Successful eradication of the nematode was achieved with an off label subcutaneous formulation of ivermectin. Here, we present a case of a man aged 60 years originally from a strongyloides endemic area with a medical history of alcohol abuse who presents with. Clinical presentation, etiology of disease, and treatment options. Is human immunodeficiency virus infection a risk factor. This is particularly common in bone marrow, renal, and other solid organ transplant sot patients, where figures may reach up to 5085%. Strongyloides stercoralis is an intestinal nematode with a complex. Pulmonary hyperinfection syndrome with strongyloides. We report the case of a 77yearold man who developed a strongyloides hyperinfection syndrome following immunosuppressive therapy more than 60 years after he moved away from an area endemic for strongyloides stercoralis.
Pulmonary hyperinfection syndrome with strongyloides stercoralis pulmonary hyperinfection syndrome with strongyloides stercoralis upadhyay, daya. The diagnosis of hyperinfection syndrome can be difficult. In hyperinfection syndrome, this classic life cycle is exaggerated ie, the parasite burden and turnaround increase and accelerate. A 78 yearold israeli man, who was born in iraq but lived in israel for 66 years, presented with multiorgan failure including acute. Here, we present a case of strongyloides hyperinfection in a 75yearold male secondary to sepsis and chronic immunosuppression due to tnf. Strongyloides stercoralis in the immunocompromised. Hyperinfection syndrome definition of hyperinfection.
Strongyloides stercoralis is an intestinal nematode parasite that affects about 30 100. Summary strongyloides stercoralis is an intestinal nematode of humans that infects tens of millions of people worldwide. Disseminated parasitosis in immunosuppressed, malignant, or malnourished hosts, caused by autoinfection with strongyloides stercoralis clinical abrupt onset of high fever, abdominal pain, bloating, intestinal ulcerations, gramnegative sepsis and shock. The clinical manifestations of strongyloides stercoralis infection vary according to the. Thelper cd4 cell count was 106 9% and hiv pcr quantification was 1 146 362 copiesml. Infection usually results in asymptomatic chronic disease of the gut, which can remain undetected for decades. In view of the patients symptoms, pneumonia, and the fact that her bronchoalveolar lavage fluid and stool showed larval forms of s. Pulmonary hyperinfection syndrome with strongyloides stercoralis. The two conditions that have been most frequently recognized as predisposing factors for the development of the hyperinfection syndrome are corticosteroid use, and human tlymphotropic virus type 1 htlv1 infection. Travelers, military personnel, and immigrants coming to developed countries can host this parasite for years without expressing any complaint 1,2,3.
Case of strongyloides hyperinfection syndrome bmj case reports. Pdf syndrome of hyperinfection with strongyloides stercoralis. A 61yearold man from the peruvian amazon presented with progressive dyspnea, abdominal pain, and cough for the past week. Strongyloides stercoralis hyperinfection syndrome is a rare complication of. Studies of disseminated disease in organ transplant patients, asthmatics, patients with chronic lung disease, and patients. Pdf intestinal strongyloidiasis and hyperinfection syndrome. Strongyloides stercoralis hyperinfection remain quiescent indefinitely, immunosuppression can lead to the hyperinfection syndrome, which is. Infection with the parasitic nematode, strongyloides stercoralis, can lead to death in patients with various clinical disorders. Screening, prevention, and treatment for hyperinfection. Hyperinfection syndrome in strongyloidiasis, current topics in tropical medicine, alfonso j. Apr 29, 2019 in clinical practice, identification of a case of severe asthma exacerbation prompts initiation of corticosteroids.
Jul 09, 2016 infection with strongyloides stercoralis is frequently asymptomatic or may show few clinical signs. It is usually asymptomatic in a healthy host but causes. Syndrome of hyperinfection with strongyloides stercoralis. Between 30 and 100 million people are infected worldwide. Hyperinfection syndrome with strongyloides stercoralis core. Strongyloides hyperinfection and hypogammaglobulinemia. Acute respiratory distress syndrome complicating strongyloides stercoralis. Rural regions in tropical and subtropical countries are known to have a high prevalence of this organism 1, 2. We describe a 67yearold hispanic female who presented with complaints of. Since transplantation, his estimated glomerular filtration rate had been slowly decreasing, most. We describe a 67yearold hispanic female who presented. Strongyloides stercoralis infection is usually asymptomatic but can result in a hyperinfection syndrome, most commonly triggered by acquired or iatrogenic immunosuppression. His medical history was remarkable for asthma since childhood.
Hyperinfection syndrome with strongyloides stercoralis. Respiratory hyperinfection with strongyloides stercoralis. Hyperinfection syndrome with strongyloides stercoralis in. Strongyloides stercoralis an overview sciencedirect topics. We report strongyloides hyperinfection in two patients with generalized hypogammaglobulinemia from multiple myeloma and nephrotic syndrome, despite a significant strongyloidesspecific immunoglobulin g igg response. Fatal outcome of a hyperinfection syndrome despite. Both were born in puerto rico and had left the island six to 15 years previously.
In contrast to reports on animals, where human igg was shown to be a protective antibody, our observation suggests that in humans, immunity to the infectivestage larvae is not. Hyperinfection syndrome is not exactly defined, but the hallmark is an increase in the number of larvae in the stool andor sputum along with manifestations confined to respiratory and gastrointestinal systems along with peritoneum. Detection and treatment of strongyloides hyperinfection. A fatal strongyloides stercoralis hyperinfection syndrome. Jan 30, 2019 hyperinfection syndrome should be considered a potential medical emergency. An accelerated infection, known as a hyperinfection, occurs in immunocompromised patients, most commonly those treated chronically with glucocorticoids or those who have human t cell leukemia virus1 htlv1 infection. Epidemiology of strongyloides stercoralis infection in bolivian.
A variety of risk factors and predisposin we use cookies to enhance your experience on our website. Strongyloides stercoralis infects 30 100 million people in 70 countries in tropical and subtropical areas. In hyperinfection syndrome, the larval load significantly increases and becomes detectable in sputum, bronchoalveolar lavage bal, and lung biopsies. Strongyloidiasis among patients with chronic kidney disease is rarely reported. Hyperinfection syndrome should be considered a potential medical emergency. It commonly causes chronic, asymptomatic infection, but a change in immune status can lead to an increase in parasite burden, hyperinfection syndrome, dissemination, and death if unrecognized.
Stool samples were not obtained because of the low suspicion and lack of gastrointestinal symptoms. The hyperinfection syndrome hs caused by strongyloides stercoralis has a high mortality rate 15% to 87%. The patient was started on treatment with ivermectin 200 gkgday for 7 days. Since transplantation, his estimated glomerular filtration rate had been slowly. We have also found it to be well tolerated in another patient with suspected strongyloides hyperinfection, when two 6 mg doses of a veterinary preparation of ivermectin were given subcutaneously on consecutive days without complications.
Histopathology of strongyloides stercoralis in the lungs and intestine of a 48year old woman with a gastric carcinoid tumor treated. Corticosteroids and strongyloid hyperinfection syndrome. Further research is needed to understand why some strongyloides stercoralis seropositive individuals develop hyperinfection syndrome and others do not. The patient had undergone renal transplantation 2 years and 6 years previously. Hyperinfection syndrome is not exactly defined, but the hallmark is an increase in the number of larvae in the stool andor sputum along with manifestations confined to respiratory and gastrointestinal systems along with peritoneum 10. Hyperinfection syndrome is a potentially fatal set of complications resulting from the spread of filariform larvae to the lungs and other organ systems. Autoinfection and hyperinfection with strongyloides stercoralis.
Strongyloides stercoralis infection after the use of. However on occasion it can persist for many years due to autoinfection and depending on the. Strongyloides hyperinfection syndrome combined with. Obm transplantation strongyloidiasis in solid organ.
Hyperinfection syndrome is estimated to happen in 1. Clinical presentation, etiology of disease, and treatment options nicolas barros 0 1 martin montes 0 1 0 m. Ivermectin is the drug of choice in the treatment of strongyloidiasis. Strongyloides stercoralis hyperinfection in a patient with. Both larva currens and gramnegative meningitis were absent in the current case.
Apr, 2019 a 50year old man who had not travelled outside the uk for the past 20 yearsbut who had lived in angola for most of his childhoodpresented at our clinic with a 4week history of worsening exercise tolerance. Curr trop med rep infection and hyperinfection with strongyloides stercoralis. Thus, treatment should be started immediately if this is being considered. May, 2016 however, hyperinfection syndrome and disseminated disease usually develop as a result of immune suppression caused by hiv infection, in addition to immunocompromised states like administration of corticosteroids, tumor necrosis factor. A woman aged 36 years with untreated aids presented with symptoms of abdominal pain, increasing dyspnoea with haemoptysis and weight loss. A 50year old man who had not travelled outside the uk for the past 20 yearsbut who had lived in angola for most of his childhoodpresented at our clinic with a 4week history of worsening exercise tolerance. She was afebrile, and had bilateral expiratory wheezing on examination. To the best of our knowledge this association has not been previously described. The soiltransmitted helminth, strongyloides stercoralis, causes strongyloidiasis affecting an estimated of 3100 million people in the world, mostly in tropical and subtropical countries but also in the united states, europe and asia. Case report strongyloides stercoralis hyperinfection. Respiratory hyperinfection with strongyloides stercoralis in. Up to 75% of people with chronic strongyloidiasis have mild peripheral eosinophilia or elevated ige levels.
However, hyperinfection syndrome and disseminated disease usually develop as a result of immune suppression caused by hiv infection, in addition to immunocompromised states like administration of corticosteroids, tumor necrosis factor. Hyperinfection syndrome in strongyloidiasis intechopen. Infection and hyperinfection with strongyloides stercoralis. Strongyloides stercoralis hyperinfection syndrome is a rare complication of strongyloidiasis that occurs. Barros department of internal medicine, university of texas. In contrast to reports on animals, where human igg was shown to be a protective antibody, our observation suggests that in humans. Montes department of medicine, division of infectious diseases, university of texas medical branch at galveston, galveston, tx, usa 1 n. Though thiabendazole mintezol has produced reasonable results in the treatment of the hyperinfection syndrome.
In general, the clinical features of strongyloides stercoralis. Fatal outcome of a hyperinfection syndrome despite successful. Strongyloides stercoralis hyperinfection syndrome is a rare but fatal disease, which occurs commonly in immunocompromised patients. Prevalence of strongyloides stercoralis infection and. The manufacturer personal communication quotes a half life of 2056 h for ivermectin. Immunosuppressives, principally corticosteroids, are the primary triggering factor. A 55yearold chinese male presented to hospital with diarrhea and abdominal pain. Strongyloides stercoralis hyperinfection syndrome and disseminated disease. Delayed strongyloides stercoralis hyperinfection syndrome. Pdf hyperinfection syndrome in strongyloidiasis researchgate. Therefore individuals with a history of tropical exposure, even many decades previously. Since further evaluation and treatment were needed. The patient was treated successfully with drotrecogin alfa activated, parenteral ivermectin, albendazole, and piperacillin.
Parenteral ivermectin in strongyloides hyperinfection the. By continuing to use our website, you are agreeing to our use of cookies. The hyperinfection syndrome occurs in immunocompromised hosts and is associated with glucocorticoid steroid therapy. Treatment of uncomplicated strongyloidiasis is simple, highly effective, and potentially lifesaving. Due to its low incidence in industrialized countries, misdiagnoses and medical errors may occur boulware et al.
Thelper cd4 cell count was 106 9% and hiv pcr quantification. Two patients hyperinfected with strongyloides stercoralis an intestinal nematode are described. Intestinal strongyloidiasis and hyperinfection syndrome. Although eosinophilia is a common finding in patients with chronic strongyloides infection, it is a very unreliable predictor of hyperinfection syndrome. Strongyloides stercoralis hyperinfection syndrome and. Strongyloides hyperinfection syndrome has not been reported in lung transplant recipients. Pdf in spite of recent advances with experiments on animal models. In patients that are infected with strongyloides stercoralis but do not have hyperinfection syndrome the recommendation is to treat at 200. The probable cause in each case was alteration of the immune responses either as a result of the malignant lymphoma or by the treatment given. Prior to arrival in the usa, she lived in the democratic republic of congo. Hyperinfection medical definition merriamwebster medical. Strongyloides stercoralis is an intestinal helminth that infects humans through contact with soil containing the larvae. Strongyloides stercoralis is an intestinal nematode with a worldwide distribution. Nov 22, 2018 we describe a patient with strongyloides stercoralis hyperinfection associated with streptococcus pyogenes and with streptococcal toxic shock syndrome.
We report a case of strongyloides stercoralis hyperinfection syndrome in a renal transplant recipient complicated by septic shock, acute respiratory distress syndrome, and klebsiella pneumoniae superinfection. A case is reported of hyperinfection syndrome with strongyloides stercoralis, with symptoms, signs and radiological appearances which led to a diagnosis of duodenal ulcer. Acute respiratory distress syndrome complicating strongyloides. Treatment of strongyloides stercoralis hyperinfection. Human strongyloidiasis varies from a chronic but limited infection in normal hosts to hyperinfection in patients treated.
Hyperinfection with strongyloides stercoralis occurred in three patients with malignant lymphoma. Donorderived strongyloides stercoralis hyperinfection syndrome. Parenteral ivermectin in strongyloides hyperinfection. Oct 18, 2018 further research is needed to understand why some strongyloides stercoralis seropositive individuals develop hyperinfection syndrome and others do not. One died shortly after diagnosis, but the other survived the hyperinfection syndrome and complicating bacterial sepsis and meningitis. Images in clinical medicine from the new england journal of medicine strongyloides stercoralis hyperinfection.
Delayed strongyloides stercoralis hyperinfection syndrome in. Wed like to understand how you use our websites in order to improve them. Alteration of the parasitehost relationship may lead to hyperinfection characterized by profound malabsorption, diarrhea, electrolyte imbalance, gramnegative or opportunistic fungal sepsis, coma, and death. He had moved to the united states from puerto rico 30. Here, we present a case of a man aged 60 years originally from a strongyloides endemic area with a medical history of alcohol abuse who presents with strongyloides hyperinfection syndrome shs complicated by partial small.
Strongyloides stercoralis is an endemic parasitic infection that can remain asymptomatic for years, but it can cause death in immunosuppressed individuals. However, in patients receiving longterm corticosteroid therapy, hyperinfection can occur, resulting in high mortality rates up to 87%. Download fulltext pdf download fulltext pdf intestinal strongyloidiasis and hyperinfection syndrome article pdf available in clinical and molecular allergy 41. Immunosuppression with antitumour necrosis factor therapy. We describe a patient with strongyloides stercoralis hyperinfection associated with streptococcus pyogenes and with streptococcal toxic shock syndrome. Clinical clues include an appropriate travel history even in the remote past, gastrointestinal symptoms, cutaneous symptoms, eosinophilia, or thrombocytosis. The mortality in strongyloides hyperinfection syndrome shs is alarmingly high. Hyperinfection definition of hyperinfection by medical. However, the patient subsequently died from acute respiratory. Streptococcus pyogenes bacteremia and toxic shock syndrome. A fatal strongyloides stercoralis hyperinfection syndrome in. Strongyloides stercoralis is an intestinal nematode acquired primarily in the tropics or subtropics, estimated to infect approximately 100 million people worldwide.
717 210 449 864 180 417 1309 1406 1085 225 351 1522 1658 941 1453 388 1474 302 758 1363 353 432 1628 1184 245 131 133 1427 467 434 1322 1603 647 936 221 912 103 1299 988 875 1278 641 1413 398