Hyperinfection syndrome with Strongyloides stercoralis in an Immunocompromised Patient with Diabetes: A Case Report

Abstract

Strongyloidiasis is an asymptomatic condition caused by the nematode Strongyloides stercoralis, which is transmitted through the soil. It can go undetected for many years but can also be more severe in immunocompromised individuals. This paper reports on a case of Strongyloides stercoralis hyperinfection syndrome in a patient with chronic liver disease and type 2 diabetes mellitus. Upon screening of a stool sample sent to the microbiology lab, many rhabditiform larvae of Strongyloides stercoralis were discovered, a finding that was substantiated by the Department of Parasitology at JIPMER in Pondicherry, India. This was further confirmed through a conventional polymerase chain reaction test using Strongyloides stercoralis specific primers. During his stay, the patient was initially started on a piperacillin tazobactam injection. After the parasite was discovered, an oral course of tablet ivermectin 12 mg and tablet albendazole (400 mg daily) was added, after which the patient's condition improved drastically. He was discharged against medical advice due to personal reasons. On further follow-up, the patient was readmitted and the administration of tablet ivermectin and tablet albendazole was halted due to abnormalities in the liver function tests. After 2 days, he developed septic shock, refractory metabolic acidosis, protein-losing enteropathy and suspected drug-induced liver injury. Unfortunately, he later experienced a cardiac arrest and passed away. This case demonstrated that the early identification of Strongyloides infection is crucial to avert serious problems in at- risk patients, particularly those with immunocompromised conditions. Early identification and prompt antiparasitic treatments are enabled by detecting the parasites in faeces