Strongyloides stercoralis Hyperinfection Presenting With Symptoms Mimicking Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Hyperinfection syndrome with Strongyloides stercoralis is not uncommon in immunocompromised patients. We present 2 fatal cases of Strongyloides hyperinfection with initial presentation mimicking acute exacerbation of chronic obstructive pulmonary disease (COPD). Both cases had a history of COPD and had received systemic steroid treatment before or during admission. The initial chest radiograph in both of these cases showed diffuse axial interstitial pattern. The sputum examinations of Gram stain both yielded larvae of Strongyloides stercoralis precipitously. Case 1 developed acute respiratory distress syndrome and bacteremia of Escherichia coli and Klebsiella pneumoniae soon after admission, and died even after receiving albendazole and antibiotic treatment. Case 2 received albendazole and antibiotic treatment for over 2 weeks, but developed refractory aseptic meningitis and died of septic shock. Neither case had high eosinophil count in peripheral blood during admission. Clinical manifestations of unexplained wheezing and respiratory failure, increased infiltration on chest radiograph, Gram-negative bacteremia, and aseptic meningitis may all be clues of Strongyloides hyperinfection. Due to the high mortality rate and severe complications in these patients, clinicians should always keep this diagnosis in mind, especially when dealing with immunocompromised patients. We suggest that a screening test be done for patients who live in endemic areas and those who are going to receive steroids for chronic disease.

Diagnosis, Treatment and Risk Factors of Strongyloides stercoralis in Schoolchildren in Cambodia

“…S. stercoralis is the only soil-transmitted helminth (STH) with the ability for auto-infection, and thus may lead to systemic infections with high parasite densities, particularly in immune-compromised hosts [3]–[5]. Disseminated strongyloidiasis may lead to severe complications with substantial mortality [4], [6].…”

Twenty-five Years of Chronic Strongyloidiasis in an Immigrant

“…Acute respiratory distress from enteric bacteria may occur, 14 with a mortality rate of 73% for disseminated strongyloidiasis 15 and 50% for hyperinfection syndrome. 2 Unfortunately, the clinical presentation of chronic strongyloidiasis can mimic chronic obstructive pulmonary disease (COPD) exacerbation, 16 acute new-onset asthma, 17 and ulcerative colitis, 5 leading to the use of empiric corticosteroids, which will be fatal in these misdiagnoses. As a matter of fact, only 9% of US physicians consider further parasitology evaluation in an immigrant who presents with an onset of wheezing and abnormal eosinophilia instead of empiric corticotherapy.…”

A case of masquerading bronchopneumonia

“…Therefore, blood cultures commonly grow Escherichia coli , Klebsiella pneumoniae , Proteus mirabilis , Pseudomonas , and Enterococcus fecalis . [4]…”