JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
High-risk groups for chronic strongyloidiasis
Dutch Ex-POWs working on the Thai-Burma Railway*, 1942-1945
British Far East Ex-POWs, including men working on the Thai-Burma Railway*, 1942-1945
British Ex-POWs imprisoned only along on the Thai-Burma Railway*
U.S. Vietnam War veterans
Allied Ex-POWs, Southeast Asia, 1942-1945
166
145
2,072
1,032
493
Number of men tested (n) Strongyloidiasis detected, n (%)
44 (27.5%)
27 (17.9%)
248 (12%)
166 (16.1%)
8 (1.6%)
+ By direct microscopy, n (%) + By culture, n (%)
37 (84%)
27 (17.9%)
248 (12%)
166 (16.1%)
Not reported (NR)
30 (68%)
NR
NR
NR
NR
17 (39%)
NR
NR
NR
NR
+ By duodenal string test, n (%)
NR
NR
NR
NR
8 (1.6%)
+ By ELISA, n(%)
1
2
3,4
3,4
5,6
Reference numbers
ELISA : Enzyme-linked immunosorbent assay. *Included the construction of the Railway Bridge over the River Kwai.
Table 1: Strongyloidiasis in WorldWar II Allied Ex-Prisoners of War (POWs) and in US VietnamWar Veterans 1-6
hemorrhage with hemoptysis and melena. Figure 3 shows a filariform larva that was expelled from the lungs in a sputum specimen during Strongyloides hyperinfection. Hyperinfection may be associated with ascites and peripheral edema due a protein losing enteropathy with hypoalbuminemia. Recurrent gram negative bacteremia and sepsis may also occur as penetrating larvae carry gut bacteria into the circulation with them as they invade the intestinal mucosa. A syndrome of inappropriate secretion of antidiuretic hormone with non-palpable purpura has also been described in hyperinfection syndromes. 18 If not treated immediately, hyperinfection will result in larval dissemination to other organs, such as the brain, causing aseptic or gram negative meningitis with case fatality rates approaching 90%. In 1994, Chaudhary and coinvestigators reported two case series for a total of 13 patients with hyperinfection and disseminated strongyloidiasiswithwidespreadpurpuric lesions that contained larvae on skin biopsies. 19 Their series included nine men and four women with a median age 61 years and an age range of 32-75 years. 19 All patients had received prior corticosteroids; six had underlying malignancies; and four had COPD. 19 Six
Figure 3: Filariform (L3) larva of Strongyloides stercoralis in in a sputum specimen, stained with Giemsa. Source: United States Centers for Disease Control and Prevention (CDC), DPDx Image Library. No copyright permission required. Available at https://www.cdc.gov/dpdx/strongyloidiasis/index. html.
J La State Med Soc VOL 170 JANUARY/FEBRUARY 2018 21
Made with FlippingBook Digital Publishing Software