Strongyloides stercoralis hyperinfection in a patient with rheumatoid arthritis and bronchial asthma: a case report

Abstract

ObjectiveStrongyloides stercoralis is a soil-transmitted intestinal nematode that has been estimated to infect at least 60 million people, especially in tropical and subtropical regions. Strongyloides infection has been described in immunosupressed patients with lymphoma, rheumatoid arthritis, diabetes mellitus etc. Our case who has rheumatoid arthritis (RA) and bronchial asthma was treated with low dose steroids and methotrexate.MethodsA 68 year old woman has bronchial asthma for 55 years and also diagnosed RA 7 years ago. She received immunusupressive agents including methotrexate and steroids. On admission at hospital, she was on deflazacort 5 mg/day and methotrexate 15 mg/week. On her physical examination, she was afebrile, had rhonchi and mild epigastric tenderness. She had joint deformities at metacarpophalengeal joints and phalanges but no active arthritis finding.ResultsOesophagogastroduodenoscopy was performed and it showed hemorrhagic focus at bulbus. Gastric biopsy obtained and showed evidence of S.Stercoralis infection. Stool and sputum parasitological examinations were also all positive for S.stercoralis larvae. Chest radiography result had no pathologic finding. Albendazole 400 mg/day was started for 23 days. After the ivermectin was retrieved, patient was treated with oral ivermectin 200 μg once a day for 3 days. On her outpatient control at 15th day, stool and sputum samples were all negative for parasites.ConclusionS.stercoralis may cause mortal diseases in patients. Immunosupression frequently causes disseminated infections. Many infected patients are completely asymptomatic. Although it is important to detect latent S. stercoralis infections before administering chemotherapy or before the onset of immunosuppression in patients at risk, a specific and sensitive diagnostic test is lacking. In immunosupressed patients, to detect S.stercoralis might help to have the patient survived and constitute the exact therapy.

Falla orgánica múltiple por estrongiloidiasis diseminada: Comunicación de un caso

“…La infección por S. stercoralis se asocia a septicemia por migración bacteriana a través de la pared intestinal. Los microorganismos más frecuentemente involucrados son Streptococcus sp., Enterobacter aerogenes, Proteus mirabilis 4 , así como E. coli, Klebsiella pneumoniae, Enterobacter cloacae, Bacteroides fragilis, Pseudomonas aeruginosa y Alcaligenes sp [17][18][19] bacterias que contribuyen finalmente al desenlace fatal 7,20,21 . El examen de las heces por la técnica de Baermann resultó imprescindible para el diagnóstico, pues la estrongiloidiasis es uno de las parasitosis de más difícil diagnós-tico 6,22 .…”

Strongyloides Stercoralis Hyperinfection in a Post-Renal Transplant Patient

“…In these conditions S. stercoralis causes hyperinfection. 1,19 The patient discussed had a S. stercoralis hyperinfection following renal transplant. Of interest is that the majority of cases of hyperinfection with S. stercoralis that have occurred following organ transplant were seen in patients following renal transplant and most of these cases seem to have been precipitated by increased glucocorticoid doses in response to rejection.…”

“…[5][6][7][8][9][10][11][12][13][14][15][16][17][18] In these patients, hyperinfection can occur, which, if not recognized and treated aggressively, can result in mortality rates as high as 87%. 1,19 In humans, S. stercoralis infestation most commonly involves the upper small intestine and the usual clinical presentation is nonspecific and vague and the infestation can mimic several other conditions such as inflammatory bowel disease. Given the increasing numbers of immunocompromised individuals, physicians caring for these patients should be aware of this potential and sometimes fatal complication.…”

“…[1][2][3][4] Many infected patients are completely asymptomatic and the infection can remain undetected for years. The uncomplicated intestinal form of the disease usually produces nonspecific abdominal symptoms with or without mild sporadic diarrhea.…”

Estrongiloidosis pulmonar

“…Además, los pacientes en tratamiento inmunosupresor también pueden desarrollar infecciones sistémicas por Candida spp. por mecanismos posiblemente similares 11,21,22 . En nuestra paciente se documentó una bacteriemia y una infección de vías urinarias por E. coli.…”