Most patients with positive Strongyloides serology were asymptomatic, and treatment regimens were not uniform, highlighting the need for standardized protocols.
Abstract
Background
Strongyloides stercoralis is an intestinal parasitic nematode that can infect humans with a 2%-7% prevalence in the United States. Immunosuppression is a crucial risk factor for disseminated infection. Diagnosis is often delayed and targeted treatment is frequently initiated late. We therefore sought to review the prevalence of positive Strongyloides antibody results and undertook a descriptive analysis of such patients.
Methods
We retrospectively reviewed patients with positive Strongyloides IgG serology from August 2012 to April 2023 across geographically distinct academic medical centers. Study period pre-dated universal donor and recipient Strongyloides screening recommendation by the Organ Procurement and transplantation network (OPTN). Clinical presentation was classified into three categories: chronic infection (positive Strongyloides IgG serology without additional clinical manifestations), hyperinfection syndrome (positive serology with involvement of the skin, gastrointestinal tract, or lungs), and disseminated infection (positive serology with involvement beyond those typically involved in hyperinfection).
Results
A total of 412 patients were identified; median age was 59 years and 66% (272) were male. The primary indication for testing was pretransplant evaluation in 230 (56%), eosinophilia workup in 84 (20%), suspicion of symptomatic infection in 74 (18%), testing based on travel history in 27 (7%), and pre-immunosuppression screening in 27 (7%). Furthermore, 401 patients (97.3%) were categorized as having chronic infection, 10 patients (2.42%) had hyperinfection, and one patient (0.24%) had disseminated infection, presenting with Escherichia coli bacteremia and meningitis. Symptomatic infection was more common at the Mayo Clinic in Rochester and Mayo Clinic Health Sciences than at the Arizona and Florida Mayo Clinic sites (6% vs. 2%, p = 0.079). Treatment was administered to 366/412 (89%) patients.
Conclusion
Most patients with positive Strongyloides serology were asymptomatic, and treatment regimens were not uniform. Patients who tested positive should be treated prior to immunosuppression initiation, though this was not systematically assessed in this cohort. The observed variability in treatment regimens highlights the need for standardized protocols.
To comprehensively review clinical, diagnostic, and therapeutic data on the global epidemiology of cryptococcosis in apparently immunocompetent patients with no or only a few minor medical conditions who were previously healthy. While cryptococcosis is often regarded as a rare presentation in presumably healthy individuals, a substantial and increasing number of cases occurring in this group of patients is evident. However, studies focusing exclusively on cryptococcal infection in so-called immunologically normal patients are lacking. In the last decade, 382 cases of cryptococcosis in apparently immunocompetent hosts were reported from 45 countries. Patients were mostly men (66.5%) with an average age of 44 years (range 0 to 86 years). Central nervous system (CNS) involvement was most frequent, followed by disseminated and pulmonary infection. Most patients survived (84.8%). Diagnosis included microscopy, culture, and cryptococcal antigen detection. The species was reported in 271 cases, mainly C. neoformans (59.4%) and C. gattii (36.5%). Amphotericin B, alone or in combination, was mostly used for CNS involvement, whereas fluconazole alone was mostly used for other presentations. This descriptive review highlights that cryptococcosis in the seemingly healthy host is no longer an uncommon etiology and that the epidemiology of this mycosis is a changing landscape.
C. Firacative, Andrés Cendales-Regalado, Óscar Gil et al.· Current Tropical Medicine Re...· 0 citations
Background Strongyloides stercoralis pulmonary hyperinfection syndrome (SPHS) is a rare, frequently fatal complication of strongyloidiasis that is difficult to recognize because of its nonspecific multisystem manifestations. Diagnosis requires a high index of suspicion. Methods This retrospective study identified 29 hospitalized patients with strongyloidiasis at Chaozhou Central Hospital between November 2018 and January 2026. We compared the clinical data of five patients with SPHS (SPHS group) and 21 patients with uncomplicated/chronic strongyloidiasis (non-SPHS group) and described the detailed clinical profiles of the five patients with SPHS. Results All five SPHS patients (median age, 67; 4/5 were male) had diabetes mellitus, glucocorticoid exposure, rural soil contact, fever, and nonspecific pulmonary computed tomography (CT) abnormalities; four (4/5, 80%) had gastrointestinal and/or neurological manifestations and intestinal obstruction. All five patients had multisystem laboratory abnormalities without eosinophilia. S. stercoralis was detected in respiratory specimens from all patients, and three (3/5, 60%) were confirmed by bronchoalveolar lavage fluid metagenomic next-generation sequencing (mNGS) or targeted next-generation sequencing (tNGS) within 2–5 days. All patients had bacterial coinfections. Adequate antimicrobial coverage was achieved in four (4/5, 80%) patients; one patient (1/5, 20%) received both ivermectin and albendazole, and three (3/5, 60%) received albendazole monotherapy. Three patients (3/5, 60%) died of severe complications. Compared with the non-SPHS group, the SPHS group had a significantly lower median eosinophil count (0.01 × 109/L); higher rates of corticosteroid exposure, diabetes mellitus, neurological and gastrointestinal symptoms, intestinal obstruction, severe complications, and mortality; and a longer time to laboratory confirmation (all P < 0.05). Conclusion In high-risk patients, normal or low eosinophil counts do not exclude SPHS. Early examination of respiratory specimens using microscopy and, when available, mNGS/tNGS may shorten the time to diagnosis. For these patients, early recognition of SPHS, antiparasitic therapy, and the management of bacterial coinfections are essential.
Huizhen Lin, Yangxi Deng, Zhuoxi Chen et al.· Infection and Drug Resistanc...· 0 citations
Background Strongyloides stercoralis is an intestinal nematode with a unique autoinfective life cycle that enables decades-long persistence in the human host. Its gastrointestinal manifestations may resemble inflammatory bowel disease (IBD), creating a clinically important diagnostic pitfall. Misdiagnosis is particularly hazardous because corticosteroids or other immunosuppressive therapies may precipitate Strongyloides hyperinfection syndrome or disseminated disease. Case Presentation We report a 52-year-old immunocompetent woman from northern Iran who presented with a 20-day history of persistent watery inflammatory diarrhea, severe hypokalemia (2.4 mEq/L), leukocytosis, and thrombocytosis. Serial stool examinations for ova and parasites were repeatedly negative for larvae; however, fecal leukocytes and erythrocytes, together with erosive duodenopathy, initially raised concern for IBD. Duodenal biopsy established the diagnosis by demonstrating marked eosinophilic infiltration of the lamina propria, reaching 45–50 eosinophils per high-power field, and rhabditiform larvae within the mucosal crypts. The larvae showed morphologic features supporting Strongyloides stercoralis, including a short buccal cavity/canal and a characteristic rhabditiform esophagus. Molecular testing, serology, and independent expert parasitologist confirmation were not performed, which represents a diagnostic limitation. The patient was treated with oral ivermectin plus adjunctive albendazole. The addition of albendazole was an individualized, non-standard clinical decision rather than a routine evidence-based recommendation. Her symptoms improved rapidly, and she remained asymptomatic at one-month follow-up. Conclusion This case emphasizes the clinical and histopathological overlap between duodenal strongyloidiasis and IBD, particularly when stool parasitology is unrevealing. The novelty of this report lies primarily in its didactic value for clinicians in endemic regions: Strongyloides should remain in the differential diagnosis of IBD-like presentations with unexplained eosinophilic mucosal inflammation before immunosuppressive therapy is considered.
Hasti Asdaghi Jahromi, A. Davoodi, Alireza Hosseini· Clinical Medicine Insights:...· 0 citations
Despite a significant population of migrants from endemic countries and of Europeans traveling to these regions, no Belgian study and few European studies have reported on strongyloidiasis. This retrospective study, conducted between January 2012 and December 2021, aimed to compare demographic data, clinical characteristics and management appropriateness of adult patients from Hôpital Universitaire de Bruxelles-Erasme and Centre Hospitalier Universitaire Saint-Pierre who had a positive serology for Strongyloides stercoralis. Serology results were classified as weakly positive (WP) or positive (P), and the two groups were compared. Qualitative and continuous data were expressed as numbers and medians, respectively, and compared using Fisher’s exact or Wilcoxon–Mann–Whitney tests, with a p-value < 0.05 considered statistically significant. A total of 358 patients (50% females) were included, with a median age of 52 (IQR: 40–63): 225 (62.8%) had WP and 133 (37.2%) had P results. Overall, 217/358 (60.6%) of the patients had at least one comorbidity, and 52/358 (14.5%) had an immunosuppressive factor. In total, 120/358 (33.5%) were symptomatic and 160/352 (45.5%) had blood eosinophilia. Only 51/358 (14.2%) benefitted from appropriate clinical management. Severe complications occurred in 17/358 (4.7%) patients, with two deaths (0.6%). This first Belgian study about strongyloidiasis shows that, despite low rates of severe complications and mortality, significant treatment delays were observed, requiring future improvement and monitoring.
Juliette Becu, Charlotte Martin, Sigi Van den Wijngaert et al.· Microorganisms· 0 citations
INTRODUCTION
Nontuberculous mycobacteria (NTM) disease is a significant morbidity in solid organ transplant recipients. Its management needs to be individualized based on factors including the potential drug-related adverse effects, which is a particular concern for liver transplant (LTx) recipients. We aim to investigate the incidence proportion, clinical presentation, management, and outcome of NTM isolation and NTM diseases in our LTx recipients.
METHODS
We conducted a single-center retrospective study in Japan. We included all LTx recipients with age ≥ 18 who had posttransplant mycobacterial microbiological testing of any clinical specimens between April 2005 and March 2022. Participants with NTM isolation who satisfied the diagnostic criteria in American Thoracic Society/Infectious Disease Society of America (ATS/IDSA) guidelines were defined as having NTM diseases. We collected demographic, clinical, microbiological, and radiographic data of participants through chart reviews.
RESULTS
Of all 472 LTx recipients, 115 received at least one mycobacterial microbiological test, of whom 15 had positive test results. Six participants had an NTM disease, all of which were pulmonary infections (6/472: 1.3%). None of them received treatment for NTM diseases, even when alternative diagnoses were absent. Except for one patient who died of posttransplant lymphoproliferative disorder, five remained free of exacerbation of NTM disease and were alive at the end of the study period, with 1067-4825 days of follow-up periods.
CONCLUSIONS
Late-onset pulmonary NTM diseases meeting ATS/IDSA criteria may be safely observed without treatment in selected LTx recipients. Diagnostic criteria may need to be tailored for immunocompromised patients including LTx recipients to help guide the management.
Toshiki Miwa, Koh Okamoto, Y. Higurashi et al.· Transplantation Proceedings· 0 citations
Background Nontuberculous mycobacteria (NTM) can disseminate and infect various organs throughout the body. However, whether NTM can infect tracheobronchial tissue is rarely reported. This study aimed to address the knowledge gap regarding the epidemiological, demographic, and clinical characteristics of patients with tracheobronchial NTM infection. Methods In this multicenter retrospective cohort study, clinical, demographic, microbiological, and radiological data from hospitalized patients with tracheobronchial NTM infections from January 2015 to May 2025 were collected and analyzed descriptively. Results Twenty-nine patients (2.3%) were included, and all the patients presented with disseminated NTM infection. Seventeen patients had comorbidities, including 5 with acquired immunodeficiency syndrome and 1 with anti-interferon-γ autoantibody syndrome. Median diagnostic delay was 130 days, and 89.7% of the patients were initially misdiagnosed with tuberculosis or malignancy. The most common symptoms were cough, expectoration, anemia, fever, weight loss, skin lesions, and bone pain. Chest CT revealed nodules, patchy opacities, mass-like shadows, and bronchial stenosis, with or without hilar/mediastinal lymphadenopathy, whereas osteolytic bone destruction was evident in 11 patients. The most common features of bronchoscopy were intraluminal masses/neoplasms/nodules. Metagenomic next-generation sequencing (mNGS) of BALF (n=12) demonstrated 100% positivity, outperforming BALF culture (46.2%, 12/26) and sputum culture (39.3%, 11/28). Mycobacterium colombiense accounted for 24.1% of cases. With respect to therapeutic management, 27 patients received systemic antimicrobial therapy, while 2 did not receive specific anti-N™ treatment. One patient underwent combined endoscopic resection. Overall, 23 patients (79.3%) achieved improvement or cure, 5 showed disease progression, 1 experienced relapse, and 1 died. Conclusions Tracheobronchial NTM infection is rare but clinically significant, often occurring in the context of disseminated disease with pulmonary involvement. Immunocompromised hosts, particularly those with AIDS or anti–IFN-γ autoantibody syndrome, are highly susceptible. Bronchoscopy typically reveals mass lesions causing luminal stenosis or occlusion. In this cohort, M. colombiense was the most frequently isolated NTM species. Early bronchoscopy, mNGS-based pathogen detection, and timely systemic or endoscopic intervention should be considered to prevent irreversible airway stenosis. Further studies are needed to validate optimal treatment strategies. Clinical Trial Registration https://www.ClinicalTrials.gov, identifier NCT07377864.
M. Pan, Yaqin Wei, Chunyuan Luo et al.· Frontiers in Cellular and In...· 0 citations