Izquierdo Isabel, Briones Javier, Lluch Rafael, Arqueros Cristina, Martino Rodrigo
Department of Hematology, Hospital Santa Creu i Sant Pau, C/Mar Casasnovas 90, 08041 Barcelona, Spain.
Case Rep Hematol. 2013;2013:860976. doi: 10.1155/2013/860976. Epub 2013 Jul 10.
Strongyloides stercoralis is an intestinal nematode that causes strongyloidiasis, which affects 30 to 100 million people worldwide. Risk factors for hyperinfection and disseminated disease include immunosuppressive drug therapy, human T-lymphotropic virus-1 (HTLV-1) infection, solid organ and bone marrow transplantation, hematologic malignant diseases, hypogammaglobulinemia, and severe malnutrition and associated conditions. The diagnosis can be difficult because a single stool examination fails to detect larvae in up to 70% of the cases, and the symptoms are nonspecific. Although eosinophilia is a common finding in patients with chronic Strongyloides infection, it is an unreliable predictor of hyperinfection. Furthermore, the lack of eosinophilia while receiving immunosuppressive therapy cannot reliably exclude the underlying chronic Strongyloides infection. We report here a fatal Strongyloides hyperinfection in a patient receiving allogeneic stem cell transplantation; risk factors and outcome in this clinical setting are discussed.
粪类圆线虫是一种肠道线虫，可引起粪类圆线虫病，全球约有3000万至1亿人受其影响。发生超感染和播散性疾病的危险因素包括免疫抑制药物治疗、人类嗜T淋巴细胞病毒1型（HTLV-1）感染、实体器官和骨髓移植、血液系统恶性疾病、低丙种球蛋白血症以及严重营养不良和相关病症。诊断可能会很困难，因为单次粪便检查在高达70%的病例中无法检测到幼虫，而且症状不具有特异性。虽然嗜酸性粒细胞增多是慢性粪类圆线虫感染患者的常见表现，但它并不是超感染的可靠预测指标。此外，在接受免疫抑制治疗时缺乏嗜酸性粒细胞增多并不能可靠地排除潜在的慢性粪类圆线虫感染。我们在此报告1例接受异基因干细胞移植患者发生的致命性粪类圆线虫超感染；并讨论了这种临床情况下的危险因素和结局。
