasite specific IgG antibody by micro-ELISA.
Anal Canal ; Biopsy* ; Climate ; Diagnosis ; Edema ; Exanthema ; Humans ; Immunoglobulin G ; Intestine, Small ; Intestines ; Korea ; Larva ; Palpation ; Parasites ; Parasitic Diseases ; Pruritus ; Serologic Tests ; Soil ; Stomach ; Strongyloides stercoralis ; Strongyloidiasis* ; Urticaria

Strongyloides stercoralis hyperinfection in immunocompromised patients is difficult to control due to delayed diagnosis, especially in nonendemic areas. A 70-year-old diabetic woman came in with an intermittent diarrhea. She received massive steroid therapy for a week under the impression of idiopathic gastrointestinal eosinophilic syndrome. Diagnosis of strongyloidiasis was made by demonstration of filariform larvae in two repeated sputum specimens two months later. Despite massive administration of albendazole, she died of diabetic ketoacidosis and septic shock. Autopsy revealed a diffusely thickened bowel wall, superimposed invasive pulmonary aspergillosis and the near total destruction of the lungs. Filariform larvae were detected only in the cutaneous lesions. It was presumed that Strongyloides stercoralis hyperinfection was caused by autoinfection in the patient's immunosuppressed status. The present case has two clinical importances; first, intensive treatment with albendazole could erradicate parasites except for the skin but sepsis presumably occurred due to a hypersensitivity reaction against liberated endotoxins during the death of the parasites by the drug. Second, cutaneous parasitic lesion resists the intensive antihelminthic treatment in an immunocompromised host.
Aged ; Albendazole ; Autopsy* ; Delayed Diagnosis ; Diabetic Ketoacidosis ; Diagnosis ; Diarrhea ; Endotoxins ; Eosinophils ; Female ; Humans ; Hypersensitivity ; Immunocompromised Host ; Invasive Pulmonary Aspergillosis ; Larva* ; Lung ; Parasites ; Sepsis ; Shock, Septic ; Skin ; Sputum ; Strongyloides stercoralis ; Strongyloidiasis*

Strongyloides stercoralis can cause systemic infection, termed strongyloidiasis, and gastrointestinal ulcer disease in immunocompromised patients. However, to our knowledge, there are no reported cases of comorbid gastric adenocarcinoma and S. stercoralis infection. Here, we report a case of an 81-year-old Korean man who presented with S. stercoralis infection coexisting with early gastric adenocarcinoma (T1aN0M0). S. stercoralis eggs, rhabditiform larvae, and adult females were observed in normal gastric and duodenal crypts. They were also observed in atypical glands representative of adenocarcinoma and adenoma. Preliminary laboratory tests revealed mild neutrophilic and eosinophilic leukocytosis. A routine stool test failed to detect rhabditiform larvae in the patient's fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues. Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever. The patient was followed-up by monitoring and laboratory testing for 4 months postoperatively, and no abnormalities were observed thus far. The fact that S. stercoralis infection may be fatal in immunocompromised patients should be kept in mind when assessing high-risk patients.
Adenocarcinoma/*complications/*diagnosis/pathology ; Aged, 80 and over ; Albendazole/therapeutic use ; Animals ; Anthelmintics/therapeutic use ; DNA, Helminth/chemistry/genetics ; DNA, Ribosomal/chemistry/genetics ; Endoscopy, Digestive System ; Female ; Histocytochemistry ; Humans ; Korea ; Male ; RNA, Ribosomal, 18S/genetics ; Sequence Analysis, DNA ; Stomach Neoplasms/*complications/*diagnosis/pathology ; Strongyloides stercoralis/*isolation & purification ; Strongyloidiasis/*complications/*diagnosis/drug therapy/pathology ; Treatment Outcome

Strongyloides stercoralis can cause systemic infection, termed strongyloidiasis, and gastrointestinal ulcer disease in immunocompromised patients. However, to our knowledge, there are no reported cases of comorbid gastric adenocarcinoma and S. stercoralis infection. Here, we report a case of an 81-year-old Korean man who presented with S. stercoralis infection coexisting with early gastric adenocarcinoma (T1aN0M0). S. stercoralis eggs, rhabditiform larvae, and adult females were observed in normal gastric and duodenal crypts. They were also observed in atypical glands representative of adenocarcinoma and adenoma. Preliminary laboratory tests revealed mild neutrophilic and eosinophilic leukocytosis. A routine stool test failed to detect rhabditiform larvae in the patient's fecal sample; however, S. stercoralis was identified by PCR amplification and 18S rRNA sequencing using genomic DNA extracted from formalin-fixed paraffin-embedded tissues. Postoperatively, the patient had a persistent fever and was treated with albendazole for 7 days, which alleviated the fever. The patient was followed-up by monitoring and laboratory testing for 4 months postoperatively, and no abnormalities were observed thus far. The fact that S. stercoralis infection may be fatal in immunocompromised patients should be kept in mind when assessing high-risk patients.
Adenocarcinoma/*complications/*diagnosis/pathology ; Aged, 80 and over ; Albendazole/therapeutic use ; Animals ; Anthelmintics/therapeutic use ; DNA, Helminth/chemistry/genetics ; DNA, Ribosomal/chemistry/genetics ; Endoscopy, Digestive System ; Female ; Histocytochemistry ; Humans ; Korea ; Male ; RNA, Ribosomal, 18S/genetics ; Sequence Analysis, DNA ; Stomach Neoplasms/*complications/*diagnosis/pathology ; Strongyloides stercoralis/*isolation & purification ; Strongyloidiasis/*complications/*diagnosis/drug therapy/pathology ; Treatment Outcome

Strongyloides stercoralis is a soil transmitted intestinal nematode that is endemic in the tropical and subtropical regions. In most individuals who are infected, chronic, usually asymptomatic, gastrointestinal infection persists. But, in immunocompromized hosts or in patients receiving immunosuppressive therapy, autoinfection of S. stercoralis may result in the dissemination of larvae, leading to fatal hyperinfection and increased rate of complications. We report a case of hyperinfective strongyloidiasis with bacterial meningitis in a patient receiving steroid therapy. Strongyloidiasis was diagnosed by the presence of filariform larvae of S. stercoralis in the bronchoalveolar lavage cytology and upper gastrointestinal endoscopic biopsy specimen. Her clinical symptoms had progressively aggravated and developed bacterial meningitis during treatment. She died despite aggressive antibiotic and antihelminthic therapy.
Adrenal Insufficiency/drug therapy ; Aged ; Animals ; Bronchoalveolar Lavage Fluid/parasitology ; Endoscopy, Gastrointestinal ; Enterococcus faecium/isolation & purification ; Female ; Humans ; Immunocompromised Host ; Intestinal Mucosa/pathology ; Larva/physiology ; Magnetic Resonance Imaging ; Meningitis, Bacterial/complications/*diagnosis/microbiology ; Steroids/adverse effects/therapeutic use ; Strongyloides stercoralis/growth & development/isolation & purification ; Strongyloidiasis/complications/*diagnosis/parasitology