Endoscopic and Histopathological Study on the Duodenum of Strongyloides Stercoralis Hyperinfection

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2008 Mar 20

PMID 18350608

Citations 35

Authors

Kazuto Kishimoto

Akira Hokama

Tetsuo Hirata

Yasushix Ihama

Manabu Nakamoto

Nagisa Kinjo

Fukunori Kinjo

Jiro Fujita

Affiliations

Soon will be listed here.

Abstract

Aim: To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis (S. stercoralis) hyperinfection.

Methods: Over a period of 23 years (1984-2006), we investigated 25 patients with S. stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis. The clinical and endoscopic findings were analyzed retrospectively.

Results: Twenty-four (96%) of the patients investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1 (HTLV-1) infection. The abnormal endoscopic findings, mainly edematous mucosa, white villi and erythematous mucosa, were observed in 23 (92%) patients. The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy. The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative (Endoscopic severity score: 4.86 +/- 2.47 vs 2.71 +/- 1.38, P < 0.05).

Conclusion: Our study clearly demonstrates that, in addition to stool analysis, endoscopic observation and biopsies are very important. We also emphasize that S. stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.

Citing Articles

Coinfection of cytomegalovirus and strongyloidiasis presenting as massive gastrointestinal bleeding in an immunocompromised host: a case report.

Huu T, Thu H, Quy K, Thanh M, Thi N, Ngoc Q Front Med (Lausanne). 2024; 11:1438689.

PMID: 39635602 PMC: 11615966. DOI: 10.3389/fmed.2024.1438689.

Residual gastritis associated with Strongyloides stercoralis infection: A case report.

Cai S, Zhou M, Zhang Y, Luo W, Xie B Medicine (Baltimore). 2024; 103(39):e39714.

PMID: 39331943 PMC: 11441947. DOI: 10.1097/MD.0000000000039714.

Malabsorption due to strongyloidiasis after high-dose steroid therapy for Coronavirus disease-19.

Malakar S, Mathur A, Mishra P, Radha P, Krishnani N, Ghoshal U Indian J Gastroenterol. 2023; 44(1):118-119.

PMID: 37470967 DOI: 10.1007/s12664-023-01378-0.

A Rare Case of Hyperinfection in a Diabetic Patient from Romania-Case Report and Review of the Literature.

Costache C, Colosi I, Neculicioiu V, Florian D, Petrushev B, Vasvari A Pathogens. 2023; 12(4).

PMID: 37111416 PMC: 10146644. DOI: 10.3390/pathogens12040530.

Prevalence of Strongyloides stercoralis infection and associated clinical symptoms among schoolchildren living in different altitudes of Amhara National Regional State, northwest Ethiopia.

Jember T, Amor A, Nibret E, Munshea A, Flores-Chavez M, Ta-Tang T PLoS Negl Trop Dis. 2022; 16(4):e0010299.

PMID: 35482629 PMC: 9049318. DOI: 10.1371/journal.pntd.0010299.

References

Milder J, Walzer P, Kilgore G, Rutherford I, Klein M . Clinical features of Strongyloides stercoralis infection in an endemic area of the United States. Gastroenterology. 1981; 80(6):1481-8. View

Csermely L, Jaafar H, Kristensen J, Castella A, Gorka W, Chebli A . Strongyloides hyper-infection causing life-threatening gastrointestinal bleeding. World J Gastroenterol. 2006; 12(39):6401-4. PMC: 4088155. DOI: 10.3748/wjg.v12.i39.6401. View

Asakura H, Miura S, Morishita T, Aiso S, Tanaka T, Kitahora T . Endoscopic and histopathological study on primary and secondary intestinal lymphangiectasia. Dig Dis Sci. 1981; 26(4):312-20. DOI: 10.1007/BF01308371. View

de PAOLA , DIAS L, Da Silva J . Enteritis due to Strongyloides stercoralis. A report of 5 fatal cases. Am J Dig Dis. 1962; 7:1086-98. DOI: 10.1007/BF02232985. View

Hirata T, Uchima N, Kishimoto K, Zaha O, Kinjo N, Hokama A . Impairment of host immune response against strongyloides stercoralis by human T cell lymphotropic virus type 1 infection. Am J Trop Med Hyg. 2006; 74(2):246-9. View

Satoh M, Kiyuna S, Shiroma Y, Toma H, Kokaze A, Sato Y . Predictive markers for development of strongyloidiasis in patients infected with both Strongyloides stercoralis and HTLV-1. Clin Exp Immunol. 2003; 133(3):391-6. PMC: 1808792. DOI: 10.1046/j.1365-2249.2003.02224.x. View

Choudhry U, Choudhry R, Romeo D, Cammerer R, Gopalswamy N . Strongyloidiasis: new endoscopic findings. Gastrointest Endosc. 1995; 42(2):170-3. DOI: 10.1016/s0016-5107(95)70077-3. View

Karmo M, Goh J, Boulton R, Sanders D . An unusual cause of diarrhoea in a patient with colitis. Gut. 2004; 54(1):77, 96. PMC: 1774355. DOI: 10.1136/gut.2004.043240. View

Ghoshal U, Alexender G, Ghoshal U, Tripathi S, Krishnani N . Strongyloides stercoralis infestation in a patient with severe ulcerative colitis. Indian J Med Sci. 2006; 60(3):106-10. View

10.

Suarez A, Sanchez C . [Strongyloides stercoralis: histopathological findings of duodenal mucosa (1999-2005)]. Rev Gastroenterol Peru. 2006; 26(1):44-8. View

11.

Friedenberg F, Wongpraparut N, Fischer R, Gubernick J, Zaeri N, Eiger G . Duodenal obstruction caused by Strongyloides stercoralis enteritis in an HTLV-1-infected host. Dig Dis Sci. 1999; 44(6):1184-8. DOI: 10.1023/a:1026636509713. View

12.

Brasitus T, Gold R, Kay R, Magun A, Lee W . Intestinal strongyloidiasis. A case report and review of the literature. Am J Gastroenterol. 1980; 73(1):65-9. View

13.

Zaha O, Hirata T, Uchima N, Kinjo F, Saito A . Comparison of anthelmintic effects of two doses of ivermectin on intestinal strongyloidiasis in patients negative or positive for anti-HTLV-1 antibody. J Infect Chemother. 2004; 10(6):348-51. DOI: 10.1007/s10156-004-0345-z. View

14.

Bhatt B, Cappell M, Smilow P, Das K . Recurrent massive upper gastrointestinal hemorrhage due to Strongyloides stercoralis infection. Am J Gastroenterol. 1990; 85(8):1034-6. View

15.

Asano K, Tada S, Kamio T, Matsumoto T, Suko H, Iida M . Strongyloidiasis. Gastrointest Endosc. 2004; 60(4):606-7. DOI: 10.1016/s0016-5107(04)01861-9. View

16.

Keiser P, Nutman T . Strongyloides stercoralis in the Immunocompromised Population. Clin Microbiol Rev. 2004; 17(1):208-17. PMC: 321465. DOI: 10.1128/CMR.17.1.208-217.2004. View

17.

Chen J, Lee C, Changchan C . Duodenal strongyloides stercoralis infection. Endoscopy. 1994; 26(2):272. DOI: 10.1055/s-2007-1008965. View

18.

Seet R, Gong L, Tambyath P . Image of the month. Strongyloides stercoralis hyperinfection and syndrome of inappropriate secretion of antidiuretic hormone. Gastroenterology. 2005; 128(1):8, 252. DOI: 10.1053/j.gastro.2004.11.034. View

19.

COUTINHO H, Robalinho T, Coutinho V, Almeida J, Filho J, King G . Immunocytochemistry of mucosal changes in patients infected with the intestinal nematode Strongyloides stercoralis. J Clin Pathol. 1996; 49(9):717-20. PMC: 500719. DOI: 10.1136/jcp.49.9.717. View

20.

Overstreet K, Chen J, Rodriguez J, Wiener G . Endoscopic and histopathologic findings of Strongyloides stercoralis infection in a patient with AIDS. Gastrointest Endosc. 2003; 58(6):928-31. DOI: 10.1016/s0016-5107(03)02280-6. View