For the patient in this case, trouble came when he took steroids, which dampen the immune system, to treat "giant-cell arteritis," a disorder that causes inflammation of arteries of the scalp, neck and arms. The drugs appeared to have allowed the worms to grow and spread because they were no longer kept in check.
Exams uncovered a massive lung infection, report co-author Banaei noted. "The adult worms were producing eggs, and the larvae emerging from the eggs were invading the intestinal wall and disseminating to multiple organs in the body," Banaei said.
When this happens, Baylor's Hotez said, hundreds of thousands of larvae can transmit bacteria from the intestines into other parts of the body.
A medication can help treat infestation with the worms, but it doesn't help when the hyperinfection reaches an advanced stage, he said.
What should be done? In cases where patients come from a region of the world where the worms are common, Hotez suggested that physicians consider that they may be infected and screen them for the worms. That may be difficult though, because multiple fecal tests may be necessary, he said, and another kind of test has limited value in terms of detecting cases.
The study findings are published in the March 21 issue of the New England Journal of Medicine.
For more about the worm species Strongyloides stercoralis, visit the University of Michigan.
SOURCES: Niaz Banaei, M.D., assistant professor of infectious diseases, Stanford University School of Medicine, Palo Alto, Calif.; Peter Hotez, M.D., Ph.D., dean, National School of Tropical Medicine, Baylor College of Medicine, Houston; March 21, 2013, New England Journal of Medicine
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