Background of study: Disseminated or hyperinfection syndrome is the result of massive infection with Strongyloides stercoralis and is typically associated with the widespread dissemination of larvae throughout the body. The risk of this evolution is greatest in-patients with HIV/AIDS disease.
Objetives and methods: We analyzed the clinical manifestations, laboratory findings and evolution of 10 HIV seropositive patients with disseminated infection due to S.stercoralis. All of them were studied for the identification of typically larvae in specimens of sputum and stools.
Results: The mean age was 30.8 years; 80% were woman; 50% IDU and 50% heterosexuals with HIV seropositive sexual partners. All patients presented abdominal pain, watery diarrhea, fever and weight loss. The most frequent laboratory findings were anemia and the erythrocyte sedimentation rate > 100mm. The mean of eosinophil counts was 2829 cells/mm3, and the mean of CD4 T lymphocyte counts was 90 cells/mm3. Peripheral blood eosinophilia was present in 6 patients (60%) and ranged from 2000 to 4350 cells/mm3; peripheral aneosinophilia detected in 4 patients (40%) was associated with a shorter
survival and increased mortality. The rhabditiform larvae of the parasite was detected in stool specimens of all patients; 2 patients (20%) had pulmonary strongyloidosis with bilateral alveolar infiltrates, cough, moderate respiratory insufficiency and the presence of filariform larvae in sputum. Secondary bacterial infections occured in 4 patients (40%); 3 had a pulmonary tuberculosis and 1 developed a meningoencephalytis due to E. coli. Six patients (60%) had a favorable evolution; 4 (40%), all with peripheral aneosinophilia, death. Four patients were treated with albendazole (400 mg during 7 days); 3 cases received thiabendazole (1g, 7days) and 3 subjects were treated with ivermectin (12 mg/4 doses).
Conclusions: S. stercoralis is an important cause of severe dissemination disease and death in AIDS patients. The absence of peripheral blood eosinophilia was associated with a poor prognosis and a short survival in this cohort of patients. We recommend and aggressive examination of stool, duodenal aspirates and sputum in-patients at risk for the disease. Secondary infections are common; treatment should be continued until viable parasites have been eradicated. Because of the high relapse rate, we considerate appropriate a close follow-up of these patients and, eventually, a secondary prophylaxis should be indicated.
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