Strongyloides stercoralis disseminated infection in a patient misdiagnosed with chronic asthmatic bronchitis
Strongyloides stercoralis disseminated infection in a patient misdiagnosed with chronic asthmatic bronchitis
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误诊慢性喘息性支气管炎患者粪类圆线虫播散性感染
DOI：
10.1016/j.jmii.2014.04.007
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发表时间：
2016
影响因子：
7.4
通讯作者：
Guo Hongqian
中科院分区：
文献类型：
--
作者：
Wang Yang;Ma Yi;Xu Ying;Zhu Bin;Guo Hongqian
粪类圆线虫是一种土传肠道线虫，通常引起肺部感染、腹痛或腹泻。 1 如果免疫系统受到损害，线虫幼虫可能会在宿主体内扩散并发展成潜在致命的自身感染综合征。 2, 3 我们介绍了一名患有播散性类圆线虫病的农民的病例，其既往病史包括 30 年反复咳嗽、咳痰并伴有喘息。他最初被误诊为慢性哮喘性支气管炎，并在哮喘发作期间接受静脉注射甲泼尼龙 40-80 毫克/天。患者的实验室数据（表 1）显着显示嗜酸性粒细胞计数高达 9.4%，这可能是寄生虫感染的迹象。血气分析显示严重低氧血症，PaO2/FiO2 < 150 mmHg（PaO2 Z 44 mmHg，FiO2 Z 40%）。他的初始胸片显示弥漫性肺部浸润（图 1 A）。高分辨率胸部计算机断层扫描 (CT) 扫描揭示了一个潜在的重要发现，即小叶间隔增厚（图 1 B）。腹部增强 CT 扫描仅显示肠壁增厚（图 1 C）。然而，随后的食管胃十二指肠镜检查显示十二指肠粘膜下组织中有多个小的白色粟粒结节（图1D）；十二指肠活检标本进一步发现了粪圆线虫的卵和虫体（图1E）。当发生脑病时，头部 MRI 扫描显示右颞叶脑膜附近有一个模糊的、稍高信号的结节性病变（图 1 F、G）。正如 Feely 等人的情况一样，4 应考虑线虫迁移引起的中枢神经系统损伤。另外，粪便和痰寄生虫学检查均呈粪圆线虫幼虫阳性，诊断为圆线虫播散性感染。诊断后 24 小时内，开始阿苯达唑治疗长达 2 周。之后的第3天
Strongyloides stercoralis is a soil-transmitted intestinal nematode, commonly causing pulmonary infection, abdominal pain, or diarrhea. 1 If immune systems are compromised, the nematode larvae may spread and develop a potentially fatal auto-infection syndrome in the host. 2, 3 We present a case of a farmer with disseminated strongyloidiasis, whose past medical history included repeated cough and expectoration associated with wheezing for 30 years. He was originally misdiagnosed with chronic asthmatic bronchitis and received intravenous methylprednisolone 40e80 mg/day during an asthmatic episode. The patient’s laboratory data (Table 1) notably revealed a high eosinophil count of 9.4%, a possible indication of a parasitic infection. Blood gas analysis indicated severe hypoxemia with PaO2/FiO2< 150 mmHg (PaO2 Z 44 mmHg and FiO2 Z 40%).His initial chest radiograph showed diffuse pulmonary infiltrates (Fig. 1 A). A potentially significant finding, interlobular septal thickening, was revealed by a high resolution chest computed tomography (CT) scan (Fig. 1 B). Contrast-enhanced CT scan of the abdomen only revealed bowel wall thickening (Fig. 1 C). However, a subsequent esophagogastroduodenoscopy showed multiple small white miliary nodules in duodenal submucosal tissue (Fig. 1 D); duodenal biopsy specimens further found the ova and the insect body of S. stercoralis (Fig. 1 E). While an encephalopathy developed, a head MRI scan showed a blurred slightly hyperintense nodular lesion in the right temporal lobe near the meninges (Fig. 1 F, G). As in the case of Feely et al, 4 central nervous system damage caused by nematodes migration should be considered. Additionally, stool and sputum parasitological examinations were all positive for S. stercoralis larvae, so the diagnosis of S. stercoralis disseminated infection was declared. Within 24 hours after the diagnosis, treatment with albendazole was started up to 2 weeks. On the 3rd day after