Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case report
Abstract Background Strongyloidiasis, caused by Strongyloides stercoralis (S. stercoralis), is endemic worldwide, especially in countries with warm and humid climates. Strongyloides stercoralis hyperinfection syndrome (SHS) is an extremely serious manifestation of strongyloidiasis, which results fro...
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-022-07670-2 |
| _version_ | 1798001631298584576 |
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| author | De-Han Cai Jun Wang Xiao-Lin Fang |
| author_facet | De-Han Cai Jun Wang Xiao-Lin Fang |
| author_sort | De-Han Cai |
| collection | DOAJ |
| description | Abstract Background Strongyloidiasis, caused by Strongyloides stercoralis (S. stercoralis), is endemic worldwide, especially in countries with warm and humid climates. Strongyloides stercoralis hyperinfection syndrome (SHS) is an extremely serious manifestation of strongyloidiasis, which results from an acute exacerbation of auto-infection and is often fatal. Case presentation We present a case of SHS mimicking pseudomembranous enteritis with a final definitive diagnosis of a triple infection including S. stercoralis, Escherchia coli (E. coli) and Pneumocytis jirovecii (P. jirovecii) that occurred in a microscopic polyangiitis (MPA) patient after immunosuppressive therapy. SHS, together with E. coli bacteremia and Pneumocytis jirovecii pneumonia (PJP) in the same patient, is rare in clinical practice, which is first reported worldwide, to our knowledge. After the diagnosis was confirmed, the treatment protocol was quickly adjusted; however, the patient’s life could not be saved. Conclusion This case reminds us of the necessity to consider strongyloidiasis as a differential diagnosis in immunocompromised populations who live in or have visited to S. stercoralis endemic areas, especially patients with suspected pseudomembranous enteritis, even if stool examination, serological tests, and eosinophilia are negative. For this group, it is advisable to complete the relevant endoscopy and/or PCR as soon as possible. The fundamental solution to prevent this catastrophic outcome is to implement effective preventive measures at multiple levels, including physicians, patients, and relevant authorities. |
| first_indexed | 2024-04-11T11:39:13Z |
| format | Article |
| id | doaj.art-97c2caecf9af4cacb989b164ea7b3813 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-04-11T11:39:13Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-97c2caecf9af4cacb989b164ea7b38132022-12-22T04:25:52ZengBMCBMC Infectious Diseases1471-23342022-09-012211610.1186/s12879-022-07670-2Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case reportDe-Han Cai0Jun Wang1Xiao-Lin Fang2Nephrology Department in Jiangxi Provincial People’s Hospital Affiliated to Nanchang Medical CollegeDepartment II of Respiratory and Critical Care in Jiangxi Provincial People’s Hospital Affiliated to Nanchang Medical CollegeDepartment II of Respiratory and Critical Care in Jiangxi Provincial People’s Hospital Affiliated to Nanchang Medical CollegeAbstract Background Strongyloidiasis, caused by Strongyloides stercoralis (S. stercoralis), is endemic worldwide, especially in countries with warm and humid climates. Strongyloides stercoralis hyperinfection syndrome (SHS) is an extremely serious manifestation of strongyloidiasis, which results from an acute exacerbation of auto-infection and is often fatal. Case presentation We present a case of SHS mimicking pseudomembranous enteritis with a final definitive diagnosis of a triple infection including S. stercoralis, Escherchia coli (E. coli) and Pneumocytis jirovecii (P. jirovecii) that occurred in a microscopic polyangiitis (MPA) patient after immunosuppressive therapy. SHS, together with E. coli bacteremia and Pneumocytis jirovecii pneumonia (PJP) in the same patient, is rare in clinical practice, which is first reported worldwide, to our knowledge. After the diagnosis was confirmed, the treatment protocol was quickly adjusted; however, the patient’s life could not be saved. Conclusion This case reminds us of the necessity to consider strongyloidiasis as a differential diagnosis in immunocompromised populations who live in or have visited to S. stercoralis endemic areas, especially patients with suspected pseudomembranous enteritis, even if stool examination, serological tests, and eosinophilia are negative. For this group, it is advisable to complete the relevant endoscopy and/or PCR as soon as possible. The fundamental solution to prevent this catastrophic outcome is to implement effective preventive measures at multiple levels, including physicians, patients, and relevant authorities.https://doi.org/10.1186/s12879-022-07670-2Strongyloides stercoralis hyperinfection syndromePseudomembranous enteritisClostridioides difficile infectionEscherichia coliPneumocystis jiroveciiCorticosteroids |
| spellingShingle | De-Han Cai Jun Wang Xiao-Lin Fang Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case report BMC Infectious Diseases Strongyloides stercoralis hyperinfection syndrome Pseudomembranous enteritis Clostridioides difficile infection Escherichia coli Pneumocystis jirovecii Corticosteroids |
| title | Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case report |
| title_full | Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case report |
| title_fullStr | Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case report |
| title_full_unstemmed | Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case report |
| title_short | Strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis, complicated by Escherichia coli bacteremia and Pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy: a case report |
| title_sort | strongyloides stercoralis hyperinfection syndrome mimicking pseudomembranous enteritis complicated by escherichia coli bacteremia and pneumocystis jirovecii pneumonia in a patient after immunosuppressive therapy a case report |
| topic | Strongyloides stercoralis hyperinfection syndrome Pseudomembranous enteritis Clostridioides difficile infection Escherichia coli Pneumocystis jirovecii Corticosteroids |
| url | https://doi.org/10.1186/s12879-022-07670-2 |
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