Hyperinfection of Strongyloides stercoralis in an immunocompetent patient
A 31-year-old male farmer was admitted to our hospital with chief complaints of chronic diarrhea since last 4 months. He had a history of passing watery and foul smelling stool. He complained of lower abdominal pain, fever, and loss of weight for 4 months as well as loss of appetite for last 2 months. The patient was diagnosed as pre-diabetic earlier and his fasting blood sugar was 110 mg/dl and post-prandial blood sugar was 145 mg/dl on admission. His weight was 53 kg and systemic examination findings including abdominal examination were normal. There was no lymphadenopathy, clubbing, and/or pedal edema. His laboratory investigations were as follows: Total leucocyte count, 11,200/cmm3; neutrophil, 64%; lymphocyte, 29%; eosinophil, 6%; monocyte, 0%; and basophil, 1%. Ultrasound of abdomen was normal; erythrocyte sedimentation rate, 5 mm in 1 h; Na+, 126 mEq/l; and K+, 2.6 mEq/l. Colonoscopy was normal. Serum urea and creatinine were 34 mg/dl and 0.9 mg/dl, respectively. Thyroid stimulating hormone (TSH) was 4.55 mIU/L and HIV - Human immunodeficiency virus, ELISA - Enzyme linked immunosorbent assay status (ELISA method) was negative. Urine examination (routine microscopy as well as culture) was normal. Stool examination done on three occasions showed larvae of S. stercoralis [Figures – and ]. He was treated with albendazole 10 mg/kg/day for 7 days. Stool examination was repeated after 1 week of therapy, which was negative for larvae. On follow-up, we found that diarrhea subsided and he had started gaining weight.