Strongyloides stercoralis Causing Polymicrobial Empyema in a Cancer Patient

Hung D. Tran, MD, Sinai Hospital, Baltimore; John N. Greene, MD, and Ramon L. Sandin, MD, MS, both from the University of South Florida College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, Tampa; and Albert L. Vincent, PhD, H. Lee Moffitt Cancer Center and Research Institute, Tampa

Disclosures

Infect Med. 2001;18(1) 

In This Article

Abstract and Introduction

Following surgery for chest wall sarcoma, a patient had recurrent infections and chronic empyema despite multiple courses of antibiotic therapy. Disseminated strongyloidiasis was eventually diagnosed. Recurrent bacteremia, meningitis, or infection of a normally sterile cavity by enteric organisms in an immunosuppressed host should prompt a workup for disseminated strongyloidiasis. Cytologic examination of sputum may reveal the larval forms, or sputum culture may demonstrate the serpiginous trails of bacterial colonies along the larval path of movement. Treatment of the parasite is necessary to prevent recurrent enteric bacterial infection.

Strongyloides stercoralis is a nematode that inhabits the small intestine. It is widely distributed in tropical regions of the world as well as the southeastern United States. This parasite is capable of causing autoinfection. It can persist in an asymptomatic host for many decades after the person has left an area in which S stercoralis is endemic. In the presence of kwashiorkor, burns, or immunosuppression, overwhelming disseminated strongyloidiasis may produce fatalities in untreated hosts. We describe the first case of polymicrobial empyema following disseminated strongyloidiasis in a patient who underwent local resection of a chest wall sarcoma, followed by chemotherapy and radiation therapy.

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