Dr. Speare's excellent summary may be useful to have on hand for clinicians
regarding severe strongyloidiasis in immunocompromised patients. I hope
they managed this case correctly!
At 06:15 AM 7/14/98 -0700, Rick Speare wrote:
>>At 07:50 PM 7/12/98 GMT, you wrote:
>>>> My mother, 49 yrs old, was diagnosed with strongyloidiasis
>>July 3rd, 1998 after being misdiagnosed for almost 3 months. First
>>was a stroke after finding a mass within her brain. She was then treated
>>masses amounts of steroids. 2nd diagnosis was "Brain Tumor"... we went
>>Anderson for a brain biopsy. Biopsy came back non-dianostic. The first
>>July she began having bad diarrhea, so a stool sample was taken. Finally a
>>proper diagnosis was made.
>>>>> She is now lying in the ICU unit in East Jefferson Hospital, in Metarie
>>Louisiana. The parasites are now in every part of her body.... Several
>>have been made to eradicate her body of these vicious parasites/ worms,
>>>As of now she in on a venilator at 100% oxygen with 12 peep. Her heart
>>very high, and her blood preassure seems to be dropping very, very slow.
>>is a severe rash from her knee's to her chin, which we were told , were the
>>parasites migrating to the skin surface. She also has been in a coma for
>>Sounds like you are talking about a case of the hyperinfective syndrome due
>to Strongyloides stercoralis. Diagnosis is often missed since presentations
>can vary quite markedly. If your mother still has larval migration tracks on
>the skin, antinematode therapy has not yet killed them. Typically with
>hyperinfection the patient has thousands of adult S. stercoralis in the
>mucosa in many parts of the gastrointestinal tract, and thousands of
>autoinfective larvae migrating in the gut wall and other organs of the body.
>>> We have many questions, yet the doctors can't seem to answer us.. They keep
>>giving us hope. small, yet hope. If anyone can help us at all, with any
>>information, we'd greatly appreciate it. we are at our last ropes
>>well as mentally...
>>What sort of information are you after? Hyperinfection is a life threatening
>situation as you know. Many patients in this state die from bacterial
>infection and multisystem failure. Management consists of focusing on
>controlling the septic aspects if they exist, manageing organ failure,
>killing the adult parasites in the gut, and killing the migrating
>>To kill the adult Strongyloides the best drugs are ivermectin and
>albendazole. In hyperinfection, ivermectin may be the drug of choice. No
>double blind therapeutic trials appear to have been published on treatment
>but one interesting case series was reported in Clin Infect Dis (1993)
>"Efficacy of ivermectin in the treatment of strongyloidiasis complicating
>AIDS." by Torres JR, Isturiz R, Murillo J, Guzman M, Contreras R. They found
>that the best treatment was 200 micrograms/kg on a multidose schedule on
>days 1, 2, 15, and 16. All seven patients who received multiple doses showed
>sustained clinical and parasitological cure; whereas one of two patients who
>received single dose therapy relapsed promptly and fatally. However,
>treatment failures have been reported even after multiple doses of
>ivermectin in some cases of chronic uncomplicated strongyloidiasis.
>>Killing autoinfective larvae of S. stercoralis is more difficult, and both
>drugs may not be very efficient. If a patient does survive a severe
>hyperinfective crisis, monitoring for Strongyloides after recovery has to be
>prolonged and enthusiastic as the parasite is quite difficult to eradicate.
>Repeat courses of albendazole or ivermectin will be required.
>>Hope this is of some assistance.
>School of Public Health and Tropical Medicine
>James Cook University
>http://www.jcu.edu.au/dept/PHTM/staff/spebio.htm>>>Gerald McLaughlin, Ph.D.
Dept Pathology and Laboratory Medicine
635 Barnhill Drive, MS A128
Indianapolis, IN 46202-5120
317-274-2651; FAX 317-278-2018
E-mail: gmclaugh at iupui.edu