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Experimental Infection of Mice with the Parasitic Nematode Strongyloides ratti
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Invasive enteric infections in hospitalized patients with underlying strongyloidiasis

Majdi N Al-Hasan1, Malkanthie McCormick, Julie A Ribes

  • 1Division of Infectious Diseases, Mayo Clinic Foundation, Rochester, MN, USA.

American Journal of Clinical Pathology
|September 19, 2007
PubMed

Insights

Strongyloides stercoralis infection can lead to invasive enteric bacterial infections, even without apparent dissemination. Patients in endemic areas with invasive infections should be screened for Strongyloides coinfection.

Area of Science:

  • Infectious Diseases
  • Parasitology
  • Clinical Medicine

Background:

  • Disseminated strongyloidiasis frequently co-occurs with enteric bacterial infections.
  • The role of enteric organisms in extraintestinal infections among non-disseminated Strongyloides stercoralis cases is not well-defined.

Purpose of the Study:

  • To investigate whether enteric organisms cause extraintestinal infections in patients with Strongyloides stercoralis but without apparent dissemination.
  • To assess the association between Strongyloides stercoralis infection and invasive enteric infections.

Main Methods:

  • Retrospective review of medical records of hospitalized patients diagnosed with strongyloidiasis in central Kentucky (1993-2003).
  • Analysis of the occurrence of extraintestinal infections caused by enteric organisms in patients with S. stercoralis.
  • Evaluation of patient characteristics, including immunosuppressive therapy and peripheral eosinophilia.

Main Results:

  • Out of 30 patients with S. stercoralis, 16 (53%) developed invasive infections (sepsis, meningitis, pneumonia, peritonitis, endocarditis) caused by enteric bacteria and Candida.
  • Invasive infections occurred in 8/13 (62%) patients with disseminated strongyloidiasis and 8/17 (47%) with disease apparently limited to the GI tract.
  • Peripheral eosinophilia was present in only 23% of patients; 15 patients received immunosuppressive therapy.

Conclusions:

  • Strongyloides stercoralis infection, even when not overtly disseminated, can predispose individuals to invasive infections by enteric organisms.
  • In Strongyloides-endemic regions, invasive enteric infections warrant investigation for concurrent S. stercoralis coinfection.

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