Hemoptysis in the Immunocompromised Patient: Do Not Forget Strongyloidiasis

Strongyloidiasis, due to infection with the nematode Strongyloides stercoralis, affects millions of people in the tropics and subtropics. Strongyloides has a unique auto-infective lifecycle such that it can persist in the human host for decades. In immunosuppressed patients, especially those on corticosteroids, potentially fatal disseminated strongyloidiasis can occur, often with concurrent secondary infections. Herein, we present two immunocompromised patients with severe strongyloidiasis who presented with pneumonia, hemoptysis, and sepsis. Both patients were immigrants from developing countries and had received prolonged courses of corticosteroids prior to admission. Patient 1 also presented with a diffuse abdominal rash; a skin biopsy showed multiple intradermal Strongyloides larvae. Patient 1 had concurrent pneumonic nocardiosis and bacteremia with Klebsiella pneumoniae and Enterococcus faecalis. Patient 2 had concurrent Aspergillus and Candida pneumonia and developed an Aerococcus meningitis. Both patients had negative serologic tests for Strongyloides; patient 2 manifested intermittent eosinophilia. In both patients, the diagnosis was afforded by bronchoscopy with lavage. The patients were successfully treated with broad-spectrum antibiotics and ivermectin. Patient 1 also received albendazole. Strongyloidiasis should be considered in the differential diagnosis of hemoptysis in immunocompromised patients with possible prior exposure to S. stercoralis.

Download Full-text

A “Terrible” Headache in a HIV Patient

Ear Nose & Throat Journal ◽

10.1177/01455613211014106 ◽

2021 ◽

pp. 014556132110141

Author(s):

Marios Stavrakas ◽

Ioannis Koskinas ◽

Jannis Constantinidis ◽

Petros D Karkos

Keyword(s):

Differential Diagnosis ◽

Surgical Treatment ◽

Fungal Infection ◽

Early Identification ◽

Fungal Sinusitis ◽

Immunocompromised Patients ◽

Immunosuppressed Patients ◽

Distant Spread ◽

Nose And Throat

Mucormycosis is a type of fungal infection more prevalent among immunosuppressed patients, requires prompt identification and surgical treatment, as it can is associated with local and distant spread. This case is aiming to highlight the importance of early identification of subtle symptoms in immunocompromised patients. The clinician should be aware of fungal sinusitis, consider it in the differential diagnosis, and seek for an ear, nose, and throat opinion.

Download Full-text

Toxoplasma Appendicitis: A Once-in-a-Lifetime Diagnosis!

International Journal of Surgical Pathology ◽

10.1177/1066896917724888 ◽

2017 ◽

Vol 26 (1) ◽

pp. 89-92 ◽

Cited By ~ 1

Author(s):

Anisha M. Fernandes ◽

Maheshkumar M. Lakhe ◽

Sanjay A. Pai

Keyword(s):

Differential Diagnosis ◽

Acute Appendicitis ◽

Muscularis Propria ◽

Immunocompromised Patients ◽

Lymphoid Follicles ◽

Negative Results ◽

Immunosuppressed Patients ◽

Life Threatening

Toxoplasmosis is generally asymptomatic in immunocompetent individuals, but it can be life-threatening in immunocompromised patients. We present a case of a 62-year-old man with clinical features of acute appendicitis. Histology showed a transmural infiltrate of eosinophils. In addition, there were reactive lymphoid follicles with histiocytes in the submucosa and tachyzoites in the muscularis propria. Immunohistochemistry confirmed the diagnosis of toxoplasma appendicitis. Serological evaluation yielded negative results. Retrospective review of the history revealed that the patient was on long-term immunosuppressive therapy with methotrexate. The patient was treated with sulfamethoxazole-trimethoprim and is asymptomatic at 7-month follow-up. Toxoplasma appendicitis must be considered in the differential diagnosis of appendicitis in immunosuppressed patients.

Download Full-text

Invasive enteritis by Strongyloides stercoralis presenting as acute abdominal distress under corticosteroid therapy

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812001000400002 ◽

2001 ◽

Vol 56 (4) ◽

pp. 103-106 ◽

Cited By ~ 21

Author(s):

Maria Aparecida Marchesan Rodrigues ◽

Raquel Cardoso Fróes ◽

Alexandre Anefalos ◽

Shoiti Kobayasi

Keyword(s):

Differential Diagnosis ◽

Immunosuppressive Therapy ◽

Corticosteroid Therapy ◽

Strongyloides Stercoralis ◽

Sao Paulo ◽

Immunocompromised Patients ◽

Surgical Specimen ◽

Endemic Areas ◽

One Year ◽

Abdominal Distress

Overwhelming helminthiasis is still a problem in endemic areas, especially in immunocompromised patients. We report a case of invasive intestinal strongyloidiasis that was clinically expressed as acute abdominal distress in a 73-year-old man from São Paulo who had been receiving methylprednisone, 20 mg/day, for one year for osteoarthritis. A surgical specimen from the ileum revealed invasive enteritis with severe infestation by Strongyloides stercoralis. The patient died of sepsis 6 days after surgery. The possibility of invasive strongyloidiasis should be considered in the differential diagnosis of acute abdominal distress in patients undergoing immunosuppressive therapy.

Download Full-text

Strongyloides Infection in a Man with Abdominal Pain and a History of Rheumatoid Arthritis

The Open Infectious Diseases Journal ◽

10.2174/1874279301810010023 ◽

2018 ◽

Vol 10 (1) ◽

pp. 23-28

Author(s):

Fariborz Mansour-Ghanaei ◽

Farahnaz Joukar ◽

Alireza Samadi ◽

Sara Mavaddati ◽

Arash Daryakar

Keyword(s):

Rheumatoid Arthritis ◽

Severe Pain ◽

Immunocompromised Patient ◽

Gastrointestinal Symptoms ◽

Strongyloides Stercoralis ◽

Stool Examination ◽

Immunocompromised Patients ◽

Pathological Analysis ◽

Immunosuppressive Medications ◽

History Of

Background:Strongyloidiasis is self-limited by the complete immune system, it may be complicated and causes hyperinfection in immunocompromised patients. Objective: Here, we report a case of an immunocompromised patient with duodenal involvement ofStrongyloides stercoralis.Case Report:A 65-year-old man presented with severe pain in central abdomen and periumbilical regions. He had no history of alcohol consumption, smoking and surgery but the history of RA (Rheumatoid Arthritis) and hypothyroidism taking immunosuppressive medications. The patient underwent endoscopy and colonoscopy which pathological analysis of the biopsies revealed remarkable findings in favor of Strongyloidiasis. After two consecutive day’s consumption of ivermectin 200µg/kg, the symptoms were completely removed. Also, the stool examination was negative forS.stercoralislarvae two weeks after end of the treatment.Conclusions:It seems that in immunocompromised patients with gastrointestinal symptoms assumption of parasite-like infections such as Strongyloidiasis should be considered as one of the diagnosis options. Due to the physiological and gut microbial alternations, these patients are more susceptible to infectious diseases.

Download Full-text

Rapid Fatal Outcome of Cryptococcal Meningoencephalitis in a Non-HIV Immunocompromised Patient with a Low Fluconazole Susceptibility Isolate: A Case Report from Madagascar

Case Reports in Infectious Diseases ◽

10.1155/2016/3492504 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Mihaja Raberahona ◽

Rivonirina A. Rakotoarivelo ◽

Njary Randriamampionona ◽

Angelot F. Rakotomalala ◽

Tiana Razafinambinintsoa ◽

...

Keyword(s):

Developing Countries ◽

Case Report ◽

Adult Patient ◽

Immunocompromised Patient ◽

Fatal Outcome ◽

Accurate Diagnosis ◽

Immunocompromised Patients ◽

Cryptococcal Meningoencephalitis ◽

Detailed Case ◽

Hiv Negative

Cryptococcal meningoencephalitis is considered rare in HIV-negative individuals. In Madagascar, the epidemiology of cryptococcosis has not yet been well described, neither in immunocompetent nor in immunocompromised patients. We report here the first Malagasy detailed case of cryptococcal meningoencephalitis in a non-HIV immunocompromised adult patient carrying a low fluconazole susceptibility isolate. We emphasize the importance of early and accurate diagnosis to meet the challenges of managing cryptococcosis in developing countries.

Download Full-text

COVID-19—Importance for Patients on the Waiting List and after Kidney Transplantation—A Single Center Evaluation in 2020–2021

Pathogens ◽

10.3390/pathogens10040429 ◽

2021 ◽

Vol 10 (4) ◽

pp. 429

Author(s):

Simone C. Boedecker ◽

Pascal Klimpke ◽

Daniel Kraus ◽

Stefan Runkel ◽

Peter R. Galle ◽

...

Keyword(s):

Kidney Transplantation ◽

Waiting List ◽

Smoking History ◽

Immunocompromised Patients ◽

Dialysis Patients ◽

Vaccination Programs ◽

Mild Disease ◽

Probability Of Survival ◽

Number Of Patients ◽

Immunosuppressed Patients

(1) Background: Dialysis patients and recipients of a kidney allograft are at high risk for infection with SARS-CoV-2. It has been shown that the development of potent neutralizing humoral immunity against SARS CoV-2 leads to an increased probability of survival. However, the question of whether immunocompromised patients develop antibodies has not yet been sufficiently investigated; (2) Methods: SARS-CoV-2 antibodies were examined in hemodialysis patients on the waiting list for kidney transplantation as well as patients after kidney transplantation. Patients were interviewed about symptoms and comorbidities, BMI, and smoking history; (3) Results: SARS-CoV-2 antibodies were found in 16 out of 259 patients (6%). The trend of infections here reflects the general course of infection in Germany with a peak in November/December of 2020. Remarkably, patients on the waiting list experienced only mild disease. In contrast, transplanted patients had to be hospitalized but recovered rapidly from COVID-19. Most interesting is that all immunosuppressed patients developed antibodies against SARS-CoV-2 after infection; (4) Conclusions: Even with extensive hygiene concepts, an above-average number of patients were infected with SARS-CoV-2 during the second wave of infections in Germany. Because SARS-CoV-2 infection triggered the formation of antibodies even in these immunocompromised patients, we expect vaccination to be effective in this group of patients. Thus, dialysis patients and patients after kidney transplantation should be given high priority in vaccination programs.

Download Full-text

From strongyloidiasis to disseminated mucormycosis: the story of an HTLV-1-infected migrant

Journal of Travel Medicine ◽

10.1093/jtm/taaa229 ◽

2020 ◽

Author(s):

Brice Autier ◽

Adélaïde Chesnay ◽

Claire Mayence ◽

Stéphanie Houcke ◽

Hélène Guégan ◽

...

Keyword(s):

Immune Deficiency ◽

Strongyloides Stercoralis ◽

The Body ◽

Life Threatening ◽

Disseminated Strongyloidiasis ◽

Disseminated Mucormycosis

Strongyloidiasis manifestations range from asymptomatic cases to the life-threatening disseminated strongyloidiasis in case of immune deficiency: larvae migrate throughout the body, disseminating germs from the digestive flora to various organs. Here, we described a case of disseminated mucormycosis consecutive to Strongyloides stercoralis hyperinfestation in a Surinamese migrant infected with HTLV-1.

Download Full-text

Saprochaete clavata Infection in Immunosuppressed Patients: Systematic Review of Cases and Report of the First Oral Manifestation, Focusing on Differential Diagnosis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052385 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2385

Author(s):

Carlo Lajolo ◽

Rupe Cosimo ◽

Schiavelli Anna ◽

Gioco Gioele ◽

Metafuni Elisabetta ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Acute Myeloid Leukemia ◽

Differential Diagnosis ◽

Myeloid Leukemia ◽

Oral Manifestation ◽

First Case ◽

Immunosuppressed Patients ◽

Meta Analyses ◽

Acute Myeloid

Background: Saprochaete clavata infection is an emerging issue in immunosuppressed patients, causing fulminant fungaemia. The purpose of this systematic review of cases is to retrieve all cases of S. clavata infection and describe oral lesions as the first manifestation of S. clavata infection. Methods: We report the first case of intraoral S. clavata infection in Acute Myeloid Leukemia (AML) affected subject, presenting as multiple grayish rapidly growing ulcerated swellings, and provide a review of all published cases of infection caused by S. clavata, according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, conducted by searching SCOPUS, Medline, and CENTRAL databases. Only articles in English were considered. Individual patient data were analyzed to identify risk factors for S. clavata infection. Results: Seventeen of 68 retrieved articles were included in the review reporting data on 96 patients (mean age 51.8 years, 57 males and 38 females). Most cases were disseminated (86) with a 60.2% mortality rate. Ninety-five were hematological patients, with AML being the most common (57 cases). Conclusions:S. clavata infection in immunosuppressed patients has a poor prognosis: middle-age patients, male gender and Acute Myeloid Leukemia should be considered risk factors. In immunosuppressed patients, the clinical presentation can be particularly unusual, imposing difficult differential diagnosis, as in the reported case.

Download Full-text

A case of fatal disseminated strongyloidiasis accompanied with intestinal obstruction

Oxford Medical Case Reports ◽

10.1093/omcr/omz087 ◽

2019 ◽

Vol 2019 (10) ◽

Author(s):

Peyman Heydarian ◽

Iraj Mobedi ◽

Mohamad Ali Mohaghegh ◽

Abozar Hosseini ◽

Fatemeh Goudarzvand Chegini ◽

...

Keyword(s):

Intestinal Obstruction ◽

Signs And Symptoms ◽

Strongyloides Stercoralis ◽

Final Diagnosis ◽

High Humidity ◽

Important Message ◽

Disseminated Strongyloidiasis ◽

Endemic Areas

Abstract Strongyloides stercoralis is an endemic parasite in some regions including the tropical and subtropical areas with high humidity. Most infections are asymptomatic with nonspecific signs and symptoms, making the final diagnosis complicated. Here, we report a patient referred to our hospital with signs consistent with sepsis, intestine obstruction, which finally died with the diagnosis of strongyloidiasis. The patient was from northern parts of Iran which are considered as endemic areas for S. stercoralis. In conclusion, there is an important message in this history, i.e. physicians should be aware of specific and non-specific signs of strongyloidiasis especially in people living in endemic areas to make an accurate final diagnosis by proper clinical and paraclinical examinations.

Download Full-text

Cardiac Aspergilloma: A Rare Case of a Cardiac Mass Involving the Native Tricuspid Valve, Right Atrium, and Right Ventricle in an Immunocompromised Patient

Case Reports in Cardiology ◽

10.1155/2018/6927436 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Christina S. Chen-Milhone ◽

Kalyan Chakravarthy Potu ◽

Sudhir Mungee

Keyword(s):

Tricuspid Valve ◽

Right Atrium ◽

Rare Case ◽

Opportunistic Infections ◽

Immunocompromised Patient ◽

Clinical Suspicion ◽

Ventricular Rate ◽

Immunocompromised Patients ◽

Transthoracic Echocardiogram ◽

The Right

Aspergillus can cause devastating opportunistic infections in immunocompromised patients. Rarely does this fungus invade the heart, and when it does, survival is especially poor despite optimal medical and surgical treatment. We report a case of cardiac aspergilloma with involvement of the tricuspid valve and both the right atrium and ventricle found on a transthoracic echocardiogram in an immunocompromised patient after developing atrial fibrillation with rapid ventricular rate. The findings from this case suggest that early clinical suspicion is critical in early diagnosis and thus early treatment.

Download Full-text