Twenty-five Years of Chronic Strongyloidiasis in an Immigrant

Abstract

Chronic strongyloidiasis is an infection of the tropical regions, caused by the nematode Strongyloides stercoralis. In the United States, patients are typically immigrants. The very long asymptomatic phase followed by the clinical presentation of the disease mimics asthma, chronic obstructive pulmonary disease (COPD), or inflammatory bowel disease (IBD) as in this case report. The inconsistency of eosinophilia and the low sensitivity of microscopic stool examination make chronic strongyloidiasis a disease that is frequently misdiagnosed in the United States. The use of corticosteroids in these misdiagnosed cases transforms chronic strongyloidiasis into disseminated strongyloidiasis or hyperacute syndrome, which leads to high mortality. Iatrogenic errors represent the essential cause of mortality due to chronic strongyloidiasis in the United States. We recommend a high index of suspicion of chronic strongyloidiasis when a physician approaches an immigrant presenting with symptoms mimicking asthma, COPD, and IBD with subcutaneous masses.

Strongyloides stercoralis Infection at Different Altitudes of the Cusco Region in Peru

“…Autoinfection allows Strongyloides to remain in the host for prolonged periods that may be counted in decades. 23 In elderly patients, age-related malnutrition and impaired immunity can increase susceptibility to severe forms of strongyloidiasis in endemic areas. 24,25 Case reports of strongyloidiasis in the elderly causing hyperinfection syndrome, invasive enteritis, and disseminated infection have resulted in high mortality.…”

Prevalence and risk factors of Strongyloides stercoralis infection among Orang Asli schoolchildren: new insights into the epidemiology, transmission and diagnosis of strongyloidiasis in Malaysia

“…Moreover, donor-derived strongyloidiasis infection in solid organ transplant recipients is increasingly being reported (Kim et al ., 2016; Winnicki et al ., 2018). Strongyloidiasis is commonly chronic and long lasting with a majority of infected individuals remaining asymptomatic, and infections could be sustained in individuals for more than 75 years (Prendki et al ., 2011; Junior et al ., 2017). Pulmonary migration of larvae results in transient eosinophilia with cough, dyspnoea (shortness of breath), wheezing and haemoptysis; known as Loeffler's syndrome which is seen in heavy infections (Al Hadidi et al ., 2018).…”

Strongyloides Hyperinfection Syndrome: A Curious Case of Asthma Worsened by Systemic Corticosteroids

“…Chronic strongyloidiasis is characterized by the parasite’s ability to autoinfect the human host and remain undetected for decades [ 5 ]. Figure 3 shows the parasitic cycle of the S. stercoralis nematode [ 8 ].…”

“…After entering the skin, the larvae travel via the bloodstream to the alveoli in the lungs. The migratory larvae in the lungs cause the pulmonary symptoms, which are often misdiagnosed as new-onset asthma or an exacerbation of asthma or COPD [ 5 , 6 , 9 , 10 ]. From the lungs, the larvae ascend the trachea and are eventually swallowed and descend down the esophagus into the gastrointestinal tract.…”

“…Patients with hyperinfection syndrome may develop signs of acute dyspnea that mimic an exacerbation of asthma or chronic obstructive pulmonary disease (COPD) [ 4 , 5 ].…”