Urinary strongyloidiasis

A minimally verbal man in his 80s presented with a one week history of productive cough, fever and appetite loss.He has been bedridden since traumatic subarachnoid hemorrhage and did not take any medication.Physical examination revealed bibasilar crackles on auscultation and decubitus ulcer on his sacrum.Laboratory results showed normal eosinophil counts, hyponatremia, hypoalbuminemia and elevated inflammatory markers.The urinalysis revealed hematuria (30-49/High-power field), pyuria (>100/HPF) and bacteriuria.Chest radiograph indicated bilateral consolidation.Antibiotic therapy improved aspiration pneumoniae, however hematuria and proteinuria persisted.Strongyloides stercoralis (S. stercoralis) larvae were identified in his urine sediment drained by urethral catheter.Disseminated strongyloidiasis was diagnosed with S. stercoralis larvae found in the sputum and stool (Figure 1).Ivermectin was started.Antibody testing for Human T-cell leukemia virus type 1 (HTLV-1) was positive.He died from aspiration pneumoniae on day 14.Strongyloidiasis is caused by S. stercoralis, an intestinal helminth that infects humans through contact with soil containing the larvae. 1 Disseminated strongyloidiasis can occur in those with immunocompromised or HTLV-1 infection, 2 and involves organs outside the autoinfection cycle including urinary tract. 3Disseminated strongyloidiasis carries high mortality due to complications such as bacteremia and meningitis. 4etecting S. stercoralis larvae in stool, sputum and gastric juice is diagnostic, but rarely reported in urine. 5Urine is easy to sample and may be valuable for diagnosing disseminated strongyloidiasis.Figure 1: Strongyloides stercoralis in the urine