title: Strongyloides stercoralis hyperinfection syndrome: a case series and a review of the literature.
abstract: BACKGROUND
  Strongyloides stercoralis may lead to overwhelming infestation [Strongyloides hyperinfection syndrome (SHS)]. We aimed at describing a case series of patients admitted in intensive care unit (ICU) with SHS and report a literature review of such cases.
  
  
  METHODS
  Retrospective multicenter study of 11 patients admitted to the ICU of tertiary hospitals with SHS between 2000 and 2013. Literature review with Pubmed retrieved 122 cases. Logistic regression analysis was performed to identify predictive factors of ICU mortality and shock occurrence.
  
  
  RESULTS
  133 patients [median age 53 (39, 64), 72.2 % males] were included. Underlying immunosuppression was present in 127 patients, mostly long-term corticosteroid treatment in 111 (83.5 %) patients. Fever (80.8 %), respiratory (88.6 %), and gastrointestinal (71.2 %) symptoms were common clinical manifestations. Shock occurred in 75 (57.3 %) patients and mechanical ventilation was required in 89 (67.9 %) patients. Hypereosinophilia and a concomitant bacterial infection were observed in 34 (34.3 %) and 51 (38.4 %) patients, respectively. The in-ICU mortality rate was 60.3 %. Predictive factors of ICU mortality were shock occurrence [Odds ratio (OR) 18.1, 95 % confidence interval (95 % CI) 3.03-107.6, p < 0.01] and mechanical ventilation (OR 28.1, 95 % CI 3.6-217, p < 0.01). Hypereosinophilia (OR 0.21, 95 % CI 0.06-0.7, p = 0.01) and a concomitant bacterial infection (OR 4.68, 95 % CI 1.3-16.8, p = 0.02) were independent predictors of shock occurrence.
  
  
  CONCLUSIONS
  SHS remains associated with a poor outcome, especially when associated with shock and mechanical ventilation. Deterioration to shock is often related to concomitant bacterial infection. The poor outcome of established SHS pleads for a large application of antiparasitic primary prophylaxis in at-risk patients.
authors.affiliation: Service de réanimation médicale, Hôpital Cochin, APHP, 27 rue du faubourg Saint-Jacques, 75014, Paris, France. guillaume.geri@cch.aphp.fr.|Université Paris Descartes, Paris, France. guillaume.geri@cch.aphp.fr.
authors.forename: Guillaume
authors.identifier: http://orcid.org/0000-0002-7691-6635
authors.initials: G
authors.lastname: Geri
authors.affiliation: Unité de soins intensifs respiratoires, Hôpital Cochin, APHP, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rabbat
authors.affiliation: Service de réanimation médicale, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Mayaux
authors.affiliation: Service de réanimation médicale, Hôpital Saint Louis, APHP, Paris, France.|Université Paris Diderot, Paris, France.
authors.forename: Lara
authors.initials: L
authors.lastname: Zafrani
authors.affiliation: Service de réanimation polyvalente, Institut Gustave Roussy, Villejuif, France.
authors.forename: Ludivine
authors.initials: L
authors.lastname: Chalumeau-Lemoine
authors.affiliation: Service de réanimation médicale, Hôpital Saint-Antoine, APHP, Paris, France.|Université Pierre et Marie Curie, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.affiliation: Service de réanimation médicale, Hôpital Saint Louis, APHP, Paris, France.|Université Paris Diderot, Paris, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Azoulay
authors.affiliation: Service de réanimation médicale, Hôpital Cochin, APHP, 27 rue du faubourg Saint-Jacques, 75014, Paris, France.|Université Paris Descartes, Paris, France.|Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
mesh_terms: D000328:Adult; D000818:Animals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012772:Shock, Septic / Q000453:epidemiology / Q000473:pathology; D017171:Strongyloides stercoralis / Q000302:isolation & purification*; D013322:Strongyloidiasis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis
keywords: Eosinophilia; Hyperinfection; Strongyloides stercoralis