Fatal Strongyloides stercoralis hyper-infection in a patient with multiple myeloma

Yassin, Mohamed A; Omri, Halima El; Al-Hijji, Ibrahim; Taha, Ruba; Hassan, Reham; Aboudi, K.; Elayoubi, Hanadi

doi:10.1016/s1413-8670(10)70106-9

Cited by 15 publications

(7 citation statements)

References 14 publications

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“…Similar to our case who was associated with Hodgkin lymphoma under treatment, other cases have been diagnosed in association with hematologic malignancy [ [9] , [10] , [11] ]. Adam et al [ 10 ] reported three cases of hyperinfection associated with lymphoma (one of them was classic Hodgkin lymphoma) treated with M.O.P.P.…”

Section: Discussionsupporting

confidence: 83%

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Histopathological diagnosis of strongyloidiasis hyperinfection in Tunisian patient with hodgkin lymphoma: Case report

Bdioui

Bchir

Missaoui

et al. 2021

Annals of Medicine &Amp; Surgery

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Introduction Strongyloides stercoralis , an intestinal nematode, is commonly dispersed throughout the tropical and subtropical regions. Strongyloides stercoralis infection typically contributes to an asymptomatic chronic disease which can remain hidden for decades. However, in immunocompromised patients, the hyperinfection can take place, causing high mortality rates. Case presentation A 45 year-old Tunisian women, with heavy medical history, suffering of stage 3 classic Hodgkin lymphoma under treatment; presented with complaints of epigastric pain, nausea, vomiting. Gastroduodenoscopy showed duodenal and gastric erythematous and ulcerated mucosa. Histological assessment showed chronic infiltration with a large amount of eosinophils around numerous helminth forms identified as larvae of Strongyloides stercoralis. Conclusion Early detection of Strongyloides stercoralis infection in immunocompromised patients is life saving and avoids fatality caused by hyperinfection or systemic dissemination. Routine stool examination may be negative, so histopathological identification of the parasite in tissue sections provides the definite diagnosis.

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Section: Discussionsupporting

confidence: 83%

“…But, the strongyloides hyperinfection was not diagnosed until necropsy [ 10 ]. Yacin et al [ 11 ] report a case of disseminated strongyloidiasis following steroids and radiotherapy treatment of myeloma. The patient developed hyperinfection with fatal outcome, even the Ivermectin and Albendazole treatment [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Histopathological diagnosis of strongyloidiasis hyperinfection in Tunisian patient with hodgkin lymphoma: Case report

Bdioui

Bchir

Missaoui

et al. 2021

Annals of Medicine &Amp; Surgery

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“…The diverse clinical manifestations of strongyloidosis are rarely associated with diagnosis until it is too late to successfully treat the infection, and the pulmonary symptoms are frequently regarded as an exacerbation of COPD [ 19 ]. This leads to the initiation or an increase in steroid therapy, which leads to more rapid progression of the strongloides hyper-infection [ 20 ]. In turn, this results in severe complications that are often fatal [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of strongyloidiasis is based on the observation of juvenile larvae in copro-parasitological studies [ 20 ]. The gold standard for the diagnosis of strongyloidiasis is serial examination of the parasites with routine saline or wet mount preparations, concentration techniques (Baermann concentration, Horadi–Mori filter paper culture, quantitative acetate concentration technique), culturing the samples on agar plates (faecal, sputum, BAL, duodenal aspirate), and histopathological and cytological studies (duodenal biopsy, duodenal aspirate) [ 10, 23 ].…”

Section: Discussionmentioning

confidence: 99%

Fatal strongyloidiasis after corticosteroid therapy for presumed chronic obstructive pulmonary disease

Khadka

Thapaliya

et al. 2018

JMM Case Reports

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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−1) 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.

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“…Several case reports have supported an association between S. stercoralis infection hypogammaglobulinaemia associated with multiple myeloma and nephrotic syndrome (Seet et al 2005; Hsieh et al 2006; Yassin et al 2010). …”

Section: Clinical Manifestationsmentioning

confidence: 98%

Human infection withStrongyloides stercoralisand other related Strongyloides species

2016

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SUMMARY The majority of the 30–100 million people infected with Strongyloides stercoralis, a soil transmitted intestinal nematode, have subclinical (or asymptomatic) infections. These infections are commonly chronic and longstanding because of the autoinfective process associated with its unique life cycle. A change in immune status can increase parasite numbers, leading to hyperinfection syndrome, dissemination, and death if unrecognized. Corticosteroid use and HTLV-1 infection are most commonly associated with the hyperinfection syndrome. Strongyloides adult parasites reside in the small intestine and induce immune responses both local and systemic that remain poorly characterized. Definitive diagnosis of S. stercoralis infection is based on stool examinations for larvae, but newer diagnostics – including new immunoassays and molecular tests – will assume primacy in the next few years. Although good treatment options exist for infection and control of this infection might be possible, S. stercoralis remains largely neglected.

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Fatal Strongyloides stercoralis hyper-infection in a patient with multiple myeloma

Cited by 15 publications

References 14 publications

Histopathological diagnosis of strongyloidiasis hyperinfection in Tunisian patient with hodgkin lymphoma: Case report

Histopathological diagnosis of strongyloidiasis hyperinfection in Tunisian patient with hodgkin lymphoma: Case report

Fatal strongyloidiasis after corticosteroid therapy for presumed chronic obstructive pulmonary disease

Human infection withStrongyloides stercoralisand other related Strongyloides species

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