Strongyloides hyperinfection syndrome complications: a case report and review of the literature.

Strongyloidiasis is a major global health challenge that is often underestimated in many countries. In immuno-compromised hosts, an autoinfection can go unchecked with large numbers of invasive Strongyloides larvae disseminating widely and causing hyperinfection, with fatal consequences. This review will highlight a case of gram negative bacteremia complicated by meningitis and Adult Respiratory Distress Syndrome (ARDS) as a fatal outcome of Strongyloides hyperinfection, commonly known to occur in the setting of immunosuppression. A middle aged female with chronic lymphocytic leukemia and hypogammaglobulinemia presented with severe respiratory distress requiring intubation. She had been on intermittent corticosteroids and multiple courses of antibiotics for the past six months for COPD exacerbations. Bronchoalveolar lavage showed Strongyloides stercoralis. Blood cultures grew Vancomycin Resistant Enterococci and a few days later Vancomycin Sensitive Enterococcus was found in the CSF. Afterwards, she grew Vancomycin Sensitive Enterococcus in the blood. She was treated with Ivermectin and Albendazole for Strongyloides and Linezolid and Vancomycin for these two different strains of E. faecium. After initial resolution of bacteremia and meningitis, she relapsed three weeks later with the same organism growing in the CSF. The clinical course continued to deteriorate with the development of significant neurological dysfunction. Poor nutritional state and ventilator associated pneumonia contributed to this downward trend. After a detailed discussion with the family, life support was discontinued and the patient succumbed to her illness.