Q: 52 year old female from Cambodia, who just migrated to United States is admitted to ICU with exacerbation of Asthma. It was noticed that patient's symptoms get worse, every time she receives corticosteroids. Knowing her country of origin and above observation, which infectious disease should be considered? (choose one)

A) Strogyloidiasis 

B) Malaria

C) Ebola

D) HIV

E) Yellow Fever

 

Answer: A

Strongyloidiasis is common in many parts of world where sanitation can be an issue. We choose Cambodia in above question as disease is very prevalent in that area and could be a hint to answer. On interesting note, patients with chronic Strongyloidiasis may also develop asthma that paradoxically may worsens with corticosteroid use.

 References: 

 Sen P, Gil C, Estrellas B, Middleton JR. Corticosteroid-induced asthma: a manifestation of limited hyperinfection syndrome due to Strongyloides stercoralis. South Med J 1995; 88:923. 

Wehner JH, Kirsch CM, Kagawa FT, et al. The prevalence and response to therapy of Strongyloides stercoralis in patients with asthma from endemic areas. Chest 1994; 106:762.