• 1.

    Kia EB, Rahimi HR, Mirhendi H, Nilforoushan MR, Talebi A, Zahabiun F, Kazemzadeh H, Meamar AR, 2008. A case of fatal strongyloidiasis in a patient with chronic lymphocytic leukemia and molecular characterization of the isolate. Korean J Parasitol 46: 261263.

    • Search Google Scholar
    • Export Citation
  • 2.

    Commision AR, 2008. The Appalachian Region. https://www.arc.gov/appalachian_region/TheAppalachianRegion.asp. Accessed June 18, 2017.

  • 3.

    Starr MC, Montgomery SP, 2011. Soil-transmitted helminthiasis in the United States: a systematic review - 1940–2010. Am J Trop Med Hyg 85: 680684.

    • Search Google Scholar
    • Export Citation
  • 4.

    Grossman D, Humphreys BR, Ruseski JE, 2017. Out of the Outhouse: The Impact of Place-Based Policies on Dwelling Characteristics in Appalachia. Accessed June 18, 2017.

  • 5.

    Russell ES, Gray EB, Marshall RE, Davis S, Beaudoin A, Handali S, McAuliffe I, Davis C, Woodhall D, 2014. Short report: prevalence of Strongyloides stercoralis antibodies among a rural Appalachian population-Kentucky, 2013. Am J Trop Med Hyg 91: 10001001.

    • Search Google Scholar
    • Export Citation
  • 6.

    Maskery B, Coleman MS, Weinberg M, Zhou W, Rotz L, Klosovsky A, Cantey PT, Fox LAM, Cetron MS, Stauffer WM, 2016. Economic analysis of the impact of overseas and domestic treatment and screening options for intestinal Helminth infection among US-bound refugees from Asia. PLoS Negl Trop Dis 10: 114.

    • Search Google Scholar
    • Export Citation
  • 7.

    Rose CE, Paciullo CA, Kelly DR, Dougherty MJ, Fleckenstein LL, 2009. Fatal outcome of disseminated Strongyloidiasis despite detectable plasma and cerebrospinal levels of orally administered ivermectin. J Parasitol Res 2009: 14.

    • Search Google Scholar
    • Export Citation
  • 8.

    Nutman TB, 2017. Human infection with Strongyloides stercoralis and other related Strongyloides species. Parasitology 144: 263273.

  • 9.

    Siddiqui AA, Berk SL, 2001. Diagnosis of Strongyloides stercoralis infection. Clin Infect Dis 33: 10401047.

  • 10.

    Geri G, Rabbat A, Mayaux J, Zafrani L, Chalumeau-Lemoine L, Guidet B, Azoulay E, Pène F, 2015. Strongyloides stercoralis hyperinfection syndrome: a case series and a review of the literature. Infection 43: 691698.

    • Search Google Scholar
    • Export Citation
  • 11.

    Croker C, Reporter R, Redelings M, Mascola L, 2010. Strongyloidiasis-related deaths in the United States, 1991–2006. Am J Trop Med Hyg 83: 422426.

    • Search Google Scholar
    • Export Citation
  • 12.

    Schwartz B, Mawhorter S, Infectious Diseases AST, 2013. Community of practice. Parasitic infections in solid organ transplantation. Am J Transplant 13: 280303.

    • Search Google Scholar
    • Export Citation
  • 13.

    Mejia R, Nutman TB, 2012. Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by Strongyloides stercoralis. Curr Opin Infect Dis 25: 458463.

    • Search Google Scholar
    • Export Citation
  • 14.

    Henriquez-Camacho C, Gotuzzo E, Echevarria J, Clinton White A, Terashima A, Samalvides F, Pérez-Molina JA, Plana MN, 2016. Ivermectin versus albendazole or thiabendazole for Strongyloides stercoralis infection. Cochrane Database Syst Rev 1: 150.

    • Search Google Scholar
    • Export Citation
 
 
 
 

 

 
 

 

 

 

 

 

 

Case Report: Strongyloides stercoralis Hyperinfection in a Patient with Chronic Lymphocytic Leukemia

View More View Less
  • 1 Section on Infectious Diseases, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina;
  • | 2 Department of Pathology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina

Strongyloides stercoralis 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 S. stercoralis hyperinfection characterized by acute respiratory failure, altered mental status, and extended-spectrum-beta-lactamase Klebsiella pneumoniae 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 S. stercoralis infection in patients from Appalachia.

Author Notes

Address correspondence to Richelle Guerrero-Wooley, Section on Infectious Diseases, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354. E-mail: richelleguerrero@gmail.com

Authors’ addresses: Richelle Guerrero-Wooley, Department of Internal Medicine, Section on Infectious Diseases, Loma Linda University Medical Center, Loma Linda,CA, E-mail: richelleguerrero@gmail.com. Ernesto Aranda-Aguirre, and Aimee Wilkin, Department of Internal Medicine, Section on Infectious Diseases, Wake Forest Baptist Medical Center, Winston-Salem, NC, E-mails: earandaa@wakehealth.edu, and awilkin@wakehealth.edu. Wencheng Li and Elizabeth Palavecino, Department of Pathology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, E-mails: wenli@wakehealth.edu and epalave@wakehealth.edu.

Save