FatalStrongyloidesHyperinfection Complicating a Gram-Negative Sepsis after Allogeneic Stem Cell Transplantation: A Case Report and Review of the Literature

Abstract

Strongyloides stercoralis is an intestinal nematode that causes strongyloidiasis, which affects 30 to 100 million people worldwide. Risk factors for hyperinfection and disseminated disease include immunosuppressive drug therapy, human T-lymphotropic virus-1 (HTLV-1) infection, solid organ and bone marrow transplantation, hematologic malignant diseases, hypogammaglobulinemia, and severe malnutrition and associated conditions. The diagnosis can be difficult because a single stool examination fails to detect larvae in up to 70% of the cases, and the symptoms are nonspecific. Although eosinophilia is a common finding in patients with chronic Strongyloides infection, it is an unreliable predictor of hyperinfection. Furthermore, the lack of eosinophilia while receiving immunosuppressive therapy cannot reliably exclude the underlying chronic Strongyloides infection. We report here a fatal Strongyloides hyperinfection in a patient receiving allogeneic stem cell transplantation; risk factors and outcome in this clinical setting are discussed.

Strongyloides hyperinfection syndrome and VRE pneumonia

“…A hyperinfection syndrome can develop when the carrier becomes immunocompromised, which can occur years after initial inoculation 5. Risk factors for hyperinfection and disseminated disease include immunosuppressive therapy (specifically steroids), HTLV-1 or HIV infection, haematological malignant disease and solid organ or bone marrow transplantation 6. This progression of disease occurs when the parasite load increases and filariform larvae penetrate the bowel mucosa, migrating to other areas normally involved in the autoinfection cycle (ie, lungs, gastrointestinal tract, peritoneum) 7.…”

Strongyloides stercoralis infection in allogeneic stem cell transplant: a case report and review of the literature

“…A systematic review of the literature was performed by PubMed search limited to English–language articles. Including our present case, only 8 cases of strongyloidiasis in allo‐SCT recipients have so far been reported to our knowledge (Table ) . All were adult patients with hematological diseases (median age 36 years, range 33–54).…”

Strongyloides stercoralis larvae or egg: Which came first?

“…Strongyloidiasis and hyperinfection in both solid organ transplant and hematopoietic stem cell transplantation (HSCT) have been described, often due to reactivation of chronic asymptomatic or oligo‐symptomatic infections in recipients following the initiation of immunosuppressive therapy . Cases associated to HSCT were associated with more severe forms of disease and a higher incidence of hyperinfection, with mortality rates at 83% .…”