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CASE REPORT
Year : 2002  |  Volume : 20  |  Issue : 2  |  Page : 115-116
 

Persistent strongyloidiasis in a case of common variable immunodeficiency


Dept. of Microbiology, Seth GS Medical College and KEM Hospital, Parel, Mumbai - 400 012, India

Correspondence Address:
Dept. of Microbiology, Seth GS Medical College and KEM Hospital, Parel, Mumbai - 400 012, India

 ~ Abstract 

A case of strongyloidiasis in common variable immunodeficiency is reported here. The patient was given several courses of albendazole without any response.

How to cite this article:
Dash L, Koticha A, Mehta P R, Ghadhikar H. Persistent strongyloidiasis in a case of common variable immunodeficiency. Indian J Med Microbiol 2002;20:115-6


How to cite this URL:
Dash L, Koticha A, Mehta P R, Ghadhikar H. Persistent strongyloidiasis in a case of common variable immunodeficiency. Indian J Med Microbiol [serial online] 2002 [cited 2019 Sep 23];20:115-6. Available from: http://www.ijmm.org/text.asp?2002/20/2/115/8357


Strongyloidiasis is an infection caused by the nematode Strongyloides stercoralis. It is potentially lethal because of its capacity to cause an overwhelming autoinfection, particularly in the immunocompromised host.[1],[2] It is more commonly seen in patients with renal transplantation and less frequently in HIV/AIDS cases.[3] Here,we report a case of persistent strongyloidiasis in a patient with common variable immunodeficiency (CVID).

 ~ Case Report: Top

A 19 year old unmarried boy was admitted in our hospital to rule out malabsorption syndrome. He complained of episodic diarrhoea with 6-12 passages of moderate amounts of loose stools per day for the past four years. He also complained of periumbilical colicky pain during diarrhoeic episodes and gave a history of loss of weight of 13 Kgs. over the same period. He did not give any history suggestive of unprotected sexual exposure. Prior to this, he was admitted three times in different city hospitals. On first admission, he presented with complaints of diarrhoea, fever, headache and vomiting. He was diagnosed as a case of pyogenic meningitis on CSF examination, treated for the same and recovered later. The latter two admissions were to rule out the cause of diarrhoea. Aetiological diagnosis could not be made then and hence the patient was treated only symptomatically.
On admission to our hospital, physical examination revealed the positive findings of pallor and hepatomegaly which was soft and 2cms. palpable below the intercostal margin. Routine and microscopic examination of stool revealed the presence of larvae of Strongyloides stercoralis. Though, thiabendazole is the drug of choice, it is not available in India. Hence the patient was started on albendazole, of which 5 courses were subsequently given. Stool samples examined over a period of four weeks remained positive for larvae of Strongyloides stercoralis and the patient continued to pass loose stools. Bacteriological cultures of stool samples yielded no pathogens.
Taking into consideration the persistence of larvae of Strongyloides stercoralis in diarrhoeic stool samples, and the weight loss, it was decided to rule out associated immunodeficiency state, if any. The investigations included serum immunoglobulin levels, ELISA test for HIV antibody and p24 antigen assay, the results of which are shown in the [Table - 1]. Results of other investigations carried out are also listed in the same table.

 ~ Discussion Top

Infectious diarrhoea is one of the most important conditions leading to morbidity and mortality, more so in the immunocompromised individuals.[3] Although severe infections with Strongyloides stercoralis were described in the earlier part of this century, it is only in the last twenty years that the condition has become increasingly recognised and its association with immunosuppression appreciated.[3]
In CVID, there is primary B cell deficiency leading to a defect in the terminal differentiation of B lymphocytes to antibody secreting cells.[4],[5] The presence of hypogammaglobulinaemia or immunodeficiency stage generally manifests by 15 years of age.[5] These patients are prone to infection with pyogenic organisms and also the intestinal protozoan, Giardia lamblia.[3],[4]
In accordance with this, our patient did not give any history suggestive of chronic and/or persistent infections in childhood. All his symptoms manifested around the age of 15 years. Moreover, he also had markedly low levels of serum immunoglobulins. Pyogenic meningitis during a previous admission and the persistence of strongyloidiasis, inspite of multiple courses of albendazole, led us to the probable association of strongyloidiasis with CVID. Hence, young individuals with persistent strongyloidiasis should also be assessed for CVID.
The monthly administration of intravenous immunoglobulin in adequate doses is an essential part of the prophylaxis and treatment of CVID.[4] But, it could not be instituted in this case due to patient non-compliance. 

 ~ References Top

1.Mandell GL, Bennett JE, Dolin R. Diseases due to helminths. In Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 4th Ed., (Churchill Livingstone, New York.)1995: 2525-2581.  Back to cited text no. 1    
2.Shelhamer JH, Neva FA, Finn DR. Persistent strongyloidiasis in an immunodeficient patient. Am J Trop Med Hyg 1982; 31(4):746-751.  Back to cited text no. 2    
3.Baker JR, Muller R, Rollinson D. Human strongyloidiasis. In: Advances in Parasitology. Vol-38. (Harcourt Brace and Co., San Diego) 1996; 251-309.  Back to cited text no. 3    
4.Fauci AS, et al. Primary immunodeficiency diseases. In: Harrison's Principles of Internal Medicine. Vol.-2.14th Ed., (McGraw - Hill Book Co, Singapore.) 1998; 1783-1791.  Back to cited text no. 4    
5.Abbas AK, Lichtman AK, Pobber JS. Congenital and acquired immunodeficiencies. In: Cellular and Molecular Immunology. 3rd Ed., (WB Saunders Company, Singapore) 1991; 410-461.  Back to cited text no. 5    
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