Hyperinfection syndrome pdf
Question: A 74-year-old Jamaican-born woman presented initially with a 3-month history of dyspepsia, nausea, bloating, early satiety, and a 40-pound weight loss. tinal infection, hyperinfection syndrome has been seen with increasing frequency in patients with impaired immunity. Case Presentation This 9-year-old girl presented with bone pain in lumbar region since 18 days before referring to our center.
The hyperinfection syndrome is caused by the wide multiplication and migration of infective larvae, with characteristic gastrointestinal and/or pulmonary involvement. There have also been reports of widespread dissemination of SS in acquired immunodeficiency syndrome patients. Clinical clues include an appropriate travel history (even in the remote past), gastrointestinal symptoms, cutaneous symptoms, eosinophilia, or thrombocytosis. Mature cysts contain four nuclei that possess a small, discrete centrally-located karyosome and evenly-distributed peripheral chromatin. The Good Syndrome is a rare cause of combined B- and T-cell immunodeficiency that occurs in association with a thymoma. Abstract Rationale: Patients with chronic Strongyloides stercoralis infection are usually asymptomatic; therefore, their condition is easily overlooked.
The clinical features of hyperinfection syndrome include GI manifestations such as abdominal pain, watery diarrhea, weight loss, vomiting, and occasionally bleeding. As per the Centers for Disease Control and Prevention, the mortality in strongyloides hyperinfection syndrome is alarmingly high, a case fatality rate that is almost 90%. We present 2 fatal cases of Strongyloides hyperinfection with initial presentation mimicking acute exacerbation of chronic obstructive pulmonary disease (COPD). During immunosuppressive therapy, however, if cellular immunity is depressed, autoinfection can occur at a higher rate, resulting in hyperinfection syndrome. Glucocorticoid treatment and HTLV -1 infection are the two conditions associated with triggering hyperinfection; Cases have been reported with hematologic malignancy, malnutrition, and AIDS. The blood agar plates demonstrated serpiginous bacterial growth suspicious for Strongyloides stercoralis infection (as the larvae crawl over the agar, they carry bacteria with them, creating visible tracks). Due to the peculiar but characteristic features of autoinfection, hyperinfection syndrome involving only pulmonary and gastrointestinal systems, and disseminated infection with involvement of other organs, strongyloidiasis needs special attention by the physician, especially one serving patients in areas endemic for strongyloidiasis.
In patients with potential exposure to Strongyloides at any time during their life, empiric ivermectin therapy (200 μg/kg orally daily for 2 days) should be given concomitantly to prevent potentially fatal GC-associated hyperinfection syndrome. management of hyperinfection syndrome requires early detection and initiation of therapy. Hyperinfection may develop as early as four days after the onset of corticosteroid therapy and as late as several years up to 20 years . Fever, abdominal pain, nausea, and diarrhea are clinically common in disseminated strongyloidiasis and . Hence, the clinicians should be well equipped to diagnose, treat, and also prevent the fatal consequences of this lethal nematode.
Hyperinfection syndrome is an often overwhelming, life-threatening infection resulting from accelerated autoinfection that is usually but not always due to cell-mediated immune dysfunction [35,43]. Stronglyoides infections in transplant recipients are an important issue that physicians also in Central Europe should be aware of, given the risk of hyperinfection syndrome and the challenges in clinical diagnosis. Annals of Geriatric Medicine and Research (Ann Geriatr Med Res) is a peer-reviewed journal that aims to introduce new knowledge related to geriatric medicine and to provide a forum for the analysis of gerontology, broadly defined.
SOT recipients are at increased risk for hyperinfection syndrome because of their requisite immunosuppressives. This disease may pose a diagnostic challenge, as it presents with nonspecific findings on endoscopy. 5 In pulmonary strongyloidiasis secondary to hyperinfection syndrome, patients can present with asthmatic bronchospasm, dyspnea, and hemoptysis, leading to adult respiratory distress syndrome, with the potential for terminal respiratory failure. Most of them are found to have strongyloidiasis after a laboratory work up reveals an incidental finding of eosi-nophilia. hyperinfection syndrome and include the increased use of immunosuppressive therapy. Strongyloides hyperinfection is unique among the parasitic infections because of its ability to autoinfect the host without a soil or intermediate host.
2 This often fatal progression most commonly occurs in immunosuppressed individuals. Left untreated, the mortality rates of hyperinfection syndrome and disseminated strongyloidiasis can approach 90%. We report the case of a 69 year-old male with diffuse abdominal pain, intermittent diarrhea, and fever. stercoralis infection almost invariably results from the hyperinfection syndrome, which is fatal in 61 percent of cases in hospitalized persons.
Its nonspecific clinical features often lead to a missed or delayed diagnosis.
A case report of a cancer patient with recurrent hyperinfection syndrome is presented, followed by a brief update on recent information about this parasitic infection and its management. Rural regions in tropical and subtropical countries are known to have a high prevalence of this organism [1, 2]. This hyperinfective syndrome can have a mortality rate of close to 90% if disseminated. stercoralis infections have been reported up to 65 years after initial exposure in veterans who served in Asia during World War II (4,6).
The detection of increased numbers of larvae in stool and/or sputum is a hall-mark of hyperinfection that normally occurs as a result of an alteration in immune status. hyperinfection or dissemination syndrome, CATMAT recommends dual-therapy with ivermectin and albendazole as outlined below, which is based on case report data (11,22,23,24,25), expert opinion and the clinical experience of CATMAT members. In the era of increased use of corticosteroids and anticancer drugs there is an absolute chance for developing hyperinfection syndrome in a previously infected and asymptomatic patient. The question of why HIV infection does not increase risk of Strongyloides dissemination or hyperinfection is perplexing. Hyperinfection syndrome and disseminated strongyloidiasis are two serious, life-threatening presentations associated with immunosuppression.
Hyperinfection syndrome with hypereosinophilia and chronic kidney disease: case report and review. In hyperinfection syndrome, this classic life cycle is exaggerated (ie, the parasite burden and turnaround increase and accelerate). The hyperinfection syndrome is characterized by an acceleration of life cycle and hyperinfection, and by an increased parasite burden within the sites of the nematode cycle. Fourteen were asymptomatic, three autochthonous cases presented with hyperinfection syndrome, and two patients died.
This allows massive proliferation of larval forms.
He had been a prisoner of war before undergoing a successful cadaveric renal transplant in the United States. The diagnosis of hyperinfection syndrome is difficult to establish and entails a high level of suspicion. In patients at risk of strongyloidiasis who receive dexamethasone without being tested or treated for Strongyloides, clinicians should include Strongyloides hyperinfection syndrome on the differential diagnosis for patients who experience acute clinical decompensation, especially if gram-negative rod bacteremia or central nervous system infection is detected. Autoinfection with metamorphosis of rhabditiform into invasive filariform larvae may occur; as a result, larvae may disseminate and involve multiple organs, causing increased morbidity and mortality. Three2-daycourses of ivermectin 200 mg/kg/day, every 15 days, resulted in a full symptomatic resolution. Strongyloides stercoralis infection derived from the donor in solid organ transplant (SOT) places recipients at risk for hyperinfection syndrome and death.
Hyperinfection also complicates protein calorie malnutrition, renal transplantation, malignancy . stercoralis.1 Strongyloidiasis is endemic in tropical and subtropical regions of the world where warmth, moisture and poor sanitation favour its spread. We describe the case of a lung transplant recipient who developed strongyloidiasis presenting with GI symptoms and progressing to diffuse alveolar hemorrhage, bacteremia and multi-organ failure. Brain and meningeal involvement in the setting of hyperinfection syndrome has been observed at autopsy in several cases; to our knowledge, however, only three cases of central nervous system involvement have been diagnosed before patient death. Larger infection loads may cause diarrhoea, protein-losing enteropathy and oedema, while in the immunocompromised a potentially fatal hyperinfection syndrome associated with Gram-negative sepsis may occur. The syndrome is characterized by the development or exacerbation of gastrointestinal (GI) and pulmonary symptoms. hyperinfection syndrome, clinicians have to be very careful when prescribing steroids in patients presenting with an ex-acerbation of asthma from areas endemic for SS. His Strongyloides IgG signal had been elevated for years before the outbreak of the disease.
Develop-ment or exacerbation of gastrointestinal and pulmonary symp-toms is seen, and the detection of increased numbers of larvae in stool and/or sputum is the hallmark of hyperinfection. In spite of recent advances with experiments on animal models, strongyloidiasis, an infection caused by the nematode parasite Strongyloides stercoralis, has still been an elusive disease.
The diagnosis of hyperinfection syndrome is often made postmortem, and mortality is high, even when the disease is recognized during life. The propensity for Strongyloides infection has been attributed to decreased T-helper type immune responses due to HTLV-1 infection9. The disseminated strongyloidiasis is defined by the presence of parasites in organs outside their habitual life cycle, such as liver, central nervous system, and urinary tract. In addition to the actual tissue damage from the migrating larvae, the patient may die . We report a patient with lepromatous leprosy on long-term steroid therapy, who presented with anemia and generalized edema due to Strongyloides hyperinfection. Severe strongyloidiasis in corticosteroid-treated patients: Case series and literature review.