Wait!!! No Steroids for this Asthma…

Abstract

Patient: Female, 31Final Diagnosis: Hyperinfection syndrome due to Strongyloides stercoralisSymptoms: Abdominal pain • shortness of breathMedication: PrednisoneClinical Procedure: Bronchoscopy with BALSpecialty: PulmonologyObjective:Unusual clinical courseBackground:Strongyloides stercoralis (SS) is a parasite seen in certain parts of the USA and in people from other endemic areas. In these patients steroids might precipitate or exacerbate asthma. Apart from worsening of asthma, serious complications like hyperinfection syndrome and even death can occur in these patients if treated with steroids. Treatment is either ivermectin or albendazole based on severity of the disease. Clinicians have to be very careful when prescribing steroids in patients presenting with an exacerbation of asthma from areas endemic for Strongyloides stercoralis.Case Report:A young woman with history of asthma presented with complaints of nausea, vomiting, abdominal pain, wheezing, and dry cough. Physical examination revealed diffuse expiratory wheezing and mild diffuse abdominal pain without rebound or guarding. Laboratory results showed leukocytosis with eosinophilia. Stool studies showed Strongyloides stercoralis. Imaging revealed ground-glass opacities in the right upper and lower lobe along with an infiltrate in the lingular lobe on the left side. Bronchoscopy showed Strongyloides stercoralis. The patient was diagnosed with hyperinfection syndrome due to Strongyloides stercoralis most probably exacerbated by prednisone given for her asthma. Steroids were then discontinued and the patient was started on ivermectin. The patient improved with treatment. Repeat stool examination was negative for Strongyloides stercoralis.Conclusions:Clinicians have to be very careful when prescribing steroids in patients presenting with an exacerbation of asthma who are from areas endemic for Strongyloides stercoralis and should test for it (preferably with serology test) before starting treatment.

Strongyloidiasis Current Status with Emphasis in Diagnosis and Drug Research

“…Strongyloidiasis is a cosmopolitan neglected disease, whose complications are strongly associated with alcoholism, organ transplants, HTLV-1 virus, and immunosuppression in general [ 11 – 14 ]. It is important to highlight that, even with early diagnostic, problems associated with the tests sensitivity may lead to false negatives, raising a need for new diagnostic methodologies.…”

“…Several studies have been published using murine models focusing in immunodiagnostic or in the host immune response, in an attempt to understand immunological aspects that are still unknown [ 4 – 10 ]. Immunosuppression has been correlated with the infection aggravation, mainly in cases of HTLV-1 virus coinfection, alcoholism, and corticoids use [ 11 – 14 ]. Understanding the parasite behavior in this particular context will allow not only the research and development of better therapeutic options but also better diagnostic methodologies that could lead to detection of lower parasite burden infections, allowing patients to be treated before their health deteriorates.…”

Strongyloides stercoralis infection after the use of emergency corticosteroids: a case report on hyperinfection syndrome

“…Ostera et al detected a prevalence of 4.2% among Latin American immigrants in Washington DC, USA [34]. More than half of the cases included in the literature review (Table 1) were reported in developed countries including the USA, England, France, and South Korea [13–18, 20, 24]. However, all the patients were exposed to endemic areas.…”

“…2015 [23]70/MEEA, steroids, DMDM109YESYESNANAIVM, 2 daysSurvived13Alsharif et al . 2015 [24]31/FEEA, steroidsNone3831YESYESNANAIVM, 17 daysSurvived14Wang et al . 2016 [25]NA/MEEA, steroidsNone1099YESYESLarvae in duodenal mucosaNAABZ, 14 daysDied ABZ albendazole, AEC absolute eosinophil count, BAL bronchoalveolar lavage, COPD chronic obstructive pulmonary disease, DEC diethylcarbamazine, DM diabetes mellitus, EEA exposure to an endemic area, F female, IVM ivermectin, M male, NA not available, RA rheumatoid arthritis, TBZ thiabendazole…”

Arterial Stiffness, Distensibility, and Strain in Asthmatic Children

“…For instance, Alsharif et al diagnosed a woman, who lived Mexico, with hyperinfection syndrome due to Strongyloides stercoralis , most probably exacerbated by prednisone given for asthma. Steroid was discontinued and she improved with treatment [ 28 ]. Due to such effects, it has been proposed that the use of corticosteroids may be associated with the development of atherosclerosis, although until now this connection has not been clearly established [ 29 ].…”