Strongyloides Stercoralis Infection After the use of Emergency Corticosteroids

A Case Report on Hyperinfection Syndrome

George Vasquez-Rios; Roberto Pineda-Reyes; Eloy F. Ruiz; Angelica Terashima; Fernando Mejia


J Med Case Reports. 2019;13(121) 

In This Article

Literature Analysis

Fourteen cases of asthma exacerbation associated with Strongyloides HS were identified (Table 1). The mean age was 58.6 years. The male-to-female ratio was 5:2. Of the individuals, 21% presented one or more comorbid conditions including ischemic heart disease, Cushing syndrome, and rheumatoid arthritis. All except one were born in endemic areas for Strongyloides and one was born in a developed country but served as military personnel in a high-risk country for STH. More than half of the cases (57%) were reports from health care centers in developed countries.

Among clinical manifestations, 64% of individuals presented with respiratory distress and 21% with GI symptoms. Fever was inconsistently reported. Two presented hemoptysis. Eosinophilia was reported in 20% of the cases that included this laboratory result (10 reports), while hypereosinophilia was seen in 30% of them. BAL and/or sputum were positive in 93% of cases, and the remaining individuals were diagnosed with Strongyloides HS by lung histopathology, which yielded numerous larvae during the autopsy. Stool examination was positive for larvae of Strongyloides in 67% of those patients tested (8 out of 12). Anti-parasitic therapy was administered to 86% of individuals (12 out of 14); ivermectin was the drug of choice in 42% of the cases (5 out of 12). Two of those patients received ivermectin plus another anti-parasitic drug. Overall, the mortality rate was 46% (6 out of 13; 1 outcome was unknown). Notably, individuals treated with ivermectin alone or in combination therapy had a survival rate of 100% (five out of five), while only 33% (two out of six) of those treated with a different anti-parasitic drug survived.