Letter to the Editor
Pulmonary Strongyloides stercoralis Infection
Infestación pulmonar por Strongyloides stercoralis
Violeta Esteban Ronda
, José Franco Serrano, María Luisa Briones Urtiaga
Corresponding author
Servicio de Neumología, Hospital Clínico Universitario, Valencia, Spain
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(B) Bronchial aspirate cytology (Papanicolaou stain) showing <span class="elsevierStyleItalic">Strongyloides stercoralis</span> filariform larvae.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Strongyloides</span> is a nematode that can repeat autoinfection cycles within the human host, perpetuating a chronic infection which may go unnoticed.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Migration of the larvae through the lungs can cause manifestations such as cough, dyspnea or wheezing,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–3</span></a> but the most typical manifestation is as a subclinical form of Löffler's syndrome. However, in immunocompromised patients, the cycles are accelerated, the parasite may even disseminate to other organs, and mortality can be as high as 87%.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> We report a case of <span class="elsevierStyleItalic">Strongyloides stercoralis</span> infestation with severe lung involvement.</p><p id="par0010" class="elsevierStylePara elsevierViewall">An 84-year-old man, active smoker with an accumulated consumption of 60 pack-years, hypertensive, gastrectomized 7 years previously due to gastric cancer, and operated again for splenic abscess requiring splenectomy. He had worked as a farmer, and had occasionally watered the land in his bare feet. He consulted due to a 5-month history of asthenia, dysphagia, low-grade fever, anorexia, and weight loss. He had been admitted to another hospital for 14 days with a diagnosis of pneumonia, and received ertapenem, clindamycin, corticosteroids and bronchodilators. Seven days after discharge, he was brought to our hospital due to progressive deterioration. Physical examination revealed cachexia, crackles in the left hemithorax, and slightly tender abdomen. Clinical laboratory testing showed increased acute phase reactants, without eosinophilia. Computed axial tomography showed consolidation in the left upper lobe, areas of cavitation with irregular walls (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), and marked dilation of the loops of the small intestine. The patient was treated with piperacillin–tazobactam and amikacin, without improvement. Fiberoptic bronchoscopy was performed, showing a greenish liquid secretion, shown on bronchial aspirate cytology to contain <span class="elsevierStyleItalic">Strongyloides stercolaris</span> filariform larvae (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). In view of the diagnosis of pulmonary infestation, albendazole and ivermectin were added to the therapeutic regimen, but the patient progressively worsened and died 26 days later.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Strongyloides stercolaris</span> filariform larvae penetrate through the skin and travel through the venous system to the right heart cavities, and from there to the lungs. They pass through the glottis to the digestive system where they lay their eggs, releasing non-infectious rhabditiform larvae. These can transform to invasive filariforms during the autoinfection cycles, penetrating the intestinal mucosa to complete the cycle,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> producing ulcerations making the patient susceptible to bacteremia. In pulmonary infestation, larvae infiltrate the alveolar and vascular spaces, progressing to diffuse hemorrhagic interstitial pneumonitis, acute respiratory distress syndrome, or lobar pneumonia, as in the case discussed here.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Our patient worked barefoot in the fields, which may explain the port of entry, while various factors may have precipitated the infestation: gastrectomy with the consequent achlorhydria, absence of spleen, malnutrition, and corticosteroid treatment.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1–4</span></a> It is interesting to note that <span class="elsevierStyleItalic">Strongyloides stercolaris</span> parasitosis is not a strictly exotic disease: it is also endemic on the Mediterranean coast,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> with the highest prevalence occurring in farmers in certain regions. It seems a reasonable approach to detect larvae in risk situations, particularly before initiating immunosuppressive treatments, to prevent disseminated disease and death.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,3,4</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Esteban Ronda V, Franco Serrano J, Briones Urtiaga ML. Infestación pulmonar por <span class="elsevierStyleItalic">Strongyloides stercoralis</span>. Arch Bronconeumol. 2016;52:442–443.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 728 "Ancho" => 1600 "Tamanyo" => 126336 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest computed axial tomography: consolidation in the posterior segment of the left upper lobe with areas of cavitation with irregular walls. (B) Bronchial aspirate cytology (Papanicolaou stain) showing <span class="elsevierStyleItalic">Strongyloides stercoralis</span> filariform larvae.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening, prevention, and treatment for hyperinfection syndrome and disseminated infections caused by <span class="elsevierStyleItalic">Strongyloides stercoralis</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Mejia" 1 => "T.B. 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Nutman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Microbiol Rev" "fecha" => "2004" "volumen" => "17" "paginaInicial" => "208" "paginaFinal" => "217" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14726461" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperinfección por <span class="elsevierStyleItalic">Strongyloides stercoralis</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Llagunes" 1 => "E. Mateo" 2 => "J.J. Peña" 3 => "P. Carmona" 4 => "J. de Andrés" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2010" "volumen" => "34" "paginaInicial" => "353" "paginaFinal" => "356" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20836249" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nematodes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.R. Murray" 1 => "K.S. Rosenthal" 2 => "M.A. Pfaller" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Medical Microbiology" "paginaInicial" => "853" "paginaFinal" => "870" "edicion" => "6.a ed." "serieFecha" => "2009" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:3 [ "titulo" => "Acknowledgement" "texto" => "<p id="par0025" class="elsevierStylePara elsevierViewall">We thank the Pathology Department of the Hospital Clínico Universitario de Valencia for their help and collaboration.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000008/v1_201607230336/S1579212916301197/v1_201607230336/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000008/v1_201607230336/S1579212916301197/v1_201607230336/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301197?idApp=UINPBA00003Z" ]
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| 2020 November | 52 | 24 | 76 |
| 2020 October | 46 | 23 | 69 |
| 2020 September | 64 | 20 | 84 |
| 2020 August | 63 | 18 | 81 |
| 2020 July | 54 | 25 | 79 |
| 2020 June | 49 | 12 | 61 |
| 2020 May | 67 | 29 | 96 |
| 2020 April | 79 | 24 | 103 |
| 2020 March | 91 | 17 | 108 |
| 2020 February | 92 | 21 | 113 |
| 2020 January | 62 | 20 | 82 |
| 2019 December | 55 | 14 | 69 |
| 2019 November | 81 | 24 | 105 |
| 2019 October | 99 | 19 | 118 |
| 2019 September | 75 | 13 | 88 |
| 2019 August | 76 | 19 | 95 |
| 2019 July | 36 | 20 | 56 |
| 2019 June | 42 | 14 | 56 |
| 2019 May | 63 | 22 | 85 |
| 2019 April | 63 | 41 | 104 |
| 2019 March | 53 | 17 | 70 |
| 2019 February | 41 | 22 | 63 |
| 2019 January | 39 | 19 | 58 |
| 2018 December | 53 | 15 | 68 |
| 2018 November | 75 | 14 | 89 |
| 2018 October | 64 | 18 | 82 |
| 2018 September | 43 | 9 | 52 |
| 2018 July | 1 | 0 | 1 |
| 2018 May | 10 | 0 | 10 |
| 2018 April | 44 | 6 | 50 |
| 2018 March | 33 | 4 | 37 |
| 2018 February | 16 | 9 | 25 |
| 2018 January | 26 | 4 | 30 |
| 2017 December | 35 | 6 | 41 |
| 2017 November | 35 | 9 | 44 |
| 2017 October | 30 | 8 | 38 |
| 2017 September | 23 | 6 | 29 |
| 2017 August | 29 | 10 | 39 |
| 2017 July | 26 | 7 | 33 |
| 2017 June | 28 | 14 | 42 |
| 2017 May | 31 | 11 | 42 |
| 2017 April | 21 | 8 | 29 |
| 2017 March | 7 | 5 | 12 |
| 2017 February | 19 | 5 | 24 |
| 2017 January | 14 | 3 | 17 |
| 2016 December | 19 | 16 | 35 |
| 2016 November | 42 | 32 | 74 |
| 2016 October | 1 | 4 | 5 |
| 2016 September | 0 | 1 | 1 |
| 2016 July | 1 | 0 | 1 |
Show all
