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)

Conclusion

Strongyloides HS should be suspected in critically ill patients with asthma with a pertinent epidemiological background, and for whom conventional breathing therapy and broad-spectrum antibiotics failed. Once the diagnosis of Strongyloides infection is established, corticosteroids should be discontinued and therapy with ivermectin should be initiated promptly. A high index of suspicion and epidemiological risk assessment are the cornerstone for the diagnosis of this condition in both developed and developing countries.

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Abbreviations
BAL: Bronchoalveolar lavage; bpm: Beats per minute; CT: Computed tomography; ELISA: Enzyme-linked immunosorbent assay; GI: Gastrointestinal; HIV: Human immunodeficiency virus; HS: Hyperinfection syndrome; HTLV-1: Human T-cell lymphotropic virus; IFN-γ: interferon-γ; IL: Interleukin; pCO₂: Partial pressure of carbon dioxide; pO₂: Partial pressure of oxygen; SO₂: Saturation of oxygen; STH: Soil-transmitted helminths; T: Temperature; Th2: T-helper type-2; TNF-α: Tumor necrosis factor-α

Acknowledgements
The authors would like to express their gratitude to the personnel of the Laboratory of Parasitology at the Tropical Medicine Institute "Alexander von Humboldt."

Funding
No specific funding was obtained.

Availability of data and materials
All data, images, and results are available from the corresponding author on reasonable request.

Ethics approval and consent to participate
The CARE guidelines were thoroughly followed to present the case report.

Consent for publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Publisher's Note
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Table 1. Hyperinfection syndrome due to *Strongyloides stercoralis* in patients with asthma
Author and year		Age/Sex	Risk factors	Comorbidities	AEC (cells/μL)	Larvae in sputum/BAL	Larvae in stool	Histopathological findings	Time to anti-parasitic administration (days)	Anti-parasitic treatment, duration	Outcome
1	Nwokolo and Imohiosen 1973 [12]	15/F	EEA	None	3502	YES	NO	NA	NA	TBZ, 2 days DEC, 25 days	Unknown
2	Higenbottam and Heard 1976 [13]	57/M	EEA, steroids	None	11	NO	NO	Larvae in bronchial sections of both lungs	None	None	Died
3	Kaslow et al. 1990 [14]	74/M	EEA, steroids	None	2665	YES	YES	Larvae in the heart, stomach, and colon	3	TBZ, 17 days	Died
4	Marsan et al. 1993 [15]	54/M	EEA, steroids	None	< 130	YES	NA	NA	NA	TBZ	Survived
5	Rivals et al. 2000 [16]	60/M	EEA, steroids	Ischemic heart disease	NA	YES	YES	NA	2	TBZ, 6 days	Survived
6	Jones et al. 2002 [17]	75/M	EEA, steroids	None	1200	YES	NO	NA	NA	ABZ, 3 days IVM, 11 days	Survived
7	Upadhyay et al. 2001 [18]	82/M	EEA, steroids	None	324	YES	NA	Larvae infiltration in lung	5	ABZ, 7 days	Died
8	Ochoa et al. 2003 [19]	55/M	EEA, steroids	None	NA	YES	YES	Larvae in mucosa and submucosa of the main bronchi	9	ABZ, 3 days	Died
9	Kim et al. 2005 [20]	71/M	EEA, steroids, DM, alcohol use	COPD, Cushing syndrome, DM	165	YES	NO	NA	None	None	Died
10	Jayaprakash et al. 2009 [21]	50/F	EEA, steroids	None	NA	YES	YES	NA	NA	IVM, 7 days	Survived
11	Altintop et al. 2010 [22]	68/F	EEA, steroids, methotrexate	RA	NA	YES	YES	Larvae in gastric glands and duodenal crypts	NA	ABZ, 23 days IVM, 3 days	Survived
12	Bashir et al. 2015 [23]	70/M	EEA, steroids, DM	DM	109	YES	YES	NA	NA	IVM, 2 days	Survived
13	Alsharif et al. 2015 [24]	31/F	EEA, steroids	None	3831	YES	YES	NA	NA	IVM, 17 days	Survived
14	Wang et al. 2016 [25]	NA/M	EEA, steroids	None	1099	YES	YES	Larvae in duodenal mucosa	NA	ABZ, 14 days	Died

ABZ albendazole, AEC absolute eosinophil count, BAL bronchoalveolar lavage, COPD chronic obstructive pulmonary disease, DEC diethylcarbamazine, DM diabetes mellitus, EEA exposure to an endemic area, F female, IVM ivermectin, M male, NA not available, RA rheumatoid arthritis, TBZ thiabendazole

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A Case Report on Hyperinfection Syndrome

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