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We present 2 patients born in Argentina who were newly diagnosed with advanced HIV disease and Chagas disease reactivation with central nervous system involvement. The patients received concurrent benznidazole treatment and antiretroviral therapy, showing good response. Improvement in morbidity and mortality due to early treatment makes this treatment appropriate for coinfected patients.

Background:The hyperinfestation by Strongyloides stercolaris is a general syndrome with high morbidity and mortality, which usually occurs in patients with immunological compromise or in corticosteroid treatments. In critical patients with paralytic intestinal ileus, the decrease in the bioavailability of oral ivermectin leads to therapeutic failure. The use of Ivermectin parenteral veterinary use is an extreme resource in patients with paralytic ileus secondary to hyperinflation by Strongyloides stercoralis. (SHSS)Methods & Materials: Retrospective and observational study. Clinical records of patients diagnosed with hyperinfestation by Strongyloides stercolaris, from January 2012 to August 2017, were evaluated in a sanatorium in the City of Buenos Aires. Inclusion criteria: positive culture (fecal matter, sputum, BAL) for Strongyloides stercoralis and diagnosis of intestinal ileus. The following variables were analyzed: sex, median age, nationality, residence, immunological commitment, corticotherapy, clinical and laboratory manifestations, days of hospitalization, stay in the ICU, treatment (enteral and parenteral), clinical resolution and mortality.Results: Of the 5 patients with inclusion criteria, the following were determined: Median age of 49.2 years; 2 foreigners (Peru and Bolivia); 4 residents of the Province of Buenos Aires and one of CABA. 2 with immunological compromise (HIV, DBT and kidney transplant); all 5 received corticotherapy. Clinical manifestations: all patients presented paralytic intestinal ileus with respiratory compromise, one presented rash and 4 had eosinophilia. The treatment started with oral Ivermectin but in the face of failure all received subcutaneous ivermectin as a last option. The 5 patients had a stay in the ICU, 4 with satisfactory clinical resolution and one death.Conclusion: Strongyloid hyperinflation syndrome is always a serious condition that can be manifested by respiratory distress, sepsis, meningitis or intestinal ileus. In this last presentation, the impossibility of digestive absorption of drugs makes it the only therapeutic option to use parenteral Ivermectin in the face of failure of the oral or rectal route. Our patients were immunosuppressed or had received corticosteroids, but they did not come from endemic areas. We emphasize the importance of the diagnosis prior to immunosuppression and the performance of the culture as a screening.