Introduction: Strongyloidiasis, caused by Strongyloides stercoralis, is a parasitic infection prevalent in tropical and subtropical regions. While often asymptomatic, it poses severe risks in immunocompromised patients. This case report highlights the association between Strongyloides stercoralis and glomerular diseases, offering valuable insights into diagnosis and management.
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Case Summary: A 44-year-old Bolivian woman, residing in Spain since 2008, was diagnosed with IgA nephropathy (IgAN) after experiencing persistent subnephrotic proteinuria and microhematuria. She was prescribed prednisone (1 mg/kg/day). One month after initiating treatment, she traveled to Bolivia, returning with fever and generalized itching. A stool examination confirmed Strongyloides stercoralis infection.
Treatment included tapering glucocorticoids and administering ivermectin 200 mcg/kg/day Serology (ELISA test) showed a gradual decrease in IgG titers, indicating a successful response to treatment.
Discussion: Strongyloides stercoralis has a unique life cycle enabling autoinfection, which can lead to hyperinfestation in immunosuppressed patients. This condition primarily affects the skin, gastrointestinal tract, and respiratory system. Diagnosis is made through stool examination, bronchoalveolar lavage, or serology.
The primary treatment is ivermectin, with albendazole as a secondary option. Managing patients with glomerular diseases and suspected Strongyloides infection is crucial, as corticosteroids can exacerbate parasitic proliferation. Studies by the World Health Organization (WHO) emphasize the necessity of early screening in endemic regions.
Clinical Implications:
- Screening for Strongyloides stercoralis before immunosuppression in high-risk patients is essential.
- Immunocompromised patients with fever of unknown origin should be tested, even without eosinophilia or diarrhea.
- Rapid diagnosis and treatment prevent complications such as hyperinfestation syndrome.
Conclusion: This case underscores the significance of preemptive screening for Strongyloides stercoralis in patients requiring immunosuppressive therapy. Awareness among clinicians can mitigate the risks associated with delayed diagnosis.
Read the full study at https://doi.com/10.29328/journal.jcn.1001099.
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