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만성 폐쇄성 폐질환 환자에서 장기간의 스테로이드 복용 중 발생한 중증 분선충 감염 1예

A Case of Severe Strongyloidiasis in a Patient with Chronic Obstructive Pulmonary Disease Receiving Long-Term Steroid Therapy

감염과화학요법 2008년 40권 5호 p.276 ~ 280
하원철, 이영현, 하경임, 안명희,
소속 상세정보
하원철 ( Ha Won-Chul ) - 동국대학교 의과대학 내과학교실
이영현 ( Lee Young-Hyun ) - 동국대학교 의과대학 내과학교실
하경임 ( Ha Gyoung-Yim ) - 동국대학교 의과대학 진단검사의학교실
안명희 ( Ahn Myoung-Hee ) - 한양대학교 의과대학 기생충학교실

Abstract


Strongyloides stercoralis is a soil-transmitted intestinal nematode that may cause long-lived autoinfection in the host. It is distributed worldwide, especially in the tropical and subtropical regions, but has been rarely reported in Korea. Chronic infections by S. stercoralis are mostly inapparent infections that carry nonspecific gastrointestinal and pulmonary symptoms. However, In immunocompromised patients such as those receiving long-term steroid therapy and patients with AIDS or malignant tumors, S. stercoralis can induce hyperinfection by autoinfection. This may lead to increased rate of complications such as resistance to chemotherapy and sepsis. In such cases mortality rate of up to 87% has been reported. We report a case of severe strongyloidiasis in a patient with chronic obstructive pulmonary disease who was receiving long-term steroid therapy. The chief complaint was repeated dyspnea and hematochezia, and strongyloidiasis was diagnosed by the presence of rhabditiform larvae of S. stercoralis in the fecal smear and isolation of filariform larvae from the stool culture. The patient developed septic shock during treatment with albendazole and showed clinical signs of hyperinfection of S. stercoralis. He eventually died despite aggressive treatment.

키워드

Strongyloides stercoralis;Hyperinfection;Corticosteroid;Chronic Obstructive Pulmonary

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