[Hemodialysis and strongyloidiasis: a presumed cause of eosinophilia able to mask the other].
The authors report a case of recurrent strongyloidiasis in a former French soldier of the Indochina colonial war (1946-54). Strongyloidiasis was associated with inaugural renal failure (acute steroid-resistant interstitial-type), requiring permanent hemodialysis. Despite antiparasitic treatment, relapse with digestive and pulmonary symptoms occurred 10 years later, following chronic eosinophilia. This observation emphasises that in dialysed subjects, eosinophilia should always stimulate a search for parasitic etiologies before incriminating dialysis-material allergy. Strongyloidiasis is a self-perpetuating helminthiasis whose distribution area is far greater than the intertropical zone. It can be completely asymptomatic, appear as late digestive complications and be responsible for bacteraemic peaks with septic visceral localizations. It causes a chronic oscillating eosinophilia. Diagnosis is usually performed by iterative stool examinations by Baermann technique in order to detect Strongyloides stercoralis rhabditoid larvae. In dialysed patients with unexplained eosinophilia awaiting renal transplant, the options of systematic thiabendazole (50 mg/kg) or ivermectine (0.2 mg/kg) single-dose to overcame the risk of disseminated strongyloidiasis induced by immunosuppressive post-transplantation therapy could be debated.
Saïd
S
S
Service de néphrologie, Centre hospitalier Universitaire d'Amiens.
Nevez
G
G
Morinière
P
P
Fournier
A
A
Raccurt
C P
CP
D000368:Aged; D000818:Animals; D000969:Antinematodal Agents / Q000627:therapeutic use; D004802:Eosinophilia / Q000209:etiology* / Q000469:parasitology; D005243:Feces / Q000469:parasitology; D006801:Humans; D007559:Ivermectin / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000469:parasitology; D008297:Male; D006435:Renal Dialysis; D017171:Strongyloides stercoralis / Q000302:isolation & purification; D013322:Strongyloidiasis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D013827:Thiabendazole / Q000627:therapeutic use
D000969:Antinematodal Agents; D007559:Ivermectin; D013827:Thiabendazole
Hémodialyse et strongyloïdose: une cause présumée d'hyperéosinophilie peut en cacher une autre.