Opportunistic Strongyloides Stercoralis Infection in an Immunocompromised Patient.

Strongyloides stercoralis is an intestinal nematode that infects human percutaneously and has a complex life cycle including a direct, an autoinfective and a non-parasitic freeliving developmental cycle. Strongyloidiasis has a worldwide distribution, and usually causes mild or asymptomatic infection. However hyperinfection syndrome can cause significant morbidity and mortality in immunocompromised states such as malignancy, HIV infection, or immunosuppressive agent administration. We report a case of a 37-year old male HIV positive patient admitted in male medical ward, RIMS with severe diarrhoea, pain abdomen, generalized weakness and history of diarrhoea off and on for past one month. His CD4+ T- lymphocyte count was 116 cell/microlitre and the patient was on antiretroviral therapy. Stool examination reveals larvae of Strongyloides stercoralis. Stool culture was negative for pathogenic bacteria and fungi. Special staining for detection of intestinal coccidian parasites and microsporidiosis was also negative .The patient was successfully treated with combined therapy of albendazole(400mg) and ivermectin(6mg) daily for 3days.

Disseminated strongyloidiasis successfully treated with extended duration ivermectin combined with albendazole: a case report of intractable strongyloidiasis.

We describe a patient with an overlapping syndrome disseminated strongyloidiasis and gram-negative sepsis. She was previously treated with albendazole 400 mg/day 14 days before admission without success. This admission, she was treated with a combination of oral ivermectin (injectable solution form), with a dosage of 200-400 microg/kg/day, and albendazole for 14 days. Strongyloides larvae disappeared from the stool by day 4 and from the sputum by day 10. No side effects were encountered during hospitalization or at the 1-month follow-up visit.

Disseminated Strongyloides stercoralis infection in an AIDS patient: The role of suppressive therapy

Patients with AIDS are prome to develop infections caused by opportunistic pathogens. Unusual agents, such as Stongyloides stercoralis, are being described in this syndrome, resulting in disseminated disease which is always severe and, in some cases, fatal. We describe a case of patient with AIDS and Strongyloides stercoralis infection involving the gastrointestinal tract and lungs. Therapy with thiabendazole for ten days led to resolution of the acute episode. Preventive therapy with 3g of thiabendazole once a week was then prescribed, and repeated fecal examinations were negative for larvae. Following discontinuation of treatment, however, the patient again had a positive fecal examination for Strongyloides stercoralis larvae, even though reinfection was considered to be very unlikely. The patient was retreated with a shorter course of therapy and once per week preventive therapy was reintroduced. After four months of follow-up, repeated fecal examinations were negative. When the treatment was changed to thiabendazole given once every two weeks, however, pulmonary Strongyloides stercoralis recurred. Subsequently, because of intolerance to thiabendazole, the patient was treated with cambendazole. The patient died three months later due to Pseudomonas aeruginosa pneumonia. Prolonged therapy for Strongyloides stercoralis infection may be necessary. Although further evaluation is needed, 3g of thiabendazole once a week may be adequate for this purpose. Cambendazole may be a useful alternative for disseminated Strongyloides stercoralis.

Strongyloidiasis. Métodos Diagnósticos

La strongyloidiasis se diagnostica rutinariamente por el examen directo de las heces del paciente. Esta no es la mejor ni la única manera de dilucidar la enfermedad, pues actualmente se cuenta con métodos inmunológicos indirectos y técnicas directas más sensibles y confiables que permiten la mayor captación de casos agudos y portadores crónicos de la infección