Estrongiloidiasis diseminada

Abstract

Disseminated strongyloidiasis (DS) is an opportunistic disease, fatal in 50% of the cases, and due to internal autoinfection with larvae of S. stercoralis. We reviewed DS in more than 14.000 autopsy protocols in Bogotá, from 1954 to 1986, in order to know the basic diseases which promoted the larvae dissemination, and also, to investigate if DS had increased recently. We found only twelve patients, 1-62 years old, dying of DS. Patients presented with smelly and bloody diarrhea, vomit, abdominal tendemess, anorexia, cough, and expectoration sometimes homoptoic. All patients had advanced malnutrition and only one han been treated with steroids and cyclophosphamide because of progressive glomerulonephritis. One patient was treated with steroids for "ulcerative colitis", which aftenvards was proved to be due to DS. Only once, a clinical diagnosis of DS was done. Strongyloides larvae were found in the stools of 3 patients, but the strongyloidiasis was not considered as disseminated. Clinical diagnosis included: malnutrition, anemic syndrome, gastric carcinoma, intestinal and pulmonary tuberculosis, intestinal parasitism and meningeal syndrome. One patient had bacterial tricuspideal endocarditis, and two, meningoencephalitis, together with the intestinal syndrome. The meningeal infection was of acute bacteria1 type, with no granulomas or larvae. These were found, with granulomatous inflammation in the small and large bowel, lung, liver and mesenteric lymph nodes. In four patients trombosis of great venous vessels was found, in the inferior vena cava, femoral, mesenteric and superior longitudinal sinus Fatal DS is not frequent and has not increased recently among the population studied. It should be suspected in patients with diarrheic syndrome and malnutrition. Slight blood eosinophilia (5 and 7%) was present only in two patients.