Strongyloides stercoralis hyperinfection in patient with autoimmune hepatitis and purpura fulminans
Vikas Khillan, Neha Rathor, S. K. Sarin
Autoimmune hepatitis, purpura fulminance, strongyloides
Citation Information :
Khillan V, Rathor N, Sarin SK. Strongyloides stercoralis hyperinfection in patient with autoimmune hepatitis and purpura fulminans. Indian J Crit Care Med 2016; 20 (1):52-54.
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Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.
Strongyloidiosis is usually an asymptomatic chronic nematodal disease. The term hyperinfection is used to denote autoinfection, a phenomenon in which the number of worms increases enormously. Development or exacerbation of gastrointestinal and pulmonary symptoms is seen, (A) and the detection of increased numbers of larvae in stool and or sputum is the hallmark. It is known to occur with a change in immune status of the host; this can occur due to immunosuppressants. Cytomegalovirus (CMV) is also known to suppress host immunity. Due to the nonspecific presentation, the diagnosis is frequently missed, and the outcome remains poor with 15-87% mortality despite therapy. We report here a case of
Strongyloides stercoralis hyperinfection following immunosuppressive therapy for autoimmune hepatitis and concomitant CMV infection with purpura fulminance and frank sepsis, with fatal outcome.
Singh S, Sharma MP. Strongyloid stercoralis in Northern India. Indian J Microbiol 1992;10:197-203.
Cruz T, Reboucas G, Rocha H. Fatal strongyloidiasis in patients receiving corticosteroids. N Engl J Med 1966;275:1093-6.
Spencer JV, Lockridge KM, Barry PA, Lin G, Tsang M, Penfold ME, et al. Potent immunosuppressive activities of cytomegalovirus-encoded interleukin-10. J Virol 2002;76:1285-92.
Hunter CJ, Petrosyan M, Asch M. Dissemination of Strongyloides stercoralis in a patient with systemic lupus erythematosus after initiation of albendazole: A case report. J Med Case Rep 2008;2:156.
Debussche X, Toublanc M, Camillieri JP, Assan R. Overwhelming strongyloidiasis in a diabetic patient following adrenocorticotropin treatment and keto-acidosis. Diabetes Metab 1988;14:294-8.
Rivera E, Maldonado N, Vélez-García E, Grillo AJ, Malaret G. Hyperinfection syndrome with Strongyloides stercoralis. Ann Intern Med 1970;72:199-204.
Mani RK, Sardana R, Chawla R, Bansal A, Bansal MS, Kansal S, et al. Respiratory failure, coma and cutaneous lesions due to disseminated strongyloidiosis. Indian J Crit Care Med 2003;7:132-6.
Bank DE, Grossman ME, Kohn SR, Rabinowitz AD. The thumbprint sign: Rapid diagnosis of disseminated strongyloidiasis. J Am Acad Dermatol 1990;23 (2 Pt 1):324-6.
Link K, Orenstein R. Bacterial complications of strongyloidiasis: Streptococcus bovis meningitis. South Med J 1999;92:728-31.
Mori S, Konishi T, Matsuoka K, Deguchi M, Ohta M, Mizuno O, et al. Strongyloidiasis associated with nephrotic syndrome. Intern Med 1998;37:606-10.
Aoyama H, Hirata T, Sakugawa H, Watanabe T, Miyagi S, Maeshiro T, et al. An inverse relationship between autoimmune liver diseases and Strongyloides stercoralis infection. Am J Trop Med Hyg 2007;76:972-6.
Garg SK, Croft AM, Bager P. Helminth therapy (worms) for induction of remission in inflammatory bowel disease. Cochrane Database Syst Rev 2014;1:CD009400.
Loutfy MR, Wilson M, Keystone JS, Kain KC. Serology and eosinophil count in the diagnosis and management of strongyloidiasis in a non-endemic area. Am J Trop Med Hyg 2002;66:749-52.
Zaha O, Hirata T, Kinjo F, Saito A, Fukuhara H. Efficacy of ivermectin for chronic strongyloidiasis: Two single doses given 2 weeks apart. J Infect Chemother 2002;8:94-8.