Strongyloides as a Cause of Fever of Unknown Origin

Abstract

Strongyloides is endemic in parts of the United States. Most often it is asymptomatic but it has a wide range of clinical presentations. Because of the unusual capacity of strongyloides for autoinfection, it can cause hyperinfection, when it effects the pulmonary and gastrointestinal systems, or disseminated infection, when other organs are involved. Both hyperinfection and disseminated strongyloides usually occur in immunosuppressed patients. We report a case of hyperinfection with strongyloides in a man presenting with fever of unknown origin who was not immunosuppressed. ( A 36-year-old Hispanic man presented with 4 weeks of fever up to 38.8°C, a nonproductive cough, generalized abdominal pain, and a 12-lb weight loss. He had no history of tick exposure, contact with sickness, or recent travel. He had been treated previously with antiviral medication for influenza and with ciprofloxacin for presumptive prostatitis with no improvement in his symptoms. He had no significant medical history and was not taking any chronic medications. He worked as a brick layer and lived with his wife and children in rural North Carolina; he denied alcohol use. Review of systems was negative for diarrhea, vomiting, rash, night sweats, and dysuria. It was positive for headache, malaise, myalgias, arthralgias, and decreased appetite.Physical examination revealed a well-nourished, well-developed man who appeared flushed but was otherwise in no acute distress. He had a temperature of 38.6°C, pulse of 95 beats per minute, respiratory rate of 22 breaths per minute, and blood pressure of 146/83 mm Hg. Physical examination was otherwise normal. Laboratory examination revealed a white blood cell count of 11.2 ϫ 10

Fatal Strongyloides hyperinfection syndrome in an immunocompetent adult with review of the literature

“…A total of 146 papers was reviewed with nine meeting all criteria (Table ) . Most patients were male (88.9%) with a median age of 48 years (range 24–79 years).…”

Strongyloides stercoralis: current perspectives

“…stercoralis infections are often mild and associated with few or no symptoms. However, during the lung migratory phase, filariform larvae may induce inflammatory reactions, such as pneumonitis, bronchopneumonia, and pulmonary hemorrhage, including fever, 16 productive cough, wheezes, dyspnea hemoptysis, and bronchospasm. [17][18][19] Pulmonary symptoms, including dyspnea, cough, and sputum discharge, were recorded in 15.7% of S. stercoralis-infected cases.…”

Focus on Clinical Practice: Improving the Quality of Care

“…Lee and Cheong, 13 2 family physicians from Korea, provide an interesting report of their endoscopic repair of a perforation that occurred during a routine screening colonoscopy. Mounsey et al, 14 family physicians from the United States, discuss a case of strongyloides causing a fever of unknown origin in an immunocompetent man, reviewing both the common and uncommon forms (such as this one) of helminth infection. Brown et al 15 found…”