Disseminated strongyloidiasis in an AIDS patient

A case of Strongyloides stercoralis hyperinfection diagnosed from respiratory secretions obtained by bronchoalveolar lavage (BAL) is communicated. The patient, born in an endemic region (Paraguay), HIV positive (50 T CD4+ lymphocytes/mu L), was hospitalized with respiratory pathology, presumptively suspected as pulmonary pneumocystosis (PCP). Fresh microscopy of the respiratory secretions concentrate revealed filariform and rabditoide larvae of Strongyloides stercoralis. India ink microscopy of CSF showed capsulated yeasts (Criptococcus neoformans by culture). The titles of polysaccharide capsular antigen of C. neoformans were 1/1.000 in blood and 1/10 in CSF. Viro-logical study of CSF by PCR was positive for citomegalovirus, and parasitological examination was negative, as well as the mycological study of respiratory secretions. After diagnosis, treatment with ivermectin (200 mu g/kg/day) was started, which proved ineffective, as was determined by the presence of multiple motile larvae in the microscopy of a tracheal lavage. The patient died 3 days later.