Corti Marcelo, Villafañe María F, Trione Norberto, Risso Daniel, Abuín Juan Carlos, Palmieri Omar
Hospital de Enfermedades Infecciosas Francisco J. Muñiz, Buenos Aires, Argentina.
Rev Chilena Infectol. 2011 Jun;28(3):217-22. Epub 2011 Jul 14.
Strongyloides stercoralis is a nematode parasite, which is endemic in tropical and subtropical regions. Infection usually remains asymptomatic, but in immunocompromised hosts severe and life-threatening manifestations such as hyperinfection syndrome and disseminated disease might occur.
We retrospectively analyzed the epidemiological and clinical characteristics, including HIV co-infection, microbiological findings, and outcome in 30 patients with strongyloidiasis, who attended in the Infectious Diseases F. J. Muñiz Hospital in Buenos Aires from January 2004 to December 2008.
The study included 20 men and 10 women with an average age of 33 years. HIV co-infection was present in 21 patients (70%) with a median CD4 T cell count of 50 cells/mm³ (range 7-355) (average 56 cells/mm³). Among HIV negative patients the following comorbidities were detected: tuberculosis (n = 3) and chronic alcoholism, leprosy treated with corticosteroids, immunosuppressive treatment for psoriasis, and diabetes mellitus (each in one patient). Two patients did not have any predisposing diseases or immunosuppressive treatments. Seventeen patients presented with diarrhea and were classified as chronic intestinal strongyloidiasis (57%), asymptomatic infection with peripheral eosinophilia was diagnosed in 7 (23%), and 6 patients (20%) developed hyperinfection syndrome. Seventeen patients (57%) presented peripheral eosinophilia. Diagnosis was achieved by direct visualization of larvae in feces by Baermann technique (n = 20), by multiple stool smears examinations (n = 2), by combination of both (n = 1), by visualization of the filariform larvae in duodenal fluid and stool (n = 1), and in fecal and bronchoalveolar lavage specimens (n = 6). Overall mortality in this series was 20% (6/30). There was no significant correlation between age and mortality. A significant inverse correlation between the survival rate and CD4 T-cell count as well as eosinophilia was observed. There was also a significant correlation between HIV co-infection and mortality. Twenty-two patients responded favorably to treatment with ivermectin.
粪类圆线虫是一种线虫寄生虫，在热带和亚热带地区流行。感染通常无症状，但在免疫功能低下的宿主中可能会出现严重且危及生命的表现，如高度感染综合征和播散性疾病。
我们回顾性分析了2004年1月至2008年12月在布宜诺斯艾利斯F. J. 穆尼兹传染病医院就诊的30例粪类圆线虫病患者的流行病学和临床特征，包括HIV合并感染、微生物学检查结果及预后。
该研究纳入了20名男性和10名女性，平均年龄33岁。21例患者（70%）合并HIV感染，CD4 T细胞计数中位数为50个/立方毫米（范围7 - 355）（平均56个/立方毫米）。在HIV阴性患者中，检测到以下合并症：结核病（n = 3）、慢性酒精中毒、接受皮质类固醇治疗的麻风病、银屑病的免疫抑制治疗以及糖尿病（各1例）。2例患者没有任何易感疾病或免疫抑制治疗史。17例患者出现腹泻，被归类为慢性肠道粪类圆线虫病（57%），7例（23%）诊断为无症状感染伴外周嗜酸性粒细胞增多，6例患者（20%）发生高度感染综合征。17例患者（57%）出现外周嗜酸性粒细胞增多。通过贝尔曼技术直接观察粪便中的幼虫确诊（n = 20），通过多次粪便涂片检查确诊（n = 2），通过两种方法联合确诊（n = 1），通过观察十二指肠液和粪便中的丝状幼虫确诊（n = 1），以及在粪便和支气管肺泡灌洗标本中确诊（n = 6）。该系列研究的总体死亡率为20%（6/30）。年龄与死亡率之间无显著相关性。观察到生存率与CD4 T细胞计数以及嗜酸性粒细胞增多之间存在显著负相关。HIV合并感染与死亡率之间也存在显著相关性。22例患者对伊维菌素治疗反应良好。
