S3301 Strongyloides stercoralis: A Case Series Review in a County Hospital in Texas

Abstract

Introduction: Strongyloidiasis is a rare parasitic disease caused by Strongyloides stercoralis (SS), which is rare in the US, but international travel and immigrants from endemic countries have led to isolated cases. The clinical presentation can be variable ranging from uncomplicated disease, hyper-infection syndrome, to disseminated life-threatening infection. In this case series, we are reviewing clinical presentation and management of patients with strongyloidiasis at a county hospital in Texas. Methods: Patients with strongyloidiasis were selected from February/2017-December/2020 at our hospital. Patient’s demographics, risk factors, clinical presentation, blood work, diagnostic tests, and management were electronically extracted from electronic medical records. Two physicians independently reviewed the collected data. Results: A total of 6 patients were enrolled in this study with 33% females (2/6). Population mean age was 50 years and all patients were Hispanic. 50% (3/6) patients had some degree of immunosuppression, 2 of them with hyperinfection syndrome. On presentation, 50% of patients had eosinophilia, 83% anemia (80% normocytic), 33% diarrhea, 33% hematochezia, and 50% melena. Additionally, 1 of 3 patients with persistent eosinophilia had a co-infection with Toxocara and Schistosoma. 3 of 6 patients were diagnosed with serology, 1 patient with stool sample, and 2 patients with multiple modalities. 83% (5/6) patients underwent Endoscopic evaluation; 4 of 6 patients had bidirectional endoscopy and 1 patient had colonoscopy. The pathological examination of biopsied specimen was conclusive in 2 patients (Table). Conclusion: SS infection has a non-specific presentation that can affect any patient, but immunocompromised patients can have more severe and life-threatening course. Similar to our case series, all of them from known endemic areas, and the immunocompromised patients had complicated disease, such as hyperinfection with Loffler syndrome. The majority of the patients’ gastrointestinal (GI) strongyloidiasis had anemia associated with GI bleeding. However, the endoscopic findings were non-specific and can be seen in different inflammatory conditions. Diagnosis of SS infection is challenging, and it requires high clinical suspicion and awareness of risk factors. Misdiagnosing strongyloidiasis with other autoimmune inflammatory condition can have a devastating impact particularly if immunosuppressants are given since it can exacerbate and lead to death from hyperinfection syndrome.Table 1.: Patient Characteristics.