title: A case of Strongyloides hyperinfection associated with tuberculosis.
abstract: Strongyloidiasis is a parasitic infection that occurs in tropical regions. Hyperinfection, which is an accelerated autoinfection, is often associated with an immunosuppressive state, such as HTLV-1 infection or steroid use. Immunosuppression can also lead to reactivation of tuberculosis infection. These infections may have interacted as a result of impaired cellular immunity. A 28-year-old Nepali male was referred to our hospital for slight abdominal pain and high fever. An abdominal CT scan showed ascites and intestinal swelling. He was admitted with suspected gastroenteritis. Results of stool microscopy on the third day of hospitalization revealed abundant strongylid larvae. We diagnosed a Strongyloides hyperinfection and prescribed ivermectin. Although the numbers of strongylid organisms in the patient's stool soon diminished, his temperature remained high. After receiving a second dose of ivermectin on day 17, he was transferred to a nearby hospital for observation, where he was noted to have massive pleural effusion. He returned to our hospital where his pleural effusion was found to be positive for adenosine deaminase (ADA), and he was diagnosed with a tuberculosis infection. Strongyloides hyperinfection can occur in a non-endemic region. It can be associated with tuberculosis infection possibly due to impaired cellular immunity. It is important to consider other possible infections when treating a patient with an infection associated with impaired cellular immunity.
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Iwashita
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Asami
authors.initials: A
authors.lastname: Masui
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kawamoto
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Yokoyama
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Akitaka
authors.initials: A
authors.lastname: Yamamoto
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Yukinari
authors.initials: Y
authors.lastname: Omori
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Ishikura
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hatada
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Fujioka
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Taichi
authors.initials: T
authors.lastname: Takeda
authors.affiliation: Emergency and Critical Care Center, Mie University hospital, 2-147 Edobashi, Tsu, Mie, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imai
keywords: Cellular immunity; Hyperinfection; Ivermectin; Strongyloidiasis; Tuberculosis