Strongyloides stercoralis infection in a patient with sickle cell disease.

Abstract

Strongyloides stercoralis is a common intestinal parasitic nematode that infects a large portion of the world’s population, and is endemic to tropical and sub-tropical regions. Infected individuals are often asymptomatic, but may have abdominal pain, diarrhea and other nonspecific findings. Immunocompromised hosts may develop massive invasion of the gastrointestinal and respiratory tracts, which represents a constellation of symptoms known as hyperinfection syndrome. This condition is most commonly seen in immunosuppressed individuals including renal allograft recipients, patients with human T-lymphotropic virus, and patients using corticosteroids. Along these lines, sickle cell anaemia (SCA) is a condition that is marked by functional asplenia and a relative state of immunocompromise, which may increase the incidence of hyperinfection. Along with the predisposition to encapsulated organisms, SCA patients may be unusually susceptible to parasitic infections, which may trigger sickle cell crises (Sodipo et al., 1997). Furthermore, blood samples from SCA patients have demonstrated increased eosinophil numbers and adhesion properties, which may also contribute to the vasoocclusive state (Canalli et al., 2004). Given the observations that strongyloidiasis is characterized by eosinophilia and eosinophils in SCA individuals may be implicated in vasoocclusive crisis (VOC), further data are necessarily to investigate the association between SCA and S. stercoralis infection. We describe a patient with SCA and chronic eosinophilia who presented to our hospital with diarrhea and VOC. She was found to have S. stercoralis infection, and experienced symptomatic improvement following the administration of ivermectin.