A 40-year-old man with recurrent urticaria and eosinophilia (1800/µL) is found to have Strongyloides stercoralis on stool examination using the Baermann technique. He is then started on systemic corticosteroids for an unrelated condition. Which serious complication is he most at risk for?
- A Hyperinfection syndrome with dissemination of filariform larvae carrying gut bacteria ✓
- B Loeffler syndrome due to massive larval migration
- C Eosinophilic meningitis due to larval CNS invasion
- D Tropical pulmonary eosinophilia with bilateral infiltrates
Explanation
Strongyloides stercoralis has a unique autoinfection cycle: rhabditiform larvae in the colon convert to infective filariform larvae that penetrate the intestinal wall or perianal skin, perpetuating infection. Immunosuppression with corticosteroids markedly accelerates this cycle, causing hyperinfection syndrome where massive numbers of filariform larvae disseminate to lungs, CNS, and other organs, carrying enteric bacteria on their surface, leading to gram-negative bacteraemia and meningitis. This is potentially fatal and is a critical consideration before initiating immunosuppression.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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