Larvas rabditoides de Strongyloides stercoralis en orina en paciente con riñón trasplantado y estrongiloidiasis diseminada. Leonor Pocaterra 1,a, Gladymar. Download PDF. 1 / 2 Pages. Previous article. Go back to website. Next article. Estrongiloidiasis diseminada: aún existen las parasitosis en Costa Rica y pueden causar la muerte. Med. leg. Costa Rica [online]. , vol, n.2, pp.
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Urinary rhabditiform larvae of Strongyloides stercoralis in disseminated disease affecting a kidney-transplanted patient.
Adicionalmente, en el sedimento urinario, se encontraron larvas rabditoides. Strongyloides stercoralistrasplante, orina. Strongyloides stercoralis, an intestinal nematode prevalent in tropical and subtropical zones, remains clinically silent or mildly symptomatic in immunecompetent individuals. This report describes a year-old male renal transplant recipient, in whom standard immunosuppressive therapy did not prevent development of acute nephritis also coinciding with appearance of larvae in fecal smears.
During a 3-days sequential copro-parasitological testing S. Significant improvement of renal dysfunction with ivermectin therapy highlights the importance of incorporating S. Strongyloides stercoralistransplantation, urine. Strongyloidiasis is an endemic soil-transmitted helminthiasis, common in dstrongiloidiasis and subtropical areas, caused by Strongyloides stercoralis, an intestinal nematode capable of surviving for years in humans by perpetuating its doseminada cycle through autoinfection.
Recent reviews, perhaps reflecting improved and extensive availability of diagnostic tools, postulate human strongyloidiasis in approximately million 1,2. Most immunecompetent hosts remain clinically silent or only mildly symptomatic. Consequently, sensitive screening procedures should be routinely employed to explore pre-transplant donors and all recipients in endemic regions, where parasitic infections remain generally underdiagnosed.
A estrongilpidiasis HIV-negative kidney-transplanted male, affected by intermittent diarrhea and hypogastric pain, was referred to our clinic after larvae were observed on direct fecal smears. Transplantation had been performed 4 months earlier. Ancillary anti-hypertensive and anti-hyperlipemia medications were maintained.
C – estrongiloidiasis diseminada (trastorno)
Epidemiologically, he had bathed in western Venezuelan rivers and beaches and had practiced frequent plant sowing for the last 10 years. Four years pre-transplantation he noticed a self-limited non-pruriginous papular rash localized to face and back, and 6 months pre-procedure he noticed epigastric pain and intermittent diarrhea.
Pertinent findings included anemia, mild eosinophilia Table 1and active erosive gastritis with diffuse edema and vascular congestion of the lamina propia. Coprologic screening for strongyloidiasis was not undertaken.
At one month post-transplant he had lost 5 kg, and developed a lower limb estrongiloiidasis and a 4-week lasting dry cough. Hemoglobinuria, proteinuria and decreased creatinine clearance coincided with normal albuminemia Table 2.
Three fecal agar cultures further confirmed filariform larvae Figure 1. Rapid improvement of clinical and renal function ensued, eosinophil counts normalized after 17 days Table 1 and graphic 1 and agar cultures and urinary sediments turned larvae-negative. He did not return for a direct follow up but on a telephone interview he denied any symptom. Undiagnosed or late recognition in inmunecompromising illnesses may preclude a timely identification of accelerated autoinfection, hyperinfection and dissemination of Strongyloides stercoralis as well as polymicrobial sepsis, determining common fatal outcomes.
In endemic areas, like Venezuela, probing for chronic infections should probably be extended to most asymptomatic individuals. Current guidelines recommend serological screening or selective stool examinations in all pre-transplantation high-risk patients and after the procedure a high level of suspicion to prevent hyperinfection syndromes 6. Of note, in our propositus digestive manifestations and eosinophilia were initially ignored. During chronic steroid administration, S.
As to other anti-rejection drugs, linkage of infection and dissemination to sirolimus remains unproven, although in a fatal bone marrow transplant recipient it was added to prednisone and mycophenolate mofetil 6.
Previous observations implicated S. A similar immune mechanism has been assumed in rare cases of arthritis in which a reactive mechanism has been suggested, although Strongyloides larvae had been encountered in synovial biopsies, as a possible alternative 9. Fortunately such secondary lesions, including estrongiloidisais ones of our case, recovered fully after anthelmintic treatment.
Estrongiloidiasis gastrointestinal diseminada
Interestingly, urinary rhabditiform and filariform undocumented stages of S. Presence of only rhabditiform larvae in our case presumes an intrarenal special autoinfection cycle in which filariform larvae develop into adult forms parthenogenic females.
This leads to ova production originating rhabditiform larvae expelled in the urine. Adults, eggs and rhabditiform larvae have also been recovered from tracheo-bronchial secretions 1, Several difficulties preclude a more widespread diagnosis of strongyloidiasis. Copro-parasitological methods require well-trained personnel, scarce in most affected demographic areas, hampering even adequate handling of serial stool samples. If it becomes available, accurate serological testing or PCR would minimize these adversities, benefit many clinical needs such as transplant-related cases, and facilitate widespread epidemiological screening.
As observed in our propositus, 1-day weekly ivermectin for 2 weeks offers similar high cure rates as conventional 2-day doses, also administered twice. Either way additional dosing is required in high-risk or relapsed cases which should be supervised periodically for at least a year. A public health response against Strongyloides stercoralis: Transmission of Strongyloides stercoralis through transplantation of solid organs-Pennsylvania, Single donor- derived Strongyloidiasis in three solid organ transplant recipients: Case series and review of the literature.
Fatal Strongyloides hyperinfection complicating a gram-negative sepsis after allogeneic stem cell transplantation: Minimal change nephrotic syndrome in a patient with strongyloidiasis. Early-onset polyarthritis as presenting feature of intestinal infection with Strongyloides stercoralis. A case of strongyloidiasis hyperinfection during oral corticosteroid therapy associated with a nephrotic patient infected with HTLV Nihon Ronen Igakkai Zasshi.
Strongyloidiasis with gastric mucosal invasion presenting with acute interstitial nephritis. Recurrent hyperinfestation with Strongyloides stercoralis in a renal allograft recipient.
Transmission of strongyloidiasis by kidney transplant?: Disseminated strongyloidiasis in both recipients of kidney allografts from a single cadaver donor. Opportunistic strongyloidiasis in renal transplant recipients. Strongyloides stercoralis in the urine.
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Disseminated Strongyloides stercoralis infection mimicking pneumonia. J Formos Med Assoc. Hyperacute pneumonitis in a patient with overwhelming Strongyloides stercoralis infection. Hyperinfection syndrome in strongyloidiasis: Schroeder L, Banaei N. Images in clinical medicine: Strongyloides stercoralis embryonated ova in the lung. N Engl J Med. The authors do not have any conflict of interest to declare. They all have participated in the study and concur with the submission and subsequent revisions of the manuscript.
Conceived and wrote the case report in Spanish. Edited the english version. Elaborated the graphs; GP: Attending physician in Parasitology outpatient clinic. Performed strongyloidiasis diagnosis and detected urinary rhabditiform larvae; AH: Elaborated the graphs; JC: He referred the patient to Parasitology outpatient clinic and laboratory to perform strongyloidiasis diagnosis; CG: Universidad Central de Venezuela.
SUMMARY Strongyloides stercoralis, an intestinal nematode prevalent in tropical and subtropical zones, remains clinically silent or mildly symptomatic in immunecompetent individuals. Honorio Delgado Urb.