Successful treatment of disseminated strongyloidiasis.
OBJECTIVE
To report the successful treatment of Strongyloides stercoralis hyperinfection, which is usually lethal but in this case was diagnosed in its early stages.


METHODS
A 44-year-old woman, who had spent much of her life in Fiji and India, was treated with a high dose of prednisolone for rheumatoid arthritis complicated by gold lung. The onset of abdominal symptoms, an exacerbation of respiratory symptoms, and a persistent high eosinophil count and serum IgE level, led to the detection of numerous Strongyloides larvae in her faeces and sputum.


RESULTS
She was treated with thiabendazole for five days, then mebendazole for one month, and the dose of prednisolone was reduced. Clinical symptoms and signs improved within days and after one week parasites could not be found in her faeces. After six months, enzyme-linked immunosorbent assay for Strongyloides infection gave a reading which was 40% of the initial level but still in the positive range.


CONCLUSIONS
Steroid therapy in individuals with chronic, subclinical strongyloidiasis predisposes to the insidious development of hyperinfection syndrome, which has a high mortality rate. If detected early, this complication can be treated effectively. It can be prevented by actively seeking Strongyloides infection, by faecal microscopy and culture techniques and by serological tests, in high-risk individuals, such as immigrants from endemic areas.
Coulter
C
C
Department of Infectious Diseases and Infection Control, Princess Alexandra Hospital, Woolloongabba, Qld.
Walker
D G
DG
Günsberg
M
M
Brown
I G
IG
Bligh
J F
JF
Prociv
P
P
D000328:Adult; D000818:Animals; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D008463:Mebendazole / Q000627:therapeutic use*; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D017171:Strongyloides stercoralis; D013322:Strongyloidiasis / Q000188:drug therapy*; D013827:Thiabendazole / Q000627:therapeutic use*
D008463:Mebendazole; D013827:Thiabendazole; D011241:Prednisone