Strongyloideshyper-infection: a case for awareness

Abstract

In patients receiving immunosuppressive therapies, Strongyloides stercoralis can cause a life-threatening septic shock, with multi-organ failure and infestation. Strongyloides hyper-infection should be considered in any immunosuppressed patient who has been exposed to the parasite, even if it is many years since that exposure occurred. Delayed eosinophilia may be a feature and treatment with high doses of anthelmintics may be required. An interesting case of S. stercoralis hyper-infection was recently observed at the Royal Darwin Hospital in tropical, northern Australia. The patient was an 18-year-old female with lupus glomerulonephritis, who was receiving immunosuppression in the form of corticosteroids and pulse cyclophosphamide. The characteristics and intensive-care management of this case, including the use of granulocyte-colony stimulating factor and high-dose ivermectin, are described. The patient, who survived, appears to represent the first reported case of S. stercoralis hyper-infection with suspected myocarditis.

Hookworm and Threadworm Infections and Their Association With Hemoglobin and Eosinophil Concentrations in Residents of Salvador-Bahia, Brazil

“…Controversially, the S. stercoralis-infected groups were not significantly different from the control group, except the adult male group. The development of anemia in S. stercoralis-infected individuals is correlated with alcoholism, malnutrition, the breakdown of local immune responses, and/or alterations in intestinal barriers 24,39,52 . Our population is characterized by a high socioeconomic status with access to basic sanitation and a good nutritional status.…”

“…The association between S. stercoralis infection and anemia is rare, except in cases of hyperinfection 28,34,39,43,52 . In contrast, hookworm infection induces iron deficiency, which constitutes one of the world's major nutritional problems 2,21,42,49 .…”

DNA Immunization with Na + -K + ATPase ( Sseat-6 ) Induces Protective Immunity to Larval Strongyloides stercoralis in Mice

“…Chronic infections may persist for the lifetime of the host and are commonly clinically asymptomatic (22). However, chronically infected individuals who become immunosuppressed due to a variety of causes, including corticosteroid treatment (40,45) or infection with human T-cell leukemia virus 1 (HTLV-1) (38), can disseminate S. stercoralis, a condition that can be life threatening (3). Although chemotherapy is available for acute and chronic infections, treatment of the potentially lethal hyperinfection syndrome remains problematic.…”

Strongyloides Stercoralis and Its Risk Factors: An Experience at a Tertiary Care Hospital

“…Hyperinfection by Strongyloides stercoralis is mainly seen amongst immunocompromised individuals with a high case fatality rate of around 60%. (19)(20)(21) The mortality rate of the patients having hyperinfection of the present study was 33.3%. This is characterized by an acceleration of the normal life cycle of Strongyloides stercoralis that increases its burden either in the skin or lungs or gastrointestinal tract.…”