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Fatal septicemic shock associated with Strongyloides stercoralis infection in a patient with angioimmunoblastic T-cell lymphoma: a case report and literature review

Abdelrahman MZ, Zeehaida M, Rahmah N, Norsyahida A, Madihah B, Azlan H, et al.

Parasitol Int, 2012 Sep;61(3):508-11.
PMID: 22575692 DOI: 10.1016/j.parint.2012.04.005

Strongyloides stercoralis infection can persist in the host for several decades, and patients with cancer and other clinical conditions who are exposed to immunosuppressive therapy are at risk of developing hyperinfection.

Matched MeSH terms: Strongyloidiasis/complications; Strongyloidiasis/drug therapy; Strongyloidiasis/pathology*
Fulltext Symptomatic chronic strongyloidiasis in children following treatment for solid organ malignancies: case reports and literature review

Norsarwany M, Abdelrahman Z, Rahmah N, Ariffin N, Norsyahida A, Madihah B, et al.

Trop Biomed, 2012 Sep;29(3):479-88.
PMID: 23018511

Strongyloidiasis is an infection caused by the intestinal nematode Strongyloides stercoralis. Infected healthy individuals are usually asymptomatic, however it is potentially fatal in immunocompromised hosts due to its capacity to cause an overwhelming hyperinfection. Strongyloidiasis could be missed during routine screening because of low and intermittent larval output in stool and variable manifestations of the symptoms. We present two cases of strongyloidiasis occurring in children with solid organ malignancies suspected to have the infection based on their clinical conditions and treatment history for cancer. Both patients were diagnosed by molecular and serological tests and were successfully treated. Thus, strongyloidiasis in patients undergoing intensive treatment for malignancies should be suspected, properly investigated and treated accordingly.

Matched MeSH terms: Strongyloidiasis/diagnosis*; Strongyloidiasis/drug therapy; Strongyloidiasis/parasitology
Enhanced production of short-peptide tagged Ss3a recombinant protein as a novel potential biomarker for strongyloidiasis

Mohd-Hassan NH, Noordin R, Arifin N

Trop Biomed, 2020 Sep 01;37(3):578-586.
PMID: 33612773 DOI: 10.47665/tb.37.3.578

Strongyloidiasis is a mysterious yet important parasitic disease that is hard to diagnose. While microscopic examination remains a "controversial" gold standard method, improved diagnosis is achieved through confirmatory assays with serological and/or molecular diagnostic approaches. In the current serodiagnosis of strongyloidiasis, recombinant proteins have been adopted in place of the use of native parasite antigens, although the availability of diagnostically potential proteins are still limited. Here, we introduce a novel Strongyloides recombinant protein that is uniquely attached to two different short peptide tags as a potential diagnostic biomarker for serodiagnosis of strongyloidiasis, namely lysine (7K) and aspartic acid (7D). The work presented focus on improving the yield and purity of the previously unexpressed recombinant protein. Preliminary diagnostic evaluation of the recombinant favors Ss3a7K protein owing to its higher antigenicity performance with 80% sensitivity and 100% specificity, respectively.

Matched MeSH terms: Strongyloidiasis
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: Strongyloidiasis/diagnosis; Strongyloidiasis/immunology; Strongyloidiasis/epidemiology*
Fulltext Prevalence of strongyloidiasis in soautheast asia: a systematic review

Mohd Shafik Abd Majid, Fadzrul Hafiz Johani, Wan Rosmawati Wan Ismail, Diyana Mohd Mokhtar, Qistina Mohd Ghazali, Norfazilah Ahmad, et al.

Int J Public Health Res, 2018;8(2):1005-1024.
MyJurnal

Introduction Strongyloides stercoralis is an intestinal helminth that infects humans
through contact with soil containing the larvae.
Methods A systematic search was performed for relevant titles, abstract and keywords
in database from Cochrane Library, PLOS One, PubMed and several other
sources in October 2017 based on PICO strategy. Out of 511 papers that were
evaluated for possible inclusion, final assessment for eligibility has yielded a
total of 17 papers to be included which were found suitable for analysis
covering period from 2012 till 2016.
Results A major challenge of giving an overview of prevalence data for S. stercoralis
lies in the low sensitivity of diagnostic method used which resulted in very
low prevalence in certain countries. Cambodia and Laos presented with high
prevalence ranging from 17.4% to 45.9% by using high sensitivity of
diagnostic methods. The current prevalence situation of S. stercoralis in
Southeast Asia still have wide gaps remains due to several reasons.
Conclusions The information we have today only scratches the surface which cannot truly
reflect the true burden of S. stercoralis in Southeast Asia The main risk factor
is personal hygiene practices especially amongst males.

Matched MeSH terms: Strongyloidiasis
Fulltext Identification and Preliminary Evaluation of a Novel Recombinant Protein for Serodiagnosis of Strongyloidiasis

Arifin N, Yunus MH, Nolan TJ, Lok JB, Noordin R

Am J Trop Med Hyg, 2018 04;98(4):1165-1170.
PMID: 29436335 DOI: 10.4269/ajtmh.17-0697

Strongyloides stercoralis is a human parasite that can cause a long-term infection. In immunosuppressed patients, strongyloidiasis may be fatal when there is overwhelming autoinfection resulting in the migration of large numbers of larvae through many organs. Definitive diagnosis is still a challenge, and a combination of symptoms, microscopic identification, and serology test results are often used to arrive at a clinical decision. However, intermittent larval excretion, low parasite burden, and occult infections are challenges with parasitological diagnosis of infection with S. stercoralis. Meanwhile, serologic tests using immunoglobulin G and parasite antigen extract have problems of cross-reactivity with other helminthic infections. Recombinant antigen-based serodiagnosis is a good alternative to overcome the laboratory diagnostic issues. Herein, we report on the isolation of cDNA clone encoding an antigen of potential diagnostic value identified from immunoscreening of a S. stercoralis cDNA library. The translated protein had highest similarity to Strongyloides ratti immunoglobulin-binding protein 1. The recombinant antigen produced, rSs1a, was assessed using western blot and enzyme-linked immunosorbent assay. The latter showed 96% diagnostic sensitivity and 93% specificity; thus, rSs1a has good potential for use in serodiagnosis of human strongyloidiasis.

Matched MeSH terms: Strongyloidiasis
Intestinal parasitic infection among five interior communities at upper Rejang River, Sarawak, Malaysia

Sagin DD, Mohamed M, Ismail G, Jok JJ, Lim LH, Pui JN

Southeast Asian J. Trop. Med. Public Health, 2002 Mar;33(1):18-22.
PMID: 12118449

Intestinal parasitic infection among five interior communities at Bakun Valley, upper Rejang River, Sarawak, Malaysia, was investigated as part of a public health impact assessment of the proposed US$ 3 billion Bakun Hydroelectric Project. Coproparasitological examination of 355 stool samples from 7 of 16 villages representing 5 of 7 tribes in the area revealed infection rate of 41%. A higher infection rate was found among the settled Kayans (56%) than the seminomadic Penans (29%). Infection rate was high (68%) among children less than 14 years old. Trichuris trichiura accounted for more than 90% of all infections; less common were Ascaris lumbricoides, hookworms and Strongyloides stercoralis. Polyparasitism was found in 8% of the individuals surveyed with dual infection due to T. trichiura and A. lumbricoides being more common than dual infection with T. trichiura and hookworm. Women had higher infection rates (57%) than men (33%).

Matched MeSH terms: Strongyloidiasis/epidemiology
Fulltext Strongyloides stercoralis hyperinfection in a diabetic patient: case report

Azira NM, Zeehaida M

Trop Biomed, 2010 Apr;27(1):115-9.
PMID: 20562820 MyJurnal

Strongyloides stercoralis is a widespread, soil-transmitted helminth affecting humans. Autoinfection occurs in S. stercoralis infection and this leads to a continuous build-up of worm burden in human host. This may lead to hyperinfection syndrome which has the potential to cause serious life-threatening disease especially in immunocompromised and immunosuppressed patients. Thus, patient with underlying risk factors should be suspicious of having this infection as severe strongyloidiasis carries a high mortality rate if the diagnosis is delayed. Here, we report a case of S. stercoralis hyperinfection in a diabetic patient.

Matched MeSH terms: Strongyloidiasis/complications*
Epidemiological Characteristics of Strongyloidiasis in Inhabitants of Indigenous Communities in Borneo Island, Malaysia

Ngui R, Halim NA, Rajoo Y, Lim YA, Ambu S, Rajoo K, et al.

Korean J Parasitol, 2016 Oct;54(5):673-678.
PMID: 27853126

Epidemiological study on strongyloidiasis in humans is currently lacking in Malaysia. Thus, a cross-sectional study was carried out to determine the prevalence of Strongyloides stercoralis infection among the inhabitants of longhouse indigenous communities in Sarawak. A single stool and blood sample were collected from each participant and subjected to microscopy, serological and molecular techniques. Five species of intestinal parasites were identified by stool microscopy. None of the stool samples were positive for S. stercoralis. However, 11% of 236 serum samples were seropositive for strongyloidiasis. Further confirmation using molecular technique on stool samples of the seropositive individuals successfully amplified 5 samples, suggesting current active infections. The prevalence was significantly higher in adult males and tended to increase with age. S. stercoralis should no longer be neglected in any intestinal parasitic survey. Combination of more than 1 diagnostic technique is necessary to increase the likelihood of estimating the 'true' prevalence of S. stercoralis.

Matched MeSH terms: Strongyloidiasis/epidemiology*
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: Strongyloidiasis
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: Strongyloidiasis
Investigations for the Possible Use of a Monoclonal Antibody Produced against Strongyloides ratti Antigen as an Immunodiagnostic Reagent for Active Strongyloidiasis

Mahmuda A, Bande F, Abdulhaleem N, Abd Majid R, Awang Hamat R, Omar Abdullah W, et al.

Iran J Parasitol, 2018 8 3;13(2):204-214.
PMID: 30069204

Background: Currently, most of the available serological diagnostic kits for strongyloidiasis are based on the use of the crude antigens of Strongyloides ratti, which are good, but with less sensitivity towards the infection. Hence, this study aimed to produce and evaluate monoclonal antibody for detecting soluble parasite antigen in animal sera.
Methods: The study was conducted in the Department of Medical Microbiology and Parasitology, University Putra Malaysia in 2014-2017. Saline extract protein from the infective larvae of S. ratti was used to immunize BALB/c mice and subsequent fusion of the B-cells with myeloma cells (SP2/0) using 50% PEG. The hybridomas were cultured in HAT medium and cloned by limiting dilutions. Positive hybrids were screened by indirect ELISA. The ascites fluid from the antibody-secreting hybridoma was purified and the MAb was characterized by western-blots and evaluated in sandwich ELISA for reactivity against the homologous and heterologous antigens.
Results: An IgG1 that recognizes a 30 and 34 kDa protein bands was obtained. The MAb was recognized by all S. ratti-related antigens and cross-reacted with only Toxocara canis antigens in both assays. The minimum antigen detection limit was found to be 5 ng/ml. All antibody-positive rat and dog sera evaluated have shown antigen-positive reactions in Sandwich-ELISA.
Conclusion: The MAb produced, was able to detect antigens in strongyloidiasis and toxocariasis in animal models and may also be useful for the serological detection of active strongyloidiasis and visceral toxocariasis in human sera.

Matched MeSH terms: Strongyloidiasis

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