SÍNDROME DE HIPERINFECCIÓN POR STRONGYLOIDES STERCORALIS: REVISIÓN INTEGRADORA DE UNA SERIE DE CASOS EN BRASIL
DOI:
https://doi.org/10.56238/levv16n55-119Palabras clave:
Strongyloides stercoralis, Estrongiloudiasis, Corticosteroides, Epidemiología, BrasilResumen
La estrongiloidiasis, o anguilulosis, es una infección intestinal causada por el nematodo Strongyloides stercoralis, que afecta a entre 30 y 100 millones de personas en todo el mundo. Se considera una enfermedad desatendida, especialmente en regiones tropicales y zonas de bajo nivel socioeconómico. Aunque frecuentemente asintomática, la enfermedad puede causar síntomas gastrointestinales y dermatológicos, evolucionando a formas graves como el síndrome de hiperinfección y la estrongiloidiasis diseminada, con alta mortalidad, principalmente en pacientes inmunodeprimidos. El diagnóstico combina técnicas serológicas y moleculares, y el tratamiento de elección es una dosis única de ivermectina. Dada su gravedad y el subregistro, la estrongiloidiasis requiere mayor atención en salud pública y más estudios epidemiológicos y clínicos. El objetivo de este estudio es realizar una revisión integrativa de casos de síndrome diseminado y de hiperinfección causados por S. stercoralis en Brasil, centrándose en los factores de riesgo, los síntomas, el diagnóstico y el tratamiento. Se analizaron informes obtenidos de PubMed, SciELO, Web of Science, EMBASE y Google Scholar, con un total de 23 casos. Los factores de riesgo incluyeron el uso de corticosteroides, quimioterapia, trasplantes, cáncer, VIH, HTLV-1 y alcoholismo crónico. Los síntomas más comunes incluyeron vómitos, dolor abdominal, diarrea, náuseas, tos, disnea, fiebre, debilidad y anorexia. Los hallazgos refuerzan la necesidad de atención clínica especial en pacientes inmunodeprimidos, considerando la sospecha temprana de infección por S. stercoralis para el seguimiento terapéutico y la prevención del síndrome de hiperinfección. El estudio destaca la importancia de mejorar la vigilancia, el diagnóstico y las intervenciones de salud pública, dada la gravedad de la enfermedad y su potencial infradiagnóstico.
Descargas
Referencias
ANSELMI, M, et al. Mass Administration of Ivermectin for the Elimination of Onchocerciasis Significantly Reduced and Maintained Low the Prevalence of Strongyloidesstercoralis in Esmeraldas, Ecuador. PLoSNeglTropDis. v. 5, n. 9(11), Nov. 2015.
ANURADHA, R, et al. Systemic Cytokine Profiles in Strongyloidesstercoralis Infection and Alterations following Treatment. Infect Immun. v. 23, n. 84 (2), p. 425-431, Nov. 2015.
BENINCASA, Cristian Chassot, et al .Hiper-infecção por Strongyloidesstercoralis: relato de caso. Rev. bras. ter. intensiva, São Paulo, v. 19, n. 1, p. 128-131, Mar. 2007.
BEKNAZAROVA, M., WHILEY, H., & ROSS, K. . Strongyloidiasis: A Disease of Socioeconomic Disadvantage. International Journal of Environmental Research and Public Health, v. 13, n. 5, p. 517, 2016.
BOLLELA, Valdes Roberto, et al. Fulminant gastrointestinal hemorrhage due to Strongyloidesstercoralishyperinfection in an AIDS patient. Rev. Soc. Bras. Med. Trop., Uberaba, v. 46, n. 1, p. 111-113, Feb. 2013.
BOGGILD, A. K. et al. CATMAT statement on disseminated strongyloidiasis: Prevention, assessment and management guidelines. Canada Communicable Disease Report, Ottawa, v. 42, n. 1, p. 12-19, 2016.
BRANDÃO, Rodrigo Martins, et al. Strongyloidesstercoralis disseminated infection and schistosomiasis in an AIDS patient. Autopsy& case reports, v. 2, n. 4, p. 35- 44, Dec. 2012.
CAMPO-POLANCO, Laura Francisca, et al. Strongyloidiasis in humans: diagnostic efficacy of four conventional methods and real-time polymerase chain reaction. Rev. Soc. Bras. Med. Trop., Uberaba, v. 51, n. 4, p. 493-502, Aug. 2018.
CRENITTE, Milton Roberto Furst et al. Strongyloidesstercoralishyperinfection: a dreaded but still missed diagnosis. Autopsy & case reports, v. 2, n. 3, p. 31-38. Sep. 2012.
DALL BELLO, Aline Gehlen et al. Disseminated paracoccidioidomycosis (simulating metastatic lung cancer) and Strongyloidesstercoralishyperinfestation in a steroid- treated patient. Journal of clinical microbiology, v. 49, n. 5, p. 2054-2055, 2011.
DE SOUZA, JN, et al. Case Report: Strongyloidesstercoralis Hyperinfection in a Patient with HTLV-1: An Infection with Filariform and Rhabditiform Larvae, Eggs, and Free-Living Adult Females Output. Am J Trop Med Hyg. v. 99, n. 6, p. 1583-1586. Dez. 2018.
DULLEY, Frederico Luiz et al. Strongyloides stercoralis hyperinfection after allogeneic stem cell transplantation. Bone marrow transplantation, v. 43, n. 9, p. 741-742, 2009.
FERREIRA, Carla Juliana Araújo et al. Fatal disseminated strongyloidiasis after kidney transplantation. Revista da Sociedade Brasileira de Medicina Tropical, v. 45, p. 652-654, 2012.
FIGUEIRA, Cláudia Frangioia et al. Strongyloides stercoralis hyperinfection associated with impaired intestinal motility disorder. Autops
GODOY, Pérsio et al. Thymoma and severe intestinal strongyloidiasis association. Revista da Sociedade Brasileira de Medicina Tropical, v. 31, n. 5, 1998.
HENRIQUEZ-CAMACHO, C, et al. Ivermectin versus albendazole or thiabendazole for Strongyloidesstercoralis infection. Cochrane Database Syst Rev. v. 18, n. 2016, Jan. 2016.
IRIEMENAM, NC, et al. Strongyloidesstercoralis and the immune response. Parasitol Int. v. 59, p. 9-14, Mar. 2010.
JOÃO, Guilherme Augusto Pivoto; ANTUNES, Italo Felipe Alves; DOS SANTOS, Luciana Mendes. Fatal Disseminated Strongyloidiasis with Periumbilical Purpura. The American Journal of Tropical Medicine and Hygiene, v. 105, n. 4, p. 860, 2021.
KOBAYASHI, Jun, et al. Studies on prevalence of Strongyloides infection in Holambra and Maceió, Brazil, by the agar plate faecal culture method. Rev. Inst. Med. trop. S. Paulo, São Paulo, v. 38, n. 4, p. 279-284, Aug. 1996.
KEISER, PB; NUTMAN, TB. Strongyloidesstercoralis in the Immunocompromised Population. Clinicalmicrobiology reviews, v. 17, p. 208–217, 2004.
KROLEWIECKI, A; NUTMAN, T B. Strongyloidiasis: A Neglected Tropical Disease. Infectious disease clinics of North America. v. 33, p. 135–151, 2019.
LAMBERTUCCI, José Roberto; LEÃO, Flávia Costa Carvalho; BARBOSA, Alfredo José Afonso. Gastric strongyloidiasis and infection by the human T cell lymphotropic virus type 1 (HTLV-1). Revista da Sociedade Brasileira de Medicina Tropical, v. 36, p. 541-542, 2003.
LEVENHAGEN, M. A.; COSTA-CRUZ, J. M. Update on immunologic and molecular diagnosis of human strongyloidiasis. Acta Tropica. v. 135, p. 33–43, 2014.
MEINE, GC, et al. Atypical gastric presentation of strongyloidiasis in HIV-infected patient—case report. Digestive and Liver Disease, v. 36, n. 11, p. 760–762, 2004.
MONTES, M, et al. Strongyloidesstercoralis: there but not seen. CurrOpin Infect Dis. v. 23, n. 5, p. 500-504, Out. 2010.
NASPOLINI, AP, et al. Periumbilical purpura: dermatoscopic findings in disseminated strongyloidiasis. Int J Dermatol., v. 57, n. 7, p. 30-31, Jul. 2018.
NUTMAN, TB. Human infection with Strongyloidesstercoralis and other related Strongyloides species. Parasitology. v. 144, n. 3, p. 263-273, Mar. 2017.
MINDERHOUND, TC et al. Infectionsduringglucocorticoid use. Rev. TijdschrGeneeskd. V.162, n. 3, p. 2215, Aug. 2018.
PAGE, W, SPEARE, R. Chronic strongyloidiasis - Don't look and you won't find. AustFamPhysician. v. 45, n. 1, p. 40-44, Jan-Fev. 2016.
PAULA, FM, COSTA-CRUZ, JM. Epidemiological aspects of strongyloidiasis in Brazil. Parasitology. v. 138, n. 11, p. 1331-1340, Set. 2011.
POLONI, JAT, et al. Strongyloidesstercoralislarvae or egg: Which came first?Transpl Infect Dis. v. 21, n. 6, 2019.
PORTO, AF, et al. HTLV-1 decreases Th2 type of immune response in patients with strongyloidiasis. Parasite Immunol., v. 23, n. 9, p. 503-507, Set. 2001.
PORTO, AF, et al. HTLV-1 decreases Th2 type of immune response in patients with strongyloidiasis. Parasite Immunol. v. 23, n. 9, p. 503-507, Set. 2001.
PORTO, Maria Aurélia F. et al. Implicações clínicas e imunológicas da associação entre o HTLV-1 e a estrongiloidíase. Rev. Soc. Bras. Med. Trop., Uberaba, v. 35, n. 6, p. 641-649, Dec. 2002.
REQUENA-MÉNDEZ, A, et al. The laboratory diagnosis and follow up of strongyloidiasis: a systematic review. PLoSNeglTropDis., v. 7, n. 1, 2013.
RIBEIRO, Luciano C, et al. Púrpura em paciente com estrongiloidíase disseminada.Rev. Soc. Bras. Med. Trop., Uberaba, v. 38, n. 3, p. 255-257, Mai. 2005.
RIOS, Juliana Trazzi, et al. Strongyloidesstercoralishyperinfection: an unusual cause of gastrointestinal bleeding. Rev. Assoc. Med. Bras., São Paulo, v. 61, n. 4, p. 311-312, Aug. 2015.
RODRIGUES, Maria Aparecida Marchesan, et al. Invasive enteritis by Strongyloidesstercoralis presenting as acute abdominal distress under corticosteroid therapy. Rev. Hosp. Clin., São Paulo, v. 56, n. 4, p. 103-106, Ago. 2001.
SANTANA, Adriana Trajano Torres, et al. Síndrome de hiperinfecção e/ou disseminação por Strongyloidesstercoralis em pacientes imunodeprimidos. Rev. bras. anal. clin. v. 49, n. 4, p. 351-358. 2017.
SIEGEL, M O; SIMON, G L. Is Human Immunodeficiency Virus Infection a Risk Factor for StrongyloidesstercoralisHyperinfection and Dissemination. PLoSNeglected Tropical Diseases, v. 6, n. 7, 2012.
SILVA, Maria do Rosário Alexandre; PAULA, Fabiana Martins. Placa de ágar no diagnóstico da estrongiloidíase. Rev. Acad. Oswaldo Cruz, São Paulo, v. 1, n.4, Out-Dez. 2015.
TABACOF, J, et al. Strongyloideshyperinfection in two patients with lymphoma, purulent meningitis, and sepsis. Cancer, v. 15, n. 68(8), p. 1821-1823, Out. 1991.
TEIXEIRA, MC, et al. Asymptomatic Strongyloidesstercoralishyperinfection in an alcoholic patient with intense anemia. J Parasitol. v. 96, n. 4, p. 833-835, Ago. 2010.
URBAN, JF Jr, et al. The importance of Th2 cytokines in protective immunity to nematodes. Immunol Rev. v. 127, p. 205-220, Jun. 1992.
VASQUEZ-RIOS, G, et al. Strongyloidesstercoralis hyperinfection syndrome: a deeper understanding of a neglected disease. J ParasitDis. v. 43, p. 167–175, 2019.
VELOSO, Moema Gonçalves Pinheiro, et al. Hiperinfecção por Strongyloidesstercoralis: relato de caso autopsiado. Rev. Soc. Bras. Med. Trop., Uberaba , v. 41, n. 4, p. 413-415, Aug. 2008.
VILELA, EG, et al. Strongyloidesstercoralishyperinfection syndrome after liver transplantation: case report and literature review. Transpl Infect Dis., v. 11, n. 2, p. 132-136, Abr. 2009.
