Strongyloides stercoralis Hyperinfection in an HIV-Infected Patient Successfully Treated with Subcutaneous Ivermectin

Abstract

A 39-year-old Ethiopian HIV-positive man with peripheral T-cell lymphoma developed Strongyloides stercoralis hyperinfection. The patient was initially treated with oral ivermectin for three weeks without response, most likely due to malabsorption because of concomitant paralytic ileus. Given the persistence of larvae in the body fluids, the worsening respiratory status and clinical malabsorption, veterinary parenteral formulation of ivermectin was administered. The very high plasma concentration of ivermectin achieved in the patient after parenteral administration led to a rapid improvement in his clinical condition and rapid disappearance of the parasite from biological samples, without any adverse reaction.

Microfilaria and Strongyloides larva diagnosed in cerebrospinal fluid and ascitic fluid, respectively: Approach to their morphology on cytology

“…Here the female adult worms produce eggs, which later hatch in the mucosa, and larvae are then excreted in the feces. Most infected people are asymptomatic or have minor gastrointestinal or respiratory symptoms . In immunocompromised individuals, hyperinfection or disseminated infection is common which includes organs other than GIT and lungs.…”

“…In immunocompromised individuals, hyperinfection or disseminated infection is common which includes organs other than GIT and lungs. With effective treatment, the fatality is 60% and without treatment, it is almost 100% . A simple stool examination can make the diagnosis of Strongyloides .…”

“…However, we get to see many cases with microfilariae in other sites which include aspirates of lymph node, joint spaces, thyroid, bone marrow, brain, breast, nipple discharges, pleural and pericardial effusions, bronchial washings, urine, cerebrospinal fluid (CSF), cutaneous swelling, soft tissue aspirates, endometrial smears, ovarian cyst fluid, cervicovaginal smear, epididymis, hydrocele fluid . Strongyloides stercoralis (S stercoralis ) is one of the most important soil‐transmitted helminths, which affect at least 370 million people worldwide . It is endemic in tropical and subtropical countries including India.…”

“…Usually, the helminth affects the lungs and gastrointestinal tract. However, immunocompromised patients are at risk of developing hyperinfection, where the S stercoralis will be seen at other sites as well …”

“…We have also added a brief discussion on morphological differences between the two larval forms. 3 It is endemic in tropical and subtropical countries including India. Usually, the helminth affects the lungs and gastrointestinal tract.…”