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Case Reports
. 2021 Nov 29;106(2):695-699.
doi: 10.4269/ajtmh.21-1011.

Case Report: Challenges for the Diagnosis and Treatment of Strongyloides stercoralis in Chronic Obstructive Pulmonary Disease Patients

Affiliations
Case Reports

Case Report: Challenges for the Diagnosis and Treatment of Strongyloides stercoralis in Chronic Obstructive Pulmonary Disease Patients

Alireza Ashiri et al. Am J Trop Med Hyg. .

Abstract

Strongyloidiasis, a neglected tropical disease (NTD), which is caused by Strongyloides stercoralis, can be fatal in immunocompromised patients. In most chronic cases, infections most frequently are asymptomatic, and eosinophilia might be the only clinical characteristic of this disease. The use of corticosteroids in some diseases like chronic obstructive pulmonary disease (COPD) may lead to the development of the life-threatening S. stercoralis hyperinfection syndrome. In the present research, we presented five cases of strongyloidiasis with a history of COPD and receiving corticosteroids from Abadan County, southwestern Iran. By performing the direct smear stool examinations, two cases were identified and the other three cases were diagnosed using the agar plate culture method. Despite reporting eosinophilia in previous patients' hospitalizations, the fecal examination was not performed for parasitic infections. Moreover, pulmonary symptoms were similar, but gastrointestinal symptoms were varied, including nausea, vomiting, abdominal pain, epigastric pain, constipation, and diarrhea. All the included patients were treated with albendazole, which is the second-line drug for S. stercoralis, and relapse of infection was observed in two patients by passing few months from the treatment. The increased blood eosinophil count was shown to play important roles in both the management of COPD and diagnosis of helminthic infections. In COPD patients who are receiving steroids, screening and follow-up for strongyloidiasis should be considered as priorities. In addition, ivermectin, which is the first-line drug for strongyloidiasis, should be available in the region.

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Figures

Figure 1.
Figure 1.
(A) Chest X-ray showing bilateral pleural effusion, patchy, and diffuse alveolar opacity. (B) Chest computed tomography (CT) scan showing emphysematous bullae and hyperinflated lungs.
Figure 2.
Figure 2.
Direct microscopic stool examination of an infected patient showing a rhabditiform larva of Strongyloides stercoralis (magnification ×400). This figure appears in color at www.ajtmh.org.
Figure 3.
Figure 3.
Adult male Strongyloides stercoralis worm and rhabditiform larvae collected from an agar plate culture of an infected patient in this study. This figure appears in color at www.ajtmh.org.
Figure 4.
Figure 4.
Chest X-ray showing bilateral pleural effusion and patchy and diffuse alveolar opacity.

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