Case Report: Challenges for the Diagnosis and Treatment of Strongyloides stercoralis in Chronic Obstructive Pulmonary Disease Patients

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  • 1 Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran;
  • | 2 Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran;
  • | 3 Abadan School of Medical Sciences, Abadan, Khuzestan, Iran;
  • | 4 Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran

Strongyloidiasis, a neglected tropical disease (NTD), which is caused by Strongyloides stercoralis, can be fatal in immunocompromised patients. In most chronic cases, infections most frequently are asymptomatic, and eosinophilia might be the only clinical characteristic of this disease. The use of corticosteroids in some diseases like chronic obstructive pulmonary disease (COPD) may lead to the development of the life-threatening S. stercoralis hyperinfection syndrome. In the present research, we presented five cases of strongyloidiasis with a history of COPD and receiving corticosteroids from Abadan County, southwestern Iran. By performing the direct smear stool examinations, two cases were identified and the other three cases were diagnosed using the agar plate culture method. Despite reporting eosinophilia in previous patients’ hospitalizations, the fecal examination was not performed for parasitic infections. Moreover, pulmonary symptoms were similar, but gastrointestinal symptoms were varied, including nausea, vomiting, abdominal pain, epigastric pain, constipation, and diarrhea. All the included patients were treated with albendazole, which is the second-line drug for S. stercoralis, and relapse of infection was observed in two patients by passing few months from the treatment. The increased blood eosinophil count was shown to play important roles in both the management of COPD and diagnosis of helminthic infections. In COPD patients who are receiving steroids, screening and follow-up for strongyloidiasis should be considered as priorities. In addition, ivermectin, which is the first-line drug for strongyloidiasis, should be available in the region.

Author Notes

Address correspondence to Molouk Beiromvand, Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, P.O. Box 61357–15794, Ahvaz, Khuzestan, Iran. E-mail: beiromvandm@gmail.com

Financial support: The work was funded by the Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz (Iran), under Grant OG/9834 to M. B.

Disclosure: The study protocol was reviewed and approved by the Ethics Committee of Ahvaz Jundishapur University of Medical Sciences (approval no. IR.AJUMS. MEDICINE.REC.1398.039). The written informed consent was obtained before enrollment.

Authors’ addresses: Alireza Ashiri, Abdollah Rafiei, and Molouk Beiromvand, Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran, and Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran, E-mails: ashiri_alireza@yahoo.com, rafieiabdollah@yahoo.com, and beiromvandm@gmail.com. Abdollah Khanzadeh, Abadan School of Medical Sciences, Abadan, Khuzestan, Iran, E-mail: drabdullakhanzadeh@gmail.com. Arash Alghasi, Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan, Iran, E-mail: alghasi-a@ajums.ac.ir.

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