Tien Dong PHUNG · Prevention of Future Deaths report

On 25 January 2019, HM Senior Coroner Mary Hassell commenced an investigation into the death of Tien Dong PHUNG (age 59 years). The investigation concluded at the end of the inquest which was conducted by me on 13 June 2019.

The medical cause of Mr Phung’s death was:
1a pulmonary strongyloidiasis
2 renal transplant (IgA nephropathy) and hypertension.

I returned a narrative conclusion which is set out in Box 4 below.

Mr Phung had a kidney transplant on 26 September 2018 and was given immuno-suppressant treatment to prevent rejection of the transplanted kidney. In December 2018, he attended the Royal London Hospital complaining of abdominal pain. He was initially treated for constipation then discharged. He returned to the hospital on 17 December and was admitted for further investigations. Investigations including CT scans, blood tests, ultrasound examination, blood and urine cultures were undertaken but the reason for Mr Phung’s symptoms could not be identified. Mr Phung showed signs of infection on 20 December. He was given broad spectrum antibiotics and fluids for presumed sepsis. He became fluid overloaded and showed signs of chest infection. He had a cardiac arrest on the afternoon of 21 December. He was transferred to the ITU where he received supportive treatment. In addition, changes were made to his antibiotics and antivirals were prescribed to protect him against opportunistic infection. A CT scan was unable to identify the source of the infection. Mr Phung continued to deteriorate and treatment was withdrawn. Mr Phung died in hospital on the afternoon of 25 December 2018. On post-mortem examination, Mr Phung was found to have strongyloides stercoralis forms in his lungs. This is a parasitic infection which can persist for many years and is commonly identified through stool sampling which was not undertaken in this case. The disease is rare in the UK and is most prevalent in tropical and sub-tropical region. Generally, the disease is chronically asymptomatic. However, strongyloides hyperinfection syndrome can develop where a person’s immune system is compromised, for example through the use of corticosteroids or immuno-suppressants associated with organ transplantation.

(1) Strongyloides stercoralis forms are not routinely screened for prior to transplant surgery. If identified early, they are treatable
(2) Strongyloides hyperinfection syndrome presents with non-specific symptoms such as abdominal pain, vomiting, intestinal obstruction, cough, wheezing and chest pain. It can evolve into respiratory distress and multi-organ failure.
(3) Strongyloidiasis is estimated to affect up to 300 million people worldwide. The infection is particularly prevalent in tropical and subtropical regions including a number of common travel destinations such as Thailand and Brazil. Mr Phung was born in Vietnam but had lived in the UK for many years.