Agrawal Vinita, Agarwal Tanu, Ghoshal Uday C
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow 226014, Uttar Pradesh, India.
Trans R Soc Trop Med Hyg. 2009 Mar;103(3):242-6. doi: 10.1016/j.trstmh.2008.08.009. Epub 2008 Sep 20.
Strongyloides stercoralis, a nematode parasite, is endemic in tropical and subtropical regions. Infection usually remains asymptomatic, but in immunocompromised hosts hyperinfection and dissemination can occur, which has a high mortality. Early detection of S. stercoralis may alter the fatal course of infection. We present our experience of five patients with S. stercoralis hyperinfection diagnosed by endoscopic duodenal and jejunal biopsy in northern India. A predisposing factor was present in all patients in the form of corticosteroid intake, chronic liver disease and panhypogammaglobulinaemia. Common gastrointestinal symptoms were abdominal pain, diarrhoea, gastrointestinal bleeding, nausea, vomiting and weight loss with evidence of malabsorption. The initial stool examination and peripheral blood eosinophil count were normal in all patients. Strongyloidiasis was not suspected clinically in any patient and the diagnosis was achieved on endoscopic biopsy. Three of the patients with disseminated disease developed fatal Gram-negative systemic infection. This study highlights the importance of considering strongyloidiasis in all patients on immunosuppressive drug therapy who present with gastrointestinal symptoms so that the patient can be appropriately investigated and promptly treated. In endemic regions, patients with systemic Gram-negative bacterial infections without an obvious cause should be tested for strongyloidiasis.
粪类圆线虫是一种线虫寄生虫，在热带和亚热带地区呈地方性流行。感染通常无症状，但在免疫功能低下的宿主中可发生超感染和播散，死亡率很高。粪类圆线虫的早期检测可能会改变感染的致命进程。我们介绍了在印度北部通过内镜十二指肠和空肠活检诊断为粪类圆线虫超感染的5例患者的经验。所有患者均存在以服用皮质类固醇、慢性肝病和全血细胞减少为形式的易感因素。常见的胃肠道症状为腹痛、腹泻、胃肠道出血、恶心、呕吐和体重减轻并有吸收不良的证据。所有患者的初始粪便检查和外周血嗜酸性粒细胞计数均正常。所有患者临床均未怀疑粪类圆线虫病，诊断通过内镜活检得以实现。3例播散性疾病患者发生了致命的革兰氏阴性全身感染。本研究强调，对于所有出现胃肠道症状的接受免疫抑制药物治疗的患者，应考虑粪类圆线虫病，以便对患者进行适当的检查并及时治疗。在流行地区，无明显原因的革兰氏阴性细菌全身感染患者应检测粪类圆线虫病。
