Fulminant and Fatal: Two Strongyloidiasis Cases in HTLV-1 Patients
A 30 year old, 25 week pregnant patient from Haiti was admitted to the Obstetrics service for abdominal pain; presumptive diagnoses was abruptio placenta vs fibroid degeneration. She later developed acute hypoxic respiratory failure and septic shock. She had a still birth delivery, and died after one week in ICU. Respiratory and stool specimens showed S.stercoralis rhabditiform larvae. She was on antibacterials and Ivermectin, and was positive for HTLV-1. Autopsy findings reveal diffuse bronchopneumonia with bilateral hemorrhagic lungs, likely from S. Stercoralis hyperinfection and E. coli.
A 61 year old female from Jamaica presents with weight loss and altered mental status. She had fever, cachexia, ascites, severe electrolyte disturbances and anemia. Her course was complicated by acute hypoxic respiratory failure, septic shock and polymicrobial bacteremia (Escherichia coli and Staphylococcus aureus). She developed skin changes thought to be necrotizing fasciitis on CT scan. Respiratory and stool microscopy were positive for S. stercoralis, and she was also positive for HTLV1. After treatment failure with oral Ivermectin, she was given oral then rectal Ivermectin mixed with 40% ethanol, and Albendazole. She improved with a prolonged course of Ivermectin. Patient had invasive S.stercoralis with cutaneous, respiratory, GI involvement causing polymicrobial sepsis.
Results: Disseminated Strongyloidosis with HTLV-1 Co-infection
These cases illustrate the mortality and morbidity of disseminated S. stercoralis in HTLV-1 co-infections. Pregnancy further enhanced the infection, which became rapidly lethal. In the second case, malnutrition and extensive GI involvement likely contributed to dissemination and caused treatment failure with standard Ivermectin treatment. Early consideration of Strongyloidiasis and HTLV-1 co-infections in patients from areas such as Caribbean and Japan, may reduce the morbidity of the infection.
C. Coyle, None
M. Corpuz, None