Maltreatment of Strongyloides Infection: Case Series and Worldwide Physicians-in-Training Survey
Background: Strongyloidiasis infects hundreds of millions of people worldwide and is an important cause of mortality from intestinal helminth infection in developed countries. The persistence of infection, increasing international travel, lack of familiarity by health care providers, and potential f...
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th-cmuir.6653943832-22072014-08-30T02:00:36Z Maltreatment of Strongyloides Infection: Case Series and Worldwide Physicians-in-Training Survey Boulware D.R. Stauffer W.M. Hendel-Paterson B.R. Rocha J.L.L. Seet R.C.-S. Summer A.P. Nield L.S. Supparatpinyo K. Chaiwarith R. Walker P.F. Background: Strongyloidiasis infects hundreds of millions of people worldwide and is an important cause of mortality from intestinal helminth infection in developed countries. The persistence of infection, increasing international travel, lack of familiarity by health care providers, and potential for iatrogenic hyperinfection all make strongyloidiasis an important emerging infection. Methods: Two studies were performed. A retrospective chart review of Strongyloides stercoralis cases identified through microbiology laboratory records from 1993-2002 was conducted. Subsequently, 363 resident physicians in 15 training programs worldwide were queried with a case scenario of strongyloidiasis, presenting an immigrant with wheezing and eosinophilia. The evaluation focused on resident recognition and diagnostic recommendations. Results: In 151 strongyloidiasis cases, stool ova and parasite sensitivity is poor (51%), and eosinophilia (>5% or >400 cells/μL) commonly present (84%). Diagnosis averaged 56 months (intra-quartile range: 4-72 months) after immigration. Presenting complaints were nonspecific, although 10% presented with wheezing. Hyperinfection occurred in 5 patients prescribed corticosteroids, with 2 deaths. Treatment errors occurred more often among providers unfamiliar with immigrant health (relative risk of error: 8.4; 95% confidence interval, 3.4-21.0; P <.001). When presented with a hypothetical case scenario, US physicians-in-training had poor recognition (9%) of the need for parasite screening and frequently advocated empiric corticosteroids (23%). International trainees had superior recognition at 56% (P <.001). Among US trainees, 41% were unable to choose any parasite causing pulmonary symptoms. Conclusions: Strongyloidiasis is present in US patients. Diagnostic consideration should occur with appropriate exposure, nonspecific symptoms including wheezing, or eosinophilia (>5% relative or >400 eosinophils/μL). US residents' helminth knowledge is limited and places immigrants in iatrogenic danger. Information about Strongyloides should be included in US training and continuing medical education programs. © 2007 Elsevier Inc. All rights reserved. 2014-08-30T02:00:35Z 2014-08-30T02:00:35Z 2007 Article 00029343 10.1016/j.amjmed.2006.05.072 17524758 AJMEA http://www.scopus.com/inward/record.url?eid=2-s2.0-34248546255&partnerID=40&md5=bf44aff4eca1d95e6af6c8ca27423ede http://cmuir.cmu.ac.th/handle/6653943832/2207 English |
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Background: Strongyloidiasis infects hundreds of millions of people worldwide and is an important cause of mortality from intestinal helminth infection in developed countries. The persistence of infection, increasing international travel, lack of familiarity by health care providers, and potential for iatrogenic hyperinfection all make strongyloidiasis an important emerging infection. Methods: Two studies were performed. A retrospective chart review of Strongyloides stercoralis cases identified through microbiology laboratory records from 1993-2002 was conducted. Subsequently, 363 resident physicians in 15 training programs worldwide were queried with a case scenario of strongyloidiasis, presenting an immigrant with wheezing and eosinophilia. The evaluation focused on resident recognition and diagnostic recommendations. Results: In 151 strongyloidiasis cases, stool ova and parasite sensitivity is poor (51%), and eosinophilia (>5% or >400 cells/μL) commonly present (84%). Diagnosis averaged 56 months (intra-quartile range: 4-72 months) after immigration. Presenting complaints were nonspecific, although 10% presented with wheezing. Hyperinfection occurred in 5 patients prescribed corticosteroids, with 2 deaths. Treatment errors occurred more often among providers unfamiliar with immigrant health (relative risk of error: 8.4; 95% confidence interval, 3.4-21.0; P <.001). When presented with a hypothetical case scenario, US physicians-in-training had poor recognition (9%) of the need for parasite screening and frequently advocated empiric corticosteroids (23%). International trainees had superior recognition at 56% (P <.001). Among US trainees, 41% were unable to choose any parasite causing pulmonary symptoms. Conclusions: Strongyloidiasis is present in US patients. Diagnostic consideration should occur with appropriate exposure, nonspecific symptoms including wheezing, or eosinophilia (>5% relative or >400 eosinophils/μL). US residents' helminth knowledge is limited and places immigrants in iatrogenic danger. Information about Strongyloides should be included in US training and continuing medical education programs. © 2007 Elsevier Inc. All rights reserved. |
format |
Article |
author |
Boulware D.R. Stauffer W.M. Hendel-Paterson B.R. Rocha J.L.L. Seet R.C.-S. Summer A.P. Nield L.S. Supparatpinyo K. Chaiwarith R. Walker P.F. |
spellingShingle |
Boulware D.R. Stauffer W.M. Hendel-Paterson B.R. Rocha J.L.L. Seet R.C.-S. Summer A.P. Nield L.S. Supparatpinyo K. Chaiwarith R. Walker P.F. Maltreatment of Strongyloides Infection: Case Series and Worldwide Physicians-in-Training Survey |
author_facet |
Boulware D.R. Stauffer W.M. Hendel-Paterson B.R. Rocha J.L.L. Seet R.C.-S. Summer A.P. Nield L.S. Supparatpinyo K. Chaiwarith R. Walker P.F. |
author_sort |
Boulware D.R. |
title |
Maltreatment of Strongyloides Infection: Case Series and Worldwide Physicians-in-Training Survey |
title_short |
Maltreatment of Strongyloides Infection: Case Series and Worldwide Physicians-in-Training Survey |
title_full |
Maltreatment of Strongyloides Infection: Case Series and Worldwide Physicians-in-Training Survey |
title_fullStr |
Maltreatment of Strongyloides Infection: Case Series and Worldwide Physicians-in-Training Survey |
title_full_unstemmed |
Maltreatment of Strongyloides Infection: Case Series and Worldwide Physicians-in-Training Survey |
title_sort |
maltreatment of strongyloides infection: case series and worldwide physicians-in-training survey |
publishDate |
2014 |
url |
http://www.scopus.com/inward/record.url?eid=2-s2.0-34248546255&partnerID=40&md5=bf44aff4eca1d95e6af6c8ca27423ede http://cmuir.cmu.ac.th/handle/6653943832/2207 |
_version_ |
1681419815170867200 |