ABSTRACT
Strongyloides stercolaris es un parásito endémico de áreas tropicales que infecta a su huésped a través de la penetración transcutánea de sus larvas filariformes. Generalmente, la infección por S. stercolaris transcurre de forma asintomática; pero en un porcentaje de pacientes inmunodeprimidos puede acontecer el síndrome de hiperinfección con diversas manifestaciones. La asociación de S. stercolaris con la afectación glomerular es inusual. Se reporta el caso de una paciente de 42 años, que acudió a Urgencias por disnea y edemas. Los síntomas y hallazgos en los exámenes de laboratorio fueron compatibles con síndrome nefrótico. La paciente ingresó en Nefrología para recibir tratamiento corticoesteroideo intravenoso, así como la realización de una biopsia renal. Tras 10 días de tratamiento presentó mejoría clínica y se dio el alta a la espera de los resultados anatomopatológicos. Diez días más tarde acudió nuevamente por dolor abdominal intenso, deposiciones diarreicas y persistencia de la disnea. La paciente se diagnosticó con síndrome de hiperinfección por S. stercolaris secundario al tratamiento inmunosupresor recibido. Los síntomas se resolvieron con ivermectina y albendazol. Los resultados de la biopsia revelaron hallazgos compatibles con glomerulonefritis por cambios mínimos secundarios a la infección por S. stercolaris. Si bien la glomerulopatía suele manifestarse entre el primer y segundo mes de tratamiento inmunosupresor, en el presente trabajo se observó una aparición precoz de los síntomas respecto al resto de casos, que se manifestó en el día 21 de tratamiento corticoesteroideo(AU)
Strongyloides stercolaris is an endemic threadworm from tropical areas that infects its host through transcutaneous penetration of its filariform larvae. Generally, S. stercolaris infection is asymptomatic. However, in a percentage of immunosuppressed patients, the hyperinfection syndrome may occur, presenting constitutional symptoms, gastrointestinal, pulmonary and, sometimes, central nervous system symptoms. The association between S. stercolaris and glomerular damage is unusual. We report the case of a 42-year-old Bolivian patient, living in Spain, that came to the emergency room due to edema in lower limbs and dyspnea. Symptoms and laboratory test results were compatible with nephrotic syndrome, so she was admitted to Nephrology to receive treatment with intravenous corticosteroids, as well as a renal biopsy. After 10 days of treatment, she presented clinical improvement, so she was discharged waiting the anatomopathological results. Ten days later, she was readmitted due to severe abdominal pain, diarrhea, and persistent dyspnea. The patient was diagnosed with hyperinfection syndrome due to S. stercolaris secondary to the immunosuppressive treatment received. Symptoms resolved with ivermectin and albendazole. Biopsy results revealed findings consistent with minimal change disease secondary to S. stercolaris infection. Although glomerulopathy usually appears between the first and second month after immunosuppressive treatment, in the present study, an early appearance of symptoms was observed compared to the rest of the cases, appearing on day 21 of corticosteroid treatment(AU)
Subject(s)
HumansABSTRACT
La estrongiloidiasis es una parasitosis endémica que produce síntomas gastrointestinales leves. Sin embargo, en pacientes inmunocomprometidos puede producir síndrome de hiperinfección o formas diseminadas. Se presentan dos casos de hiperinfección en pacientes infectados por VIH. Esta entidad es rara en pacientes con SIDA y puede producir hemorragia alveolar. Se demuestra, en estos casos, la utilidad de la broncoscopía para confirmar la etiología y la posible coinfección.
Strongyloidiasis is an endemic parasitic disease that causes benign gastrointestinal symptoms. In immunocompromised patients, hyperinfection syndrome or disseminated forms can developed. We present two cases of hyperinfection in HIV-positive patients. This entity is rare in AIDS patients and can cause alveolar hemorrhage. The bronchoscopy is useful to confirm the etiology and possible coinfection.
Subject(s)
Acquired Immunodeficiency Syndrome , HIV , Strongyloides stercoralisABSTRACT
Pulmonary strongyloidiasis is an uncommon presentation of Strongyloides infection, usually seen in immunocompromised hosts. The manifestations are similar to that of acute exacerbation of chronic obstructive pulmonary disease (COPD). Therefore, the diagnosis of pulmonary strongyloidiasis could be challenging in a COPD patient, unless a high index of suspicion is maintained. Here, we present a case of Strongyloides hyperinfection in a COPD patient mimicking acute exacerbation, who was on chronic steroid therapy.
Subject(s)
Humans , Acute Disease , Adrenal Cortex Hormones , Diagnosis , Immunocompromised Host , Pulmonary Disease, Chronic Obstructive , Strongyloides , Strongyloides stercoralis , StrongyloidiasisABSTRACT
JUSTIFICATIVA E OBJETIVOS: O Strongyloides stercoralis é um agente comum de infecção do trato gastrintestinal. Em pacientes imunodeprimidos este nematódeo pode causar hiper-infecção, com manifestações pulmonares e sepse por germes gram-negativos. O objetivo deste relato foi apresentar um caso com evolução letal e ressaltar a importância do diagnóstico e do tratamento precoce. RELATO DO CASO: Paciente do sexo masculino, 60 anos, com diagnóstico de tumor de timo, submetido a tratamento cirúrgico, radioterapia e quimioterapia. Foi consultado na emergência relatando queixa de diarréia e dispnéia, sendo admitido na UTI após apresentar quadro de insuficiência respiratória aguda hipoxêmica e choque refratário, evoluindo para óbito. No aspirado traqueal, foi identificado larvas de Strongyloides stercoralis. CONCLUSÕES: A estrongiloidíase, apesar de tratar-se de infecção parasitária freqüentemente leve, em pacientes imunodeprimidos pode apresentar-se de forma grave e disseminada. Deve-se suspeitar deste agente em pacientes que vivem em áreas endêmicas, sendo o diagnóstico estabelecido através da pesquisa da larva do Strongyloides stercoralis na secreção traqueal e nas fezes.
BACKGROUND AND OBJECTIVES: Strongyloides Stercoralis is a common cause of gastrointestinal infection. This nematode can produce an overwhelming hyperinfection syndrome, especially in the immunocompromised patient. Typically, patients present with pulmonary symptoms, but subsequently they can acquire Gram-negative sepsis. The objective of this report is to describe a lethal case and call attention to the importance of early diagnosis and treatment. CASE REPORT: Male patient, 60 year-old with diagnosis of timoma, treated with surgery, radiotherapy and chemotherapy in the past. He presented to the emergency room complaining of diarrhea and dyspnea, and then transferred to the ICU after development of hypoxemic acute respiratory failure and refractory septic shock, and despite treatment the patient died. A bronchial sample of sputum showed Strongyloides stercoralis worms. CONCLUSIONS: Strongyloides stercoralis infection symptoms are usually mild, but in the setting of impaired host immunity, a disseminated and severe illness may occur. Clinicians must be aware for patients from endemic areas. Diagnosis may be established through sputum and stool examination for Strongyloides stercoralis worms.