Juliá RC, Badenes GF, Veintimilla EA

Language: Spanish
References: 15
Page:
PDF size: 379.16 Kb.

ABSTRACT

Strongyloides stercolaris is an endemic threadworm from tropical areas that infects its host through transcutaneous penetration of its filariform larvae. Generally, S. stercolaris infection is asymptomatic. However, in a percentage of immunosuppressed patients, the hyperinfection syndrome may occur, presenting constitutional symptoms, gastrointestinal, pulmonary and, sometimes, central nervous system symptoms. The association between S. stercolaris and glomerular damage is unusual. We report the case of a 42-year-old Bolivian patient, living in Spain, that came to the emergency room due to edema in lower limbs and dyspnea. Symptoms and laboratory test results were compatible with nephrotic syndrome, so she was admitted to Nephrology to receive treatment with intravenous corticosteroids, as well as a renal biopsy. After 10 days of treatment, she presented clinical improvement, so she was discharged waiting the anatomopathological results. Ten days later, she was readmitted due to severe abdominal pain, diarrhea, and persistent dyspnea. The patient was diagnosed with hyperinfection syndrome due to S. stercolaris secondary to the immunosuppressive treatment received. Symptoms resolved with ivermectin and albendazole. Biopsy results revealed findings consistent with minimal change disease secondary to S. stercolaris infection. Although glomerulopathy usually appears between the first and second month after immunosuppressive treatment, in the present study, an early appearance of symptoms was observed compared to the rest of the cases, appearing on day 21 of corticosteroid treatment.

REFERENCES

1. Buonfrate D, Bisanzio D, Giorli G, Odermatt P, Fu¨rst, Greenaway C. The Global Prevalence of Strongyloides stercoralis Infection. Pathogens. 2020 Jun;9(6):468. DOI: https://doi.org/10.3390/pathogens9060468

2. Schar F, Trostdorf U, Giardina F. Strongyloides stercoralis: global distribution and risk factors. PLoS Negl Trop Dis. 2013;7(7):e2288.

3. Krolewiecki A, Nutman TB. Strongyloidiasis: A neglected tropical disease. Infect Dis Clin N Am. 2019 Mar;33(1):135-51. DOI: https://doi.org/10.1016/j.idc.2018.10.006

4. Ortega-Díaz M, Puerta-Carretero M, Martín-Navarro JA, Aramendi-Sánchez T, Alcázar-Arroyo R, Corchete-Prats E, et al. Inmunosupresión como desencadenante de un síndrome de hiperinfestación por Strongyloides stercolaris en la nefropatía membranosa. Nefrología. 2020;40(3):345-50. DOI: https://doi.org/10.1016/j.nefro.2019.04.007

5. Abdullah A, Winnicka L, Raghu C, Zeykan V, Singh J. Disseminated strongyloidiasis in association with nephrotic syndrome. Case Rep Nephrol Dial. 2018;8:155-60.

6. 6 . Gravellone L, Battaglia C, Caligara F, d'Amato I, Gandini E, Lucatello A, et al. Strongyloidiasis in nephrologic patients. G Ital Nefrol. 2015;32(2):gin/32.2.26. Disponible en: https://pubmed.ncbi.nlm.nih.gov/26005937/

7. Miyazaki M, Tamura M, Kabashima N, Serino R, Shibata T, Miyamoto T, et al. Minimal change nephrotic syndrome in a patient with strongyloidiasis. Clin Exp Nephrol. 2010;14:367-71.

8. Sathe PA, Madiwale CV. Strongyloidiasis hyperinfection in a patient with membranoproliferative glomerulonephritis. J Postgrad Med. 2006;52:221-2.

9. Hsieh YP, Wen YK, Chen ML. Minimal change nephrotic syndrome in association with strongyloidiasis. Clin Nephrol. 2006;66:459-63.

10. Morimoto J, Kaneoka H, Sasatomi Y, Sato YN, Murata T, Ogahara S, et al. Disseminated strongyloidiasis in nephrotic syndrome. Clin Nephrol. 2002;57:398-401.

11. Yee YK, Lam CS, Yung CY, Que TL, Kwan TH, Au TC, et al. Strongyloidiasis as a possible cause of nephrotic syndrome. Am J Kidney Dis. 1999;33:E4.

12. Wong TYH, Szeto CC, Lai FFM, Mak CK, Li PKT. Nephrotic syndrome in strongyloidiasis. Remission after erradiaction with helmintic agents. Nephron. 1998;79:333-36.

13. Mori S, Konishi T, Matsuoka K, Deguchi M, Ohta M, Mizuno O, et al. Strongyloidiasis associated with nephrotic syndrome. Intern Med. 1998;37:606-10.

14. Arifin N, Hanafiah KM, Ahmad H, Noordin R. Serodiagnosis and early detection of Strongyloides stercoralis infection. J Microbiol, Immunol Infect. 2019 Jun;52(3):371-378. DOI: https://doi.org/10.1016/j.jmii.2018.10.001

15. Mejia R, Nutman TB. Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis. Curr Opin Infect Dis. 2012;25(4):458-63.