title: Respiratory hyperinfection with Strongyloides stercoralis in a patient with renal failure.
abstract: BACKGROUND
  A 40-year-old female presented to hospital with rapidly progressive renal failure secondary to antineutrophil cytoplasmic antibody (ANCA)-positive crescentic glomerulonephritis. She was started on immunosuppressive therapy (oral steroids and oral cyclophosphamide) and hemodialysis. She re-presented with persistent fever, persistent vomiting and dry cough 135 days after starting immunosuppression. A chest X-ray revealed left lower zone consolidation. Repeated sputum Gram stains were negative, and both sputum and blood cultures were sterile. A sputum smear was negative for acid-fast bacilli. The patient's fever did not respond to empirical antibiotics or antitubercular therapy. Bronchoscopic alveolar lavage and stool examination revealed larval forms of Strongyloides stercoralis.
  
  
  METHODS
  Physical examination, urine and blood analyses, chest X-ray, bronchoscopy and bronchoalveolar lavage examination.
  
  
  METHODS
  Respiratory hyperinfection syndrome due to S. stercoralis.
  
  
  RESULTS
  Ivermectin, albendazole and empirical broad-spectrum antibiotics for bacterial superinfection (amoxicillin and clavulanic acid for 5 days followed by piperacillin and tazobactam plus levofloxacin).
authors: Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India. mmr@icenet.net
authors: Mohan
authors: M
authors: Rajapurkar
authors: Umapati
authors: U
authors: Hegde
authors: Mahesh
authors: M
authors: Rokhade
authors: Sishir
authors: S
authors: Gang
authors: Kalpesh
authors: K
authors: Gohel
mesh_terms: D000284:Administration, Oral; D000328:Adult; D015766:Albendazole / Q000627:therapeutic use; D000818:Animals; D000871:Anthelmintics / Q000627:therapeutic use; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D000977:Antiparasitic Agents / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007559:Ivermectin / Q000627:therapeutic use; D011014:Pneumonia / Q000469:parasitology; D013902:Radiography, Thoracic; D051437:Renal Insufficiency / Q000150:complications* / Q000209:etiology; D012141:Respiratory Tract Infections / Q000150:complications* / Q000000981:diagnostic imaging; D013256:Steroids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D017171:Strongyloides stercoralis / Q000302:isolation & purification; D013322:Strongyloidiasis / Q000139:chemically induced / Q000150:complications* / Q000175:diagnosis
chemical_list: D000871:Anthelmintics; D019268:Antibodies, Antineutrophil Cytoplasmic; D000977:Antiparasitic Agents; D007166:Immunosuppressive Agents; D013256:Steroids; D007559:Ivermectin; D003520:Cyclophosphamide; D015766:Albendazole