Journal of Cytology
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Year : 2012  |  Volume : 29  |  Issue : 4  |  Page : 278-279
Strongyloides stercoralis hyperinfection with features of acute intestinal obstruction in a patient operated for prolapse disc


Department of Pathology, Institute of Medical Sciences and SUM Hospital, Under Sikshya 'O' Anushandhan University, K8, Kalinga Nagar, Bhubaneswar, Odisha, India

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Date of Web Publication28-Nov-2012
 

How to cite this article:
Dash K, Chauhan S, Tripathy R, Chakravorty S. Strongyloides stercoralis hyperinfection with features of acute intestinal obstruction in a patient operated for prolapse disc. J Cytol 2012;29:278-9

How to cite this URL:
Dash K, Chauhan S, Tripathy R, Chakravorty S. Strongyloides stercoralis hyperinfection with features of acute intestinal obstruction in a patient operated for prolapse disc. J Cytol [serial online] 2012 [cited 2020 Sep 21];29:278-9. Available from: http://www.jcytol.org/text.asp?2012/29/4/278/103955


Sir,

Strongyloides stercoralis (SS) is an intestinal nematode of humans that infects tens of millions of people worldwide [1] and is endemic in tropical and subtropical regions. It causes minimal clinical manifestation in an immunocompetent host. However, SS infection, though rare, can be life threatening in immunocompromised subjects and is associated with neoplastic diseases such as Hodgkin lymphoma, other lymphomas, leukemias, nonmalignant conditions treated with corticosteroids, e.g., organ transplantation, and alcoholism. There have also been reports of widespread dissemination of SS in acquired immunodeficiency syndrome patients. [2] We present here a rare case of SS hyperinfection diagnosed on gastric aspirate smears, causing features of acute intestinal obstruction in a patient immediately following surgery for management of prolapse disc.

The case was of a 65-year-old male who got admitted with features of intervertebral disc prolapse (left lateral) at the level of L5/S1. He had a history of intermittent loose motion for a period of 15 days. The initial treatment was for relief of pain but there was no response. The serological tests for hepatitis B virus, hepatitis C virus and human immunodeficiency virus were negative. The patient underwent operative procedure for prolapse disc. On fourth post-operative day, the patient developed dysphagia for solid food followed by both solid and liquid food. It was followed by vomiting with pain in abdomen. The vomitus initially contained food material. Later on brown colored foul smelling (feculent) content was voided. Ryle's tube gastric suction material was collected and sent for cytological examination. Surprisingly good number of larval form of SS [Figure 1] were found. The diagnosis was acute intestinal obstruction due to SS hyperinfection after exclusion of other possible causes. The patient was treated with gastro-duodenal suction drainage, replacement and maintenance of fluid, and electrolyte balance. There was symptomatic relief and this treatment relieved the abdominal distension and pain. He was given weekly doses of Ivermectin for 2 weeks and Albendazole for 5 days. The patient showed good response and Ivermectin was repeated for the third week. The patient was unremarkable on discharge.
Figure 1: Strongyloides stercoralis larval form showing a simple tubular digestive tract in the gastric suction aspirate material (Leishman stain, ×400)

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SS is unique among intestinal nematodes in its ability to complete its lifecycle within the host through an asexual autoinfective cycle, allowing the infection to persist in the host indefinitely. In persons debilitated by diseases, malnutrition, serious illness, severe complications and some immunocompromised conditions, the autoinfective cycle can become amplified into a potentially fatal hyperinfection syndrome (characterized by increased number of infective filariform larvae in stool and sputum). The clinical manifestation of increased parasite burden and migration is respiratory discomfort and gastrointestinal symptoms and signs such as severe abdominal pain, vomiting, diarrhea, reduced bowel sound, paralytic ilieus and necrotizing jejunitis. [3] Small bowel obstruction may develop with early heavy infection. [4] Daneshbod et al., [5] diagnosed SS infection mimicking a malignant tumor of duodenum by examination of intraoperative touch imprint from the resected specimen.

In this case, the patient had previous history of intermittent diarrhea. The patient was debilitated and malnourished and underwent operative procedure due to his acute symptoms. The debilitated condition might have predisposed to the development of hyperinfection and manifestation of features of acute intestinal obstruction.

It is important to have high index of suspicion in patients who are debilitated and malnourished and have some history suggestive of intermittent diarrhea, so as to avoid complications like intestinal obstruction due to SS hyperinfection.

 
   References Top

1.Grove DI. Historical introduction. In: Grove DI, editor. Stronglyoidiasis: A major roundworm infection of man. Philadelphia: Taylor and Francis; 1989. p. 1-9.  Back to cited text no. 1
    
2.Satyanarayana S, Nema S, Kalghatgi AT, Mehta SR, Rai R, Duggal R, et al. Disseminated Strongyloides stercoralis in AIDS: a report from India. Indian J Pathol Microbiol 2005;48:472-4.  Back to cited text no. 2
    
3.Gilles HM. Soil transmitted helminths (Geohelminths). In: Cook GC, Zumla A, editors. Manson's tropical diseases. 21st ed. Philadelphia: Saunders Elsevier; 2003. p. 1445-9.  Back to cited text no. 3
    
4.Weller PF, Nutman TB. Intestinal nematodes. In: Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, JAmeson JL, et al. editors.Harrison's principles of internal medicine. Vol 1.17th ed. New York: McGraw Hills; 2008. p. 1319-23.  Back to cited text no. 4
    
5.Daneshbod Y, Daneshbod K, Negahban S, Aledavud A, Taghavi A, Saberi-Firuzi M, et al. Intraoperative touch imprint diagnosis of Strongyloides stercorails infection mimicking a malignant tumor. Acta Cytol 2008;52:387-9.  Back to cited text no. 5
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Correspondence Address:
Kanakalata Dash
Department of Pathology, Institute of Medical Sciences and SUM Hospital, Under Sikshya 'O' Anushandhan University, K8, Kalinga Nagar, District Centre, Chandrasekharpur, Bhubaneswar, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9371.103955

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This article has been cited by
1 Rare but serious complications of Strongyloides infestation
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2 Rare but serious complications of Strongyloides infestation
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