{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:04:51Z","timestamp":1756339491330,"version":"3.44.0"},"reference-count":20,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,8,16]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:p>Strongyloidiasis, a helminth infection caused by <jats:italic>Strongyloides stercoralis<\/jats:italic>, can be complicated by hyperinfection, especially in the setting of immunosuppression; however, many patients go undiagnosed. One clue to diagnosis is unexplained gram-negative bacteraemia or meningitis in patients who are immunosuppressed. Serology can be helpful but may be negative in these patients who are immunocompromised.<\/jats:p>\n               <jats:p>We present the case of a white cisgender man from Central America in his 40s, living with HIV, with a CD4 count of 77\u2009cells\/\u00b5L. He was diagnosed with <jats:italic>Strongyloides<\/jats:italic> hyperinfection after an increase in his steroid dose. He also had <jats:italic>Escherichia coli<\/jats:italic> meningitis and bacteraemia. Strongyloidiasis was diagnosed by stool microscopy despite a negative serology test.<\/jats:p>\n               <jats:p>This case highlights the challenges in diagnosing strongyloidiasis in the setting of immunosuppression. A high index of clinical suspicion is warranted for patients living with HIV on high-dose corticosteroids. Up to three stool microscopy studies for <jats:italic>Strongyloides<\/jats:italic> should be sent in addition to serology.<\/jats:p>","DOI":"10.1136\/bcr-2023-256105","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T12:56:19Z","timestamp":1693313779000},"page":"e256105","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Disseminated <i>Strongyloides stercoralis<\/i> infection in the setting of <i>Escherichia coli<\/i> meningitis and bacteraemia in a patient living with HIV on high-dose corticosteroid therapy"],"prefix":"10.1136","volume":"16","author":[{"given":"Nadine","family":"Montreuil","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases\/Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Candice 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Glucocorticoid effects on the immune system. UptoDate. 2021. Available: https:\/\/www.uptodate.com\/contents\/glucocorticoid-effects-on-the-immune-system"},{"key":"2025082708161530000_16.8.e256105.16","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.39.4.366"},{"key":"2025082708161530000_16.8.e256105.17","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.16-0923"},{"key":"2025082708161530000_16.8.e256105.18","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0b013e3283551dbd"},{"key":"2025082708161530000_16.8.e256105.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0016-5107(04)00337-2"},{"key":"2025082708161530000_16.8.e256105.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-020-05333-8","article-title":"Strongyloides hyperinfection in an HIV-positive kidney transplant recipient: a case report","volume":"20","author":"Lai","year":"2020","journal-title":"BMC Infect Dis"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-256105","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T15:16:23Z","timestamp":1756307783000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-256105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8,29]]},"published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1136\/bcr-2023-256105"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-256105","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2023,8]]}}}