Respiratory Manifestations of Strongyloidiasis: Significance of Diagnosis, Treatment, and Screening

Abstract

Strongyloidiasis is a widespread disease characterized clinically by acute or chronic manifestations, which, in high-risk individuals and immunocompromised individuals, can progress to hyperinfection syndrome and disseminated forms with significant mortality rates. Among extraintestinal organs, the lungs are most commonly affected. Clinical presentations are very diverse, contributing to the challenges of diagnosis and timely treatment initiation. We present the case of a 57-year-old patient who was admitted to the intensive care unit (ICU) due to bilateral pneumonia and septic shock. During a two-month hospitalization period, the patient spent 16 days on invasive mechanical ventilation. Initially, nonspecific symptoms, such as weakness, fatigue, and cough, evolved into complications, including diarrheal syndrome, hemoptysis, urticaria, and ventilator-associated pneumonia (VAP) caused by Gram-negative bacteria. Numerous larvae of Strongyloides stercoralis were identified in a stool sample. In addition to antibiotic therapy, antiparasitic treatment was administered, resulting in significant improvement in the patient's overall condition, leading to discharge for further home care. In this case, community-acquired pneumonia was complicated by the reactivation of chronic strongyloidiasis in the form of hyperinfection syndrome in a high-risk patient. High-risk individuals and immunocompromised individuals should undergo screening for parasitic infections in cases presenting with gastrointestinal symptoms, particularly diarrhea and respiratory symptoms. Screening for parasitic infections should be integrated into routine clinical practice for this population.

Keywords: diarrhea; hyperinfection syndrome; pneumonia; screening; strongyloides stercoralis.

Figure 1. Chest X-ray on the day of admission indicates bilateral, predominantly right-sided strip-like patchy pneumonia infiltrates, as well as decreased transparency in the left basal region, where a small amount of pleural effusion was verified by ultrasound.

Figure 2. Chest X-ray on the sixth day of hospitalization indicates bilateral progression of fine mottled changes, which was accompanied by clinical deterioration and the need for reintubation.

Figure 3. Larva of S. stercoralis in an unstained wet mount of stool sediment (400x).

The red arrow indicates a short buccal canal, and the black arrow indicates a rhabditoid esophagus.

Figure 4. Presence of multiple S. stercoralis larvae in an unstained wet mount of stool sediment (100x).

Figure 5. The chest CT scan performed one month after admission described bilateral irregular consolidations with an air bronchogram, primarily of inflammatory etiology, with signs of perilesional bronchiolitis, and then bilateral reticular changes in the interstitium and ground-glass opacity (GGO) zones.