Update on Strongyloidiasis in the Immunocompromised Host

Abstract

Immunocompromised persons are the most vulnerable population at risk for developing life-threatening clinical syndromes associated with strongyloidiasis, such as hyperinfection syndrome (HS) or dissemination. This review focuses on describing Strongyloides infection in the immunocompromised host, including immune response against this infection, analyzing the cases with HS published during the past 4 years in the United States, and describing the most sensitive diagnostic tools and the most effective treatment for each clinical syndrome. Strongyloidiasis is becoming an important parasitic disease in the United States, especially in the immunocompromised immigrant population. Because the transplant population is particularly at risk for developing HS, both recipients and donors should be screened for Strongyloides. Clinicians should also be aware that the development of HS can follow unexpectedly a few days after appropriate anthelminthic therapy. Highly sensitive screening tests are still not available in the major tertiary medical centers. Parenteral ivermectin has been used in some severe cases. Further therapy developments and improving diagnostic tools are warranted.

Características clínico-epidemiológicas de la estrongiloidiasis en pacientes portadores de co-morbilidades

“…La preocupación con la asociación de trasplantes y estrongiloidiasis ha sido mencionada en países desarrollados, principalmente por el hecho de que muchos pacientes provienen de América Latina, donde la endemia de S. stercoralis es importante 21 . Un estudio realizado en Brasil con 1.754 receptores de trasplantes identificó que 82 (4,7%) de esos pacientes desarrollaron algún tipo de enfermedad endémica o infección oportunista; de estos, 21 pacientes poseían alguna enteroparasitosis, siendo 2,4% de estas, correspondientes a infección por S. stercoralis 22 .…”

Strongyloides Stercoralis Hyperinfection Syndrome: An Uncommon Mimicker

“…In the immunocompetent host, excessive replication of SS is kept in check by Th2 activation with IL-3, IL-4 and IL-13 secretion resulting in eosinophilia and immunoglobulin production [5]. In SHS, immunosuppression leads to accelerated auto-infective cycle and increased larval migration [5].…”

“…In SHS, immunosuppression leads to accelerated auto-infective cycle and increased larval migration [5]. Table 1 [ [3][4][5][6] presents the various immunosuppressive states associated with SHS [5].…”

“…SS detection in feces could be challenging since conventional smear examination failed to detect larvae in as much as 70% of cases [1,5]. In fact, excretion of SS can be scanty even in SHS and hence missed.…”

Study of a Neglected Tropical Disease (Ntd): Strongyloides Stercoralis and Its Associated Risk Factors Among School Children in Ahoda-East Local Government Area, Rivers State, Nigeria

“…Strongyloidiasis mostly occur in children due to their habit of playing outdoors barefooted in contaminated soil (Moon and Oberhelman, 2005) but advanced age is also a risk factor for severe strongyloidiasis, because of its association with immunosuppression. Immunocompromised individuals tend to develop hyperinfection syndrome and disseminate strongyloidiasis which are fatal if unrecognized (Marcos et al, 2011). The risk of Strongyloides stercoralis infection is increased by occupations that involve contact with faecal contaminated soil, which may include farming (Sanchez et al, 2001) and coal mining (Keiser and Nutman, 2004) depending on local practices.…”