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Fulltext Detection of Strongyloides stercoralis infection among cancer patients in a major hospital in Kelantan, Malaysia

Zueter AM, Mohamed Z, Abdullah AD, Mohamad N, Arifin N, Othman N, et al.

Singapore Med J, 2014 Jul;55(7):367-71.
PMID: 25091885

INTRODUCTION: Strongyloidiasis is one of the most commonly neglected but clinically important parasitic infections worldwide, especially among immunocompromised patients. Evidence of infection among immunocompromised patients in Malaysia is, however, lacking. In this study, microscopy, real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assays (ELISAs) were used to detect Strongyloides stercoralis (S. stercoralis) infection among cancer patients in a Malaysian hospital.

METHODS: A total of 192 stool and serum samples were collected from cancer patients who were receiving chemotherapy with or without steroid treatment at a hospital in northeastern Malaysia. Stool samples were examined for S. stercoralis using parasitological methods and real-time PCR. Serology by ELISA was performed to detect parasite-specific immunoglobulin G (IgG), IgG4 and immunoglobulin E (IgE) antibodies. For comparison, IgG4- and IgG-ELISAs were also performed on the sera of 150 healthy individuals from the same area.

RESULTS: Of the 192 samples examined, 1 (0.5%) sample was positive for S. stercoralis by microscopy, 3 (1.6%) by real-time PCR, 8 (4.2%) by IgG-ELISA, 6 (3.1%) by IgG4-ELISA, and none was positive by IgE-ELISA. In comparison, healthy blood donors had significantly lower prevalence of parasite-specific IgG (2.67%, p < 0.05) and IgG4 (2.67%, p < 0.05) responses.

CONCLUSION: This study showed that laboratory testing may be considered as a diagnostic investigation for S. stercoralis among immunocompromised cancer patients.

Matched MeSH terms: Strongyloides stercoralis*
Fulltext Review of patients with Strongyloides stercoralis infestation in a tertiary teaching hospital, Kelantan

Azira NM, Abdel Rahman MZ, Zeehaida M

Malays J Pathol, 2013 Jun;35(1):71-6.
PMID: 23817397 MyJurnal

Strongyloides stercoralis is an intestinal nematode infecting humans. The actual prevalence of infestation with this parasite in our setting is not well established. Thus, this study was conducted to determine the age, sex and co-morbid conditions among patients with S. stercoralis infestation as well as to study the common manifestations of strongyloidiasis in our patients. Records of patients with positive S. stercoralis larvae from January 2000 to December 2012 in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan were reviewed. Ten patients were male and two were female. Their ages ranged from 19 to 78 years old. The majority (92%) of cases, presented with intestinal symptoms and 50% with moderate to severe anaemia. Thirty percent of cases had extraintestinal manifestations such as cough, sepsis and pleural effusion. Ninety-two percent of the patients had a comorbid illness. Most patients were immunocompromised, with underlying diabetes mellitus, retroviral disease, lymphoma and steroid therapy contributing to about 58% of cases. Only 58% were treated with anti-helminthic drugs. Strongyloidiasis is present in our local setting, though the prevalence could be underestimated.

Matched MeSH terms: Strongyloides stercoralis
Fulltext Unresolved pneumonia: a case report of Strongyloides stercoralis hyperinfection in an immunocompromised patient

Esteban Chin, Lim Han Hua

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):58-58.
MyJurnal

Introduction: Strongyloidiasis is endemic in the tropical and subtropical regions. Clinical manifestations of the dis-ease can range from asymptomatic eosinophilia in an immunocompetent host to a wide range of presentations in immunocompromised patients. Failure to consider the diagnosis of strongyloides infection, especially Strongyloides hyperinfection syndrome, is a major contributor of high mortality rate in such cases. Case Description: We report a case of 60 years old gentleman who was admitted to Sarawak General Hospital for a left subtrochanteric femur pathological fracture and the diagnosis of multiple myeloma was made in the same setting. He was started on treat-ment for multiple myeloma which includes high dose steroids. During his course of admission, he was diagnosed with hospital-acquired pneumonia was subsequently initiated with broad-spectrum antibiotics. Despite being exten-sively treated with multiple courses of broad-spectrum antibiotics, he deteriorated clinically, with eventual respirato-ry failure requiring ventilator support and ICU admission. A diagnosis of strongyloides hyperinfection syndrome was made after an incidental discovery of larvae in his sputum, which was later confirmed with stool sample. He was given a one-week course of albendazole 400mg twice daily and clinical improvement was observed. A repeated stool sample also demonstrated clearance of the parasites. Conclusion: This case highlights the need for clinical sus-picion of strongyloides hyperinfection syndrome in cases of unresolved pneumonia, especially for patients with risk factors of underlying immune-deficiency state. Preventive steps such early detection and eradication of strongyloides infection should be undertaken prior to initiation of immuno-suppressive therapy.

Matched MeSH terms: Strongyloides stercoralis
Fulltext Strongyloides Hyperinfection Syndrome in an Immunosuppressed Patient

Cheo, Seng Wee, Tan, Yee Ann, Low, Qin Jian

Borneo Journal of Medical Sciences, 2019;13(1):39-43.
MyJurnal

Strongyloides stercoralis is an intestinal nematode which is endemic in tropical and subtropical countries. The global prevalence of Strongyloides is unknown. Strongyloidiasis is found more frequently in the socioeconomically disadvantaged, in institutionalized populations, and in rural areas. The spectrum of disease varies. It may cause asymptomatic infection, mild eosinophilia or hyperinfection syndrome in the most severe form. Here we reported a case of Strongyloides hyperinfection syndrome in an immunosuppressed patient. This patient is a 54-year-old man with myasthenia gravis on long term azathioprine and prednisolone. He presented with fever associated with diarrhoea and was in septic shock. His blood culture was positive forKlebsiella pneumoniae.Strongyloides stercoralis larvae were detected in his sputum and stool sample. He was diagnosed to have Strongyloides hyperinfection and was treated with subcutaneous ivermectin. He recovered well. Our case demonstrated the association of Strongyloideshyperinfection with superimposed gram-negative sepsis as a consequence of prolonged immunosuppression. A high index of suspicion is needed in approaching patient with risk factors of hyperinfection syndrome.

Matched MeSH terms: Strongyloides stercoralis
Prevalence and intensity of helminths among inhabitants of the Chi River and Lahanna water reservoir areas of Northeastern Thailand

Rattanapitoon SK, Pechdee P, Boonsuya A, Meererksom T, Wakkhuwatapong P, Leng M, et al.

Trop Biomed, 2020 Sep 01;37(3):730-743.
PMID: 33612786 DOI: 10.47665/tb.37.3.730

Helminth infections (HIs) are an important public health problem in tropical countries, and the associated problems have been neglected in rural areas of Thailand. Therefore, this study reports the prevalence and intensity of HIs among inhabitants of the Khon Sawan district, Chaiyaphum province, and Kaeng Samnam Nang district, Nakhon Ratchasima province, which are located near the Chi River and Lahanna water reservoir, northeastern Thailand. A cross-sectional descriptive study was conducted between July 31, 2018, and June 30, 2019, among rural villagers from 40 rural villages in 4 subdistricts. The participants were selected from the village enrolment list after proportional allocation of the total sample size. Faecal samples from 691 inhabitants were prepared using solvent-free faecal parasite concentrator, and helminths were then detected using a light microscope. Statistical analysis included the Chi-square test with Yates correction, and multivariable logistic regression was performed. A P-value of <0.05 was considered statistically significant. The prevalence of HIs was 2.03%. The most prevalent helminths were Opisthorchis viverrini (1.31%), followed by Strongyloides stercoralis (0.44%), Ascaris lumbricoides (0.29%), hookworm (0.15%), Teania spp. (0.15%) and one minute intestinal fluke (0.15%). Coinfections were identified in 2 cases for S. stercoralis and hookworm and 1 case for O. viverrini and S. stercoralis infection. All infected participants had a light intensity of HI. There was no significant difference between general characteristics for all HIs. The prevalence of HIs was not significantly associated with general characteristics. This study indicates that the infections result mainly from foodborne helminths and skin-penetrating nematodes. Therefore, interventions should concentrate on the personal hygiene of the population and improving sanitation to reduce HIs in this area.

Matched MeSH terms: Strongyloides stercoralis
Lateral Flow Dipstick Test for Serodiagnosis of Strongyloidiasis

Yunus MH, Arifin N, Balachandra D, Anuar NS, Noordin R

Am J Trop Med Hyg, 2019 08;101(2):432-435.
PMID: 31218996 DOI: 10.4269/ajtmh.19-0053

The conventional method of detecting Strongyloides stercoralis in fecal samples has poor diagnostic sensitivity. Detection of Strongyloides-specific antibodies increases the sensitivity; however, most tests are ELISAs that use parasite extract which may cross-react with the sera of other helminth infections. To improve the serological diagnosis of strongyloidiasis, this study aimed at developing a sensitive and specific lateral flow rapid dipstick test. Two recombinant proteins, recombinant NIE (rNIE) and recombinant Ss1a (rSs1a), were used in preparing the dipstick, with gold-conjugated antihuman IgG4 as detector reagent. In parallel, the corresponding ELISA was performed. Both assays demonstrated diagnostic sensitivity of 91.3% (21/23) when tested with serum samples of patients with Strongyloides infection, and 100% specificity with 82 sera of asymptomatic (healthy) and those with other parasitic infections. The ELISA and dipstick test results were positively correlated to each other (r = 0.6114, P = 0.0019). The developed lateral flow dipstick test may improve the serodiagnosis of strongyloidiasis and merit further validation studies.

Matched MeSH terms: Strongyloides stercoralis
Fulltext Seroprevalence of fascioliasis, toxocariasis, strongyloidiasis and cysticercosis in blood samples diagnosed in Medic Medical Center Laboratory, Ho Chi Minh City, Vietnam in 2012

Nguyen T, Cheong FW, Liew JW, Lau YL

Parasit Vectors, 2016 09 05;9(1):486.
PMID: 27595647 DOI: 10.1186/s13071-016-1780-2

BACKGROUND: Despite the global effort against neglected tropical diseases (NTDs), developing countries with middle to low income are still burdened by them. Vietnam has been undergoing substantial economic growth and urbanization, but underprivileged people living in rural and suburban areas are still having little access to public health infrastructure and proper sanitation. Hitherto, limited information is available for seroprevalence and risk factors of several parasitic diseases in Vietnam.
METHODS: A retrospective study was performed on diagnostic results of Fasciola spp., Toxocara spp., Strongyloides stercoralis and Taenia solium IgG ELISA tests from Medic Medical Center Laboratory, Ho Chi Minh City in 2012. The data were first stratified before statistical analyses were performed. Seroprevalence of fascioliasis, toxocariasis, strongyloidiasis and cysticercosis was determined and the age and gender risk factors were evaluated.
RESULTS: Seroprevalence of fascioliasis, toxocariasis, strongyloidiasis and cysticercosis was 5.9 % (590/10,084; 95 % CI: 5.44-6.36), 45.2 % (34,995/77,356; 95 % CI: 44.85-45.55), 7.4 % (3,174/42,920; 95 % CI: 7.15-7.65) and 4.9 % (713/14,601; 95 % CI: 4.55-5.25), respectively. Co-exposure to multiple parasites was detected in 890 males (45.7 %; 95 % CI: 43.49-47.91) and 1,059 females (54.3 %; 95 % CI: 52.09-56.51). Social structure and differences in behavioural factors caused the gender factor to have a significant effect on the prevalence of all the diseases, while the seropositivity for fascioliasis and strongyloidiasis were age group-related.
CONCLUSIONS: The seroprevalence of fascioliasis, toxocariasis, strongyloidiasis and cysticercosis in the blood samples diagnosed in Medic Medical Center Laboratory, Ho Chi Minh City, in year 2012 were comparatively high. The Vietnamese customs and cultures, dietary habits and agricultural practices exposed them to high risk of contracting NTDs. Despite the possibility of false positive results due to antigenic cross-reactions, detection of IgG antibodies remains as a reliable method in sero-epidemiological study as it is non-invasive and demonstrates previous exposure of individuals to the parasites. Besides the implementation of strategies to control these diseases, epidemiological analysis and surveillance of diseases should also be continually strengthened to monitor the effectiveness of regimens and interventions.

Matched MeSH terms: Strongyloides stercoralis/immunology
Fulltext Diagnostic Potential of an IgE-ELISA in Detecting Strongyloidiasis

Ahmad H, Balachandra D, Arifin N, Nolan TJ, Lok JB, Hayat Khan A, et al.

Am J Trop Med Hyg, 2020 12;103(6):2288-2293.
PMID: 32996454 DOI: 10.4269/ajtmh.20-0265

Strongyloides stercoralis infection is prevalent worldwide and can cause lifelong infection in immunocompetent individuals, and potentially death in immunosuppressed patients. The diagnosis is hindered by the low sensitivity of microscopic examination, thus making serology an important complementary test to improve the detection rate. However, there were reports that some Strongyloides-infected individuals were negative with specific IgG and IgG4 assays, and other helminth infections were positive with commercial Strongyloides IgG-ELISAs. Thus, there is a need to develop better serodiagnostic methods for strongyloidiasis. We investigated the diagnostic potential of IgE-ELISAs using Strongyloides larval lysate. Sera from two groups infected with Strongyloides served as the positive reference, that is, 1) positive by commercial IgG-ELISAs and IgG4 rapid test, and stool samples positive by microscopy and/or PCR (group IA; n = 20); and 2) negative by IgG-ELISAs and IgG4 rapid test, but stool samples were PCR positive (group IB sera; n = 11). Sera from another two groups served as negative reference (controls), that is, 1) infected with other parasites (group II; n = 73) and 2) healthy donors (group III; n = 22). Results showed a 100% diagnostic sensitivity in detecting sera from groups IA and IB. The latter group of individuals probably had early infection because their IgG and IgG4 assays were negative. The optical density values of group IB sera were also significantly lower than those of group IA (P < 0.003). The IgE-ELISA was 100% specific when tested against sera from groups II and III. This study highlights the diagnostic potential of IgE-ELISA using larval lysate to detect strongyloidiasis, especially those with probable early infection.

Matched MeSH terms: Strongyloides stercoralis