Background: Strongyloidiasis is an infection caused by Strongyloides
stercoralis, a globally prevalent nematode. It is estimated to infect about 600
million people globally mainly from tropical and subtropical regions of Africa,
Asia, South America, and the Southeastern United States. India, being a
tropical country, is prone to many such infections, but there is limited
availability of data showing the prevalence of Strongyloides stercoralis
infection.
Aim: This case report aims to emphasise the importance of
keeping parasitic infections as a differential diagnosis in cases clinically
suspicious for gastrointestinal malignancies.
Case Presentation: This chapter reports a case of a
60-year-old male with a co-infection by Strongyloides stercoralis and
Helicobacter pylori. The patient presented with the non-specific symptoms of
epigastric discomfort, fatigue and unintentional weight loss over several
months with no significant past medical history. This led to a suspicion of
malignancy for which routine investigations, along with upper gastrointestinal
endoscopy with biopsy, were performed. Subsequently, rhabditiform larvae of
Strongyloides stercoralis and Helicobacter pylori were identified on gastric
and duodenal biopsies. The patient was treated with Amoxicillin 1 g twice
daily, Clarithromycin 500 mg twice daily, Proton pump inhibitor (Omeprazole) 20
mg twice daily for Helicobacter pylori infection, and Ivermectin at a dose of
200 µg/kg/day for Strongyloides stercoralis infection. Follow-up evaluations
after 4 weeks showed normalisation of the patient’s haemoglobin levels, stool
examination and a significant improvement in overall health and nutritional
status.
Discussion: Strongyloidiasis usually targets
immune-compromised hosts owing to hyperinfestation, but remains asymptomatic in
healthy individuals. Moreover, there is limited availability of diagnostic
modalities for such parasitic infections which hinders the way for early
diagnosis, therefore leading to poor prognosis. In selected cases with
non-specific symptoms like that in this case, early upper gastrointestinal
endoscopy with histopathology can help in early diagnosis and prompt treatment.
Conclusion: Due to the non-specific nature of the symptoms,
it is difficult to reach a diagnosis, though it is necessary to have a high
degree of suspicion and make an early diagnosis to have better outcomes.
Author(s) Details
Shruti Varshney
Jawaharlal Nehru Medical College, Aligarh Muslim University, India.
Bushra Siddiqui
Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim
University, India.
Shahbaz Habib Faridi
Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim
University, India.
Please see the book here :- https://doi.org/10.9734/bpi/aodhr/v6/6325
