Parasites, Hosts and Diseases

The Korea Society for Parasitology and Tropical Medicine (대한기생충학·열대의학회)
권호 표지
DOI QR코드

DOI QR Code

A case of disseminated strongyloidiasis diagnosed by worms in the urinary sediment

  • Young-Ha Lee (Department of Infection Biology and Department of Medical Science, Chungnam National University College of Medicine)
  • Received : 2023.12.25
  • Accepted : 2024.03.13
  • Published : 2024.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Strongyloidiasis is a chronic infection caused by the intestinal nematode parasite Strongyloides stercoralis and is characterized by a diverse spectrum of nonspecific clinical manifestations. This report describe a case of disseminated strongyloidiasis with urination difficulty, generalized weakness, and chronic alcoholism diagnosed through the presence of worms in the urinary sediment. A 53-year-old man was hospitalized for severe abdominal distension and urinary difficulties that started 7-10 days prior. The patient also presented with generalized weakness that had persisted for 3 years, passed loose stools without diarrhea, and complained of dyspnea. In the emergency room, approximately 7 L of urine was collected, in which several free-living female adult and rhabditiform larvae of S. stercoralis, identified through their morphological characteristics and size measurements, were detected via microscopic examination. Rhabditiform larvae of S. stercoralis were also found in the patient's stool. During hospitalization, the patient received treatment for strongyloidiasis, chronic alcoholism, peripheral neurosis, neurogenic bladder, and megaloblastic anemia, and was subsequently discharged with improved generalized conditions. Overall, this report presents a rare case of disseminated strongyloidiasis in which worms were detected in the urinary sediment of a patient with urination difficulties and generalized weakness combined with chronic alcoholism, neurogenic bladder, and megaloblastic anemia.

Keywords

Acknowledgement

This work was supported by a research fund from Chungnam National University and performed in accordance with the ethical standards of the Institutional Review Board of Chungnam National University (Approval number: 202304-BR-058-01) and with the Declaration of Helsinki as revised in 2013.

References

  1. Buonfrate D, Bisanzio D, Giorli G, Odermatt P, Furst T, et al. The Global Prevalence of Strongyloides stercoralis Infection. Pathogens 2020;9(6):468. https://doi.org/10.3390/pathogens9060468 
  2. Luvira V, Siripoon T, Phiboonbanakit D, Somsri K, Watthanakulpanich D, et al. Strongyloides stercoralis: a neglected but fatal parasite. Trop Med Infect Dis 2022;7(10):310. https://doi.org/10.3390/tropicalmed7100310 
  3. Czeresnia JM, Weiss LM. Strongyloides stercoralis. Lung 2022; 200(2):141-148. https://doi.org/10.1007/s00408-022-00528-z 
  4. Ita OI, Akpayak IC, Onyedibe KI, Otu AA. Strongyloides stercoralis larvae in the urine of a patient with transitional cell carcinoma of the bladder: a case report. J Parasit Dis 2019;43(1):154-157. https://doi.org/10.1007/s12639-018-1051-6 
  5. Pocaterra L, Perez G, Rojas E, Hernan A, Castro J, et al. Urinary rhabditiform larvae of Strongyloides stercoralis in disseminated disease affecting a kidney-transplanted patient. Rev Med Hered 2016;27:35-40. 
  6. Baker ML, Brewster UC. Strongyloides stercoralis infection identified on urine microscopy. BMJ Case Rep 2022;15(4):e250078. https://doi.org/10.1136/bcr-2022-250078 
  7. Pasqualotto AC, Zborowski MF, dos Anjos M, Poloni JA, dos Santos AP, et al. Strongyloides stercoralis in the urine. Trans R Soc Trop Med Hyg 2009;103(1):106-107. https://doi.org/10.1016/j.trstmh.2008.08.011 
  8. Barreto NMPV, de Souza JN, Araujo WAC, Khouri NA, de Oliveira EP, et al. Urinary tract infection by Strongyloides stercoralis: a case report. J Parasitol 2018;104(4):433-437. https://doi.org/10.1645/17-88 
  9. Kim EJ. Acute respiratory distress syndrome with alveolar hemorrhage due to Strongyloidiasis hyperinfection in an older patient. Ann Geriatr Med Res 2018;22(4):200-203. https://doi.org/10.4235/agmr.18.0041 
  10. Won EJ, Jeon J, Koh YI, Ryang DW. Strongyloidiasis in a diabetic patient accompanied by gastrointestinal stromal tumor: cause of eosinophilia unresponsive to steroid therapy. Parasites Hosts Dis 2015;53(2):223-226. https://doi.org/10.3347/kjp.2015.53.2.223 
  11. Seo AN, Goo YK, Chung DI, Hong Y, Kwon O, et al. Comorbid gastric adenocarcinoma and gastric and duodenal Strongyloides stercoralis infection: a case report. Parasites Hosts Dis 2015;53(1):95-99. https://doi.org/10.3347/kjp.2015.53.1.95 
  12. Garcia LS, Bruckner DA. Diagnostic medical parasitology. Clin Microbiol Newsl 2016;16(14):322-325. https://doi.org/10.1128/9781555819002 
  13. Wallace FG, Mooney RD, Sanders A. Strongyloides fulleborni infection in man. Am J Trop Med Hyg 1948;28(2):299-302. https://doi.org/10.4269/ajtmh.1948.s1-28.299 
  14. Little MD. Comparative morphology of six species of Strongyloides (Nematoda) and redefinition of the genus. J Parasitol 1966;52(1):69-84. 
  15. Little MD. Seven new species of Strongyloides (Nematoda) from Louisiana. J Parasitol 1966;52(1):85-97. 
  16. Sandground JH. Observations on Rhabditis hominis Kobayashi in the United States. J Parasitol 1925;11(3):140-148. https://doi.org/10.2307/3270989. 
  17. Ganesh S, Cruz RJ Jr. Strongyloidiasis: a multifaceted disease. Gastroenterol Hepatol (N Y). 2011;7(3):194-196. 
  18. Teixeira MC, Ines EJ, Pacheco FT, Silva RK, Mendes AV, et al. Asymptomatic Strongyloides stercoralis hyperinfection in an alcoholic patient with intense anemia. J Parasitol 2010;96(4):833-835. https://doi.org/10.1645/GE-2358.1 
  19. Teixeira MC, Pacheco FT, Souza JN, Silva ML, Ines EJ, et al. Strongyloides stercoralis infection in alcoholic patients. Biomed Res Int 2016;2016:4872473. https://doi.org/10.1155/2016/4872473 
  20. De Souza JN, Soares BNRR, Goes LL, Lima CS, Barreto NMPV, et al. Case report: Strongyloides stercoralis hyperinfection in a patient with HTLV-1: an infection with filariform and rhabditiform larvae, eggs, and free-living adult females output. Am J Trop Med Hyg 2018;99(6):1583-1586. https://doi.org/10.4269/ajtmh.18-0402 
  21. Concha R, Harrington W Jr, Rogers AI. Intestinal strongyloidiasis: recognition, management, and determinants of outcome. J Clin Gastroenterol 2005;39(3):203-211. https://doi.org/10.1097/01.mcg.0000152779.68900.33