High Rate of Strongyloidosis Infection, Out of Endemic Area, in Patients with Eosinophilia and without Risk of Exogenous Reinfections

Silvia A. Repetto Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires; Departamento de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires; División Infectología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina

Search for other papers by Silvia A. Repetto in
Current site
Google Scholar
PubMed
Close
,
Pablo A. Durán Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires; Departamento de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires; División Infectología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina

Search for other papers by Pablo A. Durán in
Current site
Google Scholar
PubMed
Close
,
María B. Lasala Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires; Departamento de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires; División Infectología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina

Search for other papers by María B. Lasala in
Current site
Google Scholar
PubMed
Close
, and
Stella M. González-Cappa Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires; Departamento de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires; División Infectología, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina

Search for other papers by Stella M. González-Cappa in
Current site
Google Scholar
PubMed
Close
Restricted access

Strongyloides stercoralis chronic infections are usually asymptomatic and underestimated. We used direct fresh stool examination, Ritchie's method, and agar plate culture for diagnosis in patients with eosinophilia and previous residence in endemic areas. The frequency of strongyloidosis detected among these patients was high: 21 of 42 were positive. Among them, 10 were positive only by agar plate culture. After ivermectin treatment, patients resulted negative for parasitological tests and reduced their eosinophil counts. Half of the submitted patients that were followed 4–12 months after treatment remained negative without eosinophilia, except one who showed an eosinophil ascending curve before reappearance of larvae in stools. The high frequency of strongyloidosis found in this group emphasizes the relevance of including this parasitosis among differential diagnosis in patients with eosinophilia and past risk of S. stercoralis infection to prevent disseminated infections secondary to corticoid therapy.

Author Notes

*Address correspondence to Silvia A. Repetto, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, piso 13, Ciudad Autónoma de Buenos Aires, Argentina. E-mail: silvia_repetto@yahoo.com.ar

Financial support: This work was supported by grants from the Agencia Nacional de Promoción Científica y Tecnológica (ANPCyT) of Argentina and the Universidad de Buenos Aires.

Disclosure: SMGC is a member of the Research Career from CONICET, and SAR is a fellow of UBA, Argentina.

Authors' addresses: Silvia A. Repetto and Stella M. González-Cappa, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina, E-mails: silvia_repetto@yahoo.com.ar, smgcappa@fmed.uba.ar, and smgcappa@gmail.com. Pablo A. Durán, Departamento de Salud Pública, Facultad de Medicina, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina, E-mail: apduran@intramed.net. María B. Lasala, Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina, E-mail: mblasala@fibertel.com.ar.

  • 1.

    Brigandi RA, Rotman HL, Nolan TJ, Schad GA, Abraham D, 1997. Chronicity in Strongyloides stercoralis infections: dichotomy of the protective inmune response to infective and autoinfective larvae in a mouse model. Am J Trop Med Hyg 56: 640646.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Concha R, Harrington W Jr, Rogers AI, 2005. Intestinal strongyloidiasis: recognition, management and determinants of outcome. J Clin Gastroenterol 39: 203211.

  • 3.

    Vadlamudi RS, Chi DS, Krishnaswamy G, 2006. Intestinal strongyloidiasis and hyperinfection syndrome. Clin Mol Allergy 30: 48.

  • 4.

    Segarra-Newnham M, 2007. Manifestations, diagnosis, and treatment of Strongyloides stercoralis infection. Ann Pharmacother 41: 19922001.

  • 5.

    Marcos LA, Terashima A, Dupont HL, Gotuzzo E, 2008. Strongyloides hyperinfection syndrome: an emerging global infectious disease. Trans R Soc Trop Med Hyg 102: 314318.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Keiser PB, Nutman TB, 2004. Strongyloides stercoralis in the inmunocompromised population. Rev Clin Microbiol Rev 17: 208217.

  • 7.

    Al-Hasan MN, McCormick M, Ribes JA, 2007. Invasive enteric infections in hospitalized patients with underlying strongyloidiasis. Am J Clin Pathol 128: 622627.

  • 8.

    Siddiqui AA, Berk SL, 2001. Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis 33: 10401047.

  • 9.

    Lim S, Katz K, Krajden S, Fuksa M, Keystone JS, Kain KC, 2004. Complicated and fatal Strongyloides infection in Canadians: risk factors, diagnosis and management. CMAJ 171: 479484.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Intapan PM, Maleewong W, Wongsaroj T, Singthong S, Morakote N, 2005. Comparison of the quantitative formalin ethyl acetate concentration technique and agar plate culture for diagnosis of human strongyloidiasis. J Clin Microbiol 43: 19321933.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Salazar SA, Gutierrez C, Berk SL, 1995. Value of the agar plate method for the diagnosis of intestinal strongyloidiasis. Diagn Microbiol Infect Dis 23: 141145.

  • 12.

    De Kamisky RG, 1993. Evaluation of three methods for laboratory diagnosis of Strongyloides stercoralis infection. J Parasitol 79: 277280.

  • 13.

    Jongwutiwes S, Charoenkorn M, Sitthichareonchai P, Akaraborvorn P, Putaporntip C, 1999. Increased sensitivity of routine laboratory detection of Strongyloides stercoralis and hookworm by agar-plate culture. Trans R Soc Trop Med Hyg 93: 398400.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Hirata T, Nakamura H, Kinjo N, Hokama A, Kinjo F, Yamane N, Fujita J, 2007. Increased detection rate of Strongyloides stercoralis by repeated stool examinations using the agar plate culture method. Am J Trop Med Hyg 77: 683684.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Sato Y, Kobayashi J, Toma H, Shiroma Y, 1995. Efficacy of stool examination for detection of Strongyloides infection. Am J Trop Med Hyg 53: 248250.

  • 16.

    van Doorn HR, Koelewijn R, Hofwegen H, Gilis H, Wetsteyn JC, Wismans PJ, Sarfati C, Vervoort T, Van Gool T, 2007. Use of enzyme-linked immunosorbent assay and dipstick assay for detection of Strongyloides stercoralis infection in humans. J Clin Microbiol 45: 438442.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Centers for Disease Control and Prevention, 2009. Diagnostic findings: strongyloidiasis antibody detection. Available at: http:/www.dpd.cdc.gov/dpdx/html/frames/S-Z/Strongyloidiasis/. Accessed August 28, 2009.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Checkley AM, Chiodini PL, Dockrell DH, Bates I, Thwaites GE, Booth HL, Brown M, Wrigght SG, Grant AD, Mabey DC, Whitty C, Sanderson F, British Infection Society and Hospital for Tropical Diseases, 2010. Eosinophilia in returning travelers and migrants from the tropics: UK recommendations for investigation and initial management. J Infect 60: 120.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Ramanathan R, Nutman T, 2008. Strongyloides stercoralis infection in the immunocompromised host. Curr Infect Dis Rep 10: 105110.

  • 20.

    González Cappa SM, Paulin P, 1997. Microbiología clínica. Diagnóstico Parasitológico. Argentina: Asociación Argentina de Microbiología, Colegio de Bioquímicos de la Provincia de Entre Ríos, Facultad de Bioquímica y Ciencias Biológicas.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Garcia LS, 2007. Diagnosis Medical Parasitology. Fifth edition. Washington, DC: ASM Press.

  • 22.

    Loutfy M, Wilson M, Keystone J, Kain K, 2002. Serology and eosinophil count in the diagnosis and management of strongyloidiasis in a non-endemic area. Am J Trop Med Hyg 66: 749762.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Olsen A, van Lieshout L, Marti H, Polderman T, Polman K, Steinmann P, Stothard R, Thybo S, Verweij JJ, Magnussen P, 2009. Strongyloidiasis–the most neglected of the neglected tropical diseases? Trans R Soc Trop Med Hyg 103: 967972.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Genta RM, 1992. Dysregulation of strongyloidiasis: a new hypothesis. Clin Microbiol Rev 5: 345355.

  • 25.

    Neva FA, 1986. Biology and immunology of human strongyloidiasis. J Infect Dis 153: 397406.

  • 26.

    Mansfield LS, Niamatali S, Bhopale V, Volk S, Smith G, Lok JB, Genta RM, Schad GA, 1996. Strongyloides stercoralis: maintenance of exceedingly chronic infections. Am J Trop Med Hyg 55: 617624.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Boulware DR, Stauffer WM, Hendel-Paterson BR, Rocha JL, Seet RC, Summer AP, Nield LS, Supparatpinyo K, Chaiwarith R, Walker PF, 2007. Maltreatment of Strongyloides infection: case series and worldwide physicians-in-training survey. Am J Med 120: 545.e1545.e8.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Igual-Adell R, Oltra-Alcaraz C, Soler-Company E, Sánchez-Sánchez P, Matogo-Oyana J, Rodríguez-Calabuig D, 2004. Efficacy and safety of ivermectin and thiabendazole in the treatment of strongyloidiasis. Expert Opin Pharmacother 5: 26152619.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Intapan P, Prasongdee T, Laummaunwai P, Sawanyawisuth K, Singthong S, Maleewong W, 2006. A modified filter paper culture technique for screening of Strongyloides stercoralis ivermectin sensitivity in clinical specimens. Am J Trop Med Hyg 75: 563564.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 186 150 4
Full Text Views 273 7 1
PDF Downloads 64 11 1
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save