1887

Abstract

Introduction. Strongyloidiasis is a neglected tropical disease with global prevalence. Under some cases of immune suppression (especially with corticosteroid administration), the nematode involved disseminates, leading to an amplified, possibly lethal hyper-infection syndrome.

Case presentation. A 56-year-old Nepalese man presenting with chief complaints of nausea, vomiting, joint pain and abdominal cramps was admitted to Sumeru Hospital. His past history revealed: chronic obstructive pulmonary disease (COPD), systemic hypertension and previously treated pulmonary tuberculosis. The patient had been treated with oral prednisolone (60 mg gl) for 8 days due to a presumed exacerbation of his COPD. Sequentially, he developed haemoptysis, chest tightness, frequent wheezing and worsening cough. Bronchoscopy showed severe diffuse alveolar haemorrhage; microbiological examination of broncho-alveolar lavage (BAL) was recommended. Examination of an acid fast bacilli stain preparation of BAL revealed filariform larvae of Strongyloides. Stool specimen examination revealed larvae of Strongyloides. The physical condition of the patient began to deteriorate; a few days after admission, vancomycin-sensitive Enterococcus faecium was isolated from a blood sample. He was treated with ivermectin and albendazole for strongyloides and linezolid plus vancomycin for E. faecium. However, the patient failed to recover from the illness and died.

Conclusion. The findings of our study suggest that corticosteroid administration in strongyloidiasis can lead to the development of fatal strongyloides hyper-infection syndrome. Hence our experience suggests the need for early diagnosis of strongyloidiasis to avoid such an outcome. A deterioration of the patient's condition after the initiation of corticosteroid therapy in endemic areas should raise the possibility of strongyloidiasis.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Loading

Article metrics loading...

/content/journal/jmmcr/10.1099/jmmcr.0.005165
2018-09-11
2024-03-19
Loading full text...

Full text loading...

/deliver/fulltext/jmmcr/5/9/jmmcr005165.html?itemId=/content/journal/jmmcr/10.1099/jmmcr.0.005165&mimeType=html&fmt=ahah

References

  1. Center for Disease Control and Prevention Strongyloides (Epidemiology and Risk Factors). https://www.cdc.gov/parasites/strongyloides/epi.html
  2. Abdelrahman MZ, Zeehaida M, Rahmah N, Norsyahida A, Madihah B et al. Fatal septicemic shock associated with Strongyloides stercoralis infection in a patient with angioimmunoblastic T-cell lymphoma: a case report and literature review. Parasitol Int 2012; 61:508–511 [View Article][PubMed]
    [Google Scholar]
  3. Krolewiecki AJ, Lammie P, Jacobson J, Gabrielli AF, Levecke B et al. A public health response against Strongyloides stercoralis: time to look at soil-transmitted helminthiasis in full. PLoS Negl Trop Dis 2013; 7:e2165 [View Article][PubMed]
    [Google Scholar]
  4. Keiser PB, Keiser PB, Nutman TB, Nutman TB. Strongyloides stercoralis; 2004; 17208–217
  5. Izquierdo I, Briones J, Lluch R, Arqueros C, Martino R. Fatal strongyloides hyperinfection complicating a gram-negative sepsis after allogeneic stem cell transplantation: a case report and review of the literature. Case Rep Hematol 2013; 2013:860976 [View Article][PubMed]
    [Google Scholar]
  6. Donadello K, Cristallini S, Taccone FS, Lorent S, Vincent JL et al. Strongyloides disseminated infection successfully treated with parenteral ivermectin: case report with drug concentration measurements and review of the literature. Int J Antimicrob Agents 2013; 42:580–583 [View Article][PubMed]
    [Google Scholar]
  7. Chandrasekar PH. Strongyloidiasis Treatment & Management Medscape;
    [Google Scholar]
  8. Vadlamudi RS, Chi DS, Krishnaswamy G. Intestinal strongyloidiasis and hyperinfection syndrome; 2006; 131–13
  9. Elzein FE, Alsaeed M, Ballool S, Attia A. Strongyloides hyperinfection syndrome combined with cytomegalovirus infection. Case Rep Transplant 2016; 2016:1–5 [View Article][PubMed]
    [Google Scholar]
  10. Siddiqui AA, Berk SL. Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis 2001; 33:1040–1047 [View Article][PubMed]
    [Google Scholar]
  11. Cristina R, Teixeira ACA, Soares NM, de AD, de Moura EB et al. Hyperinfection with Strongyloides stercoralis in an asthmatic patient on corticosteroids. Parasitol Int 2012; 25:e3638
    [Google Scholar]
  12. Al Maslamani MA, Al Soub HA, Al Khal AL, Al Bozom IA, Abu Khattab MJ et al. Strongyloides stercoralis hyperinfection after corticosteroid therapy: a report of two cases. Ann Saudi Med 2009; 29:397–401 [View Article][PubMed]
    [Google Scholar]
  13. Morris TA, Ries AL, Bordow RA. Manual of clinical problems in pulmonary medicine. In Lippincott Manual Series 2005 pp. 180–184
    [Google Scholar]
  14. Woods JA, Wheeler JS, Finch CK, Pinner NA. Corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9:421 [View Article][PubMed]
    [Google Scholar]
  15. Aaron SD, Vandemheen KL, Hebert P, Dales R, Stiell IG et al. Outpatient oral prednisone after emergency treatment of chronic obstructive pulmonary disease. N Engl J Med 2003; 348:2618–2625 [View Article][PubMed]
    [Google Scholar]
  16. Niewoehner DE, Erbland ML, Deupree RH, Collins D, Gross NJ et al. Effect of systemic glucocorticoids on exacerbations of chronic obstructive pulmonary disease. N Engl J Med Overseas Ed 1999; 340:1941–1947 [View Article]
    [Google Scholar]
  17. Concha R, Harrington W, Rogers AI. Intestinal strongyloidiasis: recognition, management, and determinants of outcome. J Clin Gastroenterol 2005; 39:203–211[PubMed]
    [Google Scholar]
  18. Shorman M, Al-Tawfiq JA. Strongyloides stercoralis hyperinfection presenting as acute respiratory failure and Gram-negative sepsis in a patient with astrocytoma. Int J Infect Dis 2009; 13:e288-91 [View Article][PubMed]
    [Google Scholar]
  19. Ortiz Romero MM, León Martínez MD, Muñoz Pérez MA, Altuna Cuesta A, Cano Sánchez A et al. Strongyloides stercoralis as an unusual cause of COPD exacerbation. Arch Bronconeumol 2008; 44:451–453 [View Article][PubMed]
    [Google Scholar]
  20. Yassin MA, El Omri H, Al-Hijji I, Taha R, Hassan R et al. Fatal Strongyloides stercoralis hyper-infection in a patient with multiple myeloma. Braz J Infect Dis 2010; 14:536–539 [View Article][PubMed]
    [Google Scholar]
  21. Qu T-T, Yang Q, Yu M-H, Wang J, Qu T et al. A fatal strongyloides stercoralis hyperinfection syndrome in a patient with chronic kidney disease. Medicine 2016; 95:e3638
    [Google Scholar]
  22. Fardet L, Généreau T, Cabane J, Kettaneh A. Severe strongyloidiasis in corticosteroid-treated patients. Clin Microbiol Infect 2006; 12:945–947 [View Article][PubMed]
    [Google Scholar]
  23. Dreyer G, Alves S, Rocha A, Albuquerque R, Dreyer G et al. Patterns of detection of Strongyloides stercoralis in stool specimens : implications for diagnosis and clinical trials. J Clin Microbiol 1996; 34:2569–2571
    [Google Scholar]
  24. Mejia R, Nutman TB. Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis. Curr Opin Infect Dis 2012; 25:458–463 [View Article][PubMed]
    [Google Scholar]
  25. Padigel UM, Lee JJ, Nolan TJ, Schad GA, Abraham D. Eosinophils can function as antigen-presenting cells to induce primary and secondary immune responses to Strongyloides stercoralis. Infect Immun 2006; 74:3232–3238 [View Article][PubMed]
    [Google Scholar]
  26. Silveira MR, Nunes KP, Cara DC, Souza DG, Corrêa A et al. Infection with Strongyloides venezuelensis induces transient airway eosinophilic inflammation, an increase in immunoglobulin E, and hyperresponsiveness in rats. Infect Immun 2002; 70:6263–6272 [View Article][PubMed]
    [Google Scholar]
  27. Moura EB, Maia MO, Ghazi M, Amorim FF, Pinhati HM. Salvage treatment of disseminated strongyloidiasis in an immunocompromised patient: therapy success with subcutaneous ivermectin. Braz J Infect Dis 2012; 16:479–481 [View Article][PubMed]
    [Google Scholar]
  28. Pornsuriyasak P, Niticharoenpong K, Sakapibunnan A. Disseminated strongyloidiasis successfully treated with extended duration ivermectin combined with albendazole: a case report of intractable strongyloidiasis. Southeast Asian J Trop Med Public Health 2004; 35:531–534[PubMed]
    [Google Scholar]
  29. Kassalik M, Mönkemüller K. Strongyloides stercoralis hyperinfection syndrome and disseminated disease. Gastroenterol Hepatol 2011; 7:766–768[PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmmcr/10.1099/jmmcr.0.005165
Loading
/content/journal/jmmcr/10.1099/jmmcr.0.005165
Loading

Data & Media loading...

Supplements

Supplementary File 1

PDF

Supplementary File 2

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error