분선충의 Hyperinfection 1례

A Case of Strongyloidiasis with Hyperinfection Syndrome

면역기능이 저하된 한국인 73세 남자가 요통을 주소로 입원하였다. 환자는 prednisolone 을 장기간 투여하였다고 하며 입원시 전신성 pitting edema와 기침, 객담, 구토, 설사를 하였고 빈 사상태였다. 백혈구는 증가하였으나 초산구중가증은 없었으며 저 단백혈증, hypoalbuminemia, 패혈증, 빈혈이 있었다. 뇨는 한색이었다. 대변검사에서 rhabditiform 유충이 관찰되었으며 대변 배양 검사로 분선충의 filariform유충이 확인되어 분선충에 의한 hyperinfection으로 진단되었다. 치료목적으로 입원 제3일부터 albendazole을 4일간 투여하였다. 입원 제7일에 객담검사에서 filariform유충이 관찰되었으며 설사변에서 분선충의 기생세대 자충 619마리를 수집하였다. 그러나 환자는 희망없이 빈사상태로 퇴원하였으며 얼마 후 자택에서 사망하였다.

A 73-year-old Korean male was admitted to Jeil hospital with clinical complaints of backache, cough, sputum, vomiting and diarrhea. He had a history of long term administration of prednisolone. At admission he was comatose and showed Efneralized pitting edema and anasarca, Laboratory data revealed leukocytosis, hlvpoproteinemia with hypoalbuminemia, sepsis, anemia and brown-colored urine. Stool examination revealed rhabditiform nematode larvae. By fecal cultivation, filariform larvae of Strongyloides were obtained and the patient was diagnosed as hyperinfection syndrome due to 5. stercoralis infection. On the 3rd day of hospitalization, albendazole treatment was started and continued for 4 days. On the 7th day of hospitalization, sputum revealed filariform larvae. Total 619 parasitic adult females, ellpelled by chemotherapy, were collected from the diarrheal stool. However, the. patient was discllarged hopelessly and died at home.