1275. Misdiagnosed Pulmonary Strongyloidiasis in New York City
Session: Poster Abstract Session: Travel/Tropical Medicine and Parasitology
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Strongyloidiasis is prevalent in many tropical areas. However, it is also an important emerging disease in metropolitan cities due to increasing immigrants and lack of familiarity among physicians. The relatively nonspecific clinical features of this infection pose a significant diagnostic challenge.

Methods: Two cases of misdiagnosed pulmonary stronglyoidiasis were identified from 2009-2011 at a community-based hospital in Brooklyn. The analyses include clinical and radiographic manifestations, co-morbidities, demographic information, time since immigration, eosinophil count, IgE level, and steroid use.

Results: Case 1 is a 74-year-old Guatemalan female with chronic heart failure (CHF) who presented with wheezing and was misdiagnosed with CHF exacerbation. Case 2 is a 75-year-old Puerto Rican female with asthma who presented with wheezing and was misdiagnosed with asthma exacerbation. In both cases, significant eosinophilia (1930 cells/μl, 2556 cells/μl) and high IgE levels (2672 IU/ml, 1483 IU/ml) were noted. Each 3 samples of stool and ova parasite were negative nor were each 2 sputum examinations. Both were diagnosed by a positive IgG titer (4.49, 8.91). Case I was diagnosed 53 years after immigration and 24 months after initial presentation to the hospital. Case 2 was diagnosed 37 years after immigration and 46 months after initial presentation. Presenting symptoms were both wheezing without gastrointestinal symptoms or skin lesions. The chest radiograph showed bilateral pulmonary edema and left pleural effusion in case 1 and diffuse interstitial pattern in case 2. Case 2 reported persistent wheezing after steroid use. Both responded to Ivermectin with improvement of wheezing and eosinophilia. 2 months of treatment delay from a positive IgG titer occurred in case 2

Conclusion: Pulmonary strongyloidiasis can manifest as wheezing mimicking asthma or CHF exacerbation. The diagnosis of strongyloidiasis is often delayed owing to its nonspecific clinical and radiographic features and lack of familiarity among physicians in metropolitan areas. The presence of eosinophilia and wheezing warrants an aggressive search for strongyloidiasis and screening should be considered regardless of the time since immigration.


Subject Category: T. Travel/tropical medicine and parasitology

Takashi Shinha and Olga Badem, Long Island College Hospital, New York, NY

Disclosures:

T. Shinha, None

O. Badem, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.