Strongyloides stercoralis infestation associated with septicemia due to intestinal transmural migration of bacteria

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Uday C Ghoshal1, Ujjala Ghoshal, Manoj Jain

  • 1Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, India. ghoshal@sgpgi.ac.in

Journal of Gastroenterology and Hepatology
|November 9, 2002
PubMed

Insights

Strongyloides stercoralis infection can cause severe illness in immunocompromised individuals. This case suggests gut bacteria migrating with the parasite cause sepsis in severe Strongyloides stercoralis infestations.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Microbiology

Background:

  • Strongyloides stercoralis (S. stercoralis) is a parasitic nematode prevalent in tropical regions.
  • While often asymptomatic, S. stercoralis can cause hyperinfection and fatal disease in immunocompromised patients.
  • A hypothesis suggests bacterial translocation across the bowel wall contributes to sepsis in severe S. stercoralis cases.

Observation:

  • A 30-year-old man presented with malabsorption syndrome due to S. stercoralis infestation and small bowel bacterial overgrowth.
  • The patient developed severe duodenojejunal ulceration, septicemia, and fatal hypokalemia.
  • Escherichia coli was isolated from both blood and jejunal fluid, exhibiting identical antibiotic sensitivity.

Findings:

  • This case report provides evidence supporting the hypothesis of bacterial migration from the intestinal lumen.
  • Bacterial translocation appears to be a significant factor in the pathogenesis of septicemia during fulminant S. stercoralis infestation.
  • The findings highlight the critical role of Escherichia coli in the fatal outcome.

Implications:

  • Understanding the mechanism of bacterial translocation in S. stercoralis is crucial for managing severe infections.
  • This study underscores the importance of considering bacterial co-infection in immunocompromised patients with S. stercoralis.
  • Further research into preventing bacterial migration could improve outcomes for patients with severe parasitic infections.

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