A rare case of imported Strongyloides fuelleborni infection in a Belgian student

• Main Authors: Idzi Potters, Isabel Micalessi, Marjan Van Esbroeck, Sarah Gils, Caroline Theunissen
• Format: Article
• Language: English
• Published: Elsevier 2020-10-01
• Series: Clinical Infection in Practice
• Subjects: Strongyloides fuelleborni; Primates; Zoonosis; Strongyloidiasis; Microscopy; Molecular diagnostics
• Online Access: http://www.sciencedirect.com/science/article/pii/S2590170220300182

Background: We report a rare case of imported and asymptomatic Strongyloides fuelleborni infection in a Belgian student, returning from the Democratic Republic of the Congo. Strongyloidiasis, one of the most neglected tropical diseases, is estimated to affect more than 100 million people worldwide. The exact number of cases attributable to Strongyloides fuelleborni is not known, as correct identification of this parasite can be difficult. S. fuelleborni is a parasitic helminth, known to infect both humans and non-human primates. S. fuelleborni eggs in the stools of infected patients may be mistaken for hookworm eggs. Correct identification of these eggs is essential, as the recommended treatment for hookworm infection is different. Case report: A Belgian student, who had returned from the Democratic Republic of the Congo, was treated at the outpatient clinic of the Institute of Tropical Medicine in Antwerp, Belgium, because of an episode of fever, rash and diarrhea. Microscopic examination of a stool sample demonstrated Trichuris trichiura eggs and Strongyloides eggs, but no helminth larvae. A Strongyloides fuelleborni infection was suspected and subsequently confirmed using molecular techniques. The patient was treated with ivermectin and mebendazole. No helminth eggs could be detected in a follow-up stool sample. Conclusions: Imported human Strongyloides fuelleborni infection is very rarely reported. When hookworm-like eggs are found during parasitological stool examination, Strongyloides spp. should be kept in mind as a possibility. Careful measurement of eggs, together with embryonation level and stool sample consistency, are important criteria to ensure correct initial identification, while molecular testing can be used for confirmation. This case should raise awareness about Strongyloides fuelleborni as a possible cause of infection in travelers returning from endemic regions, something which should be kept in mind in order to avoid erroneous treatment.