Strongyloides stercoralis hyperinfection syndrome: a case series and a review of the literature

Géri, Guillaume; Rabbat, Antoine; Mayaux, Julien; Zafrani, Lara; Chalumeau-Lemoine, Ludivine; Guidet, Bertrand; Azoulay, Élie; Pène, Frédéric

doi:10.1007/s15010-015-0799-1

Cited by 99 publications

(131 citation statements)

References 39 publications

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“…[3] Larvae can be isolated from the stool in 3-4 weeks after an initial infection and eosinophilia is seen in a minority of infections. [4] Chronic strongyloides infection is frequently asymptomatic; however, chronic symptoms can include vomiting, diarrhea, weight loss, constipation, anal puritis and larva currens are common. [2] In a non-disseminated infection, the numbers of larvae is increased, but remain confined to the gastrointestinal and pulmonary tracts.…”

Section: Discussionmentioning

confidence: 99%

“…[3] Strongyloidiasis is a neglected tropical disease that infects an estimated 30-100 million people mainly in developing countries, but remains endemic in rural pockets of the United States. [4,5] Studies in immigrant populations have shown a prevalence of infection up to 38% and living in an endemic area remains strong risk factor for infection. [4,6] We present a case of spontaneous community acquired acute bacterial meningitis due to a GNR infection associated with Strongyloides stercoralis hyperinfection syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Gram negative rod meningitis due to Strongyloides stercoralis

Hendren

Chindhy

Shepard

2017

CRIM

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A 57-year-old male Mexican immigrant living in Dallas presented with altered mental status, progressive confusion, mild headache and fevers. He was diagnosed with embryonal liver sarcoma one year prior to admission and had recently started dexamethasone therapy for metastatic spinal lesions. Blood and cerebrospinal fluid cultures from a lumbar puncture were both positive for Escherichia coli. He was diagnosed with spontaneous gram negative rod (GNR) meningitis. Given his travel history, immunosuppression and GNR meningitis, a stool ova and parasite sample was obtained to screen for Strongyloides stercoralis. His stool was markedly positive for Strongyloides stercoralis larvae and he was further diagnosed with Strongyloides hyperinfection syndrome. Strongyloides is capable of chronically re-infecting human hosts without an external life cycle via autoinfection. In chronic infections, hyperinfection can be triggered with immunosuppressive medications, especially steroids. Disseminated Strongyloides should be considered as the source for unexplained GNR bacteremia or meningitis especially in immunosuppressed patients. Our patient likely had a chronic asymptomatic Strongyloides infection acquired in Mexico that became a hyperinfection resulting in GNR meningitis after starting high doses of dexamethasone.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Gram negative rod meningitis due to Strongyloides stercoralis

Hendren

Chindhy

Shepard

2017

CRIM

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“…In one series, most common findings were fever, respiratory symptoms, GI symptoms, neurologic symptoms, rash and hypereosinophilia [6]. Nearly 40% of patients presented bacterial infection, most often enterobacteriacae bacteremia due to damage to bowel mucosa [4].…”

Section: Clinical Manifestationsmentioning

confidence: 99%

“…In SHS, immunosuppression leads to accelerated auto-infective cycle and increased larval migration [5]. Table 1 [ [3][4][5][6] presents the various immunosuppressive states associated with SHS [5].…”

Section: Epidemiology and Pathophysiologymentioning

confidence: 99%

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Strongyloides Stercoralis Hyperinfection Syndrome: An Uncommon Mimicker

Chalut¹,

Zulay-Acero²,

Laskine³

2017

Clin Infect Immun

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COVID-19 and Dexamethasone

Stauffer

Alpern

Walker

2020

JAMA

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A widely publicized press release and subsequent preliminary report of the RECOVERY trial, a randomized study conducted in the UK, noted a survival benefit with the use of dexamethasone in hospitalized patients with coronavirus disease 2019 (COVID-19). 1 The use of dexamethasone for management of COVID-19 has already increased, particularly given the recent National Institutes of Health COVID-19 Treatment Panel guidelines that recommend its use. 2 Although clinicians are familiar with the most common adverse effects associated with dexamethasone, a corticosteroid, they may be less familiar with a potentially severe, but preventable, less common complication: Strongyloides hyperinfection or dissemination syndrome (hyperinfection). 3 Strongyloidiasisiscausedbyanematode(roundworm) infection, with most human disease associated with Strongyloidesstercoralis.Strongyloidesinfectionispredominantly acquired through contact with soil contaminated withfree-livinglarvae,whichpenetratetheskinandmigrate totheintestine,wheretheylayeggs.Eggsareexcretedinto the environment where they hatch. Larvae complete the lifecyclebypenetratingtheskinofanewhost.Unlikeother soil-transmittedinfections,eggsofStrongyloidesmayhatch into filariform larvae in the intestines and directly autoinoculate, reinfecting their human host (autoinfection) withoutanenvironmentalstage.Thisuniquecharacteristicperpetuates chronic infection, often lasting for decades.Although a majority of individuals with strongyloidiasis are asymptomatic, a severe disease manifestation is hyperinfection syndrome. This frequently fatal iatrogenic complication is usually associated with use of an immunosuppressive drug in persons with unrecognized chronic infection. The most common precipitator is use of a corticosteroid agent, which appears to be independent of dose or duration of treatment. [3][4][5] Coinfection with human T-lymphotropic virus type 1, which is disproportionately found in immigrant and refugee populations, is also associated with hyperinfection syndrome. 3,4 Although prevalence data are lacking from many regionsoftheworld,Strongyloidesisestimatedtoinfecthundreds of millions of people worldwide, 3,6 with studies sug-gestingthat10%to40%ofpopulationsintropicalandsubtropical regions may be infected. 6,7 A 2019 meta-analysis of studies involving migrants worldwide found a pooled strongyloidiasis seroprevalence of 12.2%; the prevalence was 17.3% among migrants from Asia, 14.6% among migrants from sub-Saharan Africa, and 11.4% among those from Latin America and the Caribbean. 8 The prevalence among certain populations of refugees from Africa and Asia arriving in the US is estimated to approach 50%. 9 Although there are no incidence or prevalence estimates

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Strongyloides stercoralis hyperinfection syndrome: a case series and a review of the literature

Cited by 99 publications

References 39 publications

Gram negative rod meningitis due to Strongyloides stercoralis

Gram negative rod meningitis due to Strongyloides stercoralis

Strongyloides Stercoralis Hyperinfection Syndrome: An Uncommon Mimicker

COVID-19 and Dexamethasone

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