粪类圆线虫病两例报告
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摘要
粪类圆线虫病是易被忽视的寄生虫病,临床表现复杂多变且无特异性,在我国呈散发感染,易被漏诊或误诊。其多数发生在免疫功能低下的人群中,且在人体中重复感染,严重者可致死。该文报道2例粪类圆线虫感染病例,1例患者以左腰部疼痛3年并加重10 d入院,入院前曾有发热,既往因皮肤湿疹有间断口服糖皮质激素(激素)史,入院检查粪便潜血试验阳性,镜下可见粪类圆线虫虫体,确诊为左肾多发结石并积液、粪类圆线虫感染,予阿苯达唑及经皮肾镜碎石取石术治愈出院;另1例患者有肾病综合征,正在接受激素及免疫抑制药联合治疗,以咳嗽、咳痰为首发症状,继而出现黑烂便,粪便潜血阳性,血色素进行性下降,在痰、胃液及粪便标本中均可看到虫体,X线胸片提示弥漫渗出病灶,最后因线虫感染并重症肺炎发展为脓毒症休克死亡。该2例的诊治经过提示,粪类圆线虫病多发生于免疫功能低下者,临床表现无特异性,早期诊治有助改善患者预后。
Strongyloides stercoralis infection is a parasitic disease that is likely to be neglected. This disease has complex, varied and non-specific clinical manifestations, which is sporadically infected in China and is likely to be misdiagnosed. Strongyloides stercoralis is primarily prevalent in the immunocompromised population, which can lead to recurrent infection and even death. In this article, 2 cases of Strongyloides stercoralis infection were reported. One patient was admitted to hospital due to left lumbar pain for 3 years and aggravation for 10 d. The patient suffered from fever prior to admission, and had a history of intermittent oral administration of glucocorticoid( hormone) due to skin eczema. Upon admission, the fecal occult blood test was positive. Strongyloides stercoralis was observed under the microscope. The patient was diagnosed with multiple stones in the left kidney complicated with effusion and Strongyloides stercoralis infection, and was discharged after receiving albendazole therapy and percutaneous nephrolithotripsy. The other patient was diagnosed with nephrotic syndrome and treated with hormone and immunosuppressive drugs. The patient had cough and expectoration as the first symptoms, followed by black stool, positive for fecal occult blood test and progressive decrease of hemoglobin. The worm bodies could be observed in the sputum, gastric fluid and stool specimens. Chest X-ray showed diffuse exudation lesions of both lungs. The patient died from septic shock due to nematode infection and severe pneumonia. The diagnosis and treatment of these two cases should be suggest that Strongyloides stercoralis infection mostly occurs in immunocompromised patients with non-specific clinical manifestations. Early diagnosis and treatment could be improve the clinical prognosis of patients.
Strongyloides stercoralis infection is a parasitic disease that is likely to be neglected. This disease has complex, varied and non-specific clinical manifestations, which is sporadically infected in China and is likely to be misdiagnosed. Strongyloides stercoralis is primarily prevalent in the immunocompromised population, which can lead to recurrent infection and even death. In this article, 2 cases of Strongyloides stercoralis infection were reported. One patient was admitted to hospital due to left lumbar pain for 3 years and aggravation for 10 d. The patient suffered from fever prior to admission, and had a history of intermittent oral administration of glucocorticoid( hormone) due to skin eczema. Upon admission, the fecal occult blood test was positive. Strongyloides stercoralis was observed under the microscope. The patient was diagnosed with multiple stones in the left kidney complicated with effusion and Strongyloides stercoralis infection, and was discharged after receiving albendazole therapy and percutaneous nephrolithotripsy. The other patient was diagnosed with nephrotic syndrome and treated with hormone and immunosuppressive drugs. The patient had cough and expectoration as the first symptoms, followed by black stool, positive for fecal occult blood test and progressive decrease of hemoglobin. The worm bodies could be observed in the sputum, gastric fluid and stool specimens. Chest X-ray showed diffuse exudation lesions of both lungs. The patient died from septic shock due to nematode infection and severe pneumonia. The diagnosis and treatment of these two cases should be suggest that Strongyloides stercoralis infection mostly occurs in immunocompromised patients with non-specific clinical manifestations. Early diagnosis and treatment could be improve the clinical prognosis of patients.
引文
[1]Jourdan PM,Lamberton PHL,Fenwick A,Addiss DG.Soiltransmitted helminth infections.Lancet,2018,391(10117):252-265.
[2]Laoraksawong P,Sanpool O,Rodpai R,Thanchomnang T,Kanarkard W,Maleewong W,Kraiklang R,Intapan PM.Current high prevalences of Strongyloides stercoralis and Opisthorchis viverrini infections in rural communities in northeast Thailand and associated risk factors.BMC Public Health,2018,18(1):940.
[3]Chan FLY,Kennedy B,Nelson R.Fatal Strongyloides hyperinfection syndrome in an immunocompetent adult with review of the literature.Intern Med J,2018,48(7):872-875.
[4]李俊达,王晓玲,黄群.粪类圆线虫二例的临床特征和诊治.中华传染病杂志,2013,31(5):308-311.
[5]Requena-Méndez A,Chiodini P,Bisoffi Z,Buonfrate D,Gotuzzo E,Mu?oz J.The laboratory diagnosis and follow up of strongyloidiasis:a systematic review.PLo S Negl Trop Dis,2013,7(1):e2002.
[6]Nadir E,Grossman T,Ciobotaro P,Attali M,Barkan D,Bardenstein R,Zimhony O.Real-time PCR for Strongyloides stercoralisassociated meningitis.Diagn Microbiol Infect Dis,2016,84(3):197-199.
[7]Henriquez-Camacho C,Gotuzzo E,Echevarria J,White AC Jr,Terashima A,Samalvides F,Pérez-Molina JA,Plana MN.Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection.Cochrane Database,Syst Rev,2016,18(1):CD007745.
[2]Laoraksawong P,Sanpool O,Rodpai R,Thanchomnang T,Kanarkard W,Maleewong W,Kraiklang R,Intapan PM.Current high prevalences of Strongyloides stercoralis and Opisthorchis viverrini infections in rural communities in northeast Thailand and associated risk factors.BMC Public Health,2018,18(1):940.
[3]Chan FLY,Kennedy B,Nelson R.Fatal Strongyloides hyperinfection syndrome in an immunocompetent adult with review of the literature.Intern Med J,2018,48(7):872-875.
[4]李俊达,王晓玲,黄群.粪类圆线虫二例的临床特征和诊治.中华传染病杂志,2013,31(5):308-311.
[5]Requena-Méndez A,Chiodini P,Bisoffi Z,Buonfrate D,Gotuzzo E,Mu?oz J.The laboratory diagnosis and follow up of strongyloidiasis:a systematic review.PLo S Negl Trop Dis,2013,7(1):e2002.
[6]Nadir E,Grossman T,Ciobotaro P,Attali M,Barkan D,Bardenstein R,Zimhony O.Real-time PCR for Strongyloides stercoralisassociated meningitis.Diagn Microbiol Infect Dis,2016,84(3):197-199.
[7]Henriquez-Camacho C,Gotuzzo E,Echevarria J,White AC Jr,Terashima A,Samalvides F,Pérez-Molina JA,Plana MN.Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection.Cochrane Database,Syst Rev,2016,18(1):CD007745.