An immunocompromised host is not only susceptible to bacterial, fungal or viral infections, instead she can also fall prey to life threatening parasitic infections. One such critical parasitic infection is by a nematode Strongyloides. This parasitic infection, though fatal, belongs to the group of “Neglected Tropical diseases”. Hence efforts all over the globe are aimed at eradication of it.
Over here, we report an unusual and fatal case that involves mixed infection due to three classes of organisms-
1. Strongyloides(Parasite)
2. Escherichia coli (Bacteria)
3. Fungal spores
A 45 year old male, farmer by occupation was presented to the hospital with complaints of low grade fever, 12-15 episodes of loose stools (Type 7 as per Bristol Stool chart) mucoid and greenish in color, abdominal discomfort and vomiting. He had been on immunosuppressive therapy with Tablet Prednisolone 7.5mg/taken once daily, post renal transplantation three years ago. He is known to be hypertensive, Diabetic and a regular alcoholic. Prolonged systemic diseases lead to the complications such as Double vessel Disease(DVD) and diabetic foot disease due to which, his left 2nd toe was amputated.
Over the course of stay in hospital he was found to be suffering from malnourishment, pancytopenia and renal graft failure (S.cr: 4.42mg/dl).His ultra sound reports show distended gall bladder while the GI endoscopy suggested of gastritis. Also, he was found to be severely immunocompromised with WBC count equal to 2900 cells/m3.His urine culture isolated E.coli while his blood cultures grew Strongyloides. The skin biopsy from his toe surface identified fungal spores.
He was treated extensively mainly with antibiotics, anthelmenthics, Antifungals, Renal replacement therapy and Proton pump inhibitors.
