Clinical Characteristics of Disseminated Strongyloidiasis, Japan, 1975-2017

Area of Science:

• Infectious Diseases
• Parasitology
• Clinical Medicine

Background:

• Disseminated strongyloidiasis is the most severe form of strongyloidiasis.
• Clinical characteristics of this severe parasitic infection are not well-documented.
• Understanding its varied presentations is essential for effective patient management.

Purpose of the Study:

• To describe the clinical characteristics of disseminated strongyloidiasis.
• To classify patients into distinct clinical phenotypes.
• To analyze associated mortality and sepsis rates for each phenotype.

Main Methods:

• Retrospective chart review of 70 patients with disseminated strongyloidiasis.
• Data collected from January 1975 to December 2017 at Okinawa Chubu Hospital.
• Classification of patients into three clinical phenotypes based on disease presentation.

Main Results:

• Three phenotypes identified: dissemination (45.7%), occult dissemination with enteric meningitis (17.1%), and occult dissemination with culture-negative meningitis (37.1%).
• Mortality rates varied significantly: 56.3% for dissemination, 16.7% for enteric meningitis, and 11.5% for culture-negative meningitis.
• Common symptoms included fever, headache, and altered mental status; sepsis rates also differed by phenotype.

Conclusions:

• Disseminated strongyloidiasis exhibits distinct clinical phenotypes impacting severity and outcomes.
• Occult dissemination, though milder, presents with significant neurological manifestations.
• Prompt identification of occult dissemination is critical for improving patient survival in strongyloidiasis.