Strongyloides Stercoralis as a Risk Factor for Arthritis in Humans
Maria Amelia A Gracio*
Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal
Submission: September 25, 2018; Published: October 01, 2018
*Corresponding author: Maria Amelia A Gracio, Instituto de Higiene Medicina Tropical, Universidade Nova de Lisboa, Portugal.
How to cite this article: Maria A A G. Strongyloides Stercoralis as a Risk Factor for Arthritis in Humans. Nov Tech Arthritis Bone Res. 2018; 3(2): 555609. DOI:10.19080/NTAB.2018.03.555609
Keywords: Strongyloides Stercoralis; Strongyloidiasis; Arthritis
Opinion
Arthritis, an inflammation of one or more joints, characterized by swelling, warmth, redness of the overlying skin, pain and restriction of motion, can have different origins, between them the parasitic origin. Effectively, the parasitic nematode worm Strongyloides stercoralis, that occurs almost world- wide, excluding only the far north and south, is a potential causal agent of arthritis in its human hosts [1]. With the present edital containing more recent information we wish to alert the reader to strongyloidiasis by S. stercoralis as a potential risk factor for arthritis in its hosts. S. stercoralis was described in 1876 but only in the 1930s, the full life cycle, pathology and clinical features in human were fully disclosed. It was then possible to know that the rhabditiform larvae are excreted in the stool of infected individuals and in the soil develop into infected third stage filariform which can infected a new host by penetrating the skin. After, they migrate to the lungs, here they cause tissue destruction and bleeding, and after migrating to the trachea branchial tree and subsequently will be ingested to the gastrointestinal tract, where they transform into the adult worms, living in the duodenojejunal mucosa and produce eggs that transform into rhabditiform larvae which are passed with feces and mature into filariform larvae. S. stercoralis can reproduce within a human host (endogenous autoinfection) which may result in long-lasting infections [2].
For demonstrate that S. stercoralis as a risk factor for arthritis in humans has deserved the attention of investigators, we selected one case published in 1984, and several cases published in the 2000s. In 1984, the authors [3] have reported the case of a 40- year- old man with vasculitis and symmetrical polyarthritis in addition to ‘boggy’ swelling of his ankles. Histológicas examination of synovium of the ankle revealed parasitic invasion by S. stercoralis larvae. In 2003, the authors [4] presented the case of a 35-year-old man with recent-onset symmetrical polyarthritis that “after repeated examination was the presence of larvae of S. stercoralis detected in concentrated fresh stool”. In 2005, the authors [5] described a 69-year-old woman without evidence of immunosuppression that had S. stercoralis infection presenting with severe malabsorption and a severe arthritis of the ankle.
In 2006, the authors [6] present the case of a 44-year- old man from Sierra Leone living in Germany For 18 years and that had presented arthritis and the microscopy of fresh stool had revealed larvae of S. stercoralis. In 2010, the authors [7] present bathe axes of a 68-year-old woman presenting S. Stercoralis hyper infection associated with rheumatoid arthritis and bronchial asthma. In 2017, the authors [8] reported the presence of reactive arthritis due to S. Stercoralis infection in a 11-year- old girl.
In 2018:
a) The authors [9] reported the case of a 65-year- old man with rheumatoid arthritis and duodenal involvement of S. Stercoralis.
b) The authors [10] reported the case of a 74-year-old woman with a history of rheumatoid arthritis and stool analysis revealing microscopic evidence of S. Stercoralis larvae. In the article [11] we found a good systematic review on the laboratory diagnosis and follow up of diagnostic of strongyloidiasis that we consider useful for reader with interest in this subject.
Conclusion
Strongyloidiasis should be considered in the differential diagnosis of severe malabsorption and acute arthritis [6] and S. stercoralis is of high importance in global helminths control and should therefore not be neglected [2].
References
- Schar F, Trostdorf V, Giardina F, Kiheu V, Muth S, et al. (2013) Strongyloides stercoralis, global distribution and risk factors. PLOS Negl Trop Dis 7(7): e2288.
- Concha R, Harrington W, Rogers AI (2005) Intestinal strongyloidiasis recognition, management, and determinants of outcome. J Clin Gastroenterol 39: 203-211.
- Akoglu T, Tunner I, Erken A, Gurçay F, Ozcan K (1984) Parasitic arthritis induced by Strongyloides stercoralis. Annals of the Rheumatic Diseases 43(3): 523-525.
- Van Kuijk AWR, Kerestens PJSM, Perenboom RM, Dijkmans BAC, Voskuyl AD (2003) Early-onset polyarthritis as presenting features of intestinal infection with Strongyloides stercoralis. Rheumatology 42(11): 1419-1420.
- Weinstein D, Lake Bakaar G (2005) Strongyloides stercoralis infection presenting with severe malabsorption arthritis in an immunocompetent host. The Internet Journal of Rheumatology 2(2): 5.
- Richter J, Müller Stover I, Strothmeyer H, Gobles K, Schmitt M, et al. (2006) Arthritis associated with Strongyloides stercoralis infection in a HLAB-27-positive African. Parasitol Res 99(6): 706-707.
- Altintop L, Cakar B, Hokelek M, BektssA, Yildiz L, et al. (2010) Strongyloides stercoralis hyperinfection in a patient with rheumatoid arthritis and bronchial asthma: a case report. Annals of Clinical Microbiology and Antimicrobials 9: 27.
- Mohanty S, Samprathi M, Parija S (2017) Reactive arthritis associated with Strongyloides stercoralis: report of an uncommon relation. Trop Parasitol 7(2): 117-119.
- Mansour Ghanaei F, Joukar F, Samadi A, Mavaddati S, Daryakar A (2018) Strongyloides infection in a man with abdominal pain and a history of rheumatoid arthritis. The open Infectious Diseases Journal 10: 23-28.
- Siddiqui AA, Berk SL (2001) Diagnosis of Strongyloides stercoralis. Infect Dis 33(7): 1040-1047.
- Mendez AR, Chiodini P, Bisoffi Z, Munoz J (2013) The laboratory diagnosis and follow up of strongyloidiasis: a systematic review. PloS neglected tropical diseases 7(1): e2002.