Strongyloides hyperinfection presenting as proteinlosing enteropathy

Abstract

Strongyloides stercoralis, a soil-transmitted helminth, affects many people in tropical and subtropical countries. It is known to cause asymptomatic infection in immunocompetent and hyperinfection and disseminated Strongyloides infection in immunocompromised due to autoinfection. Here, we report a case of Strongyloides hyperinfection presenting with proteinlosing enteropathy. The diagnosis was made only with duodenal biopsy as the repeated stool examinations were negative. He was treated with ivermectin and his condition improved.

Strongyloidiasis as a Hidden Cause of Protein Losing ‎Enteropathy

“…The direct disappearance of the patient for 5 years after receiving albendazole therapy did not give us the chance to complete her investigations and exclude immunocompromising conditions including chronic illness, immunosuppressive therapy and HIV. However, a nearly similar clinical presentation was reported by Lakshmanan et al [2]. Moreover, the mere advanced age and malnutrition -manifested in this patient -can be considered as a cause of immunocompromisation that leads to enhancing the autoinfection, hyperinfection and even ultimately disseminated infection [4].…”

“…The endoscopic findings of duodenumincluding inflammation and ulceration of the mucosa were reported also by Lakshmanan et al [2]. They may be not pathognomonic for strongyloidiasis but they can be considered good diagnostic signs for strongyloidiasis in endemic areas [9].…”

“…In endemic areas, the parasite can persist and replicate in the host for years causing various clinical presentations including diarrhea, abdominal pain, vomiting, fever, GI hemorrhage, weight loss, adynamic ileus, skin manifestations and pneumonia. In hyperinfection , strongyloidiasis could be a strong etiological factor for chronic diarrhea and protein losing enteropathy [2]. Disseminated infection occurs when larvae invade organs other than GIT and lungs i.e, beyond the autoinfection range.…”