Severe strongyloidiasis: a systematic review of case reports

Abstract

BackgroundStrongyloidiasis is commonly a clinically unapparent, chronic infection, but immuno suppressed subjects can develop fatal disease. We carried out a review of literature on hyperinfection syndrome (HS) and disseminated strongyloidiasis (DS), in order to describe the most challenging aspects of severe strongyloidiasis.MethodsWe conducted a structured search using PubMed to collect case reports and short case series on HS/DS published from 1991 to 2011. We restricted search to papers in English, Spanish, Italian and French. Case reports were classified as HS/DS according to given definitions.ResultsRecords screened were 821, and 311 were excluded through titles and abstract evaluation. Of 510 full-text articles assessed for eligibility, 213 were included in qualitative analysis. As some of them were short case series, eventually the number of cases analyzed was 244.Steroids represented the main trigger predisposing to HS and DS (67% cases): they were mostly administered to treat underlying conditions (e.g. lymphomas, rheumatic diseases). However, sometimes steroids were empirically prescribed to treat signs and symptoms caused by unsuspected/unrecognized strongyloidiasis. Diagnosis was obtained by microscopy examination in 100% cases, while serology was done in a few cases (6.5%). Only in 3/29 cases of solid organ/bone marrow transplantation there is mention of pre-transplant serological screening. Therapeutic regimens were different in terms of drugs selection and combination, administration route and duration. Similar fatality rate was observed between patients with DS (68.5%) and HS (60%).ConclusionsProper screening (which must include serology) is mandatory in high - risk patients, for instance candidates to immunosuppressive medications, currently or previously living in endemic countries. In some cases, presumptive treatment might be justified. Ivermectin is the gold standard for treatment, although the optimal dosage is not clearly defined in case of HS/DS.

Strongyloides stercoralis found in imported dogs, household dogs and kennel dogs in Iceland

“…stercoralis is most commonly diagnosed by searching for the first stage larvae in faeces, using methods such as the formalin-ethyl acetate sedimentation technique (FEAST) (Allen & Ridley 1970, Young et al 1979) and the more sensitive Baermann technique, which is recommended (Dreyer et al 1996, Krolewiecki et al 2013, Requena-Mendez et al 2013.…”

Multiorgan Dysfunction Syndrome from Strongyloides stercoralis Hyperinfection in a Patient with Human T-Cell Lymphotropic Virus-1 Coinfection After Initiation of Ivermectin Treatment

“…[10][11][12][13]48 Strongyloides infection occurs transcutaneously through penetration of the skin by filariform larvae after contact with contaminated soil. 1,2,5 Clinical infection is usually characterized by chronic relapsing gastrointestinal manifestations including nausea, vomiting, dyspepsia, anorexia, bloating, or diarrhea, but one-third of the patients may be asymptomatic. 10,12 Our patient had intractable hiccups.…”

“…5 Unfortunately, the knowledge regarding many aspects of the infection, its awareness, and its potential seriousness among the health-care providers in nonendemic areas seem to be low. [5][6][7] Herein, we describe a case report of a patient with chronic S. stercoralis infection, who developed disseminated strongyloidiasis hyperinfection syndrome and developed multiorgan dysfunction syndrome shortly after initiation of treatment with ivermectin.…”

Estrongiloidosis pulmonar

“…Otras manifestaciones radiográficas menos frecuentes son los cambios granulomatosos que pueden llevar a una fibrosis pulmonar 17 . La mayoría de las publicaciones relacionan el síndrome de hiperinfección con el tratamiento inmunosupresor, fundamentalmente los corticoesteroides y la coinfección con el virus HTLV-1 18,19 . Del mismo modo, la paciente presentó complicaciones gastrointestinales y respiratorias, manifestadas por la presencia de larvas de S. stercoralis en la secreción traqueal, insuficiencia respiratoria con necesidad de soporte ventilatorio, infiltrados mixtos en la radiografía de tórax, diarrea, colitis crónica, hipoalbuminemia y edema.…”