Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection

Table 1 Clinical characteristics of patients with S. stercoralis hyperinfection

Case No.	Age/Gender	Presenting symptoms and/or illness	Immunosuppressive state	Diagnosis	Treatment	Outcome
1	51/M	Meningitis, GI bleeding	Alcoholism	Duodenal biopsy, stool	TBZ	Cured
2	72/M	Diarrhea	HTLV-1	Stool	TBZ	Cured
3	80/M	Sepsis, meningitis	HTLV-1, corticosteroids	Duodenal biopsy, stool, sputum, gastroduodenal drainage	TBZ	Cured
4	38/M	Abdominal pain	HTLV-1	Duodenal biopsy, stool	TBZ	Cured
5	58/F	Sepsis, diarrhea, pneumonia	Corticosteroids	Sputum	IVM	Dead
6	86/F	Vomiting, weight loss	HTLV-1, DM	Duodenal biopsy, stool, sputum	IVM	Cured
7	31/F	SBO, abdominal pain, vomiting	HTLV-1, alcoholism	Duodenal biopsy, stool, gastroduodenal drainage	TBZ	Cured
8	58/F	Vomiting, weight loss	HTLV-1	Duodenal biopsy, gastroduodenal drainage	IVM	Cured
9	62/M	Meningitis, diarrhea	HTLV-1, DM	Duodenal biopsy, gastroduodenal drainage	TBZ	Cured
10	73/F	Abdominal pain	HTLV-1, liver cirrhosis	Stool	IVM	Cured
11	58/M	SBO, abdominal pain, vomiting	HTLV-1, DM	Duodenal biopsy	IVM, TBZ	Cured
12	52/M	SBO, abdominal pain, vomiting	HTLV-1	Duodenal biopsy, stool, gastroduodenal drainage	TBZ	Cured
13	74/M	Diarrhea, weight loss	Chronic renal failure	Stool	IVM	Cured
14	66/F	Vomiting, diarrhea	HTLV-1	Duodenal biopsy, stool	TBZ	Cured
15	42/M	SBO, abdominal pain, GI bleeding	HTLV-1	Duodenal biopsy, stool	IVM, TBZ	Cured
16	56/F	Vomiting, abdominal pain	HTLV-1	Duodenal biopsy, gastroduodenal drainage	TBZ	Cured
17	62/M	SBO, abdominal pain, vomiting	None	Stool	TBZ	Cured
18	80/M	SBO, abdominal pain, vomiting	Alcoholism	Stool	IVM	Cured
19	82/M	SBO, meningitis, pneumonia	DM	Stool, sputum	IVM	Dead
20	57/M	Diarrhea, weight loss	HTLV-1	Stool	IVM	Cured
21	76/F	Vomiting, weight loss	HTLV-1	Duodenal biopsy, stool	TBZ	Cured
22	50/F	SBO, abdominal pain, vomiting	HTLV-1, corticosteroids	Duodenal biopsy	IVM	Cured
23	66/M	Vomiting, weight loss	HTLV-1	Duodenal biopsy, gastroduodenal drainage	IVM	Cured
24	71/M	Sepsis, diarrhea	Corticosteroids	Gastroduodenal drainage	IVM	Cured
25	74/F	Vomiting, diarrhea, weight loss	HTLV-1	Gastroduodenal drainage, stool	IVM	Cured

GI: Gastrointestinal; SBO: Small bowel obstruction; DM: Diabetes mellitus; TBZ: Thiabendazole; IVM: Ivermectin.

Table 2 Endoscopic and histopathological findings of the duodenum

Case No.	Endoscopic findings of the duodenum	Histopathologic detection of S. stercoralis in the duodenum
1	Edema, erythema, erosion, hemorrhage	Larvae
2	Erythema	Negative
3	Edema, white villi, erosion	Larvae
4	Edema, white villi, erythema, dilatation	Larvae
5	White villi	ND
6	Edema, fine granule	Larvae
7	Erythema	Larvae
8	Edema, erosion, stenosis	Larvae
9	Edema, white villi	Larvae
10	Normal	ND
11	Edema, white villi, dilatation	Larvae
12	Edema, white villi	Larvae
13	White villi, erythema	Negative
14	Edema, white villi, fine granule	Larvae
15	Edema, erythema, ulcer, hemorrhage, pseudopolyps	Larvae
16	Edema, white villi, stenosis	Larvae
17	Edema, stenosis	Negative
18	White villi, erythema, erosion	Negative
19	Edema, ulcer	Negative
20	Normal	ND
21	Edema, white villi, erosion, hemorrhage	Larvae
22	Edema, white villi, erosion, fine granule, stenosis	Larvae
23	Fine granule, dilatation	Larvae
24	Edema, white villi, erythema	Negative
25	Erythema	Negative

Edema: Edematous mucosa; Erythema: Erythematous mucosa; ND: Biopsies were not done.

Table 3 Reported endoscopic findings of the duodenum with strongyloidiasis in literature

Authors	Year	No. of cases	Immunosuppressive state	Endoscopic findings of the duodenum
Brasitus et al[3]	1980	1	None	Brisk bleeding, deformed bulb
Milder et al[4]	1981	2	ND	Enlarged folds
Bone et al[5]	1982	1	ND	Deformed cap, obliterated second part
Bhatt et al[6]	1990	1	None	Mild erythema
Chen et al[7]	1994	1	Corticosteroids	Flattened folds, swelling mucosa, tiny ulcer
Choudhry et al[8]	1995	3	DM, none	Multiple serpiginous lesions, duodenal nodule
Hizawa et al[9]	1996	1	HTLV-1 and corticosteroids	Edema, tiny white spots
Friedenberg et al[10]	1999	1	HTLV-1	Severe stenosis
Overstreet et al[11]	2003	1	HIV	White punctate dotting mucosa
Asano et al[12]	2004	1	HTLV-1	Fine granule, coarse mucosa, disappeared folds
Thompson et al[13]	2004	6	Corticosteroids, DM, HIV, none	Edema, brown discoloration, erythematous spots,
				subepithelial hemorrhage, megaduodenum
Seet et al[14]	2005	1	Anti-myeloma drugs	Erythematous and granular mucosa
Karmo et al[15]	2006	1	Corticosteroids	Normal
Ghoshal et al[16]	2006	1	Corticosteroids	Multiple nodules
Werneck-Silva et al[17]	2006	4	ND	Erythema, erosion
Csermely et al[18]	2006	1	Anti-myeloma drugs	Necrotic ulcerations
Suarez and Sanchez[19]	2006	11	ND	Swollen folds of nodular aspect

ND: Not determined.