Pulmonary strongyloidiasis is a common manifestation of strongyloides hyperinfection syndrome
, and the detection of increased number of larva in sputum is the hallmark of hyperinfection as seen with the case reported here.
2,4) The hyperinfection syndrome
causes overwhelming infection in immunocompromised hosts as the parasite begins to replicate without leaving its host, through an accelerated autoinfection cycle.
6) Corticosteroid use causing immunosuppression is commonly associated with hyperinfection syndrome
and have precipitated death in more than 60% of cases.
As a standard laboratory protocol, to rule out hyperinfection syndrome
an additional sputum specimen of the patients infected with Strongyloidiasis was also submitted to Parasitology division.
Immunosuppressed persons can develop strongyloides hyperinfection syndrome
, which can be fatal (1).
develops when immunosuppression reduces the immune surveillance and results in augmentation of the normal life cycle of the parasite leading to a dramatic increase in the density of the larvae.
Dx: Strongyloides stercoralis hyperinfection syndrome
Subcutaneous ivermectin as a safe salvage therapy in Strongyloides stercoralis hyperinfection syndrome
In immunocompromised patients, the endogenous autoinfection cycle may result in the overproduction and dissemination of larvae into intestinal and extraintestinal tissues, including the central nervous system, leading to the hyperinfection syndrome
which can be lethal (5).
The most common nematodes to consider include Strongyloides stercoralis as part of a hyperinfection syndrome
, Toxocara species or less commonly Baylisascaris species as agents of visceral larva migrans, or other nematode worms that may involve the CNS such as Angiostrongylus and Gnathostoma species.
2), (3) During autoreinfection, the larvae disseminates into the intestinal track, pulmonary tissue, and skin, resulting in a hyperinfection syndrome
with a fatality rate of 90%.
In HIV-infected patients, the presence of peripheral eosinophilia should always raise the suspicion of the strongyloides hyperinfection syndrome