EPIDEMIOLOGICAL AND CLINICAL PROFILE OF STRONGYLOIDIASIS - EXPERIENCE FROM A TERTIARY CARE CENTRE

RATNA HARIKA DUSI; SUBBARAYUDU BODA; NITIN MOHAN; RAJYALAKSHMI CHEPURU; JYOTHI PADMAJA INDUGULA

doi:10.22159/ajpcr.2022.v15i11.45733

Authors

RATNA HARIKA DUSI Department of Microbiology, GITAM Institute of Medical Sciences and Research, GITAM Deemed to be University, Rushikonda, Visakhapatnam, Andhra Pradesh, India. https://orcid.org/0000-0001-6601-9693
SUBBARAYUDU BODA Department of General Medicine, NRI Institute of Medical Sciences, Visakhapatnam. https://orcid.org/0000-0003-0294-8463
NITIN MOHAN Department of Microbiology, GITAM Institute of Medical Sciences and Research, GITAM Deemed to be University, Rushikonda, Visakhapatnam, Andhra Pradesh, India. https://orcid.org/0000-0001-8813-3147
RAJYALAKSHMI CHEPURU Department of Community Medicine, GITAM Institute of Medical Sciences and Research, GITAM Deemed to be University, Rushikonda, Visakhapatnam, Andhra Pradesh, India.
JYOTHI PADMAJA INDUGULA Department of Microbiology, GITAM Institute of Medical Sciences and Research, GITAM Deemed to be University, Rushikonda, Visakhapatnam, Andhra Pradesh, India.

DOI:

https://doi.org/10.22159/ajpcr.2022.v15i11.45733

Keywords:

Strongyloides stercoralis, Epidemiology, Neglecteddisease, Parasite, Nematode, Helminth

Abstract

Objectives: The objective of the study was to study the clinical presentations, predisposing factors, and underlying conditions associated with Strongyloidiasis.

Methods: A prospective observational study was conducted from 2018 to 2021on patients who presented with medical complaints in a tertiary care hospital, and 19 were diagnosed with strongyloidiasis by stool wet mount examination. Other relevant details were collected to analyze the risk factors.

Results: A total of 19 cases were found positive for strongyloidiasis. Males 13 (68.4%) were more and females 6 (31.6%), and most of them were above 50 years age group (73.7%). Among the cases, respiratory symptoms (42.1%) were predominantly observed, followed by gastrointestinal (31.6%). Multiple predisposing factors such as chronic obstructive pulmonary disease, corticosteroid usage, TB, diabetes, alcohol, and asthma have been identified in strongyloidiasis cases. Peripheral eosinophilia is a frequent finding in the complete blood picture.

Conclusions: Strongyloidiasis should be strongly suspected in every immune compromised patient presenting with gastrointestinal, respiratory manifestations, or peripheral eosinophilia, and asymptomatic immune competent patients with comorbid conditions.

Downloads

Download data is not yet available.

References

Puthiyakunnon S, Boddu S, Li Y, Zhou X, Wang C, Li J, et al. Strongyloidiasis--an insight into its global prevalence and management. PLOS Negl Trop Dis 2014;8:e3018.

Kaminsky RL, Reyes-García SZ, Zambrano LI. Unsuspected Strongyloides stercoralis infection in hospital patients with comorbidity in need of proper management. BMC Infect Dis 2016;16:98. doi: 10.1186/s12879-016-1424-3, PMID 26923091

Keiser PB, Nutman TB. Strongyloides stercoralis in the immunocompromised population. Clin Microbiol Rev 2004;17:208-17. doi: 10.1128/CMR.17.1.208-217.2004, PMID 14726461

Teixeira MC, Pacheco FT, Souza JN, Silva ML, Inês EJ, Soares NM. Strongyloides stercoralis infection in alcoholic patients. BioMed Res Int 2016;2016:4872473. doi: 10.1155/2016/4872473, PMID 28105424

Rajamanickam A, Munisankar S, Bhootra Y, Dolla CK, Nutman TB, Babu S. Elevated systemic levels of eosinophil, neutrophil, and mast cell granular proteins in Strongyloides stercoralis infection that diminish following treatment. Front Immunol 2018;9:207. doi: 10.3389/fimmu.2018.00207, PMID 29479356

Yates J. Parasitic infections: Do not neglect Strongyloidiasis. Am Fam Physician 2021;104:224-5. PMID 34523890

Olsen A, van Lieshout L, Marti H, Polderman T, Polman K, Steinmann P, et al. Strongyloidiasis--the most neglected of the neglected tropical diseases? Trans R Soc Trop Med Hyg 2009;103:967-72. doi: 10.1016/j. trstmh.2009.02.013, PMID 19328508

Nutman TB. Human infection with Strongyloides stercoralis and other related Strongyloides species. Parasitology 2017;144:263-73. doi: 10.1017/S0031182016000834, PMID 27181117

Chordia P, Christopher S, Abraham OC, Muliyil J, Kang G, Ajjampur SS. Risk factors for acquiring Strongyloides stercoralis infection among patients attending a tertiary hospital in south India. Indian J Med Microbiol 2011;29:147-51. doi: 10.4103/0255-0857.81797, PMID 21654109

Nagpal S, Oberoi A. Strongyloides stercoralis-an underdiagnosed parasitic infection?-a study from a tertiary care hospital in North India. J Evol Med Dent Sci 2018;7:1468.

Khanna V, Tilak K, Mukhopadhyay C, Khanna R. Significance of diagnosing parasitic infestation in evaluation of unexplained eosinophilia. J Clin Diagn Res 2015;9:DC22-4. doi: 10.7860/ JCDR/2015/12222.6259, PMID 26393130

Negrão-Corrêa D. Importance of immunoglobulin E (IgE) in the protective mechanism against gastrointestinal nematode infection: Looking at the intestinal mucosae. Rev Inst Med Trop Sao Paulo 2001;43:291-9. doi: 10.1590/s0036-46652001000500011, PMID 11696854

Maruyama H, Yabu Y, Yoshida A, Nawa Y, Ohta N. A role of mast cell glycosaminoglycans for the immunological expulsion of intestinal nematode, Strongyloides venezuelensis. J Immunol 2000;164:3749-54. doi: 10.4049/jimmunol.164.7.3749, PMID 10725734

Dawson-Hahn EE, Greenberg SL, Domachowske JB, Olson BG. Eosinophilia and the seroprevalence of schistosomiasis and strongyloidiasis in newly arrived pediatric refugees: An examination of centers for disease control and prevention screening guidelines. J Pediatr 2010;156:1016-8.e1. doi: 10.1016/j.jpeds.2010.02.043, PMID 20400098

Spencer JV, Lockridge KM, Barry PA, Lin G, Tsang M, Penfold ME, et al. Potent immunosuppressive activities of Cytomegalovirus-encoded interleukin-10. J Virol 2002;76:1285-92. doi: 10.1128/jvi.76.3.1285- 1292.2002, PMID 11773404

Hunter CJ, Petrosyan M, Asch M. Dissemination of Strongyloides stercoralis in a patient with systemic lupus erythematosus after initiation of albendazole: A case report. J Med Case Rep 2008;2:156. doi: 10.1186/1752-1947-2-156, PMID 18479527

Tiwari S, Rautaraya B, Tripathy KP. Hyperinfection of Strongyloides stercoralis in an immunocompetent patient. Trop Parasitol 2012;2:135- 7. doi: 10.4103/2229-5070.105182, PMID 23767024

Marcos LA, Terashima A, Canales M, Gotuzzo E. Update on Strongyloidiasis in the immunocompromised host. Curr Infect Dis Rep 2011;13:35-46. doi: 10.1007/s11908-010-0150-z, PMID 21308453

Romero MD, Martínez MD, Pérez MA, Cuesta AA, Sánchez AC, Martínez JH. Strongyloides stercoralys as an unusual cause of COPD exacerbation. Arch Bronconeumol 2008;44:451-3. doi: 10.1016/s1579- 2129(08)60079-8, PMID 18775258

Liu HC, Hsu JY, Chang KM. Strongyloides stercoralis hyperinfection presenting with symptoms mimicking acute exacerbation of chronic obstructive pulmonary disease. J Chin Med Assoc 2009;72:442-5. doi: 10.1016/S1726-4901(09)70403-4, PMID 19687002

Henriquez-Camacho C, Gotuzzo E, Echevarria J, White AC Jr., Terashima A, Samalvides F, et al. Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection. Cochrane Database Syst Rev 2016;2016:CD007745. doi: 10.1002/14651858. CD007745.pub3, PMID 26778150

Schär F, Trostdorf U, Giardina F, Khieu V, Muth S, Marti H, et al. Strongyloides stercoralis: Global distribution and risk factors. PLOS Negl Trop Dis. 2013;7:e2288. doi: 10.1371/journal.pntd.0002288, PMID 23875033

Silver ZA, Kaliappan SP, Samuel P, Venugopal S, Kang G, Sarkar R, et al. Geographical distribution of soil transmitted helminths and the effects of community type in South Asia and South East Asia-a systematic review. PLOS Negl Trop Dis 2018;12:e0006153. doi: 10.1371/journal.pntd.0006153, PMID 29346440

Salam N, Azam S. Prevalence and distribution of soil-transmitted helminth infections in India. BMC Public Health 2017;17:201. doi: 10.1186/s12889-017-4113-2, PMID 28209148

Devi U, Borkakoty B, Mahanta J. Strongyloidiasis in Assam, India: A community-based study. Trop Parasitol 2011;1:30-2. doi: 10.4103/2229-5070.72110, PMID 23508997

Pradhan G, Behera P, Panigrahi MK, Bhuniya S, Mohapatra PR, Turuk J, et al. Pulmonary strongyloidiasis masquerading as exacerbation of chronic obstructive pulmonary disease. Tuberc Respir Dis (Seoul) 2016;79:307-11. doi: 10.4046/trd.2016.79.4.307, PMID 27790284

Reddy PR, Thomas SM, Rajalakshmi A, Vijayan D, Raman M. A rare case of Strongyloides hyperinfection from hypogammaglobulinemia. Indian J Crit Care Med 2017;21:466-8. doi: 10.4103/ijccm. IJCCM_139_17, PMID 28808370

Beknazarova M, Whiley H, Ross K. Strongyloidiasis: A disease of socioeconomic disadvantage. Int J Environ Res Public Health 2016;13:517. doi: 10.3390/ijerph13050517, PMID 27213420

Paul M, Meena S, Gupta P, Jha S, Rekha US, Kumar VP. Clinico-epidemiological spectrum of strongyloidiasis in India: Review of 166 cases. J Family Med Prim Care 2020;9:485-91. doi: 10.4103/jfmpc. jfmpc_1182_19, PMID 32318369