Hiper-infecção por Strongyloides Stercoralis: relato de caso

Abstract

RESUMO JUSTIFICATIVA E OBJETIVOS:O Strongyloides stercoralis é um agente comum de infecção do trato gastrintestinal. Em pacientes imunodeprimidos este nematódeo pode causar hiper-infecção, com manifestações pulmonares e sepse por germes gram-negativos. O objetivo deste relato foi apresentar um caso com evolução letal e ressaltar a importância do diagnóstico e do tratamento precoce. RELATO DO CASO: Paciente do sexo masculino, 60 anos, com diagnóstico de tumor de timo, submetido a tratamento cirúrgico, radioterapia e quimioterapia. Foi consultado na emergência relatando queixa de diarréia e dispnéia, sendo admitido na UTI após apresentar quadro de insufi ciência respiratória aguda hipoxêmica e choque refratário, evoluindo para óbito. SUMMARY BACKGROUND AND OBJECTIVES: StrongyloidesStercoralis is a common cause of gastrointestinal infection. This nematode can produce an overwhelming hyperinfection syndrome, especially in the immunocompromised patient. Typically, patients present with pulmonary symptoms, but subsequently they can acquire Gram-negative sepsis. The objective of this report is to describe a lethal case and call attention to the importance of early diagnosis and treatment. CASE REPORT: Male patient, 60 year-old with diagnosis of timoma, treated with surgery, radiotherapy and chemotherapy in the past. He presented to the emergency room complaining of diarrhea and dyspnea, and then transferred to the ICU after development of hypoxemic acute respiratory failure and refractory septic shock, and despite treatment the patient died. A bronchial sample of sputum showed Strongyloides stercoralis worms. CONCLUSIONS: Strongyloides stercoralis infection symptoms are usually mild, but in the setting of impaired host immunity, a disseminated and severe illness may occur. Clinicians must be aware for patients from endemic areas. Diagnosis may be established through sputum and stool examination for Strongyloides stercoralis worms.

HIPERINFESTAÇÃO POR Strongyloides stercoralis: UMA ABORDAGEM A CLÍNICA E AO DIAGNÓSTICO LABORATORIAL

“…Durante essa migração, ocorre uma muda para o estágio L4. Posteriormente, são deglutidas e atingem o trato gastrintestinal alojando-se na mucosa intestinal, particularmente no duodeno, mergulhadas nas glândulas de Lieberkuhn e na porção superior do jejuno, onde se transformam em fêmeas partenogenéticas e iniciam a oviposição dando origem às larvas rabditóides (Benincasa et al, 2007).…”

“…A maioria das larvas rabditóides nos estágios, L1 e L2, é eliminada nas fezes e algumas delas sofrem uma segunda ecdise antes de serem expelidas, ou seja, tornam-se filarióides infectantes, ainda no intestino grosso do hospedeiro penetram na mucosa do cólon e reiniciam o ciclo (ARANGO, 1998). As larvas rabditóides eliminadas nas fezes podem evoluir para larvas infectantes (filarióides) no solo ou transformar-se em vermes machos ou fêmeas de vida livre (Rey, 2001;Benincasa et al, 2007).…”

P a n g a s t r i t i s b y S t r o n g y l o i d e s s t e r c o r a l i s i n A n Immunocompetent Patient: Case Report and Literature Review

“…Strongyloides stercoralis is a common worldwide nematode, most frequently found in tropical and temperate areas, such as Brazil. The majority of infected patients are asymptomatic, what possibly contributes to the underdiagnosis of this condition [1,2] . The symptomatic, disseminated and lethal forms of the disease are more commonly observed in immunocompromised patients, especially those in use of chronic corticosteroids therapy.…”

“…The symptomatic, disseminated and lethal forms of the disease are more commonly observed in immunocompromised patients, especially those in use of chronic corticosteroids therapy. In Brazil, screening or empiric treatment of this condition is highly recommended in patients who will be submitted to immunosuppressive therapy for a period longer than 14 days or to those who presents others immunosuppressive conditions, such as HIV [1,2] . Estrongiloidiasis is caused by the female worm and its life cycle initiates through skin contamination.…”

“…Estrongiloidiasis is caused by the female worm and its life cycle initiates through skin contamination. Gastric involvement is a rare phenomenon and only a few case reports have been described [1][2][3] .…”