Strongyloides hyperinfection syndrome after heart transplantation: case report and review of the literature.
Stronglyoides hyperinfection syndrome (SHS) is an augmentation of the infective life cycle of S stercoralis. Immunosuppressed patients, especially those taking corticosteroid therapy, are at risk. We present a case of fatal SHS with disseminated infection following orthotopic heart transplantation. The patient was treated with increased doses of immunosuppressive medications for graft rejection, including corticosteroids. A review of the literature describing the pathophysiology, host defenses and treatment of SHS is also presented. Diagnostic tests for S stercoralis are reviewed. SHS should be part of the differential diagnosis in immunosuppressed patients presenting with sepsis or gastrointestinal or pulmonary complaints. Pretransplant evaluation for parasitic infections, including strongyloidiasis, should occur in endemic areas or in patients at risk for occult infestation.
Schaeffer
Michael W
MW
Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio 45267, USA.
Buell
Joseph F
JF
Gupta
Manish
M
Conway
Ginger D
GD
Akhter
Shahab A
SA
Wagoner
Lynne E
LE
D001992:Bronchoalveolar Lavage Fluid / Q000469:parasitology; D017809:Fatal Outcome; D005243:Feces / Q000469:parasitology; D006084:Graft Rejection / Q000517:prevention & control; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology*; D013322:Strongyloidiasis / Q000209:etiology* / Q000276:immunology / Q000503:physiopathology; D013577:Syndrome