Severe strongyloidiasis in corticosteroid-treated patients: case series and literature review.
OBJECTIVE
To describe the main features of severe strongyloidiasis in corticosteroid-treated patients


METHODS
We report on 3 cases of corticosteroid-treated patients with severe strongyloidiasis and review cases of severe strongyloidiasis in corticosteroid-treated patients reported in the literature.


RESULTS
One hundred and fifty-one cases of severe strongyloidiasis complicated a therapy with corticosteroids were evaluated. The mean age of the patients was 48+/-17 years and 71% were men. Corticosteroids were given for hematological malignancies in 34 (23%), systemic lupus erythematosus or vasculitis in 27 (18%), and nephropathy or renal transplantation in 32 (21%). At time of infection, the mean daily dosage of prednisone-equivalent was 52+/-42 mg (median: 40 mg) and 84% of patients had received a cumulative dosage of prednisone-equivalent higher than 1000 mg. The total duration of treatment ranged from 4 days to 20 years (6 months or less: 69%). Non-specific gastro-intestinal symptoms were reported in 91% of these patients associated or not with pulmonary complaints. Low-grade fever was present in 54% of patients. Fifty-nine patients (39%) experienced severe bacterial or yeast infection during the course of severe strongyloidiasis. Peripheral eosinophilia was detected at presentation in 32% of patients. Strongyloidiasis was usually confirmed by repeated stool examinations. Thiabendazole was the treatment the more widely used. Eighty-nine patients (59%) deceased during the course of the disease.


CONCLUSIONS
Severe strongyloidiasis is a risk in every corticosteroid-treated patient who has traveled to a soil-infested country, even if the contact was 30 years prior. This diagnosis should be suspected in patients who either experience unusual gastro-intestinal or pulmonary symptoms or suffer from unexplained Gram-negative bacilli sepsis.
Hopital Saint-Antoine, Internal Medicine, Parasitology and Intensive Care Department, 184 rue du Fbg Saint-Antoine, 75012 Paris, France. lfardet@club-internet.fr
Laurence
L
Fardet
Thierry
T
Généreau
Jean-Louis
JL
Poirot
Bertrand
B
Guidet
Adrien
A
Kettaneh
Jean
J
Cabane
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000188:drug therapy; D016030:Kidney Transplantation; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D013322:Strongyloidiasis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D014657:Vasculitis / Q000150:complications* / Q000188:drug therapy
D000305:Adrenal Cortex Hormones