Title
Parasitic Infections in Pulmonary and ICU Patients
Authors
Adam C. Kley MD; and A. Clinton White, Jr. MD, FACP, FIDSA, FASTMH
Journal
Chest
Abstract
Parasitic infections in the United States are mostly seen in immigrants and travelers. In many cases, pulmonary and intensive care physicians fail to consider parasitic disease,
which can result in delayed diagnosis and adverse outcomes. Almost 2,000 cases of imported malaria are diagnosed in the United States each year. Severe cases can be
confused with bacterial sepsis (shock, lactic acidosis, pneumonia, renal failure,
respiratory failure, and jaundice). In contrast to bacterial sepsis, survival is improved
by restrictive fluid therapy. Parenteral artesunate is licensed to treat severe cases but
may not be readily accessible. Strongyloidiasis is endemic in warm and most tropical
regions. Chronic strongyloidiasis causes few symptoms and can persist for decades
after the patient leaves the endemic region. Treatment with corticosteroids may lead to
hyperinfection, which may present with bacteremia and meningitis caused by enteric
organisms, pulmonary hemorrhage, and gastrointestinal pain, bleeding, or obstruction.
Treatment with ivermectin can be curative if initiated early. Cystic echinococcosis can
present as pulmonary mass. Paragonimus presents with hemoptysis, pulmonary
nodules, or pleural effusions, and usually with eosinophilia. Endemic regions include
not only East Asia but also Southeast Asia, West Africa, the Pacific coast of Latin
America, and even North America. Other parasitic infections can involve the lungs. This
article aims to provide awareness of the most clinically relevant parasitic infections
seen in pulmonary and critical care medicine.