Hyperinfection strongyloidiasis in renal transplant recipients

• 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
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2014-205068

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.