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