Case history
Case history #1
A former migrant from southeast Asia, who has lived in Europe for several years, presents with an eosinophilia of >0.4 × 10⁹ eosinophils/L (>400 eosinophils/microlitre) (or >5% of the WBC differential count) detected on an FBC. Repeat stool ova and parasite examinations are negative. The patient has vague non-specific complaints of abdominal discomfort, dermatitis, and a chronic dry cough. He has previously been diagnosed with asthma and irritable bowel syndrome.
Case history #2
A newly arriving refugee from sub-Saharan Africa presents for his health-screening examination. Prior to immigration, he received albendazole as a single dose. There are no specific findings from the history or physical examination. FBC reveals eosinophilia of >0.4 × 10⁹ eosinophils/L (>400 eosinophils/microlitre). Three stool tests detect only Giardia intestinalis. Serological screening for strongyloides and schistosomiasis is performed and asymptomatic strongyloides infection diagnosed.
Other presentations
Chronic strongyloides infection may result in a misdiagnosis of a somatic symptom disorder, psychogenic pruritus, irritable bowel disorder or asthma. People who have migrated from endemic areas who have chronic strongyloides infection and are started on corticosteroids may develop life-threatening hyperinfection. Hyperinfection may present with fever, cough, wheezing, and/or abdominal pain. Patients often rapidly become critically ill with bacteraemia and sepsis caused by an enteric organism, such as Escherichia coli or enterococcus. Strongyloides larvae may be detectable in stool or sputum specimens in patients with hyperinfection, and pulmonary infiltrates may be present on an chest x-ray. Eosinophilia may be absent. Absence of eosinophilia is a strong predictor of mortality from strongyloides hyperinfection.
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