Strongyloides hyper-infection: a case for awareness.
In patients receiving immunosuppressive therapies, Strongyloides stercoralis can cause a life-threatening septic shock, with multi-organ failure and infestation. Strongyloides hyper-infection should be considered in any immunosuppressed patient who has been exposed to the parasite, even if it is many years since that exposure occurred. Delayed eosinophilia may be a feature and treatment with high doses of anthelmintics may be required. An interesting case of S. stercoralis hyper-infection was recently observed at the Royal Darwin Hospital in tropical, northern Australia. The patient was an 18-year-old female with lupus glomerulonephritis, who was receiving immunosuppression in the form of corticosteroids and pulse cyclophosphamide. The characteristics and intensive-care management of this case, including the use of granulocyte-colony stimulating factor and high-dose ivermectin, are described. The patient, who survived, appears to represent the first reported case of S. stercoralis hyper-infection with suspected myocarditis.
Potter
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Intensive Care Unit, The Royal Darwin Hospital, PO Box 41326, Casuarina, NT 0811, Australia. a.w.potter@doctors.org.uk
Stephens
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D
De Keulenaer
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B
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000009:adverse effects; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007559:Ivermectin / Q000627:therapeutic use; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D009205:Myocarditis / Q000469:parasitology; D009894:Opportunistic Infections / Q000150:complications* / Q000188:drug therapy; D017171:Strongyloides stercoralis; D013322:Strongyloidiasis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D015163:Superinfection / Q000150:complications* / Q000188:drug therapy
D000305:Adrenal Cortex Hormones; D000871:Anthelmintics; D007166:Immunosuppressive Agents; D007559:Ivermectin; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003520:Cyclophosphamide