Hyperinfection syndrome due to Strongyloides stercoralis presenting as acute respiratoryb failure in a patient with immunosuppression due to HIV: a case report

Síndrome de hiperinfección por Strongyloides stercoralis que se presenta como falla ventilatoria aguda en una paciente con inmunosupresión por VIH: reporte de caso

The strongyloidiasis is an infection caused by a parasite known as Strongyloides stercoralis, this infection has a high morbidity and mortality in immunocompromised patients, with serious malnutrition and coinfection with the HIV virus. A hyper infection can be developed, given that the parasite has potential to develop an internal autoinfection. A case of pulmonary infection is present due to S. stercoralis that progressed to respiratory failure and required ventilatory and hemodynamic support in the intensive care unit, providing the standard combined treatment of ivermectin with a subsequent death of the patient. In this clinical case, some aspects are presented and discussed related to a case of hyperinfection by Strongyloides stercoralis (HSS). It has been described in patients with immunosuppression due to a transplant, malnutrition, alcoholism and with infection by the human immunodeficiency virus (HIV). Particularly, the administration of systemic corticosteroids causes the change of intestinal rabditoid larvae to invasive filariform. Thereby, in chronically infected patients, who have a drastic decrease in cellular immunity, the parasite multiplies abundantly and spreads through the lungs, liver, brain, and other organs; it is the so-called HSS syndrome, which has a high mortality rate. The possibility that its incidence may increase due to population migration and in certain regions, should alert us to the possibility of HSS, especially in immunosuppressed patients. In front of the suspicion of this parasitosis, in patients at risk should resort to complementary methods for the detection of larvae, such as coprocultivo, which would allow us to act early, prevent its spread and change the unfortunate prognosis of these patients.