Unrecognized Strongyloides stercoralis Infection in Hemodialysis Patient With Recurrent Diarrhea and Readmissions

Strongyloidiasis can vary from asymptomatic infection to life-threatening multisystem disease especially in immunocompromised patients. Although strongyloidiasis is a rare diagnosis in USA, transmission through immigrants and refugees obscured the geographical boundary. The clinical presentations vary widely depending on underlying comorbidities and immunosuppression..
Here we present a case of strongyloidiasis in hemodialysis patient requiring multiple admissions. Although the patient had high eosinophil count in previous admissions, eosinophil count was normal when the diagnosis was made..
Although strongyloidiasis is not endemic in USA, immigration obscured the geographical barrier of endemicity. The diagnosis can be difficult because of nonspecific symptoms and lack of sensitivity of microscopic diagnosis. Although eosinophilia is a common finding in patients with chronic strongyloidiasis, it is unreliable indicator of active infection, especially in immunosuppressed condition. Eosinophil count also may be falsely high in patients with hemodialysis. As Laboratory diagnosis is mainly based on microscopic identification of larvae in the stool, examination of multiple stool samples is warranted to increase the yield of diagnosis..