Javier A. Cerra-Franco, MD, Pedro Rosa-Cortes, MD, Rodolfo Estremera, MD, Antonio Soto-Ramos, MD, Sonia Saavedra, MD, PhD, Doris Toro-Lugo, MD
VA Caribbean Healthcare System, San Juan, Puerto Rico
Introduction: Strongyloidiasis is a soil-transmitted parasitic infection caused by an intestinal nematode classified as a neglected tropical disease by the World Health Organization. Although predominantly asymptomatic it can potentially turn into a life-threatening disease in immunocompromised host. Epidemiologic studies in the western hemisphere are scarce but even more is the description of the natural course of this disease. The objectives of this study were to identify the different clinical presentations and outcomes associated to Strongyloides stercolaris infection in the Hispanic population in our institution.
Methods: This is a single center, retrospective record review study involving patients diagnosed with S. stercolaris infection via serological studies, stool samples or organ biopsies from 2008 to 2014
Results: A total of 270 patients tested positive during the study period of which 210 (77.8%) were asymptomatic. Out of the patients who presented with symptoms, 25 had pulmonary manifestations, 21 gastrointestinal, 5 rash, 9 with more than one manifestation of which 5 presented with hyperinfection. The most common laboratory abnormalities were an elevated eosinophil count: 1.4 x103/ul (normal: 0-0.1 x103/ul) and eosinophil percent: 15.5% (normal: 0-7%). The other laboratory parameters were essentially unaffected. The mean age at diagnosis was 75.4 years old. The most common reasons for testing for S. stercoralis were eosinophilia (n=235), asthma (n=21), diarrhea (n=20), rash (n=10) and others (n=31).
Discussion: Evolving globalization trends have increased migratory rates around the globe. People from endemic countries can easily travel to places where S. stercoralis is not endemic. Natural disasters account for increased translocation of people from endemic to non-endemic areas. More recently, Hurricane María struck Puerto Rico and the Caribbean during September 2017. In its aftermath, nearly 400,000 Puerto Ricans left the island and established themselves in the continental United States, a crisis documented in multiple newspaper articles, columns and news outlets. The present study highlights the need to establish guidelines aimed towards increased screening of patients in communities with known increased migrant flow from endemic countries in order to timely diagnose and prevent the potentially fatal outcomes that may occur as a result of steroid or immunosuppressive therapy in patients with untreated strongyloidiasis.
Citation: Javier A. Cerra-Franco, MD, Pedro Rosa-Cortes, MD, Rodolfo Estremera, MD, Antonio Soto-Ramos, MD, Sonia Saavedra, MD, PhD, Doris Toro-Lugo, MD. P2599 - CLINICAL MANIFESTATIONS OF STRONGYLOIDES INFECTION ON HISPANIC PATIENTS AT THE VETERANS AFFAIRS CARIBBEAN HEALTHCARE SYSTEM. Program No. P2599. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.