final program.qxd - Parallels Plesk Panel

PP 6.12
Severe, extensive, and difficult-to-eradicate Strongylodies stercoralis infection
probably supported by an underlying Sjogren syndrome requiring long-term steroid
treatment
Roberto Manfredi, Sergio Sabbatani
Infectious Diseases, University of Bologna, Italy
Introduction
In the majority of otherwise healthy patients (p), strongyloidiasis (S) remains
underestimated: only when some primary-secondary immunodeficiency occurs, S may
involve multiple organs, outside the more obvious gut localization, towards disseminated
and/or relapsing manifestations.
Case report
A female p who suffered from Sjogren syndrome treated since over 20 years with cyclic
oral steroids, due to dyspeptic signs and symptoms underwent an endoscopy which
detected a histopathology-confirmed gastroduodenal S. After a three-day albendazole a
repeated endoscopy-histology showed a persisting S, so that a further albendazole cycle
was administered, but two subsequent controls (performed four and ten months after),
demonstrated the persistence of S. stercoralis infection. Upon Hospital admission (nine
months later), our p suffered from weight loss and anemia. Stool, sputum, and urine
search for S. sterocoralis tested negative, as well as HIV and HTLV-1 serology, and
tumoral markers. A two-day ivermectine treatment at 12 g/day, preceded a three-day
albendazole course performed the subsequent week, and a three-day mebendazole one
week later. Repeated endoscopy was performed one and two months after discharge,
confirming a sustained cure of S, associated with improved general conditions and a body
weight regain. During the entire evaluation and treatment period, the concurrent steroid
therapy (prednisone, at 25 mg/day), was deemed necessary for the concurrent Sjogren
disease, and was therefore never interrupted.
POSTERS
Discussion
S is endemic in tropical and subtropical regions, where severe associations were
demonstrated in HTLV-1-infected p. In developed countries, p with a broad spectrum of
underlying diseases, or receiving immunosuppressive drugs, may suffer from S
refractory to first-line therapy, due the frequency of re-infestation. Although anecdotal
reports regarded p with chronic disorders and collagen vascular disease, no p with
Sjogren syndrome was reported to date. The described report is therefore an unique
association of a difficult-to treat S occurring in a p with a steroid-controlled Sjogren
syndrome. Since controlled trials and definite recommendations are lacking, either
albendazole, thiabendazole, ivermectin, or mebendazole at different dosages and
schedules were used, while the management of relapses lacks of evidence-based
guidelines. Clinicians should also consider that S is expected to increase its frequency,
based on environmental changes (increased temperatureand humidity), just in countries
where an increasing number of p become at risk for opportunism in the meantime.
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