Hyperinfection strongyloidiasis in renal transplant recipients

Strongyloidiasis is infection caused by the nematode Strongyloides stercoralis. Chronic uncomplicated strongyloidiasis is known to occur in immunocompetent individuals while hyperinfection and dissemination occurs in selective immunosuppressed hosts particularly those on corticosteroid therapy. We r...

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Bibliographic Details
Published in:BMJ case reports 2014-08, Vol.2014, p.bcr2014205068
Main Author: Khuroo, Mehnaaz S
Format: Article
Language:English
Subjects:
Abdomen
Adult
Animals
Asia
Biopsy
Blood pressure
Diagnosis, Differential
Duodenitis - diagnosis
Duodenitis - parasitology
Emergency medical care
Endoscopy
Endoscopy, Gastrointestinal
Female
Females
Hepatitis
Humans
Immunocompetence
Immunocompromised Host
Indian Sub-Continent
Infections
Intestinal Mucosa - parasitology
Intestinal Mucosa - pathology
Kidney diseases
Kidney Transplantation
Kidney transplants
Lungs
Neutrophils
Peritoneal dialysis
Small intestine
Strongyloides stercoralis - isolation & purification
Strongyloidiasis - diagnosis
Strongyloidiasis - parasitology
Superinfection - diagnosis
Superinfection - parasitology
Transplant Recipients
Unusual Association of Diseases/Symptoms
Worms
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Summary:Strongyloidiasis is infection caused by the nematode Strongyloides stercoralis. Chronic uncomplicated strongyloidiasis is known to occur in immunocompetent individuals while hyperinfection and dissemination occurs in selective immunosuppressed hosts particularly those on corticosteroid therapy. We report two cases of hyperinfection strongyloidiasis in renal transplant recipients and document endoscopic and pathological changes in the involved small bowel. One patient presented with features of dehydration and malnutrition while another developed ileal obstruction and strangulation, requiring bowel resection. Oesophagogastroduodenoscopy showed erythematous and thickened duodenal mucosal folds. Histopathological examination of duodenal biopsies revealed S. stercoralis worms, larvae and eggs embedded in mucosa and submucosa. Wet mount stool preparation showed filariform larvae of S. stercoralis in both cases. Patients were managed with anthelmintic therapy (ivermectin/albendazole) and concurrent reduction of immunosuppression. Both patients had uneventful recovery. Complicated strongyloidiasis should be suspected in immunocompromised hosts who present with abdominal pain, vomiting and diarrhoea, particularly in endemic areas.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2014-205068