Pulmonary Strongyloidiasis in Immunocompetent(Ic) Host

1Fairview Hospital,Cleveland Clinic Hospital, Cleveland, OH
2Fairview Hospital, Cleveland, OH
3Cleveland Clinic, Cleveland, OH

Meeting: Hospital Medicine 2015, March 29-April 1, National Harbor, Md.

Abstract number: 562


Case Presentation: A 75 year old male from Puerto Rico with past medical history of stage Ia lung adenocarcinoma with bronchoalveolar features treated only with lobectomy, otherwise healthy presented to the ER with non-productive  cough, sore throat, fever, chest tightness & dyspnea that failed to respond to bronchodilator therapy. Within the past months, he was hospitalized twice with similar symptoms, treated once for pulmonary embolism based on clinical suspicion and CT findings & the other time for possible community acquired pneumonia. He had lived in the US for the past 55 yrs with the most recent travel 5 yrs ago. Quit smoking after his lung surgery with a 40 PPD history. On examination, Temperature is 36.8,heart rate is 78/min, Respiratory rate is 20 /min, in mild distress,blood pressure is 142/77 mm of Hg, pulse oximeter is 88% on room air and 96% on 4 L. His exam was normal except for slightly decreased air entry to both lung fields with mild scattered expiratory wheezes. CMP, urine legionella Ag and streptococcal Ag, Mycoplasma serology were negative. Complete blood count showed increased WBCs with 20% eosinophils. Chest X ray and Computed tomography chest revealed new ground-glass opacities in the right upper lobe and a nodular density in the left base.Patient was started on Cefepime and Azithromycin. The next day, the patient developed right lower abdominal pain with diarrhea and mucoid stool. Colonoscopy and biopsy revealed a patch of inflamed cecum that showed active colitis with granulomatous response to parasitic organisms. Stool cultures/ova & parasites were repeatedly negative. Serum IgE was normal, Toxocara serology was negative but Bronchoscopy/Bronchoalveolar lavage showed the larval nematode.(Fig.1)Subsequently strongyloides serology titers were elevated.

Discussion: Strongyloidiasis: a parasitic  infestation by the nematode strongyloides, most commonly with Strongyloides stercoralis.Strongyloides stercoralis infestation is usually asymptomatic in Immunocompetent hosts. Relatively common in immunocompromised  patients, dissemination or hyperinfection is associated with mortality upto 87%. Diagnosis is difficult in at risk symptomatic patients, even more difficult in Immunocompetent hosts. Patients at risk who are started on chemotherapy or other immunosupresion should be screened for latent infection. Cutaneous, Gastrointestinal & Pulmonary symptoms with eosinophilia /serology can raise diagnosis suspicion. Detection of Larvae in stool/bronchoalveolar lavage is diagnostic. Ivermectin is the treatment of choice for both latent & disseminated infection.

Conclusions: Strongyloidiasis should be suspected in Immunocompetent patients with recurrent respiratory symptoms, pulmonary infiltrates and eosinophilia,especially if travelled to an endemic area.

To cite this abstract:

Karivedu V, Ghobrial M, Narechania S, Kistangari G, Haddad B. Pulmonary Strongyloidiasis in Immunocompetent(Ic) Host. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. Abstract 562. Journal of Hospital Medicine. 2015; 10 (suppl 2). https://www.shmabstracts.com/abstract/pulmonary-strongyloidiasis-in-immunocompetentic-host/. Accessed April 4, 2020.

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