Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Department of Parasitology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Am J Trop Med Hyg. 2021 Nov 29;106(2):695-699. doi: 10.4269/ajtmh.21-1011.
Strongyloidiasis, a neglected tropical disease (NTD), which is caused by Strongyloides stercoralis, can be fatal in immunocompromised patients. In most chronic cases, infections most frequently are asymptomatic, and eosinophilia might be the only clinical characteristic of this disease. The use of corticosteroids in some diseases like chronic obstructive pulmonary disease (COPD) may lead to the development of the life-threatening S. stercoralis hyperinfection syndrome. In the present research, we presented five cases of strongyloidiasis with a history of COPD and receiving corticosteroids from Abadan County, southwestern Iran. By performing the direct smear stool examinations, two cases were identified and the other three cases were diagnosed using the agar plate culture method. Despite reporting eosinophilia in previous patients' hospitalizations, the fecal examination was not performed for parasitic infections. Moreover, pulmonary symptoms were similar, but gastrointestinal symptoms were varied, including nausea, vomiting, abdominal pain, epigastric pain, constipation, and diarrhea. All the included patients were treated with albendazole, which is the second-line drug for S. stercoralis, and relapse of infection was observed in two patients by passing few months from the treatment. The increased blood eosinophil count was shown to play important roles in both the management of COPD and diagnosis of helminthic infections. In COPD patients who are receiving steroids, screening and follow-up for strongyloidiasis should be considered as priorities. In addition, ivermectin, which is the first-line drug for strongyloidiasis, should be available in the region.
匐形线虫病（Strongyloidiasis）是一种被忽视的热带病（NTD），由粪类圆线虫（Strongyloides stercoralis）引起，在免疫功能低下的患者中可能致命。在大多数慢性病例中，感染通常无症状，嗜酸性粒细胞增多可能是该病的唯一临床特征。在一些疾病（如慢性阻塞性肺疾病，COPD）中使用皮质类固醇可能导致危及生命的粪类圆线虫过度感染综合征。在本研究中，我们报告了来自伊朗西南部阿巴丹县的 5 例 COPD 合并皮质类固醇治疗史的匐形线虫病病例。通过直接粪便涂片检查，发现了 2 例病例，而另 3 例病例则通过琼脂平板培养法诊断。尽管之前的住院患者报告了嗜酸性粒细胞增多症，但未进行寄生虫感染的粪便检查。此外，肺部症状相似，但胃肠道症状不同，包括恶心、呕吐、腹痛、上腹痛、便秘和腹泻。所有纳入的患者均接受了阿苯达唑治疗，这是治疗粪类圆线虫的二线药物，在治疗后几个月，有 2 例患者出现了感染复发。嗜酸性粒细胞计数增加在 COPD 的管理和寄生虫感染的诊断中都起着重要作用。在接受类固醇治疗的 COPD 患者中，应优先考虑筛查和随访匐形线虫病。此外，伊维菌素，作为治疗匐形线虫病的一线药物，应该在该地区使用。
