Volume 97, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



is an intestinal nematode that can cause disseminated infection in an immunocompromised host. It is most commonly acquired in developing countries. It was previously a common infection in many parts of the United States, particularly in the Appalachian region, but is rarely identified currently. Here, we describe a patient born and raised in Appalachia, with no history of travel outside the United States, who presented with chronic lymphocytic leukemia and hyperinfection characterized by acute respiratory failure, altered mental status, and extended-spectrum-beta-lactamase bacteremia. Despite prompt identification of the parasite on sputum microscopy and initiation of therapy with oral ivermectin and meropenem, the patient subsequently died. This case highlights the continued possibility of infection in patients from Appalachia.


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  • Received : 20 Jun 2017
  • Accepted : 05 Sep 2017
  • Published online : 30 Nov 2016
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