The Strongyloides hyperinfection syndrome.
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We report a fatal case of disseminated strongyloidiasis masquerading clinically as stage IV caecal malignancy diagnosed at post mortem by needle necropsy. The parasite was seen in the smears from CSF, pleural fluid, ascitic fluid, splenic aspirate, lung aspirate and aspirates from caecal area. Enteric organisms like Group D streptococci and candida sp were also associated. We believe that this is the first report of widespread dissemination of S. stercoralis in AIDS from India.
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Pulmonary infection due to the filariform larvae of Strongloides stercoralis may occur in immunocompromised patients residing in endemic areas of the United States. Such infection usually presents as dyspnea with a cough that sometimes results in bloody sputum. Although the chest roentgenogram often reveals a patchy bilateral alveolar infiltrate, acute respiratory distress is unusual. We report a patient who experienced severe exacerbation of his underlying obstructive lung disease that was associated with chest infiltrates and recovery of S stercoralis from his sputum. Although initial improvement was accomplished with Thiobendazole treatment, a re-exacerbation occurred when antiparasitic therapy was completed. The persistence of his infection is correlated to factors that are commonly employed in the treatment of COPD but may be overlooked as predisposing causes of hyperinfection with S stercoralis.
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