Igra-Siegman Y, Kapila R, Sen P, Kaminski Z C, Louria D B
Rev Infect Dis. 1981 May-Jun;3(3):397-407. doi: 10.1093/clinids/3.3.397.
Two patients hyperinfected with Strongyloides stercoralis (an intestinal nematode) are described. Both were both in Puerto Rico and had left the island six to 15 years previously; both were receiving adrenal steroids (one for Hodgkin's disease and the other for Goodpasture's syndrome). One died shortly after diagnosis, but the other survived the hyperinfection syndrome and complicating bacterial sepsis and meningitis. In addition to our case reports, 103 previously described cases of presumed strongyloides hyperinfection are reviewed. Among 89 patients immunocompromised by therapy or disease, the mortality rate was 86%; bacterial sepsis often contributed to the fatal outcome. In most cases, infection was acquired in an endemic area, sometimes long before the hyperinfection syndrome occurred. The few patients who had never been to an endemic area had a history of prolonged contact with highly soiled material, an observation suggesting cross infection from a contaminated person. When administered in time, thiabendazole, the drug of choice for strongyloidiasis, was effective in 70% of cases. If intestinal infection with S. stercoralis is detected and treated before immunosuppressive therapy is initiated and if a high index of suspicion for the hyperinfection syndrome is maintained while immunosuppressive therapy is given, the mortality from this disease should decrease.
本文描述了两名感染粪类圆线虫（一种肠道线虫）的重度感染患者。两名患者均来自波多黎各，且均在6至15年前离开该岛；两人均在接受肾上腺皮质类固醇治疗（一人因霍奇金病，另一人因古德帕斯丘综合征）。其中一人在诊断后不久死亡，但另一人在重度感染综合征及并发的细菌性败血症和脑膜炎中幸存下来。除了我们的病例报告外，还对之前描述的103例疑似粪类圆线虫重度感染病例进行了回顾。在89例因治疗或疾病导致免疫功能低下的患者中，死亡率为86%；细菌性败血症往往是导致致命结局的原因。在大多数情况下，感染是在流行地区获得的，有时是在重度感染综合征发生很久以前。少数从未去过流行地区的患者有长期接触高度污染物质的病史，这一观察结果提示可能存在来自受污染者的交叉感染。及时使用噻苯达唑（类圆线虫病的首选药物），70%的病例有效。如果在开始免疫抑制治疗之前检测并治疗肠道粪类圆线虫感染，并且在给予免疫抑制治疗时保持对重度感染综合征的高度怀疑指数，那么这种疾病的死亡率应该会降低。
