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27-year wait for symptoms

The unusual case of a woman whose symptoms of colitis emerged 27 years after she left the country in which she was infected is detailed in a Case Report in this week’s edition of the Lancet.

Dr Astrid Oude Lashof, Nijmegen University Centre for Infectious Diseases, Radboud University Nijmegen Medical Centre, Netherlands, and colleagues treated the 49-year-old patient and authored the Case Report.

The woman was admitted to the hospital in 2004 with a two-three week history of vomiting, diarrhoea, abdominal cramps and fever. She had no relevant medical history and took no medications. She had been born and raised in Surinam, South America, before migrating to the Netherlands aged 22 years.

She underwent a number of tests, and eventually analysis of her faeces revealed larvae of Strongyloides stercoralis, a parasitic worm, which had caused the woman to get colitis – a digestive disease characterised by inflammation of the colon. She was successfully treated with ivermectin and discharged

The authors believe that the woman was extremely unlikely to pick up S stercoralis either in the Netherlands or Spain – the one place she had been for a short holiday since emigrating- since the worm is not endemic in either country. They say: “She [the patient] must therefore have been infected in Surinam and presented 27 years later.”

S stercoralis appears particularly likely to present as colitis in patients with cellular immune defects, such as those caused by corticosteroid use and alcoholism.

The authors say: “We believe that in our patient, chronic alcohol misuse, probably exacerbated by malnutrition, caused the infestation to manifest.”

They conclude: “We wish to emphasise that, when patients have lived in areas where S stercoralis is endemic, S stercoralis colitis should be included in the differential diagnosis of intestinal inflammation – particularly when the patient is immunocompromised.”

Tony Kirby | alfa
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