Hyperinfection Strongyloides stercoralis: diagnosis by bronchoalveolar lavage cytology

Síndrome de hiperinfección por Strongyloides stercoralis: diagnóstico por medio de citología de lavado broncoalveolar

Published 2015-10-20

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Vol. 27 No. 4 (2015)
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Research article
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Hyperinfection Strongyloides stercoralis: diagnosis by bronchoalveolar lavage cytology.
rev. colomb. neumol. [Internet]. 2015 Oct. 20 [cited 2024 Nov. 21];27(4). Disponible en: https://doi.org/10.30789/rcneumologia.v27.n4.2015.69
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https://doi.org/10.30789/rcneumologia.v27.n4.2015.69
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Liliana Fernández, MD.
Fundación Valle del Lili. Facultad de Ciencias de la Salud, Universidad Icesi. Cali, Colombia.
    Alejandro González, MD.
    Universidad Icesi. Cali, Colombia.
      Luz Fernanda Sua, MD., PhDc.
      Fundación Valle del Lili. Universidad Icesi. Cali, Colombia.
        Diego Vargas, MD.
        Universidad del Valle. Cali, Colombia.
          Carlos Andrés Muñoz, MD.
          Fundación Valle del Lili. Universidad Icesi. Cali, Colombia.
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            Liliana Fernández, MD.,

            Medicina Interna, Neumología y Neumología intervencionista. Línea de Investigación Biomédica en Tórax. Fundación Valle del Lili. Profesora Clínica Asociada, Facultad de Ciencias de la Salud, Universidad Icesi. Cali, Colombia.

            Alejandro González, MD.,

            Medicina Interna, Facultad de Ciencias de la Salud, Universidad Icesi. Cali, Colombia.

            Luz Fernanda Sua, MD., PhDc.,

            Anatomía Patológica y Patología Clínica, Departamento de Patología y Medicina de Laboratorio, Patología pulmonar. Ciencias Biomédicas. Línea de investigación Biomédica en Tórax, Fundación Valle del Lili. Profesora Clínica Auxiliar, Facultad de Ciencias de la Salud, Universidad Icesi. Cali, Colombia.

            Diego Vargas, MD.,

            Anatomía Patológica y Patología clínica. Departamento de Patología, Universidad del Valle. Cali, Colombia.

            Carlos Andrés Muñoz, MD.,

            Médico Rural en Investigación, Centro de Investigaciones Clínicas, Fundación Valle del Lili. Línea de Investigación Biomédica en Tórax, Facultad de Ciencias de la Salud, Universidad Icesi. Cali, Colombia.

            Introduction: Strongyloides stercoralis (Ss) is a parasite that causes severe infections, especially in immunocompromised patients; hyperinfection syndrome is one of its most serious manifestations. Early detection is vital for initiating adequate therapy. In this sense, bronchoscopy and bronchoalveolar lavage cytology are useful tools for early diagnosis.

            Patients and methods: retrospective review of cases of Ss hyperinfection syndrome diagnosed by bronchoalveolar lavage cytology at the Fundación Valle del Lili, Cali over the period from 2004 to 2012; 8 cases were found; we describe the demographic and clinical characteristics, risk factors, findings, and outcomes, and carry out a review of the literature.

            Results: 7 male (88%) and 1 female (12%) cases were found, the mean age was 48 years, 2 patients (22%) had HIV infection, 3 patients had chronically taken steroids (heart transplant, SLE nephritis, and chemotherapy) (33%), 2 patients were severely malnourished, 2 patients had positive human T-cell lymphotropic virus (HTLV-1). None of the patients had eosinophilia. All were treated with ivermectin and broad spectrum antibiotics in order to cover Gram-negative bacteremia (33% had positive cultures). In-hospital mortality was 62,5%.

            Conclusion: hyperinfection syndrome is a severe complication of Ss infection in immunocompromised patients. Despite great deterioration of the patient’s general condition, its clinical presentation is not specific. A high index of clinical suspicion is necessary for diagnosis and timely therapy. In these cases, bronchoalveolar lavage cytology is a useful tool form identifying the organism.

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