Extensive intra-alveolar haemorrhage caused by disseminated strongyloidiasis

We describe here four cases of disseminated strongyloidiasis. In Okinawa, it has been reported that about 10% of the residents are infected with Strongyloides stercoralis, but disseminated cases are rare. Detailed histopathological examination revealed that the present four cases could clearly be se...

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Bibliographic Details
Published in:International journal for parasitology 1998-02, Vol.28 (2), p.323-330
Main Authors: Kinjo, T., Tsuhako, K., Nakazato, I., Ito, E., Sato, Y., Koyanagi, Y., Iwamasa, T.
Format: Article
Language:English
Subjects:
Adult
Autopsy
Biological and medical sciences
Diseases caused by nematodes
Disseminated strongyloidiasis
Female
Helminthic diseases
Hemorrhage - pathology
Humans
Immunohistochemistry
Infectious diseases
Intra-alveolar haemorrhage
Japan
Lung Diseases, Parasitic - pathology
Male
Medical sciences
Middle Aged
Parasitic diseases
Pulmonary Alveoli - pathology
Strongyloidiasis - complications
Strongyloidiasis - pathology
Strongyloidosis
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Summary:We describe here four cases of disseminated strongyloidiasis. In Okinawa, it has been reported that about 10% of the residents are infected with Strongyloides stercoralis, but disseminated cases are rare. Detailed histopathological examination revealed that the present four cases could clearly be separated into two groups, two acute cases and two subacute cases. The acute cases died rapidly due to extensive diffuse intra-alveolar haemorrhage in both lungs. However, there were no inflammatory infiltrates, abscesses or granulomas in the lungs. Worms were demonstrated in the alveolar spaces. No extensive bleeding was observed in any organs except the lungs. The acute cases could be diagnosed as severe diffuse intra-alveolar haemorrhage syndrome, but deposition of immune complex (parasite antigen and immunoglobulins) and complement C3c was not demonstrated in the alveolar wall and small vessels of the lung. The subacute cases exhibited no such extensive haemorrhage, but scattered microabscesses were found with sepsis. During the migration of the worms from the colon, enteric bacteria entered the circulation in the two subacute cases. The acute cases received steroid therapy before the dissemination of the worms, but the two subacute cases did not. Steroids might have influenced the Strongyloides stercoralis dissemination and/or the course of the disease.
ISSN:0020-7519
1879-0135
DOI:10.1016/S0020-7519(97)00162-8