Introduction

Strongyloides stercoralis is a globally distributed nematode that causes diverse clinical symptoms in humans. Spain, once considered an endemic country, has experienced a recent increase in imported cases. The introduction of serology helps diagnosis and is currently replacing microbiological techniques in some settings, but its sensitivity is variable and can be low in immunocompromised patients. Diagnosis can only be confirmed by identification of larvae. Often, this “gold standard” can only be achieved in severe cases, such as disseminated S.stercoralis infection, or S.stercoralis hyperinfection syndrome, where parasite load is high. In addition, these clinical presentations are not well-defined. Our aim is to describe severe cases of S.stercoralis, their epidemiological profile, and their clinical details.

Methods

An observational retrospective study of disseminated S.stercoralis infection, or hyperinfection syndrome. Inclusion criteria: aged over 18, with a diagnosis of disseminated S.stercoralis infection, or hyperinfection syndrome, confirmed by visualization of larvae. Patients were identified through revision of clinical records for the period 2000–2015, in collaboration with eight reference centers throughout Spain.

Results

From the period 2000–2015, eighteen cases were identified, 66.7% of which were male, with a median age of 40 (range 21–70). Most of them were foreigners (94.4%), mainly from Latin America (82.3%) or Western Africa (17.6%). Only one autochthonous case was identified, from 2006. Immunosuppressive conditions were present in fourteen (77%) patients, mainly due steroids use and to retroviral coinfections (four HIV, two HTLV). Transplant preceded the clinical presentation in four of them. Other comorbidities were coinfection with HBV, Trypanosoma cruzi, Mycobacterium leprae or Aspergillus spp. All presented with digestive disorders, with 55.6% also presenting malaise. 44.4% of cases had fever, 27.8% skin complaints, and 16.7% respiratory or neurological disorders. One patient presented anemia, and one other nephrotic syndrome. Diagnosis was confirmed by identification of larvae in fresh stool samples (n = 16; 88.9%), concentration techniques (n = 6; 33.3%), larval culture (n = 5; 29.4%), or digestive biopsies (n = 8; 44%). S.stercoralis forms were identified during necropsy in one case. In addition, ten (55%) had a positive serology. All the cases were treated with ivermectin, six (33%) also received albendazole and one case received thiabendazole followed by ivermectin. All needed inpatient management, involving a mean hospitalization stay of 25 days (range 1–164). Two cases received intensive care and eventually died.

Conclusions

Only eighteen cases of disseminated S.stercoralis infection/hyperinfection syndrome were identified from the 15-year period, most of which were considered to have been imported cases. Among those, immunosuppression was frequent, and mortality due to S.stercoralis was lower than previously described.

中文翻译：

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严重的圆线虫病的管理在西班牙的参考中心参加

介绍

甾体类固醇纲线虫是一种在全球范围内分布的线虫，可在人类中引起多种临床症状。西班牙曾经被认为是一个流行国家，最近进口案件有所增加。血清学的引入有助于诊断，目前在某些情况下正在取代微生物学技术，但是其敏感性是可变的，并且在免疫功能低下的患者中可能较低。诊断只能通过鉴定幼虫来确认。通常情况下，这个“金标准”只能在严重的情况下，如弥漫实现小号。粪类圆线虫感染，或小号。甾体高感染综合征，其中寄生虫负荷高。此外，这些临床表现尚不明确。我们的目的是描述严重的S病例。固醇，其流行病学特征及其临床细节。

方法

播散的观察回顾性研究小号。甾体感染或过度感染综合征。纳入标准：18岁以上，具有弥散性的诊断小号。幼虫可视化证实了甾体感染或过度感染综合征。通过与西班牙各地的八个参考中心合作，通过修订2000-2015年的临床记录来识别患者。

结果

从2000年至2015年，发现了18例病例，其中66.7％为男性，中位年龄为40岁（21-70岁）。他们大多数是外国人（94.4％），主要来自拉丁美洲（82.3％）或西非（17.6％）。自2006年以来，仅发现了1例本地病例。14例（77％）患者存在免疫抑制疾病，主要是由于使用类固醇和逆转录病毒合并感染（4例HIV，2例HTLV）。其中有四个在临床表现之前先进行了移植。其他合并症包括乙型肝炎病毒，克氏锥虫，麻风分枝杆菌或曲霉菌的合并感染。全部表现出消化系统疾病，其中55.6％也表现出不适。44.4％的病例发烧，27.8％的皮肤不适和16.7％的呼吸或神经系统疾病。一名患者出现贫血，另一名出现肾病综合征。通过鉴定新鲜粪便样本中的幼虫（n = 16； 88.9％），浓缩技术（n = 6； 33.3％），幼虫培养（n = 5； 29.4％）或消化活检（n = 8； n = 8； 5 = 2； 3 = 10）来确诊。 44％）。小号。甾体尸检中鉴定出一种形式。此外，十名（55％）的血清学检查呈阳性。所有病例均用伊维菌素治疗，其中6例（33％）也接受阿苯达唑治疗，1例患者接受噻菌灵治疗，随后接受伊维菌素治疗。所有需要的住院治疗，平均住院天数为25天（范围1–164）。两例接受了重症监护，最终死亡。

结论

只有十八例弥漫的小号。从15年的时间里就鉴定出了甾体感染/高感染综合征，其中大多数被认为是外来病例。在这些，免疫抑制是频繁，死亡率由于小号。固醇比以前描述的要低。