The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and
Prevention. The authors state that they have no conflicts of interest. “
“Strongyloidiasis is a soil-transmitted selleck helmithiasis with worldwide distribution. Contrary to chronic form, hyperinfestation and life-threatening dissemination, first (invasive) stages of the disease are not well characterized. This paper describes two cases of acute strongyloidiasis in travelers returning from Southeast Asia and highlights the need to take strongyloidiasis into account also among acute travel-related illnesses. Strongyloidiasis is an intestinal nematode infection caused by Strongyloides stercoralis and occasionally Strongyloides fuellerborni.
The disease is distributed worldwide, but more common in populations of the tropical and subtropical areas.1,2 It is rarely observed in temperate regions3,4 where it is more frequently described in migrants, expatriates, elderly local population and very occasionally in travelers.5 Strongyloidiasis usually causes a chronic infection with mild, if any symptoms except in immunosuppressed patients selleck chemicals llc who may suffer from the disseminated and almost invariably fatal form of disease. The symptoms and signs of chronic strongyloidiasis (abdominal pain, diarrhea, and urticaria) occur irregularly, often with prolonged asymptomatic intervals. The penetration phase usually does not give rise to skin signs, whereas little is known about the invasive (acute) stage of the disease which has been infrequently reported. We describe two cases of invasive strongyloidiasis observed in a couple of Italian tourists returning from Thailand, Malaysia, and Singapore. Mr S.F. and Mrs P.F., respectively 32 and 29 years old, native of Apulia, South Italy, traveled to Southeast from Asia (Malaysia, Singapore, and Thailand) on honeymoon from August 27 to September 12, 2008. A few
days after returning to Italy they developed a diffuse urticarial rash, itching, high fever, cough, and fatigue. The signs appeared 7 days after return in S.F. and 10 days in P.F. (incubation period after presumed exposure in Koh Samui Island, Thailand ranging from 7–11 and 10–14 d, respectively). The patients were admitted to the Infectious Disease Unit of Triggiano Hospital, Bari. They both had splenomegaly. Blood tests showed a marked eosinophilia in both patients (absolute eosinophil count 5,130 mm−3, 38.5% for S.F. and 5,740 mm−3, 37% for P.F; normal values <450 eosinophils mm−3, <7%), mild hepatic cytolysis (alanine aminotransferase 56 and 77 U/L, respectively, normal value <41 U/L), increased C-reactive protein (108.2 and 49.1 mg/L, respectively, normal value <5 mg/L), and no other abnormal result. During hospitalization, they were treated with antibiotics and their clinical status partially improved, whereas the eosinophil counts further increased for both.