Endoscopic and histopathological study on the duodenum of Strongyloides stercoralis hyperinfection.
OBJECTIVE
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).


CONCLUSIONS
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.
Kishimoto
Kazuto
K
Department of Endoscopy, Ryukyu University Hospital, Okinawa 903-0215, Japan.
Hokama
Akira
A
Hirata
Tetsuo
T
Ihama
Yasushix
Y
Nakamoto
Manabu
M
Kinjo
Nagisa
N
Kinjo
Fukunori
F
Fujita
Jiro
J
D000368:Aged; D000818:Animals; D001706:Biopsy; D004382:Duodenitis / Q000469:parasitology / Q000473:pathology*; D004386:Duodenum / Q000469:parasitology / Q000473:pathology*; D016145:Endoscopy, Digestive System; D005243:Feces / Q000469:parasitology; D005260:Female; D015490:HTLV-I Infections / Q000150:complications; D006801:Humans; D007413:Intestinal Mucosa / Q000469:parasitology / Q000473:pathology; D007564:Japan; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013183:Sputum / Q000469:parasitology; D017171:Strongyloides stercoralis / Q000302:isolation & purification*; D013322:Strongyloidiasis / Q000150:complications / Q000469:parasitology / Q000473:pathology*