Strongyloides hyperinfection syndrome in an immunocompetent host resulting in bandemia and death

Abstract

infection is usually asymptomatic but can result in a hyperinfection syndrome, most commonly triggered by acquired or iatrogenic immunosuppression. Here, we present a case of a man aged 60 years originally from a strongyloides endemic area with a medical history of alcohol abuse who presents with strongyloides hyperinfection syndrome (SHS) complicated by partial small bowel obstruction, pulmonary haemorrhage, large bandemia without eosinophilia and cardiac arrest resulting in death. This case is notable for the presence of bandemia and absence of eosinophilia, lack of historical risk factors for hyperinfection, specifically corticosteroid immunosuppressants, and dramatic decline in clinical status which ultimately resulted in the patient's death. Clinicians should suspect SHS in immunocompetent patients who are from an endemic area and who have persistent gastrointestinal and/or pulmonary manifestations in the absence of a clear cause.

Pulmonary Hyperinfection with Strongyloides stercoralis in an Immunocompetent Patient

“…We hypothesize that bowel handling in all the above cases could have led to the migration of a large number of S. stercoralis larva into the systemic circulation and development of hyperinfection syndrome in the immediate postoperative period. 9,10…”

A 63-year-old returned traveller with fever, rash, hepatitis and eosinophilia

“…9 Treatment with corticosteroids, in the presence of S. stercoralis colonization, can precipitate strongyloides hyperinfection syndrome. 10 In this syndrome, which carries a mortality rate as high as 87%, invasive filariform larvae precipitate leakage of gut flora from damaged bowel, 9 disseminating bacterial and fungal infections. Hyperinfection is most commonly seen in patients who are immunosuppressed, including those who received treatment with corticosteroids (regardless of duration of therapy).…”

“…Hyperinfection is most commonly seen in patients who are immunosuppressed, including those who received treatment with corticosteroids (regardless of duration of therapy). 10 Diagnosis in asymptomatic patients involves collection of three consecutive stool samples at 24-hour intervals to identify ova and parasites. However, sensitivity of stool studies is only 50%.…”

Comparison of Trials Using Ivermectin for COVID-19 Between Regions With High and Low Prevalence of Strongyloidiasis

“…Although SHS can occur in immunocompetent hosts, 7 , 8 , 9 it is associated with immunosuppression, particularly from corticosteroid use. Iatrogenic corticosteroid use is commonly noted in disseminated strongyloidiasis, with a disease onset as early as 5 days and a mortality rate as high as 90%.…”