Cases reported "Opportunistic Infections"

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1/11. Strongyloides hyper-infection: a case for awareness.

    In patients receiving immunosuppressive therapies, strongyloides stercoralis can cause a life-threatening septic shock, with multi-organ failure and infestation. Strongyloides hyper-infection should be considered in any immunosuppressed patient who has been exposed to the parasite, even if it is many years since that exposure occurred. Delayed eosinophilia may be a feature and treatment with high doses of anthelmintics may be required. An interesting case of S. stercoralis hyper-infection was recently observed at the Royal Darwin Hospital in tropical, northern australia. The patient was an 18-year-old female with lupus glomerulonephritis, who was receiving immunosuppression in the form of corticosteroids and pulse cyclophosphamide. The characteristics and intensive-care management of this case, including the use of granulocyte-colony stimulating factor and high-dose ivermectin, are described. The patient, who survived, appears to represent the first reported case of S. stercoralis hyper-infection with suspected myocarditis.
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keywords = stercoralis
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2/11. strongyloides stercoralis hyperinfection in a patient with angioimmunoblastic lymphadenopathy.

    A 29 year old Bengali male patient on chemotherapy for angioimmunoblastic lymphadenopathy developed Strongyloides hyperinfection syndrome 3 months after being treated with a single 3 day course of thiabendazole. His complicated hospitalization and successful management are described. Prevention of this potentially fatal disease in immunocompromised patients by early diagnosis and proper management of intestinal strongyloidiasis is emphasized.
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keywords = stercoralis
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3/11. strongyloidiasis: challenges in diagnosis and management in non-endemic kuwait.

    Among immunocompromised individuals, hyper-infection with strongyloides stercoralis may occur and lead to fatal strongyloidiasis. To clinicians and laboratory diagnosticians in non-endemic countries such as kuwait, this severe infection poses a particular problem. The clinical histories and signs and symptoms of four Kuwaiti cases of S. stercoralis hyper-infection were reviewed. Each of the four was found not only to have lived in an area where S. stercoralis was endemic but also to have been treated with immunosuppressive steroids (for medical problems unrelated to the nematode infection). When they presented with undiagnosed hyper-infections their clinical features were confusing. Three of the cases, all with low eosinophil counts, died but the other, who was treated with thiabendazole, survived. In the light of these observations, healthy medical examinees who had recently moved from endemic zones were checked for asymptomatic S. stercoralis infection, both by stool examination and ELISA-based serology. Of 381 stool samples investigated over a 3-month period, 183 (48%) were found positive for helminths, 7% for S. stercoralis. Of 198 individuals from endemic zones who were screened after another medical examination, 71 (35.8%) were found positive for intestinal helminth parasites, including one (1.45%) infected with S. stercoralis. Although ELISA appear reliable in making a presumptive diagnosis of strongylodiasis, the results of such assays are not very specific and are best interpreted in conjunction with the patient's clinical status. The concurrent administration of anthelminthics to patients prescribed steroids who, because they live or have lived in an area where S. stercoralis is endemic, are at risk of infection with the nematode, should be considered.
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4/11. strongyloides stercoralis hyperinfection in a carrier of HTLV-I virus with evidence of selective immunosuppression.

    A patient with near fatal Strongyloides hyperinfection syndrome is briefly described. Investigation for possible risk factors for this parasitic infection disclosed that he was a carrier of human T-cell leukemia virus type I (HTLV-I), but without evidence of disease due to this retrovirus. Over the next few years, the patient's serum antibody levels of IgG to S. stercoralis larvae declined and became undetectable despite continued infection with the parasite. Repeated courses of appropriate treatment cleared the parasitic infection only temporarily. The patient was also found to have undetectable total serum IgE and a negative immediate hypersensitivity skin test to S. stercoralis antigens. Five of six other patients with HTLV-I-associated disease and with or without strongyloidiasis were also found to have very low total serum IgE levels. It is postulated that HTLV-I infection in certain individuals may selectively impair immune responses that are critical in controlling strongyloidiasis.
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keywords = stercoralis
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5/11. Fatal disseminated strongyloidiasis in patients on immunosuppressive therapy: report of two cases.

    Disseminated strongyloidiasis is a rare manifestation in patients on immunosuppressive drugs. We report two cases of fatal disseminated Strongyloides stercoralis infestation. The first was in a patient of pemphigus vulgaris who developed an exacerbation of symptoms, one year after diagnosis and was given intravenous dexamethasone and azathioprine and in the third week of hospitalization developed features of septicemia, respiratory failure and petechial hemorrhages which were proven to be due to disseminated strongyloidiasis. The second patient was diagnosed to have stage IV diffuse large cell type of non-Hodgkin lymphoma and after the second cycle of chemotherapy, developed generalized symptoms of septicemia, respiratory failure, purpuric macules and patches. This was also proven to be disseminated strongyloidiasis.
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keywords = stercoralis
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6/11. Opportunistic parasitic infections in immunocompromised hosts.

    Parasitological and serological examination was done for 111 cases with various types of malignancies under immunosuppressive therapy and another 20 apparently healthy individuals as a control group to determine the prevalence of opportunistic parasitic infections among immunocompromised patients. Single examination showed that 74 (66.7%) harboured infection with different parasites: strongyloides stercoralis infection was found in 4 (3.64%) cases; 3 cases (2.7%) had pneumocystis carinii infection. No cryptosporidium oocysts were detected; IFAT for toxoplasmosis was positive in 40 cases (36%) with titres ranging from 1/16 - 1/256 but IFAT-IgM was negative. The control group did not show any parasitic infection except that IFAT was positive in 4 out of 20 (20%) with titres ranging from 1/16 to 1/128 but IFAT-IgM was also negative. Although toxoplasma infection was higher among patients the difference was insignificant. Generally the percentages recorded for the different parasites were found to be within the expected prevalence. One case report of concomitant opportunistic Pneumonocytis and toxoplasma infection is reviewed.
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keywords = stercoralis
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7/11. strongyloides stercoralis hyperinfection in an hiv positive patient.

    A 25 year old British man of previous good health presented with persistent generalised lymphadenopathy and was found to be human immunodeficiency virus (hiv) antibody positive. Three years later after weight loss and loose stools strongyloides stercoralis was identified in the latter and successfully treated with thiabendazole. Shortly afterwards, a further episode again responded rapidly, but was swiftly followed by a final and fatal illness with severe debility and metabolic imbalance unresponsive to all treatment. Necropsy showed widespread and heavy strongyloidiasis with pulmonary haemorrhage, bronchopneumonia, and meningitis.
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keywords = stercoralis
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8/11. opportunistic infections with strongyloides stercoralis in renal transplantation.

    opportunistic infections with the nematode strongyloides stercoralis occur most often in patients with impaired T lymphocyte function, including recipients of renal allografts. Occult intestinal infection can remain quiescent for more than 30 years, becoming apparent only after the initiation of immunosuppression. Pulmonary and gastrointestinal symptoms predominant as initial clinical manifestations in patients with strongyloides hyperinfection or dissemination. Although thiabendazole remains the treatment of choice for all forms of strongyloidiasis, the duration of therapy must be individualized on the basis of frequent examinations of both stool and sputum. transplantation centers drawing patients from areas with endemic Strongyloides should evaluate potential recipients closely for occult strongyloides infection prior to initiating immunosuppressive therapy. Empiric therapy with thiabendazole should be considered for renal allograft recipients with unexplained eosinophilia and a history of travel or residence in an area with endemic Strongyloides. Prophylactic monthly administration of thiabendazole in immunocompromised patients who have survived strongyloides hyperinfection or dissemination can prevent reinfection.
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ranking = 2.6474856951099
keywords = stercoralis, strongyloides
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9/11. Disseminated strongyloidiasis with central nervous system involvement diagnosed antemortem in a patient with acquired immunodeficiency syndrome and Burkitts lymphoma.

    A 45-year-old man presented with central nervous system involvement as the initial manifestation of disseminated infection with strongyloides stercoralis. Several concurrent clinical factors contributed to this event, all related to the patient's immunosuppression, including high-grade lymphoma, corticosteroid therapy, and acquired immunodeficiency syndrome. This is only the third case of CNS involvement in disseminated strongyloidiasis diagnosed antemortem.
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keywords = stercoralis
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10/11. Opportunistic strongyloides stercoralis infection in lymphoma patients. Report of a case and review of the literature.

    strongyloides stercoralis is an intestinal parasite that may cause fatal opportunistic infections in immunocompromised patients. Herein is reported a patient who developed fatal disseminated strongyloidiasis 6 weeks after the initiation of chemotherapy for a large cell lymphoma of the small intestine. After reviewing the clinical and epidemiologic features of 16 other cases of disseminated strongyloidiasis in patients with malignant lymphomas, the currently available laboratory methods for the diagnosis of this parasite are outlined. Because uncomplicated infections are treatable, candidates for chemotherapy or immunosuppression with a relevant geographic history should be screened for S. stercoralis prior to the initiation of the treatment.
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keywords = stercoralis
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