Diagnosis of Strongyloides Hyperinfection Syndrome in a COPD Patient with Routine Sputum Smear Study-A Case Report and Literature Review

經由痰液常規抹片檢查診斷慢性阻塞性肺疾合併糞小桿線蟲過度感染－一病例報告和文獻回顧

蕭建隆(Chien-Lung Hsiao) ； 徐志育(Chih-Yu Hsu) ； 吳錦桐(Jiin-Torng Wu)

《胸腔醫學》 21卷1期 (2006/02) Pp. 25-32

https://doi.org/10.29806/TM.200602.0004

摘要

糞小桿線蟲感染症是由Strongyloides stercoralis所引起的一種全身性的寄生蟲感染症。和其他寄生蟲不同的是，它可以在體內完成自體感染的整個過程。而它寄生在人體身上可以沒有症狀長達50年以上。但是在細胞免疫功能異常的人身上，它可能會造成致命性高達80%以上的Strongyloides hyperinfection。診斷上通常是藉由濃縮的大便抹片及十二指腸的抽取液來直接觀察糞小桿線蟲的幼蟲蟲體。我們報告一位慢性阻塞性肺病及肝硬化的78歲老先生因氣促、喘嗚、咳痰和帶狀泡疹引發的左側頸神經痛而送來醫院治療。來院之前已在外院診所接受長達l個月以上的類固醇治療。在住院的當天，我們在常規的痰液抹片檢查意外發現了糞小稈線蟲幼蟲的存在。然而在此同時，反覆的糞便檢查卻一無所獲，甚至連消化道內視鏡小腸切片也無法找到此蟲體。我們開始使用每天一次12毫克ivermectin兩天，來治療糞小稈線蟲的過度感染症候群(Strongyloides hyperinfection syndrome)。病人的症狀逐漸改善，蟲體的數目和活動力顯著的減少，並且在入院的第15天之後再也找不到蟲體了。病人因病情穩定而在住院的第35天出院繼續在門診追蹤治療。由此個案的經驗，我們發現不可忽略痰液的常規抹片檢查在診斷慢性阻塞性肺疾合併糞小桿線蟲過度感染的重要性。同時我們回顧一些文獻報告，並且討論糞小桿線蟲過度感染症候群之危險因子及臨床表現之症狀，此外也討論其診斷方法以及治療。

關鍵字

糞小桿線蟲感染症 ； 糞小桿線蟲過度感染症 ； 自體感染

並列摘要

Strongyloidiasis is an infection caused by Strongyloides stercoralis. In contrast to other helminthic parasites, S. stercoralis can complete its life cycle entirely within the human host. It can cause a wide spectrum of diseases in humans, ranging from chronic asymptomatic infections to a hyperinfective and often fatal syndrome, particularly in immunocompromised patients. Strongyloides hyperinfection syndrome is 1 of several clinical manifestations of strongyloidiasis and has a mortality rate exceeding 80%. A diagnosis of sstrongyloidiasis is usually made by detecting larvae in concentrated stool or duodenal fluid specimens, and sometimes by duodenal biopsy or sputum smears. We present a case of Strongyloides hyperinfection syndrome with lung involvement in a patient with chronic obstructive pulmonary disease (COPD) and liver cirrhosis, who suffered from severe shortness of breath, productive cough and herpes zoster neuralgia of the cervical nerve, diagnosed by a routine sputum smear study. The simultaneous daily concentrated stool smears and endoscopic duodenal biopsy were negative for rhabditiform larvae, while the consecutive daily sputum smears were rich in larvae. The clinical symptoms greatly improved after antihelminthic therapy with 2 courses of 12 mg oral ivermectin daily for 2 days. The larval count significantly decreased after the introduction of ivermectin, with a negative conversion of larvae on the sputum smears from the 15th hospital day. He was discharged from our hospital on the 35th day after admission in a stable clinical condition. Through this case experience, we concluded that the sputum smear study cannot be overlooked in the diagnosis of Strongyloides hyperinfection, particularly for COPD patients. The relevant literature is reviewed, including the risk factors, clinical symptoms, diagnosis, and prognosis of strongyloidiasis.

並列關鍵字

strongyloidiasis ； Strongyloides hyperinfection syndrome ； autoinfection