Clinical Research
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Mar 21, 2008; 14(11): 1768-1773
Published online Mar 21, 2008. doi: 10.3748/wjg.14.1768
Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection
Kazuto Kishimoto, Akira Hokama, Tetsuo Hirata, Yasushi Ihama, Manabu Nakamoto, Nagisa Kinjo, Fukunori Kinjo, Jiro Fujita
Kazuto Kishimoto, Yasushi Ihama, Manabu Nakamoto, Nagisa Kinjo, Fukunori Kinjo, Department of Endoscopy, Ryukyu University Hospital, Okinawa 903-0215, Japan
Akira Hokama, Tetsuo Hirata, Jiro Fujita, Department of Medicine and Therapeutics (First Department of Internal Medicine), Control and Prevention of Infectious Disease, Faculty of Medicine, University of the Ryukyus, Okinawa 903-0215, Japan
Correspondence to: Akira Hokama, Department of Medicine and Therapeutics (First Department of Internal Medicine), Control and Prevention of Infectious Disease, Faculty of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan. hokama-a@med.u-ryukyu.ac.jp
Telephone: +81-98-8951144
Fax: +81-98-8951414
Received: September 24, 2007
Revised: November 18, 2007
Published online: March 21, 2008
Abstract

AIM: To investigate endoscopic and histopathological findings in the duodenum of patients with Strongyloides stercoralis (S. stercoralis) hyperinfection.

METHODS: Over a period of 23 years (1984-2006), we investigated 25 patients with S. stercoralis hyperinfection who had had an esophagogastroduodenoscopy before undergoing treatment for strongyloidiasis. The clinical and endoscopic findings were analyzed retrospectively.

RESULTS: Twenty-four (96%) of the patients investigated were under immunocompromised condition which was mainly due to a human T lymphotropic virus type 1 (HTLV-1) infection. The abnormal endoscopic findings, mainly edematous mucosa, white villi and erythematous mucosa, were observed in 23 (92%) patients. The degree of duodenitis including villous atrophy/destruction and inflammatory cell infiltration corresponded to the severity of the endoscopic findings. The histopathologic yield for identifying larvae was 71.4% by duodenal biopsy. The endoscopic findings of duodenitis were more severe in patients whose biopsies were positive for larvae than those whose biopsies were negative (Endoscopic severity score: 4.86 ± 2.47 vs 2.71 ± 1.38, P < 0.05).

CONCLUSION: Our study clearly demonstrates that, in addition to stool analysis, endoscopic observation and biopsies are very important. We also emphasize that S. stercoralis and HTLV-1 infections should be ruled out before immunosuppressive therapy is administered in endemic regions.

Keywords: Strongyloides stercoralis; Strongyloidiasis; Hyperinfection; Endoscopy; Histopathology; Duodenum