This patient has classic symptoms of Strongyloides hyperinfection, which is seen in patients from endemic countries with preexisting strongyloidiasis (eg, India, Africa, Southeast Asia, the Caribbean). When host immunity is impaired, especially by corticosteroid therapy, there is an accelerated generation of filariform larva leading to disseminated strongyloidiasis involving the gastrointestinal tract, lungs, central nervous system, and other organs. As the worms migrate from the gut, they are often accompanied by gram-negative rods from the gastrointestinal tract. Hence, these patients often present with gram-negative bacteremias, gram-negative meningitis, and pneumonias. This diagnosis must be considered in the appropriate clinical setting (ie, in patients who have traveled to endemic areas) and can be confirmed by visualizing larvae in wet mount preparations of sputum, cerebrospinal fluid, and blood. Ascariasis, dracunculiasis, hookworm, and tapeworm would not be found in BAL wet mounts.
Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennetts principles and practice of infectious diseases. 6th ed. New York: Elsevier/Churchill Livingstone; 2005.
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