1685. Retrospective Analysis of Strongyloides Hyperinfection-Dissemination Syndrome Risk Factors in a County Hospital

BACKGROUND: Strongyloides stercoralis is a parasitic infection endemic to tropic, subtropic, and temperate regions globally, affecting nearly 100 million people. Clinical disease ranges from asymptomatic strongyloidiasis (AS) to hyperinfection-dissemination syndromes (HDS), a syndrome of accelerated autoinfection and fulminant illness. This study aims to identify risk factors for HDS in a county hospital. METHODS: Subjects admitted to Ben Taub Hospital in Houston, TX, a safety net facility providing care to uninsured and underinsured Harris County residents, from 2012–2016 were identified by ICD-9 and -10 codes. Charts were retrospectively reviewed, and statistical analysis was completed using chi-square with R-software. RESULTS: 15 subjects with strongyloidiasis were identified, 9 (60%) with AS and 6 (40%) with HDS. There was no statistical demographic difference between the groups in terms of age, country of origin, or presence of co-morbidities, including chronic T-cell-mediated immunosuppressed states, such as HIV, diabetes mellitus, chronic kidney disease, malignancy, and malnutrition. When compared with patients with AS, patients with HDS were more likely to have acutely received immunosuppressant medications, such as corticosteroids or chemotherapy, prior to admission (P = 0.009). Common presenting symptoms, including abdominal pain, diarrhea, cough/dyspnea, and rash, were similar between the groups. Subjects with HDS were more likely to present with hypotension (P = 0.017) and have concurrent severe infections (P = 0.0361) at the time of presentation, reflecting the subjects’ underlying immunosuppressed status. Additionally, there was no difference in levels of peripheral eosinophils in subjects with AS vs. HDS. However, subjects with AS were more likely to have a positive serum S. stercoralis IgG (P = 0.002). CONCLUSION: HDS should be considered in all individuals from endemic regions who have acutely received immunosuppressive medications presenting with hypotension, irrespective of chronic underlying co-morbidities. Recognizing the high likelihood of co-infection with virulent pathogens is of particular importance in subjects with HDS. As diagnostic tests are unreliable in subjects with HDS, empiric treatment is imperative. DISCLOSURES: All authors: No reported disclosures.