title: Strongyloides Stercoralis Infection Among Human Immunodeficiency Virus (HIV)-Infected Patients in the United States of America: A Case Report and Review of Literature.
abstract: BACKGROUND Strongyloides stercoralis infection is endemic in subtropical and tropical regions but is reported rather sporadically in temperate countries. In the USA, the highest rates of infection are from the southeastern states, predominantly among immigrants. There is paucity of case reports on S. stercoralis infection among HIV-infected patients who were born and raised in the USA. CASE REPORT A 61-year-old male with known HIV infection (CD4 count: 235 cells/uL, undetectable HIV RNA, on antiretroviral therapy) presented with a 3-month history of diarrhea. He was initially diagnosed to have diarrhea secondary to norovirus and later with Escherichia coli. He was treated with levofloxacin but the diarrhea persisted. Stool PCR, Clostridium difficile enzyme-linked immunoassay, cryptosporidium and giardia antigen, cyclospora and isospora smear, and fecal microscopy were all negative. Peripheral blood eosinophil count was 1,000 eosinophils/mcL. Colonic biopsies revealed fragments of S. stercoralis larvae within the crypts. The patient was treated with ivermectin with improvement of symptoms. Social history revealed that he was born and raised in the northeastern USA. He was a daily methamphetamine user and engaged in anal sex with men. He denied travel to endemic areas, except for a visit to Japan more than 30 years ago. CONCLUSIONS Our case highlights that S. stercoralis may be an underdiagnosed/under-reported cause of chronic diarrhea among HIV-infected patients. What makes this case peculiar is that the patient was born and raised in the continental USA, absence of recent travel to endemic areas, and relatively high CD4 counts. Parasitic infections, such as S. stercoralis, should be considered among HIV-infected patients with persistent diarrhea and eosinophilia regardless of ethnicity or recent travel history.
authors.affiliation: Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA.
authors.forename: Laia Jimena
authors.initials: LJ
authors.lastname: Vazquez Guillamet
authors.affiliation: Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA.|Department of Internal Medicine and Infectious Disease, Associates P.C. Stratford, Stratford, CT, USA.
authors.forename: Zane
authors.initials: Z
authors.lastname: Saul
authors.affiliation: Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA.|Department of Internal Medicine and Infectious Disease, Associates P.C. Stratford, Stratford, CT, USA.
authors.forename: Goran
authors.initials: G
authors.lastname: Miljkovich
authors.affiliation: Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA.
authors.forename: Gabriel Alejandro
authors.initials: GA
authors.lastname: Vilchez
authors.affiliation: Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA.
authors.forename: Nikolai
authors.initials: N
authors.lastname: Mendonca
authors.affiliation: Section of Gastroenterology, Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA.
authors.forename: Venkata
authors.initials: V
authors.lastname: Gourineni
authors.affiliation: Section of Gastroenterology, Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lillo
authors.affiliation: Department of Pathology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Pinto
authors.affiliation: Department of Internal Medicine, Saba University School of Medicine, The Bottom, Saba, Netherlands.
authors.forename: Aurengzaib
authors.initials: A
authors.lastname: Baig
authors.affiliation: Department of Internal Medicine, Yale New Haven Health-Bridgeport Hospital, Bridgeport, CT, USA.
authors.forename: Louie Mar
authors.initials: LM
authors.lastname: Gangcuangco
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis*; D000818:Animals; D003967:Diarrhea / Q000469:parasitology*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017171:Strongyloides stercoralis / Q000302:isolation & purification*; D013322:Strongyloidiasis / Q000175:diagnosis*; D014481:United States