| Abstract | Uvod: Infekcija oblićem Strongyloides stercoralis česta je u tropskim i suptropskim područjima, a sporadična u krajevima s umjerenom klimom. Najčešće je asimptomatskog ili blagog tijeka te može nedijagnosticirana perzistirati u domaćinu desetljećima, no u uvjetima imunosupresije može uzrokovati i fatalnu bolest. U Europi su epidemiološka i klinička obilježja bolesti slabo istražena, a u Hrvatskoj istraživanje dosad nije rađeno.
----- Cilj: Odrediti epidemiološka i klinička obilježja bolesnika liječenih od strongiloidoze.
----- Ispitanici i metode: Retrospektivno deskriptivno istraživanje na bolesnicima oba spola i svih dobi liječenih zbog strongiloidoze u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ u Zagrebu u razdoblju od 01.01.2010. do 31.03.2019. Podatci su statistički obrađeni.
----- Rezultati: Od 65 bolesnika, bolest je u 83,1% dokazana nekom od direktnih metoda a u 16,9% samo serološki. U promatranom razdoblju je broj bolesnika bio u značajnom porastu (P=0,013). Muškarci su činili 60% uzorka, 78,5 % bolesnika je bilo dobi 50-79 g. (raspon 17- 82 g.; prosjek: 62 g.). Klinički se bolest prezentirala kao: asimptomatska eozinofilija (41,5%), kronična simptomatska bolest (33,9%), preplavljujuća strongiloidoza (6,1%), akutna primoinfekcija (18,5%). 20 bolesnika (30,8%) je bilo imunosuprimirano (45% kortikosteroidi, 20% citostatici, 35% teže kronične bolesti); od njih je četvero (20%) razvilo hiperinfekciju, a dvoje (10%) umrlo. 71,7% bolesnika je inicijalno liječeno albendazolom, po 13,3% ivermektinom i tiabendazolom, 1,7% mebendazolom. U 9,2% bolesnika je liječenje ponavljano. Razlika stopa izlječenja albendazolom vs. ivermektinom nije bila statistički značajna (kontrola nakon liječenja nije učinjena u 48,8% liječenih albendazolom i 25% liječenih ivermektinom) (p=0,0878).
----- Zaključci: Strongiloidoza jest recentno endemična bolest u kontinentalnoj Hrvatskoj te se preporuča provoditi probir prije uvođenja imunosupresije i u davatelja organa. Udio hiperinfekcija u imunosuprimiranih i njihova stopa smrti odgovara do sada objavljenima. |
| Abstract (english) | Background: Infection with helminth Strongyloides stercoralis is common in tropics and subtropics, whereas in temperate zones it occurs sporadically. Chronic infection is mostly asymptomatic or mild and may persist for decades undiagnosed. However, in immunosupressed hosts it can have a fatal outcome. Epidemiological and clinical features of the disease in Europe are not well studied and there has been no study in Croatia up to this point.
----- Objective: To determine epidemiological and clinical features of patients with strongyloidiasis.
----- Patients and methods: Retrospective descriptive study that included patients of both genders and all age groups treated for strongyloidiasis from January 1st 2010 to May 31st 2019 at University Hospital for Infectious Diseases „Dr. Fran Mihaljević“, Zagreb. Statistical analysis was done.
----- Results: Among 65 patients, diagnosis was made by direct method in 83.1% and by serology in 16.9%. The number of patients significantly increased over the study period (p=0.013). 60% were men. 78.5% were aged 50-79 (range 17-82 y.; average: 62 y.). Clinical presentations were asymptomatic eosinophilia (41.5%), chronic symptomatic disease (33.9%), hyperinfection (6.1%) and acute primoinfection (18.5%). 20 patients (30.8%) were immunosupressed (45% corticosteroids, 20% cytostatic drugs, 35% immunodebilitating illness). Among those, 20% developed hyperinfection and 10% died. 71.7% were initially treated with albendazole, 13.3% with thiabendazole, 13.3% with ivermectin, 1.7% with mebendazole. 9.2% of the patients received repeated treatment. There was no significant difference in the cure rate for albendazole and ivermectin (no follow-up in 48.8% of albendazole and in 25% of ivermectin group) (p=0.0878).
----- Conclusions: Strongyloidiasis is recently an endemic disease in continental Croatia, therefore patients undergoing immunosupression and organ donors should be screened. The hyperinfection rate and associated mortality rate are as described in the literature. |
