Strongyloides stercoralis infection in a non-endemic area

Amity L. Roberts, Ashley E. Schneider, Renee L. Young, Steven Heye Hinrichs, Peter Charles Iwen

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

Patient: 75-year-old Caucasian male. Chief Complaint: Frequent diarrhea. History of Present Illness: The patient had a history of Crohn's disease, initially diagnosed in 1976 with a positive test for toxigenic Clostridium difficile (C. difficile) in August 2011, successfully treated with methronidazole (500 mg PO bid ×10 d). There was a concern that diarrhea may be a result of C. difficile recurrence. Past Medical History: The patient had an extensive medical history, including eosinophilia (8%, normal 0%-7%) in October 2011, gastroesophageal reflux disease, anemia secondary to Crohn's disease, coronary artery disease, hypertension, osteoarthritis, and Type II diabetes mellitus. Additionally, the patient has severe Crohn's disease which involves the terminal ileum and colon, and has undergone multiple small bowel resections as well as a colectomy. Medications included immunomodulatory therapy with balsalazide (Colazal), azathioprine (Imuran), infliximab (Remicade), ranitidine, and prednisone for both Crohn's disease and osteoarthritis. Previous biopsies of the small intestine and colon (before the current presentation) indicated changes consistent with Crohn's disease. Travel History: The patient was originally from Louisiana, and briefly lived in Las Vegas, NV. For approximately 40 years, he has lived in western Iowa. The patient did not have a history of foreign travel nor had he recently traveled outside of Iowa or Nebraska. He drives a bus for a local business. Principle Laboratory Findings: Loose brown stool was collected in December 2011 and submitted for laboratory testing for toxigenic C. difficile and cultured for enteric pathogens. An ova and parasites exam was not ordered at that time. Salmonella, Shigella, and Campylobacter species, as well as Shiga toxin producing-Escherichia coli, were not detected; the toxigenic C. difficile assay was negative. A laboratory technologist noted the presence of small trails of displaced bacteria on the blood agar plate from the original stool culture (Image 1). From this, a full ova and parasites exam was performed on the stool specimen.

Original languageEnglish (US)
Pages (from-to)339-343
Number of pages5
JournalLaboratory medicine
Volume44
Issue number4
DOIs
StatePublished - Sep 1 2013

Fingerprint

Strongyloides stercoralis
Crohn Disease
Clostridium difficile
Clostridium
Infection
Azathioprine
Osteoarthritis
Ovum
Diarrhea
Colon
Parasites
Shiga-Toxigenic Escherichia coli
Ranitidine
Shigella
Campylobacter
Shiga Toxin
Immunomodulation
Colectomy
Eosinophilia
Motor Vehicles

Keywords

  • Crohn's disease
  • Diarrhea
  • Prednisone
  • Strongyloides stercoralis
  • Strongyloidiasis

ASJC Scopus subject areas

  • Clinical Biochemistry
  • Biochemistry, medical

Cite this

Strongyloides stercoralis infection in a non-endemic area. / Roberts, Amity L.; Schneider, Ashley E.; Young, Renee L.; Hinrichs, Steven Heye; Iwen, Peter Charles.

In: Laboratory medicine, Vol. 44, No. 4, 01.09.2013, p. 339-343.

Research output: Contribution to journalReview article

Roberts, Amity L. ; Schneider, Ashley E. ; Young, Renee L. ; Hinrichs, Steven Heye ; Iwen, Peter Charles. / Strongyloides stercoralis infection in a non-endemic area. In: Laboratory medicine. 2013 ; Vol. 44, No. 4. pp. 339-343.
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AB - Patient: 75-year-old Caucasian male. Chief Complaint: Frequent diarrhea. History of Present Illness: The patient had a history of Crohn's disease, initially diagnosed in 1976 with a positive test for toxigenic Clostridium difficile (C. difficile) in August 2011, successfully treated with methronidazole (500 mg PO bid ×10 d). There was a concern that diarrhea may be a result of C. difficile recurrence. Past Medical History: The patient had an extensive medical history, including eosinophilia (8%, normal 0%-7%) in October 2011, gastroesophageal reflux disease, anemia secondary to Crohn's disease, coronary artery disease, hypertension, osteoarthritis, and Type II diabetes mellitus. Additionally, the patient has severe Crohn's disease which involves the terminal ileum and colon, and has undergone multiple small bowel resections as well as a colectomy. Medications included immunomodulatory therapy with balsalazide (Colazal), azathioprine (Imuran), infliximab (Remicade), ranitidine, and prednisone for both Crohn's disease and osteoarthritis. Previous biopsies of the small intestine and colon (before the current presentation) indicated changes consistent with Crohn's disease. Travel History: The patient was originally from Louisiana, and briefly lived in Las Vegas, NV. For approximately 40 years, he has lived in western Iowa. The patient did not have a history of foreign travel nor had he recently traveled outside of Iowa or Nebraska. He drives a bus for a local business. Principle Laboratory Findings: Loose brown stool was collected in December 2011 and submitted for laboratory testing for toxigenic C. difficile and cultured for enteric pathogens. An ova and parasites exam was not ordered at that time. Salmonella, Shigella, and Campylobacter species, as well as Shiga toxin producing-Escherichia coli, were not detected; the toxigenic C. difficile assay was negative. A laboratory technologist noted the presence of small trails of displaced bacteria on the blood agar plate from the original stool culture (Image 1). From this, a full ova and parasites exam was performed on the stool specimen.

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