PDF(Pubmed)
Abstract：
Severe cases of strongyloidiasis are most often associated with multiple causes of immune suppression, such as corticoid treatment and HTLV (human T-lymphotropic virus) coinfection. Diabetes is not traditionally considered a risk factor for the development of severe strongyloidiasis. We report a rare case of autochthonous severe strongyloidiasis in Romania, a European country with a temperate climate. A 71-year-old patient with no prior travel history was admitted with multiple gastrointestinal complaints and recent weight loss. CT (computed tomography) scans indicated duodenal wall thickening, and duodenal endoscopy evidenced mucosal inflammation, ulcerations and partial duodenal obstruction at D4. Microscopic examination of stool samples and biopsy specimens from the gastric and duodenal mucosa revealed an increased larval burden characteristic of Strongyloides stercoralis hyperinfection. Sequential treatment with albendazole and ivermectin achieved parasitological cure and complete recovery. The novelty of our case stems from the scarcity of severe strongyloidiasis cases reported in Europe and especially in Romania, the absence of other risk factors in our patient aside from diabetes, the involvement of the gastric mucosa and the rare presentation as partial duodenal obstruction. This case highlights the importance of considering strongyloidiasis as a differential diagnosis, even in temperate climates where cases are sporadic, in cases in which immune suppression is not evident and in the absence of eosinophilia. The case is presented in the context of the first literature review examining the relationship between severe strongyloidiasis and diabetes, emphasizing diabetes as a possible risk factor for severe strongyloidiasis.
摘要：
严重的圆线虫病通常与免疫抑制的多种原因有关，如皮质激素治疗和HTLV（人类嗜T淋巴细胞病毒）共感染。传统上，糖尿病不被认为是严重的圆线虫病发展的危险因素。我们报道了在罗马尼亚发生的罕见的自生严重线虫病病例，气候温和的欧洲国家。一名没有旅行史的71岁患者因多次胃肠道不适和最近体重减轻而入院。CT（计算机断层扫描）扫描显示十二指肠壁增厚，十二指肠内窥镜检查证实了粘膜炎症，D4时溃疡和十二指肠部分梗阻。对胃和十二指肠粘膜的粪便样本和活检标本的显微镜检查显示，胸圆圆线虫过度感染的幼虫负担增加。阿苯达唑和伊维菌素的序贯治疗实现了寄生虫学治愈和完全恢复。我们病例的新颖性源于欧洲，尤其是罗马尼亚报道的严重线虫病病例很少，除了糖尿病，我们的病人没有其他危险因素，胃粘膜受累，罕见表现为十二指肠部分梗阻。该病例强调了将圆线虫病作为鉴别诊断的重要性，即使在温带气候中，病例也是零星的，在免疫抑制不明显和没有嗜酸性粒细胞增多的情况下。该病例是在第一篇文献综述的背景下提出的，该文献综述了严重的圆线虫病与糖尿病之间的关系，强调糖尿病是严重的圆线虫病的可能危险因素。
