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Introduction. Strongyloidiasis in a parasitic diseases determined by the intestinal nematode Strongyloides stercoralis. In most cases, this disease is asymptomatic, but the immunocompromised patients can develop severe forms like hyper infestation and disseminated strongyloidiasis. There severe forms of the disease are associated with bacteremias with gastrointestinal microorganisms which can determine infectious complication anywhere in the body. Bacterial meningitis is the most common complication of this kind. Case presentation. We present you the case of a 78 years old patient who initially presented in another hospital for suddenly installed aphasia. He was clinical and paraclinical evaluated and the suspected diagnosis was acute meningoencephalitis, so he was transferred in our hospital. This is a case about a patient with an immunocompromised status determined by recent infection with SARS-CoV-2 who was hospitalized and received prolonged corticosteroid therapy. The clinical examination performed at the admission shows a patient with mediocre general status, partially cooperative, partially time-spatial oriented and to one’s own person, discreet neck stiffness, anxious-depressive mood, with acute respiratory failure. A coproparasitological examination is performed which reveals the presence of filariform larvae of Strongyloides stercoralis in the stool. Also, a parasitic PCR test from a stool sample is positive for Strongyloides stercoralis. These clinical and paraclinical findings corroborated with those found in the cerebrospinal fluid examination establish the diagnosis: acute bacterial meningoencephalitis secondary to disseminated strongyloidiasis. During the disease’s evolution, he is confirmed with a new infection with SARS-CoV-2. He receives antiviral treatment, antiparasitic treatment, antibiotic treatment and symptomatic treatment. The evolution of the disease is favorable. Conclusions. The immunocompromised status of the patient determined the evolution of the infestation with Strongyloides stercoralis to a severe form complicated with acute bacterial meningoencephalitis. The difficulty in establishing the diagnosis of strongyloidiasis is represented by the fact that Romania is a non-endemic country for the infection with this parasite. [ABSTRACT FROM AUTHOR]

Severe cases of strongyloidiasis are most often associated with multiple causes of immune suppression, such as corticoid treatment and HTLV (human T-lymphotropic virus) coinfection. Diabetes is not traditionally considered a risk factor for the development of severe strongyloidiasis. We report a rare case of autochthonous severe strongyloidiasis in Romania, a European country with a temperate climate. A 71-year-old patient with no prior travel history was admitted with multiple gastrointestinal complaints and recent weight loss. CT (computed tomography) scans indicated duodenal wall thickening, and duodenal endoscopy evidenced mucosal inflammation, ulcerations and partial duodenal obstruction at D4. Microscopic examination of stool samples and biopsy specimens from the gastric and duodenal mucosa revealed an increased larval burden characteristic of Strongyloides stercoralis hyperinfection. Sequential treatment with albendazole and ivermectin achieved parasitological cure and complete recovery. The novelty of our case stems from the scarcity of severe strongyloidiasis cases reported in Europe and especially in Romania, the absence of other risk factors in our patient aside from diabetes, the involvement of the gastric mucosa and the rare presentation as partial duodenal obstruction. This case highlights the importance of considering strongyloidiasis as a differential diagnosis, even in temperate climates where cases are sporadic, in cases in which immune suppression is not evident and in the absence of eosinophilia. The case is presented in the context of the first literature review examining the relationship between severe strongyloidiasis and diabetes, emphasizing diabetes as a possible risk factor for severe strongyloidiasis. [ABSTRACT FROM AUTHOR]

Strongyloides stercoralis is a zoonotic soil-transmitted nematode affecting mainly humans and dogs but identified also in non-human primates, cats and wild carnivores. It has a cosmopolitan distribution being endemic in tropical and subtropical areas. In Romania, the infection was reported on several occasions in dogs with low prevalence (3.5% -3.8%), assessed by coproscopy and it was confirmed in human patients with no travel history. A 2-year-old male Boston Terrier dog presented to a private clinic due to severe digestive problems, in July 2022. The animal had a long history of health problems. The dog was in a very bad clinical condition with severe abdominal pain, bloody diarrhea, and weight loss. Coproparasitological examinations using the saline flotation method and the modified Baermann's technique were done, both being negative. In addition, an intestinal biopsy was performed during the second endoscopy. Nematodes were collected and identified morphologically and molecularly confirmed. Histology revealed severe inflammation of the duodenal mucosa with areas of edema, necrosis, and hemorrhage, and in the intestinal glands, there were numerous nematodes suggesting a parasitic infection by Strongyloides spp. PCR followed by sequencing confirmed the infection with S. stercoralis. The dog was treated with a combination of oral fenbendazole and milbemycin oxime for 5 months. No relapse was observed 3 months after negativity was attained. This case describes a severe clinical infection by Strongyloides stercoralis in a domestic dog from Romania and the recovery after long-term treatment. • Strongyloides stercoralis in dogs can produce severe acute infections. • Diagnosis can be achieved by using endocscopy. • Treatment of canine strongyloidosis is changeling. • Combination of benzimidazoles and macrocyclic lactones seems effective when administered long time. [ABSTRACT FROM AUTHOR]

Background: Severe strongyloidiasis caused by the parasite Strongyloides stercoralis can manifest in two distinct forms: Strongyloides hyperinfection syndrome (SHS) and disseminated strongyloidiasis. Both can be the result of multiple risk factors with immunosuppression as the underlying theme: usage of immunosuppressive treatments (drugs, irradiation), organ or bone marrow transplantation, coinfection with HTLV-1 or HIV, presence of IRIS, hematologic malignancies, hypogammaglobulinemia, malnutrition or alcoholism. While severe strongyloidiasis has been described in immunocompetent patients with diabetes mellitus, it is still unclear if diabetes can be considered a relevant risk factor for the infection. Objective: The aim of this comprehensive review is to assess whether diabetes alone can be regarded as a risk factor for the occurrence of severe strongyloidiasis. Material and methods: A search of the existing literature was conducted in three different databases (PubMed, Web of Science, Scopus) by using two separate search algorithms adapted for each one of them: (strongyloides OR strongyloidiasis) AND diabetes AND (hyperinfection OR disseminated strongyloidiasis); (strongyloides OR strongyloidiasis) AND immunocompetent. The searches were performed on the 27th of February 2024 and yielded a total number of 265 results. Case reports and case report series were selected to further apply the inclusion criteria: coexistence of diabetes mellitus and severe strongyloidiasis without any other risk factor associated with the latter being present. A total of 13 cases written in English were included in the final analysis. Results : From the total of 13 patients that met the inclusion criteria, 11 (84.62%) were male and 2 (15.38%) were female. The median age for these patients was 61 years (range 31-82 years). The cases mainly originated in Asia (n = 6, 46.15%) with only one case reported in Europe (n = 1, 7.69%) and one in Australia (n = 1, 7.69%). The rest (n = 5, 38.46%) had northern American origin. Most included cases described SHS (n = 9, 69.23%) and only 4 patients (30.77%) presented with eosinophilia. An increased mortality rate (n = 6, 46.15%) was observed, the cause being failure in diagnosing S. stercoralis infection, a delayed diagnosis, or major complications despite starting appropriate treatment. A total of 9 patients (69.23%) were treated with ivermectin, the first-line therapy for strongyloidiasis. Conclusions: Based on our findings, we cannot exclude diabetes as a risk factor in the occurrence of severe strongyloidiasis. However, due to limited data, future research is required to further reach a clearer conclusion. [ABSTRACT FROM AUTHOR]