Guillaume Geri1,2, Antoine Rabbat3, Julien Mayaux4, Lara Zafrani5,6, Ludivine Chalumeau-Lemoine7, Bertrand Guidet8,9, Elie Azoulay5,6, Frédéric Pène10,11,12. 1. Service de réanimation médicale, Hôpital Cochin, APHP, 27 rue du faubourg Saint-Jacques, 75014, Paris, France. guillaume.geri@cch.aphp.fr. 2. Université Paris Descartes, Paris, France. guillaume.geri@cch.aphp.fr. 3. Unité de soins intensifs respiratoires, Hôpital Cochin, APHP, Paris, France. 4. Service de réanimation médicale, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France. 5. Service de réanimation médicale, Hôpital Saint Louis, APHP, Paris, France. 6. Université Paris Diderot, Paris, France. 7. Service de réanimation polyvalente, Institut Gustave Roussy, Villejuif, France. 8. Service de réanimation médicale, Hôpital Saint-Antoine, APHP, Paris, France. 9. Université Pierre et Marie Curie, Paris, France. 10. Service de réanimation médicale, Hôpital Cochin, APHP, 27 rue du faubourg Saint-Jacques, 75014, Paris, France. 11. Université Paris Descartes, Paris, France. 12. Institut Cochin, INSERM U1016, CNRS UMR8104, Paris, France.
Abstract
BACKGROUND: Strongyloides stercoralis may lead to overwhelming infestation [Strongyloides hyperinfection syndrome (SHS)]. We aimed at describing a case series of patients admitted in intensive care unit (ICU) with SHS and report a literature review of such cases. PATIENTS AND METHODS: Retrospective multicenter study of 11 patients admitted to the ICU of tertiary hospitals with SHS between 2000 and 2013. Literature review with Pubmed retrieved 122 cases. Logistic regression analysis was performed to identify predictive factors of ICU mortality and shock occurrence. RESULTS: 133 patients [median age 53 (39, 64), 72.2 % males] were included. Underlying immunosuppression was present in 127 patients, mostly long-term corticosteroid treatment in 111 (83.5 %) patients. Fever (80.8 %), respiratory (88.6 %), and gastrointestinal (71.2 %) symptoms were common clinical manifestations. Shock occurred in 75 (57.3 %) patients and mechanical ventilation was required in 89 (67.9 %) patients. Hypereosinophilia and a concomitant bacterial infection were observed in 34 (34.3 %) and 51 (38.4 %) patients, respectively. The in-ICU mortality rate was 60.3 %. Predictive factors of ICU mortality were shock occurrence [Odds ratio (OR) 18.1, 95 % confidence interval (95 % CI) 3.03-107.6, p < 0.01] and mechanical ventilation (OR 28.1, 95 % CI 3.6-217, p < 0.01). Hypereosinophilia (OR 0.21, 95 % CI 0.06-0.7, p = 0.01) and a concomitant bacterial infection (OR 4.68, 95 % CI 1.3-16.8, p = 0.02) were independent predictors of shock occurrence. CONCLUSION: SHS remains associated with a poor outcome, especially when associated with shock and mechanical ventilation. Deterioration to shock is often related to concomitant bacterial infection. The poor outcome of established SHS pleads for a large application of antiparasitic primary prophylaxis in at-risk patients.
BACKGROUND: Strongyloides stercoralis may lead to overwhelming infestation [Strongyloides hyperinfection syndrome (SHS)]. We aimed at describing a case series of patients admitted in intensive care unit (ICU) with SHS and report a literature review of such cases. PATIENTS AND METHODS: Retrospective multicenter study of 11 patients admitted to the ICU of tertiary hospitals with SHS between 2000 and 2013. Literature review with Pubmed retrieved 122 cases. Logistic regression analysis was performed to identify predictive factors of ICU mortality and shock occurrence. RESULTS: 133 patients [median age 53 (39, 64), 72.2 % males] were included. Underlying immunosuppression was present in 127 patients, mostly long-term corticosteroid treatment in 111 (83.5 %) patients. Fever (80.8 %), respiratory (88.6 %), and gastrointestinal (71.2 %) symptoms were common clinical manifestations. Shock occurred in 75 (57.3 %) patients and mechanical ventilation was required in 89 (67.9 %) patients. Hypereosinophilia and a concomitant bacterial infection were observed in 34 (34.3 %) and 51 (38.4 %) patients, respectively. The in-ICU mortality rate was 60.3 %. Predictive factors of ICU mortality were shock occurrence [Odds ratio (OR) 18.1, 95 % confidence interval (95 % CI) 3.03-107.6, p < 0.01] and mechanical ventilation (OR 28.1, 95 % CI 3.6-217, p < 0.01). Hypereosinophilia (OR 0.21, 95 % CI 0.06-0.7, p = 0.01) and a concomitant bacterial infection (OR 4.68, 95 % CI 1.3-16.8, p = 0.02) were independent predictors of shock occurrence. CONCLUSION: SHS remains associated with a poor outcome, especially when associated with shock and mechanical ventilation. Deterioration to shock is often related to concomitant bacterial infection. The poor outcome of established SHS pleads for a large application of antiparasitic primary prophylaxis in at-risk patients.
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