title: Unsuspected Strongyloides stercoralis infection in hospital patients with comorbidity in need of proper management.
abstract: BACKGROUND
  Investigate the role of latent strongyloidiasis infection in patients at the University Hospital, Honduras.
  
  
  METHODS
  Prospective observational cohort study during 20 non consecutive months from March 2009 to February 2011. Epidemiological and clinical data obtained from patients excreting Strongyloides stercoralis larvae in stool who consulted at the hospital were recorded and analyzed.
  
  
  RESULTS
  Thirty five (5 %) of 712 patients had S. stercoralis larvae in one stool sample; 62.8 % came from rural areas and 91.7 % were poor; 68.5 % (24/35) were 21 years old or older. Eight patients (22.8 %) had no predisposing illness; 3 (8.6 %) received steroid treatment, 29/35 (82.8 %) presented with persistent diarrhea and 24/35 (68.5 %) presented following comorbidities: HIV/AIDS (31.4 %), alcoholism alone (11.4 %) or with other associated illness (8.6 %), malignancy (8.6 %), renal failure (5.7 %) and hyperthyroidism (2.8 %). A combination of symptoms suggestive of strongyloidiasis but indistinguishable from those potentially associated to their comorbid condition included severe epigastric pain, diarrhea of weeks duration, peripheral eosinophilia, astenia, adynamia, fever, anemia and weight loss in 85.7 % of the cases, 3 of whom described skin lesions compatible with larva currens. None of the diagnostic clinical impressions mentioned Strongyloides infection. Ten strongyloidiasis patients received partial treatment with albendazole or ivermectin. Incomplete data, underestimation of the parasitic infection and no laboratory follow-up of the patients limited our observations.
  
  
  CONCLUSIONS
  Strongyloides stercoralis is an unsuspected and neglected parasitic infection by health personnel in Honduras. Lack of awareness of its importance represents a strong barrier to proper treatment and follow-up, posing a threat of possible fatal complications in patients with comorbid conditions.
authors.affiliation: Department of Pediatric, School of Medical Sciences, National Autonomous University of Honduras, and Parasitology Service, Department of Clinical Laboratory, University Hospital, Tegucigalpa, Honduras. camilaestela12@yahoo.com.
authors.forename: Rina Lisette Girard
authors.initials: RL
authors.lastname: Kaminsky
authors.affiliation: Department of Morphological Sciences, School of Medical Sciences, National Autonomous University of Honduras, Tegucigalpa, Honduras. selvin.reyes@unah.edu.hn.
authors.forename: Selvin Zacarías
authors.initials: SZ
authors.lastname: Reyes-García
authors.affiliation: Department of Morphological Sciences, School of Medical Sciences, National Autonomous University of Honduras, Tegucigalpa, Honduras. lysien.zambrano@unah.edu.hn.
authors.forename: Lysien Ivania
authors.initials: LI
authors.lastname: Zambrano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005243:Feces / Q000469:parasitology; D005260:Female; D006721:Honduras / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007814:Larva; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D017171:Strongyloides stercoralis / Q000302:isolation & purification*; D013322:Strongyloidiasis / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult