In milder forms of chronic infections, strongyloides is capable of persisting in a host for years to decades. The patient was treated successfully with drotrecogin alfa activated, parenteral ivermectin, albendazole, and piperacillin. It is usually asymptomatic in a healthy host but causes. Strongyloides stercoralis is a soiltransmitted intestinal nematode. Under some conditions associated with immunocompromise, this. During immunosuppressive therapy, however, if cellular immunity is depressed, autoinfection can occur at a higher rate, resulting in hyperinfection syndrome. Hyperinfection syndromewith strongyloides stercoralis a.
Wansteadhospital, london summary acase is reported of hyperinfection syndrome with strongyloides stercoralis, with symptoms, signs and radiological appearances which led to a diagnosis of duodenal ulcer. Subcutaneous ivermectin as a safe salvage therapy in strongyloides stercoralis hyperinfection syndrome. Strongyloidosis hyperinfection syndrome in an hivinfected patient. Duodenal strongyloidiasis and hyperinfection syndrome. However, immunosuppression or chemotherapy have been described as leading triggers for strongyloides stercoralis hyperinfection syndrome.
A case is reported of hyperinfection syndrome with strongyloides stercoralis, with symptoms, signs and radiological appearances which led to a diagnosis of duodenal ulcer. Strongyloides hyperinfection syndrome, which is associated with a high mortality rate. Hyperinfection syndrome is estimated to happen in 1. Salim surani, mauricio rodriguez, sophia nooruddin, joseph. A rare manifestation of immune reconstitution inflammatory syndrome kartik natrajan,1 mahenderkumar medisetty,1 raviraj gawali,1 ajit tambolkar,1 divya patel,2 vinay thorat,3 nachiket. Neva, md, chief laboratory of parasitic diseases, national institute of allergy and infectious diseases, national institutes of health, bethesda, maryland. All uploads and downloads are deemed secure and files are permanently deleted from the smallpdf servers within an hour. In some people, particularly those who require corticosteroids or other immunosuppressive medication, strongyloides can cause a hyperinfection syndrome that can lead to death if untreated. Severe strongyloidiasis includes the hyperinfection syndrome and disseminated infection, and occurs most frequently in the immunocompromised and immunosuppressed populations. Often, a single course of treatment is insufficient. Summary strongyloides stercoralis is an intestinal nematode of humans that infects tens of millions of people worldwide. Hyperinfection syndrome with strongyloides stercoralis. Internal medicine department, university of texas health science, 6431 fannin street, suite 1.
Critical care medicine certification examination blueprint purpose of the exam the exam is designed to evaluate the knowledge, diagnostic reasoning, and clinical judgment skills expected of the certified critical care medicine specialist in the broad domain of the discipline. Invasion of the intestinal wall can facilitate the translocation of bacteria. Pdf strongyloides stercoralis hyperinfection syndrome. Hyperinfection syndrome in a renal transplant recipient. Hyperinfection syndrome is not exactly defined, but the hallmark is an increase in the number of larvae in the stool andor sputum along with manifestations confined to respiratory and gastrointestinal systems along with peritoneum.
Pdf on mar 16, 2012, cristiane tef silva and others published hyperinfection syndrome in strongyloidiasis find, read and cite all the research you need. Strongyloides hyperinfection syndrome combined with. A fatal strongyloides stercoralis hyperinfection syndrome in a patient with chronic kidney disease. For people who are from or have traveled to an area. Hyperinfection syndrome in strongyloidiasis 381 hyperinfection cases following organ transplant principally occur during the initial months after transplantation, but the infection was acquired before transplantation in the majority of cases roxby et al. Hyperinfection syndrome with strongyloides stercoralis in. Hyperinfection with strongyloides stercoralis in association with malignant lymphomahas been reported rogers and nelson, 1966 and from those who have been treated with immunosuppressive drugs and corticosteroids cruz, rebouces and rochas, 1966. Intestinal strongyloidiasis and hyperinfection syndrome clinical. We report a case of strongyloides stercoralis hyperinfection syndrome in a renal transplant recipient complicated by septic shock, acute respiratory distress syndrome, and klebsiella pneumoniae superinfection. Strongyloides stercoralis in solid organ notify library. Strongyloides hyperinfection syndrome after intestinal.
Intestinal strongyloidiasis and hyperinfection syndrome. Case of strongyloides hyperinfection syndrome bmj case reports. A condition of massive infection in which threadworm larvae multiply rapidly and spread throughout the body. A fatal strongyloides stercoralis hyperinfection syndrome in. The term hyperinfection refers to autoinfection of the strongyloides stercolis larvae which burrow through the gastrointestinal mucosa, resulting in massive dissemination, thus greatly increasing the parasite burden potentially leading to septic shock. We report on the successful treatment of two surviving immunocompromised patients with s. Hyperinfection syndrome with strongyloides stercoralis s.
Although eosinophilia is a common finding in patients with chronic strongyloides infection, it is a very unreliable predictor of hyperinfection syndrome. Syndrome of hyperinfection with strongyloides stercoralis. Pdf hyperinfection syndrome in strongyloidiasis researchgate. Diagnosis of strongyloides hyperinfection syndrome andor disseminated disease can be very difficult to establish and entails a high level of suspicion. Hyperinfection syndrome in strongyloidiasis 381 hyperinfection cases following organ transplant principally occur during the initial months after transplantation, but the infection was acquired.
We conducted a structured search using pubmed to collect case reports. Epidemiology of strongyloides stercoralis infection in bolivian. About half the time, it occurs along with other autoimmune conditions, like rheumatoid arthritis or lupus. The medication ivermectin is widely used to treat strongyloidiasis. It is usually associated with damage to the immune system, the use of steroid medications, or malnutrition. Health, general antibacterial agents complications and side effects blood medical examination blood tests corticosteroid drugs corticosteroids meningitis strongyloidiasis care and treatment case studies. A case report of a cancer patient with recurrent hyperinfection syndrome is presented, followed by a brief update on recent information about this parasitic infection and its management. It can present over 30 years after initial infection. Before you combine the files into one pdf file, use merge pdf to draganddrop pages to reorder or to delete them as you like. Higher mortality rate s occur from extraintes tinal strongyloidiasis. Rearrange individual pages or entire files in the desired order. The mortality rates of hyperinfection are high, making strongyloides infection an important global health.
Pdf in spite of recent advances with experiments on animal models, strongyloidiasis, an infection caused by the nematode parasite. Split pdf file separate one page or a whole set for easy conversion into independent pdf files. Management of strongyloides hyperinfection syndrome. Strongyloides hyperinfection syndrome complications.
Strongyloidiasis is commonly a clinically unapparent, chronic infection, but immuno suppressed subjects can develop fatal disease. Strongyloidiasis is caused by the female nematode strongyloides stercoralis. Shs is a lifethreatening condition that usually affects immunosuppressed individuals. Strongyloides hyperinfection syndrome correspondence to. Prevalence of strongyloides stercoralis infection and hyperinfection. In hyperinfection syndrome, this classic life cycle is exaggerated ie, the parasite burden and turnaround increase and accelerate. The only data that exists regarding the us incidence of strongyloides infection is from the 1980s in rural southeastern us.
The clinical presentation of hyperinfection syndrome is similar to that of classic strongyloidiasis, which includes nausea, vomiting, diarrhea, weight loss, abdominal pain, gi hemorrhage, cough, fever, and dyspnea. Strongyloides stercoralis hyperinfection syndrome after. Pdf intestinal strongyloidiasis and hyperinfection syndrome. Strongyloides stercoralis infection in an intestinal. Strongyloidosis hyperinfection syndrome in an hivinfected. Eosinophilia is rare in the strongyloides hyperinfection syndrome. Infection with strongyloides stercoralis is frequently asymptomatic or may show few clinical signs. We report on an intestinal transplant recipient who had s. However on occasion it can persist for many years due to. Afrequentcomplication of hyperinfection syndrome is bacteremia, usually with enteric gramnegative bacteria, caused by. Strongyloides stercoralis hyperinfection syndrome and. Strongyloides infection in a cardiac transplant recipient. Strongyloides stercoralis is an intestinal nematode that causes human infections and whose life cycle has special features, including autoinfection.
Hyperinfection definition of hyperinfection by medical. Alabama usa having implications for the origin of tooth plates from tooth files. One died shortly after diagnosis, but the other survived the hyperinfection syndrome and complicating bacterial sepsis and meningitis. Scientific article, clinical report by west virginia medical journal. Autoinfection and hyperinfection with strongyloides.
Strongyloides infection may be asymptomatic for years, owing to a low parasite load. Hyperinfection syndrome definition of hyperinfection. In hyperinfection syndrome, this classic life cycle is exaggerated ie, the parasite burden and turnaround increase and. Treatment of strongyloides stercoralis hyperinfection. Transplant recipients under the treatment of immunosuppressant agents. It is usually asymptomatic in a healthy host but causes life threatening hyperinfection involving multiple organs in immunocompromised patients. Hyperinfection with strongyloides stercoralis occurred in three patients with malignant lymphoma. Generating an epub file may take a long time, please be patient. Immunosuppressed individuals are at risk for developing strongyloides hyperinfection syndrome. For hyperinfection syndrome and disseminated infections, ivermectin is the drug of.
Up to 75% of people with chronic strongyloidiasis have mild peripheral eosinophilia or elevated ige levels. Hyperinfection syndrome develops when immunosuppression reduces the immune surveillance and results in augmentation of the normal life cycle of the parasite leading to a dramatic increase in the density of the larvae. Screening, prevention, and treatment for hyperinfection syndrome. Introduction hyperinfection with strongyloides stercoralis in. Full text get a printable copy pdf file of the complete article 960k, or click on a page image below to browse page by page. Hyperinfection syndrome with hypereosinophilia and chronic. Treatment of uncomplicated strongyloidiasis is simple and highly. Strongyloides hyperinfection syndrome presenting as. Hyperinfection syndrome in a renal transplant recipient franklin a. Strongyloides stercoralis is a soiltransmitted intestinal nematode that. The goals of treatment are investigated for the different infection states.
Infection with strongyloides stercoralis was first reported in the year 1876 in. Delayed strongyloides stercoralis hyperinfection syndrome. Strongyloides stercoralis may lead to overwhelming infestation strongyloides hyperinfection syndrome shs. Bronchoalveolar lavage microscopy showing a strongyloides stercoralis larva. Infection with the parasitic nematode, strongyloides stercoralis, can lead to death in patients with various clinical disorders. The probable cause in each case was alteration of the immune responses either as a result of the malignant lymphoma or by the treatment given. Rare disease strongyloides hyperinfection syndrome. Apatient with hyperinfection is reportedwhohadbeentreated withcimetidineforone year. Strongyloides stercoralis in the immunocompromised. The diagnosis of hyperinfection syndrome can be difficult. In addition, solid organ transplant recipients receiving organs from donors with epidemiologic risk for latent strongyloides infection are at risk for donorderived strongyloidiasis 8,9.
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