Strongyloides stercoralis hyperinfection in an immunosuppressed patient with a nephrotic syndrome

Abstract number: P1139

Baptista-Fernandes T., Alfaiate D., Branco P., Relvas L., Dias A., Marques T.

Objectives: Strongyloidiasis is highly prevalent in tropical and subtropical regions, with endemic foci in some temperate areas. Its real prevalence is probably underestimated.

We intend to alert to nephrotic syndrome as an unusual presentation of chronic infection, to the risk of potentially fatal hyperinfection syndrome in the immunocompromised population and, therefore, the need for a high suspicion and accurate laboratory diagnosis.

Methods: We report the case of a 31-year old Cape Verdean woman living in Portugal, admitted with profuse diarrhoea, abdominal pain and dehydration. She had been diagnosed with nephrotic syndrome (minimal change disease) of unknown aetiology four months before and was receiving prednisone and mycophenolate mofetil.

Bacteriological and parasitological investigation included examination of faeces, sputum, urine, blood and cerebrospinal fluid.

Results: A diagnosis of Klebsiella pneumoniae sepsis was made and Strongyloides stercoralis larvae were found in faeces and sputum. Hyperinfection was considered and mycophenolate mofetil was suspended, steroids tapered and albendazole was started. Eosinophilia on peripheral blood only became evident after suspension of the immunosuppressors (reaching 5.0×109/L). Human Immunodeficiency Virus and Human T-limphotropic Virus serologies were negative.

She was treated for a month, with dramatic clinical improvement, regression of the eosinophilia, absence of larvae on stool or sputum and resolution of the nephrotic syndrome (proteinuria was 13 g/day prior to therapy to 1.3 g/day on discharge).

Conclusions: Chronic strongyloidiasis is a rare and reversible cause of nephrotic syndrome.

Immunosuppressive therapy has a high risk of causing fatal hyperinfection or dissemination of S. stercoralis and, therefore, screening is advised, in patients with a sugestive epidemiological history, prior to its initiation. Combination of parasitological examination (including faecal concentration and culture) with serology is probably the best approach.

The diagnosis of S. stercoralis hyperinfection should be considered in immunosuppressed patients from endemic areas presenting with acute respiratory or gastrointestinal symptoms and Gram-negative sepsis, even in the absence of eosinophilia. In these cases other body fluids should also be examined and attention should be payed, on routine examination, to the incidental finding of larvae.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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