Strongyloidiasis: A case with acute pancreatitis and a literature review

Table 1 Results of blood tests

Blood tests	Labs on first admissionDay 16 of illness	Labs on second admissionDay 22 of illness
Hemoglobin (g/dL)	16.4	15.9
Hematocrit (%)	48.3	46.0
Platelet count	237000	286000
(/μL)
White blood cell count	18700	23300
(/mm3)
Differential count (%)
Neutrophils	35.2	33.5
Lymphocytes	18.4	16.5
Eosinophils	42.2	46.5
INR	1.1	1.0
Blood urea nitrogen (mg/dL)	10	10
Creatinine (mg/dL)	1.0	0.9
Albumin (g/dL)	3.4	3.8
Alanine aminotransferase	26	65
(U/L)
Aspartate aminotransferase (U/L)	31	39
Alkaline phosphatase	144	284
(U/L)
Total bilirubin (mg/dL)	0.2	0.3

Table 2 Reported cases of acute pancreatitis associated with Strongyloides stercoralis

Case	Age (yr)/gender	Place of origin	Presentation	Eosinophil count(per mm3)	Amylase(U/L)	Lipase(U/L)	Diagnostic method	Treatment	Ref.
1	44/F	West Indies (Caribbean)	Abdominal pain Fever Pruritus	210	Not provided	Not provided	Examination of biliary fluid obtained through percutaneous biliary drain	Thiabendazole	Delarocque Astagneau et al[14], 1994
2	45/F	Ecuador	Abdominal pain Nausea Vomiting	900	259	1574	Endoscopic duodenal biopsy Stool examination	Albendazole Thiabendazole Ivermectin	Núñez et al[15], 2003
3	81/F	Kentucky, USA	Abdominal pain Nausea Vomiting	1254	2100	>2000	Examination of biliary fluid obtained through ERCP	Albendazole	Perez-Jorge et al[16], 2008
4	64/M	Puerto Rico	Abdominal pain Nausea Vomiting Dyspnea Confusion	776	4367	>396	Clinical history and stool examination	Ivermectin	Jones et al[17], 2009
5 (our case)	48/M	Dominican Republic	Abdominal pain	10900	263	476	Endoscopic duodenal biopsy and serology	Ivermectin	Makker et al, 2015

ERCP: Endoscopic retrograde cholangio pancreatography.

Table 3 Various diagnostic tests available for Strongyloides stercoralis

Test	Sensitivity and specificity	Remarks
Stool smear	30% sensitivity for single stool sample[35]	Simple test but insensitive
Agar plate culture	90% sensitivity[28]	Sensitive and simple
		But needs 2 d for results
		Health hazard to lab workers
		Serologic tests
IFAT	IFAT: 97% sensitivity and 98% specificity[29]	Cross reactivity except with LIPS
ELISA	ELISA: 93% sensitivity and 95% specificity[30]	Inability to differentiate past and current infection
LIPS	LIPS: 97% sensitivity and 100% specificity[32]	Expensive
Molecular tests
PCR	PCR: 99%-100% sensitivity and 15%-100% specificity[34]	Low specificity with low parasite burden
		Expensive
LAMP		Not widely available

ELISA: Enzyme Linked Immunosorbent Assay; IFAT: Indirect immunofluorescence antibody test; LAMP: Loop-mediated isothermal amplification; LIPS: Immunoprecipitation system; PCR: Polymerase chain reaction.

Table 4 Treatment of Strongyloidiasis

Drug	Dose	Pregnancy class
Ivermectin	200 μg/kg of bodyweight orally repeated on two days consecutively or after 2 wk	C
(preferred drug of treatment)
Albendazole	400 mg orally two times a day for 3-7 d	C
Hyperinfection syndrome and disseminated Strongyloides infection
200 μg/kg of bodyweight orally until stool and/or sputum tests are negative for two wk (duration of auto-infective cycle)