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Respiratory hyperinfection with Strongyloides stercoralis in a patient with renal failure

Nature Clinical Practice Nephrology volume 3, pages 573–577 (2007)Cite this article

Abstract

Background A 40-year-old female presented to hospital with rapidly progressive renal failure secondary to antineutrophil cytoplasmic antibody (ANCA)-positive crescentic glomerulonephritis. She was started on immunosuppressive therapy (oral steroids and oral cyclophosphamide) and hemodialysis. She re-presented with persistent fever, persistent vomiting and dry cough 135 days after starting immunosuppression. A chest X-ray revealed left lower zone consolidation. Repeated sputum Gram stains were negative, and both sputum and blood cultures were sterile. A sputum smear was negative for acid-fast bacilli. The patient's fever did not respond to empirical antibiotics or antitubercular therapy. Bronchoscopic alveolar lavage and stool examination revealed larval forms of Strongyloides stercoralis.

Investigations Physical examination, urine and blood analyses, chest X-ray, bronchoscopy and bronchoalveolar lavage examination.

Diagnosis Respiratory hyperinfection syndrome due to S. stercoralis.

Management Ivermectin, albendazole and empirical broad-spectrum antibiotics for bacterial superinfection (amoxicillin and clavulanic acid for 5 days followed by piperacillin and tazobactam plus levofloxacin).

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Figure 1: Chest radiographs of the patient.
Figure 2: Larval forms of Strongyloides stercoralis isolated from bronchoalveolar lavage.

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Acknowledgements

The authors would like to thank Dr Anila Mathews for taking the photographs shown in Figure 2.

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Authors and Affiliations

  1. M Rajapurkar is Medical Director and Head of Nephrology, U Hegde is a Consultant Nephrologist, M Rokade is a Resident in Nephrology, S Gang is a Consultant Nephrologist, and K Gohel is a Consultant Nephrologist, all at the Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India.,

    Mohan Rajapurkar, Umapati Hegde, Mahesh Rokhade, Sishir Gang & Kalpesh Gohel

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  1. Mohan Rajapurkar
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  2. Umapati Hegde
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Correspondence to Mohan Rajapurkar.

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The authors declare no competing financial interests.

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Rajapurkar, M., Hegde, U., Rokhade, M. et al. Respiratory hyperinfection with Strongyloides stercoralis in a patient with renal failure. Nat Rev Nephrol 3, 573–577 (2007). https://doi.org/10.1038/ncpneph0598

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