Lab Med Online.  2019 Jul;9(3):171-176. 10.3343/lmo.2019.9.3.171.

A Case of Chronic Strongyloidiasis with Recurrent Hyperinfection

• Park K
• Kim MS
• Chang J
• Kim EJ
• Yoo C
• Kim MJ
• Sung H
• Kim MN

• KMID: 2450843
• DOI: http://doi.org/10.3343/lmo.2019.9.3.171

Abstract

Strongyloides stercoralis is an intestinal nematode that often causes chronic diarrhea and may develop severe complicated form of hyperinfection or disseminated infection in immunocompromised patients. Here, we report a case of recurrent strongyloidiasis presenting with pulmonary and meningeal involvement. A 55-year-old male diagnosed with pancreatic cancer 4 months ago was admitted due to chronic diarrhea, abdominal pain, and weight loss for 2-3 months. He had been treated with albendazole for chronic recurrent strongyloidiasis 13 years ago and again 2 years ago. He developed sepsis of Klebsiella pneumoniae and Escherichia coli on Days 3 and 7, respectively, and then meningitis of E. coli on Day 42. Strongyloidiasis was diagnosed by detection of abundant filariform larvae in sputum specimens on Day 15. He was treated for disseminated strongyloidiasis with albendazole and ivermectin for five weeks until clearance of larvae was confirmed in sputum and stool specimens. Laboratory diagnosis is important to guide appropriate treatment and to prevent chronic and recurrent strongyloidiasis.

Keyword

Strongyloides stercoralis; Chronic; Recurrent; Hyperinfection; Sepsis; Meningitis

MeSH Terms

Abdominal Pain
Albendazole
Clinical Laboratory Techniques
Diarrhea
Escherichia coli
Humans
Immunocompromised Host
Ivermectin
Klebsiella pneumoniae
Larva
Male
Meningitis
Middle Aged
Pancreatic Neoplasms
Sepsis
Sputum
Strongyloides stercoralis
Strongyloidiasis*
Weight Loss
Albendazole
Ivermectin

Figure

• 

  Fig. 1. Microscopy of sputum and stool specimens showing Strongyloides stercoralis larvae. (A) coiled larvae (arrowheads) of spiral shape in endotracheal aspirates (gram stain, ×100) (B) filariform stage which has long esophagus, and notched tail end in endotracheal aspirates (formalin-fixed, ×400) (C) rhabditiform stage which has short buccal cavity in stool (formalin-fixed, ×400).

• 

  Fig. 2. Clinical and laboratory findings of the present case, including bowel habit, antihelminth treatment, parasitic examination of sputum and stool specimens, leukocyte count of peripheral blood, and bacterial cultures of blood and cerebrospinal fluid. D, denoted diarrhea; 0, Not observed; 1, 1–2/cover glass; 2, 3–9/cover glass; 3, ≥10/cover glass as a quantitation of larvae per 22 mm cover glass of wet mount in sputum and stool specimens; ○, No growth from blood culture; ●, Klebsiella pneumoniae from blood culture; ▲, Escherichia coli from blood culture; ■, Escherichia coli from cerebrospinal fluid culture.

Reference

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